The lunge test is a common movement screen used to assess ankle dorsiflexion in a weight bearing position (closed kinetic chain). Research shows that individuals with restricted lunge distance have an increased risk of lower extremity injury.
This study aimed to establish normative values for female college students using a weight bearing lunge test measurement of ankle dorsiflexion.
Getting Started
Getting your patients to perform the lunge test on both sides is an excellent way to measure how their ankles move. Efficient ankle dorsiflexion is critical for many real world movements that your clients are required to perform each day. This includes activities such as walking and climbing stairs, kneeling and squatting in gym class, and even running! Having adequate ankle dorsiflexion helps to prevent injuries to the ankle and foot and improves movement efficiency.
The lunge test is a weight bearing assessment of ankle dorsiflexion that has demonstrated a high reliability / repeatability. This makes it an excellent screening tool for current ankle mobility and to demonstrate progress with interventions. The lunge test is also more functional than passive open kinetic chain assessments such as dorsiflexion against a wall.
Performing the test is relatively simple. Your patient should stand with their back leg against a wall and the front leg in a half-kneeling position. They should then push their knee towards the wall and see if they can touch it with their knee (keeping the heel on the ground).
This position will drive the tibia into some valgus but will still allow for the shortening of the flexor hallucis longus as well as dorsiflexion of the talus and sub-talar joint. This test will help you determine the limiting factors in your patient’s ankle dorsiflexion range.
If the patient has a block in this test you may wish to consider the anterior ankle ligaments, namely the posterior tibiotalar and talofibular joint. Alternatively, if they have a more medial block then you could encourage them to push through the ball of the feet for more dorsiflexion of the flexor digitorum longus and through the pad of the big toe for more flexor hallucis longus lengthening. Getting this tissue to work together efficiently and in concert is the key to effective ankle mobility. This is the principle that we teach in Go-To Physio Mentorship. We believe that the best approach to restoring ankle dorsiflexion is a hands-on approach. This is because when tissues are activated directly they respond much more positively and you get longer-lasting changes than a band exercise.
Initiating the Lunge
Start by standing facing a wall about a foot away and positioning the leg you want to test about five inches or more to the rear of the other leg (a simple rule of thumb is the width of your hand). Lean forward into the lunge, moving your knee toward the wall until it touches it with the back calf. Achieving this range is a good sign of ankle dorsiflexion and indicates you have a healthy amount of mobility in the joint.
Some clinicians choose to use a tape measure or inclinometer during the lunge test to determine the lateral extent of the range of movement. Others use the width of their hand as a more subjective standard. Whatever method is used, it’s important to remember that the test measures not just the range of motion but also the stiffness of the joint. This is an important point given that the foot and ankle are asked to perform many of their functions during weight bearing activities.
To make the most of this assessment, it’s best to do it barefoot or with minimalist footwear. Performing the test while wearing footwear that adds to the weight of the person may cause an artificial extension of the range of motion, making it higher than it would be in a healthy person.
The average amount of weight bearing dorsiflexion that a healthy person is able to achieve in the lunge test is about 12-15 cm or about 4.5-6 inches. This range of movement varies between individuals, however, so it’s important to determine a target level of movement that’s appropriate for the person and activity at hand.
Trying to reach an unrealistic goal can cause the person to become frustrated with the exercise and less likely to continue with it, thereby increasing their risk for injury. It’s also important to note that as the person moves in and out of the range of the lunge, their feet will pronate slightly while doing so, which is normal. This may have a negative impact on the results of the test, as it may reduce the accuracy of the measurement.
Keeping the Heel on the Ground
The ankle proper is a single joint that connects the two leg bones, the tibia and fibula to the bone at the top of the foot, called the talus. It moves up and down, a movement called dorsiflexion. There is also a small joint right below the ankle that allows the foot to move side to side, a movement called plantar flexion.
The lunge test is one of the most popular screeners in the physical therapy profession for assessing ankle mobility and flexibility. It is a weight-bearing assessment that has been shown to be reliable and valid.
When a patient is unable to touch their knee to the wall in the lunge test it indicates poor ankle dorsiflexion mobility. This can result in stiff ankles that are difficult to bend, leading to pain and altered movement patterns. It can also increase the risk of injury when performing movements such as squats or lunges.
To perform the lunge test, a patient will stand with their back against the wall and place their feet about 10cm apart. They will then move one foot back a hand’s width and push their knee forward against the wall, trying to touch the wall with the knee (keeping the heel on the ground). They should be able to reach the wall if they have adequate dorsiflexion.
A study conducted on female college students has demonstrated that the weight bearing lunge test is a good way to measure the amount of dorsiflexion in the ankle. This test has been shown to be reliable and has minimal detectable change, which makes it a great tool for screening.
The study showed that the average dorsiflexion range in the weight-bearing lunge test was 11.1 cm on the right and 10.3 cm on the left. This is a good average and may be used as a normal value to help guide the physical therapist in their practice. It is important to remember that this average does not represent the true range of motion for every person as it is based on the typical range of the group surveyed, and this will vary from individual to individual.
Keeping the Knee Over the Toes
When performing weight-bearing lunges, it’s important to make sure the knee stays over the toes. This helps avoid putting too much pressure on the front of the ankle or forcing the hips to act as ankles, which can lead to pain and injury over time. This screen is a quick way to assess this vital joint mobility, and it’s also a good way to set movement baseline measures for patients or clients.
The MAT team is a big fan of functional tests, as they tend to be more practical and relevant to real-world activities than non-functional testing. This is why we love the knee-to-wall test to assess ankle dorsiflexion, as it mimics a common functional activity and provides reliable measurements that can be used as a reference for future comparisons.
Unlike the foot-to-wall screen, which relies on measuring the distance between the heel and the floor surface, this measurement is made by comparing the distance between the knee and the wall, rather than the distance of the foot from the ground. This helps to account for differences in leg length and shoe size, which could impact the results of the foot-to-wall screen.
The study analyzed 400 female research participants who were enrolled in various colleges under the Alva’s Education Foundation in Dakshina Kannada, Karnataka, India. They were all asked to perform a weight-bearing lunge while their dorsiflexion was measured. This was done by a professional researcher using a measuring tape. Other pertinent demographic data, including age, height in centimetres, and dominant limb, were recorded.
After analyzing the results, the researchers found that there were no significant differences between the right and left side for ankle dorsiflexion during the lunge test. The average distance of the participant’s knee to the wall was 11.1 cm, which is considered the normative value for this test. However, the research was limited to only females ages 17 to 27 and did not use an inclinometer or goniometer, which would have added more validity to the findings. As such, this screen should be used in conjunction with other measures of ankle mobility to ensure proper assessment and treatment.