Hurdle Step Asymmetry After an Old Ankle Sprain
A 29-year-old male recreational basketball player sprained his right ankle eight months ago. He completed physical therapy and has no pain, swelling, or giving way now. He plays twice weekly and has no history of low back pain. You screen the hurdle step with the cord set at his tibial tuberosity. When he stands on his left leg and lifts the right leg, the hips, knees, and ankles stay aligned, the dowel and hurdle stay parallel, and there is minimal lumbar movement: score 3. When he stands on his right leg and lifts the left leg, the foot clears the hurdle, but his pelvis rotates, his lumbar spine extends, and the dowel and hurdle lose parallel by about 15 degrees; he does not lose balance and does not contact the hurdle. He reports no pain. He asks whether his right ankle is 'still weak.'
1. Score both sides and explain which criteria determine the right-side score, including why it is not 1 or 3.
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Left stance = 3; right stance = 2. A 1 would require foot contact with the hurdle or loss of balance; neither happened. A 3 requires hips, knees, and ankles aligned, minimal lumbar movement, and the dowel and hurdle parallel. On the right stance, the pelvis rotates, the lumbar spine extends, and the dowel and hurdle lose parallel, so the score is 2. The foot clearing the hurdle does not earn a 3 by itself; clearing the hurdle only avoids the 1. The key is that alignment and lumbar control are lost on the right.
2. Interpret the asymmetry in light of the ankle history without diagnosing the ankle.
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The asymmetry is real: left 3, right 2. It does not diagnose the right ankle, but the right-stance limitation is consistent with the history. Single-leg stance on the right demands ankle dorsiflexion, foot stability, and hip and pelvis control; the lumbar extension and pelvic rotation suggest he is compensating for something on that side. The screen cannot tell you whether the driver is ankle mobility, ankle stability, or hip control. Do not tell him the ankle is 'weak' or 'unstable' based on the FMS. Instead, say the right single-leg pattern is less controlled and needs assessment.
3. What would you prioritize in the program, and what would you avoid?
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Prioritize the right side because asymmetry outranks symmetrical low scores in the FMS hierarchy. Assess right ankle dorsiflexion, single-leg balance, hip abduction and external rotation control, and squat and lunge mechanics. Program right-side single-leg balance and controlled deceleration, ankle mobility if restricted, and hip stability; keep bilateral strength work. Avoid only stretching the calf or taping the ankle and calling it done, because the screen shows a control and alignment problem, not just a range-of-motion problem. Re-screen the hurdle step after 4-6 weeks and compare the right side with the baseline 2.