Mark Comerford’s Clinical Insights: Articular Or Myofascial Restriction (Ankle Dorsi Flexion)
Restriction within a conceptual framework
The presence of articular and/or myofascial restriction; does it matter? Here we propose an answer to the question from the perspective of a conceptual framework that some clinicians have applied for decades.
Let’s assume the body’s multiple degrees of freedom can be harnessed in a multitude of different ways (movement coordination strategies) to achieve/attempt any given movement task (Dingenen et al., 2018). For example, during a drop landing, the combination of ankle, knee and hip interactions, accommodating the body’s impact with the floor, may display varying strategies of dorsi flexion, knee flexion, and hip flexion, respectively; and that’s just the sagittal plane. In the case in which the ankle’s permissible range of motion is diminished (due to restriction), the knee and hip may also alter their contribution to the task. Practitioners, in the belief that these altered joint contributions may be possess clinical relevance, may then seek to target both the restriction and its associated consequences on the knee and hip.
Does it matter?
A recent publication (Waldron et al.,2020) reported the following; individuals identified with dorsi flexion restrictions display reduced sagittal plane joint displacement at not only the ankle but also the knee and hip during drop landing tasks compared to those absent of the restriction. The authors suggest the stiffer landing as a movement coordination strategy potentially linked to elevated injury risk (Waldron et al., 2020). However, reliant upon 2D rather than 3D analysis, non-sagittal plane kinematics were not reported. Hypothetically, distinctions in foot, knee, and hip frontal and transverse plane kinematics may have revealed the presence of dorsi flexion restriction as accompanied by movement coordination strategies linked to catastrophic knee injuries. Taken as a whole, the presence of restriction is accompanied by changes in movement coordination strategies. Practitioners can reason if these are clinically relevant.
Determining the associated sources of restriction is likely to increase the chance to efficiently managing this inability to achieve a benchmark of range of motion; a process subsequently supporting interventions seeking to address resilient movement coordination strategies (loss of movement choices) adopted in the presence of restriction to permit task outcomes (Mottram & Blandford, 2020). Distinguishing between myofascial and articular restriction may allow for clinically expedient interventions to applied. Yet how to distinguish? How to address?
In this short video (< 5 min), Mark Comerford supplies clinical insights to distinguish and address articular restrictions of talo-crural joint dorsi flexion.
Dingenen, B., Blandford, L., Comerford, M., Staes, F., & Mottram, S. (2018). The assessment of movement health in clinical practice: A multidimensional perspective. Physical Therapy in Sport, 32, 282-292.
Mottram, S., & Blandford, L. (2020). Assessment of movement coordination strategies to inform health of movement and guide retraining interventions. Musculoskeletal Science and Practice, 45, 102100.
Waldron, M., North, J. S., Howe, L., & Bampouras, T. (2020). Restrictions in ankle dorsiflexion range of motion alter landing kinematics but not movement strategy when fatigued. Journal of Sport Rehabilitation.