Ankle sprains, the common curse of basketball, have caused a curious evolution of the sports shoe. The basketball sneaker, once made of canvas and a thin rubber sole, turned into a piece of high tech equipment. Today shoe companies market their product with claims of better protection and smarter shock-absorption and yet, as many observers of the sport will know, knee and ankle injuries are still very common.
In a previous post we’ve already covered how shock-absorbing shoes cause knee pain through faulty running mechanics. To recap: the cushioned shoes actually don’t absorb anything except the information necessary for our body to move properly. As a result our running mechanics undergo a subtle yet fundamental change and we turn into heel-strikers. Now, if you’re wearing high top shoes with cushioned soles you run even higher risk of knee pain.
Enter Gray Cook, Movement mastermind
There are numerous very smart minds in the fitness industry out there today and one of those shining the brightest probably belongs to Gray Cook. Gray has written an incredibly extensive book on movement (Movement by Gray Cook on Amazon.com) and today we’re going to borrow one of the many great ideas he put in there. This idea is the joint-by-joint approach.
What is the joint-by-joint approach? In very simple terms this is the idea that certain joints are built for stability and certain other joints for mobility. But there’s more: next to a mobile joint is a stable joint and next to a stable joint is a – you guessed it – mobile joint. Remember our little anatomy lesson on the passive structures in the knee? If so you remember that the knee is built for stability first and foremost. It’s a hinge joint with very little rotational freedom. Gray now looked at all other major joints and determined what they were designed for. Let’s have a look:
Joint — Primary Need
Ankle — Mobility (sagittal)
Knee — Stability
Hip — Mobility (multi-planar)
Lumbar Spine — Stability
Thoracic Spine — Mobility
Scapula — Stability
Gleno-humeral — Mobility
First off, what does sagittal mean? The sagittal plane is a term from anatomy and it describes a vertical movement plane that goes from the front to the rear. In our case “sagittal” thereby means that the ankle only needs increased mobility in the sagittal plane, i.e. good range of motion for plantarflexion and dorsiflexion of the foot. Remember plantarflexion from knee anatomy: muscles around the knee? Plantar flexing the foot means pointing your foot away from you or, if you’re standing, going from standing on your whole foot to standing on your toes. Dorsiflexion is the opposite, so pointing your foot towards your tibia.
Now back to the joint-by-joint approach: while the ankle needs mobility, the knee requires stability. The hip is mobile again, the lumbar spine stable (your lower back), the thoracic spine mobile (the spine behind your ribcage), the scapula stable and finally there is the gleno-humeral joint, which is mobile again. “So what”, you might ask, but hang in there, we’re getting to the good stuff.
How high top shoes cause knee pain
If a joint that is intended for mobility becomes less mobile, a stable joint directly above picks up the slack with increased mobility, i.e. less stability. This means that if you lack ankle mobility you automatically have a higher predisposition for knee pain. Now there are several ways how high top sneakers restrict ankle mobility. For one they restrict your mobility by adding a brace to your foot. Then again, sneakers also make you more likely to sprain your ankle in the first place (more on that: sneakers and ankle sprains). Now if you injure a joint the body’s first reaction is to decrease range of motion, but if after we’re healed we don’t work actively to regain ROM in the ankle, full ankle range of motion will likely not be regained.
Hence high top shoes increase the chance of knee pain because
1) they reduce ankle range of motion
2) they increase chances of ankle sprain, which in turn leads to one (either through additional bracing our through injury reduced ROM)
3) they change your running technique (heel-striking)
What’s more is that wearing high top shoes all the time will permanently decrease your ankle range of motion (just like wearing heels will). The high top shoes therefore create a vicious cycle: they cause your ankle sprain and limited ankle ROM. Then you think “oh, better brace my ankle and lace that high top sneaker up really tight” and further decrease ROM of the ankle. Of course you’re still just as likely to suffer ankle sprains, since your proprioception is severely limited and your ankle weakened anyways, but as a side effect you dramatically increased your chances for knee pain. Been there, done that.
What to do about it
Ditch the high top sneaker or at least wear healthy shoes most of the time. This can either be minimalist shoes like the Vibram FiveFinger or Merrell’s Trail Glove, but your situation also gets a lot better if you just start wearing leather shoes with a solid sole and a minimally elevated heel. Then you need to do ankle mobility and there’s one good drill that will get you started. Dr. Perry Nickelston demonstrates it in his video (also take note of his shoes, those are the kind of leather shoes I meant):
Now to add to what Dr. Nickelston said a little bit: this is not a stretch, this is a mobility drill. As such you’re not looking to create a lot of tension, but you’re moving the joint in the completely pain free end range of motion. If this is painful you’re either overdoing it or there’s something wrong with your ankle.
What about taping?
While taping does decrease range of motion, the degree by which ROM is decreased depends on how you tape the joint. I assume there are ways in which you can tape the ankle without restricting sagittal range of motion, but that certainly requires someone skilled at taping ankles. If the tape is not applied by someone knowledgeable you are likely to do more harm than good and are well-advised to stay away.
Ankle mobility is vitally important for healthy knees and if you restrict range of motion, for example by wearing a high top sneaker, you increase your chances for knee pain dramatically. If your ankle mobility is already compromised you need to work on regaining normal ankle range of motion in both ankles symmetrically. This will help you one major potential cause for knee pain (you 1, knee pain 0!).
Now get cracking on the mobility drill as advised by Dr. Nickelston.