Measurement Of Ankle Joint Flexibility And Its Relationship With Injury Risk: Literature Review
DOI:
https://doi.org/10.26858/cpjok.v18i2.976Keywords:
Ankle Flexibility; Dorsiflexion Range Of Motion; Injury Risk; Weight-Bearing Lunge Test; Literature ReviewAbstract
Ankle joint flexibility, particularly dorsiflexion range of motion (ROM), is recognized as a fundamental component of movement quality, biomechanical efficiency, and injury prevention. According to contemporary biomechanical and sports injury theories, limited ankle mobility may alter lower-extremity movement patterns and increase susceptibility to musculoskeletal injuries. However, evidence regarding the measurement of ankle flexibility and its relationship with injury risk remains scattered across different disciplines. This literature review aimed to analyze methods used to measure ankle joint flexibility and to examine their association with injury risk from both conceptual and empirical perspectives. This study employed a literature review design based on the principles of evidence-based practice. Relevant articles published between 2015 and 2025 were identified through Scopus, PubMed, Web of Science, ScienceDirect, Google Scholar, and SINTA-indexed databases using keywords related to ankle flexibility, dorsiflexion ROM, mobility assessment, and injury risk. A total of 126 studies were initially identified, and 22 articles met the inclusion criteria for final analysis. The findings revealed that 77.3% of the reviewed studies reported a significant association between reduced ankle dorsiflexion ROM and increased injury risk. The most frequently reported injuries were ankle sprains (38%), chronic ankle instability (24%), patellofemoral pain syndrome (18%), and Achilles tendinopathy (12%). The Weight-Bearing Lunge Test (WBLT) emerged as the most commonly used assessment method, accounting for 68.2% of the reviewed studies due to its high validity and reliability. Adequate ankle flexibility is strongly associated with optimal movement mechanics and reduced injury risk. Therefore, ankle flexibility assessment should be integrated into injury screening and prevention programs to support evidence-based clinical and sports practice.
References
Akbari, M., Sahebozamani, M., Daneshjoo, A., & Amiri-Khorasani, M. (2023). The relationship between ankle dorsiflexion range of motion and lower extremity biomechanics during landing tasks. Sports Biomechanics, 22(4), 512–526. https://doi.org/10.1080/14763141.2021.1903548
Aromataris, E., & Munn, Z. (2020). JBI Manual for Evidence Synthesis. Joanna Briggs Institute. https://doi.org/10.46658/JBIMES-20-01
Behm, D. G., Alizadeh, S., Daneshjoo, A., Anvar, S. H., Mahmoud, M. M., & Cappa, D. F. (2021). Acute effects of stretching on physical performance, range of motion, and injury incidence in healthy active individuals: A systematic review. Applied Sciences, 11(16), 7499. https://doi.org/10.3390/app11167499
Bishop, C. (2020). Translational sports science: Bridging the gap between research and practice. Strength and Conditioning Journal, 42(2), 48–54. https://doi.org/10.1519/SSC.0000000000000515
Bittencourt, N. F. N., Meeuwisse, W. H., Mendonça, L. D., Nettel-Aguirre, A., Ocarino, J. M., & Fonseca, S. T. (2021). Complex systems approach for sports injuries: Moving from risk factor identification to injury pattern recognition. British Journal of Sports Medicine, 55(6), 321–326. https://doi.org/10.1136/bjsports-2020-102070
Booth, A., Sutton, A., Clowes, M., & Martyn-St James, M. (2021). Systematic Approaches to a Successful Literature Review (3rd ed.). Sage Publications. https://us.sagepub.com
Cerrillo-Sanchis, D., Balsalobre-Fernández, C., & Cuenca-Fernández, F. (2024). Ankle dorsiflexion range of motion and athletic performance: A systematic review. Physical Therapy in Sport, 66, 45–56. https://doi.org/10.1016/j.ptsp.2024.01.005
Cook, G., & Burton, L. (2018). Functional Movement Systems: Screening, Assessment and Corrective Strategies. On Target Publications. https://www.functionalmovement.com
Cook, G., & Boyle, M. (2016). Joint-by-joint approach to training and rehabilitation. In Advances in Functional Training. On Target Publications.
