Running is one of the most natural forms of human movement. The ability to run upright on two legs is rare in the world of mammals. Humans posses the combination of long, light bones propelled and stabilized by powerful gluts, quads, and hamstrings. Reciprocal lower extremity and upper extremity motion are made possible by our strong core musculature. Running injuries, however, sideline even the most experienced runners. The simplicity of running is dependent upon a complex sequence of mobility and stability through each of our lower extremity joints. This month I will focus on the ankle joint.

The ankle and foot absorb impact, allow our body to move from flexion (forward stride phase) to extension (propulsion phase), and keep us upright in the process. While extensive running injury prevention focuses on the hips, gluts, and quadriceps, the importance of the ankle is often overlooked. The trails on Mount Sentinel, Mount Jumbo, Blue Mountain, and the Rattlesnake are buff and smooth compared to many of the trails I have encountered while racing. A lack of adequate ankle mobility and strength will likely result in an ankle injury when running or racing on technical, rocky trails. Whether you run on the roads or on the trails, ankle mobility and strength must be incorporated into your training program.

The ankle is comprised of two main joints. The talocrural joint is formed by the tibia bone and the talus bone. The talocrural joint and its associated ligaments basically attach the lower leg to the foot. The surface of the ankle talus bone is smooth and shaped like a dome. The tibia bone glides over the talus, allowing us to pick our foot up, clear the ground, and push off. The subtalar joint is formed by the calcaneus (heel) bone and the bottom of the talus bone. The subtalar joint is responsible for balance reactions (lateral and medial) and provides stability on uneven surfaces. A comprehensive physical therapy evaluation by a therapist who understands the intricacies of the running stride can evaluate your ankle mobility as part of either a preventative consultation or to determine the underlying cause of pain. Inadequate ankle joint motion causes stiffness and increases compression through the ankle. While often not perceptible while running, prolonged ankle stiffness and compression increased the risk of osteoarthritis. If you have already been diagnosed with age-related or trauma-related ankle joint arthritis, reducing joint compression through mobilization can relieve your symptoms.

In order to strengthen the ankle, one must look at the foot and the lower leg (foot intrinsic strength and mobility are a topic for a separate article). The muscles which stabilize and guide the ankle are located on the anterior, posterior, and lateral aspects of the tibia bone. Four planes of motion (plantarflexion, dorsiflexion, inversion, eversion) which are crucial for efficient running must be strengthened both in isolation, and through functional single leg dynamic exercises.

Below are a few training suggestions to improve your speed and safety while running when the pavement ends and the trail turns into a ridge line. Theraband ankle strengthening is a good start, but incorporating ankle and foot specific single leg balance and mobility exercises in weight bearing will protect and prepare your foot ankle for running.

Single Leg Strengthening Exercises

Stand on one leg with your big toe planted into the floor. Engage your core (gluteal, abdominal, lumbar musculature) and use gravity with or without dumbbells, weight bars, a medicine ball, or a pulley system to teach your body to stabilize in a single leg position. Add dynamic partial squats, trunk rotation, and reaching motions for greater challenge.

Running Specific Agility Training

Moving lightly and confidently on your feet comes only with training. Set up an agility course inside or outside. Work on foot placement, accuracy, eyes open, and eyes closed.

Incorporate plyometrics and bounding in your agility training at a training heart rate.

Practice bounding uphill and rapid foot placement on technical terrain of varying gradients. Try running from rock surface to rock surface rather than avoiding rocks.

Relax when running on technical terrain and let your natural balance reactions and core strength do the stabilizing.

Foot and Ankle Mobility and Strengthening

Protect your lower leg, foot, and ankle from injury and overuse through proper conditioning. Ankle joint mobility is necessary for proper running mechanics and to reduce the risk of ankle sprain. Using a Theraband, move your foot/ankle inward with your toes relaxed and your ankle pointed downwards slightly. Next, move your foot/ankle outward against Theraband resistance with toes relaxed. Finally, pull your ankle upwards towards you with Theraband resistance.

For a comprehensive lower extremity mobility and strength evaluation to take your running to the next level or to address a chronic running injury issue, contact the Sapphire Physical Therapy.

John Fiore, PT
Sapphire Physical Therapy