Kinesiology THURSDAY – Over Supination in a Golfer’s Left Ankle

“My left ankle is killing me,” she said, pointing to the lateral side behind the lateral malleolus. “I played nine holes of golf and walked the course,” she continued, “and the next day it felt like my ankle was broken.”

Left lateral ankle pain in golfers is more common than one would think for a sport that doesn’t require quick directional changes. The picture above is what the deceleration of the golf drive SHOULD look like. Check out the left ankle. The foot is flat on the ground at the top of the follow-through.

The picture below illustrates what commonly happens in golfers:

Junior golfer in a blue shirt and beige shorts, swinging a golf club on a transparent background, captured in three dynamic positions showcasing skill and athleticism

Notice how you can see the bottom of his left shoe at the top of his follow-through. This indicates over supination of the ankle and, over time or with repetition, may cause strain to the peroneus longus and brevis muscles or lateral ankle ligaments (ATFL or CFL).

But this doesn’t get solved by simply by putting theraband around the ankle and strengthening the peroneal muscles. (RESIST THE URGE!)

Instead, try checking out the list below of biomechanical causes of left ankle over supination in golfers:

A left-rotated pelvis – this usually occurs due to weakness of the left gluteus maximus. The FIX: Left tubing punch with a left glute squeeze
A tight bicep femoris (lateral hamstring) – as the hip internally rotates, a tight BF will cause the fibula to be pulled posteriorly, preventing the tibia from internally rotating. This also causes knee hyperextension at the end of the swing. The FIX: revolving triangle pose, anterior cone touch with the opposite hand
Tight hip external rotators – lack of hip internal rotation will cause the foot to supinate. The FIX – pigeon pose, lateral low rows, supine figure 4, etc.
A leg that feels too short – check for trigger points in the psoas major or quadratus lumborum. The FIX for the psoas: activate abdominal muscles; for the quadratus: lengthen with a wall wash or overhead press with weight shift to the same side and/or strengthen the gluteus medius (mini-band walk, side planks), as the QL will become chronically short in the presence of a weak gluteus medius.
Over supination at rest – check for trigger points in the tibialis anterior, tibialis posterior and medial gastrocnemius. The FIX: deep trigger point release and fascial release (cupping or IASTM) to these muscles.
Subtalar joint eversion hypomobility – lack of STJ eversion will make it difficult to keep the ball of the big toe on the ground. The FIX – mobilize the subtalar joint

For my patient, the cause of her over supination was #1, 3, 5 and 6. That’s a pretty good list to start working off of to solve her lateral ankle pain.

Why does this matter?

Non-traumatic lateral ankle pain in golfers is often due to lack of motion up the biomechanical chain. Solving the problem by strengthening the peroneal tendons is like putting a bandaid on a gusher. Resist the urge for the simple fix. Instead, assess the proximal structures that may be causing over supination. Your golfers will thank you.

Because nobody has time to be in pain.

Until next time…