Dill, K. E., Begalle, R. L., Frank, B. S., Zinder, S. M., & Padua, D. A. (2022). Altered biomechanics associated with limited ankle dorsiflexion during landing tasks. Journal of Athletic Training, 57(4), 342–350. https://doi.org/10.4085/1062-6050-0460.21
Dingenen, B., & Gokeler, A. (2020). Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: A critical review. Sports Medicine, 50(5), 1017–1034. https://doi.org/10.1007/s40279-020-01252-7
Dos’Santos, T., Thomas, C., Jones, P. A., & Comfort, P. (2022). The role of movement screening in injury prevention and performance enhancement. Strength and Conditioning Journal, 44(2), 58–71. https://doi.org/10.1519/SSC.0000000000000647
Gribble, P. A., Bleakley, C. M., Caulfield, B. M., Docherty, C. L., Fourchet, F., Fong, D. T. P., Hertel, J., Hiller, C. E., Kaminski, T. W., McKeon, P. O., Refshauge, K. M., Verhagen, E. A. L. M., Vicenzino, B. T., Wikstrom, E. A., & Delahunt, E. (2021). Evidence review for the 2021 international ankle consortium consensus statement. British Journal of Sports Medicine, 55(22), 1270–1279. https://doi.org/10.1136/bjsports-2020-103985
Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2020). PRISMA2020: New reporting guidelines for systematic reviews. Systematic Reviews, 9(1), 89. https://doi.org/10.1186/s13643-020-01371-3
Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M. P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M. C., Vedel, I., & Pluye, P. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018. Education for Information, 34(4), 285–291. https://doi.org/10.3233/EFI-180221
Kibler, W. B., Sciascia, A., & Wilkes, T. (2019). The kinetic chain and rehabilitation. Sports Health, 11(2), 90–98. https://doi.org/10.1177/1941738118815121
Konor, M. M., Morton, S., Eckerson, J. M., & Grindstaff, T. L. (2021). Reliability of ankle dorsiflexion measurements and relationship with functional movement. International Journal of Sports Physical Therapy, 16(3), 611–620. https://doi.org/10.26603/001c.22178
Lepley, L. K., Gribble, P. A., & Pietrosimone, B. G. (2020). Effects of ankle mobility and proprioception on dynamic postural control. Journal of Sport Rehabilitation, 29(7), 901–909. https://doi.org/10.1123/jsr.2019-0125
Macrum, E., Bell, D. R., Boling, M., Lewek, M., & Padua, D. (2019). Effect of limited ankle dorsiflexion on lower extremity kinematics during landing. Journal of Sport Rehabilitation, 28(5), 493–500. https://doi.org/10.1123/jsr.2017-0192
Meeuwisse, W. H., Tyreman, H., Hagel, B., & Emery, C. (2017). A dynamic model of etiology in sport injury: The recursive nature of risk and causation. Clinical Journal of Sport Medicine, 27(6), 533–539. https://doi.org/10.1097/JSM.0000000000000394
Newell, K. M. (2017). Constraints on the development of coordination. In M. Wade & H. T. A. Whiting (Eds.), Motor Development in Children (pp. 341–360). Springer. https://link.springer.com
Nigg, B. M., Baltich, J., Hoerzer, S., & Enders, H. (2021). Running shoes and injury prevention: A review of biomechanical evidence. Sports Medicine, 51(5), 971–982. https://doi.org/10.1007/s40279-020-01404-9
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Paul, J., & Criado, A. R. (2020). The art of writing literature review. International Business Review, 29(4), 101717. https://doi.org/10.1016/j.ibusrev.2020.101717
Portney, L. G., & Watkins, M. P. (2020). Foundations of Clinical Research: Applications to Evidence-Based Practice (4th ed.). Pearson. https://www.pearson.com
Powden, C. J., Hoch, J. M., & Hoch, M. C. (2021). Reliability and validity of the weight-bearing lunge test. International Journal of Sports Physical Therapy, 16(1), 1–12. https://doi.org/10.26603/001c.18749
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339. https://doi.org/10.1016/j.jbusres.2019.07.039
Taylor, J. B., Wright, A. A., Dischiavi, S. L., Townsend, M. A., & Marmon, A. R. (2022). Activity demands and injury risk associated with limited ankle mobility. Sports Health, 14(3), 381–389. https://doi.org/10.1177/19417381211034028
Williams, C. M., Caserta, A. J., & Haines, T. P. (2023). Clinical applications of the weight-bearing lunge test in sports injury prevention. Physical Therapy in Sport, 61, 88–96. https://doi.org/10.1016/j.ptsp.2023.02.004
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