01 Thu

The ankle and the step down test

The ankle and the step down test

Written by: Paul Kochoa, PT, DPT, OCS, CKTP, CGFI

Previously in my post, Stairs and knee problems, I spoke about the relationship between the hip and the knee. With movement screen testing, a physiotherapist can evaluate the movement dysfunctions that can lead to pain and injury.  The hip is a key component to controlling the knee with closed-chain activities (weight bearing movements).  The other joint involved with knee alignment and stability is the ankle.  In a post on his website, Mike Reinold discusses how the ankle fits into the movement equation.

Knee problems like patellofemoral pain, tendonitis, or ACL injuries can be linked to movement dysfunction with the step down test.  If the hip is weak or the foot is poorly stabilized, the knee will buckle inward, increasing the stress and torque on that joint thus leading to injury and pain.

Mike also references a study in the Journal of Orthopedic and Sports Physical Therapy that details the ankle-knee-hip relationship.  The study found that decreased mobility in the ankle can cause movement dysfunctions up the kinetic chain (ankle-knee-hip-pelvis).  The subjects in the study were young women who performed a lateral step down test.  Their movement quality was assessed and compared to their leg strength and flexibility.

The study detailed how movement quality suffered, not just because of hip strength, but because of ankle range of motion.  Subjects with good ankle dorsiflexion (that’s when the foot is flexed upward) range of motion had better quality of motion than subjects with less ankle dorsiflexion.  The tightness in the ankle caused their knees to buckle inward and their pelvis to drop, causing increased torque and strain onto the knee joint.

So when you have knee pain, not only is the hip important, but the ankle as well.  Bottom line, one of the key points in assessing and treating knee pain is to look at the joint above and below the problem joint.  Strengthen the hip to increase the stability of the hip and its deep rotator muscles; and stretch the Achilles tendon to make sure you have enough dorsiflexion range of motion and flexibility.  The combination of the two will improve your quality of movement and decrease the stress on your knee joint.

If you would like more information, please call Professional Physical Therapy and Training at 973-270-7417.  Our offices our located within the YMCA locations in Madison and Summit, NJ.  You do not need to be a member of the YMCA to visit with us.

Image courtesy of nuttakit / FreeDigitalPhotos.net

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