333
Journal of Sport Rehabilitation, 2011, 20, 333-344
© 2011 Human Kinetics, Inc.
Measurement of Ankle Dorsiflexion:
A Comparison of Active and Passive
Techniques in Multiple Positions
David A. Krause, Beth A. Cloud, Lindsey A. Forster,
Jennifer A. Schrank, and John H. Hollman
Context: Limited ankle DF (DF) range of motion (ROM) resulting from restricted
gastrocnemius and soleus mobility is associated with a variety of lower extremity
pathologies. Several techniques are used clinically to measure ankle DF. Objec-
tives: To evaluate the reliability and minimal detectable change of DF ROM
measurement, determine whether there is a difference in measured DF between
techniques, and quantify the electromyographic (EMG) activity of the soleus
and tibialis anterior muscles associated with the techniques. Design: Repeated
measures. Setting: Controlled laboratory setting. Participants: 39 healthy sub-
jects, age 22–33. Main Outcome Measures: DF measurements using 5 different
techniques including active and passive DF with the knee extended and flexed
to 90° and a modified lunge. EMG activity of the soleus and anterior tibialis
muscles. Results: Intrarater reliability values (ICC
3,1
) ranged from .68 to .89.
Interrater reliability (ICC
2,1
) ranged from .55 to .82. ICCs were the greatest with
the modified lunge. The minimal detectable change (MDC
95
) ranged from 6° to
8° among the different techniques. A significant difference in DF ROM was found
between all methods. Measurements taken with active DF were greater than the
same measures taken passively. The lunge position resulted in greater DF ROM
than both active and passive techniques. EMG activity of the soleus was greater
with active DF and the lunge than with passive DF. Conclusions: The modified
lunge, which demonstrated excellent intrarater and interrater reliability, may best
represent maximal DF. Active end-range DF was significantly greater than passive
end-range DF when measured at either 0° or 90° knee flexion. Greater active DF
was not explained by inhibition of the soleus. Finally, using the modified lunge,
a difference between 2 measurements over time of 6° or more suggests that a
meaningful change has occurred.
Keywords: testing and measurement, goniometry, range of motion
Adequate ankle mobility is necessary for normal gait, as well as participation
in many sporting and recreational activities. Limited dorsiflexion (DF) may be
caused by factors such as heel-cord tightness or posterior arthrokinetic restrictions.
The authors are with the Program in Physical Therapy, Mayo Clinic, Rochester, MN.