Alleviating Knee Pain Through Ankle Mobility

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Knee pain is a common issue in the running world. Typically, in the case of chronic pain, the knee isn’t the source of the problem. (In contrast, direct trauma to the knee is an acute injury and that’s a true knee problem.) Lack of ankle mobility can be the culprit of knee pain, especially if there’s pain while descending.

Why you need three-dimensional ankle motion

All human motion occurs in three planes: front/back (sagittal plane), side-to-side (frontal plane) and rotation (transverse plane). If ankle motion is limited in any plane and the ankle can’t adequately share the load of moving, then another nearby joint will likely be overstressed. It’s not just your knees that could suffer. If your ankles don’t move well in three dimensions, then everything up the kinetic chain—from your knees to your neck—could be compromised.

Your feet have 26 bones, 33 joints and over 100 muscles, tendons and ligaments. If all those components aren’t moving well together then you could have problems.

Anyone who’s experienced an ankle sprain may have poor ankle mobility, even if the injury occurred long ago. If you’ve never sprained an ankle, then it’s likely that our modern seated lifestyle and your shoe choices may limit your ankle mobility.

Ankles, knees and running

You must disperse impact forces throughout the body as you run. Those forces are magnified in downhill running and thus more demand is placed on your joints and tissues. Let’s examine the ankle and knee in downhill running:

When you’re running downhill, the foot stops on the ground while the rest of your body, from the ankle up, continues traveling forward. The shin moves toward the foot in a motion called dorsiflexion. Not only does it move forward, but it should also rotate (twist left/right) and tilt inward just a bit.

Thus, ankle movement should happen in three planes. If your ankle can’t move adequately, then excess forces are shifted up to the knee. The knee may be forced to flex, and/or rotate, and/or tilt more than it should. This may result in loads that the tissues of the knee can’t handle. Hello knee pain.

Here’s a critical point: Downhill running requires more dorsiflexion than flat running. That’s why downhill running may be painful where flat or uphill running is fine. Also, ankles must move well with both a straight and a bent knee so it’s important to mobilize the ankles in both knee positions.

3D mobility drills

Typically, tilting (leaning left/right) and rotation (twisting left/right) are overlooked with most ankle mobility drills and calf stretches.

By doing the following drills, you will give your ankles the three-dimensional motion they need for running. By progressing from kneeling to standing, you will add stress gradually. If anything hurts, then back off. Don’t drive into pain.

Flexed-knee 3-way ankle-mobility matrix

Straight-leg 3-way ankle-mobility matrix

When to do the drills

● It’s most ideal to do these drills throughout the day. Much like practicing anything from a language to watercolor painting to a musical instrument, the more often you practice, the faster you’ll make progress.

● It’s easy to roll these into your pre-workout and warm-up routine. Do them before a run or gym workout.

● Between sets of your gym workout is a great time to do some mobility work. For instance, after a set of pull-ups or deadlifts, go mobilize your ankles.

Use your new mobility

You should have gained some new range of motion through doing the drills. Now, it’s crucial to coordinate that new mobility into the complex, multi-joint movements used in real life—get out on the trails and have fun.

A note on extending the knees over the toes

You may have heard that allowing the knees to go past the toes will cause knee pain. These drills are designed to address this issue. If ankle mobility is inadequate, then excessive forces go to the knees and cause pain. Generally, humans can adapt to all sorts of movement patterns. Our tissues and nervous system can handle a lot more than we may think so long as we load it gradually.

The ability for the ankles to move and manage forces in three dimensions is crucial for healthy, powerful movement like running downhill. If your pain doesn’t resolve or if it gets worse then seek out professional help from an appropriate physician.

Kyle Norman, MS, is a Denver, Colorado-based personal trainer, strength coach and running coach with 20 years of experience. He specializes in helping people move well, get strong and get out of pain. You can follow his blog at

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