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Flexibility-enhancing Interventions for Ankle Range of Motion: A Network Meta-analysis
Jong Mi Park1, Kun Wook Lee1, Seo Yeon Yoon1,2
1Yonsei University College of Medicine, Department and Research Institute of Rehabilitation Medicine, Korea (the Republic of), Seodaemun-gu.
International Journal of Sports Medicine
|May 14, 2026
Summary
Proprioceptive neuromuscular facilitation (PNF) and foam rolling (FR) best enhance long-term ankle flexibility. Foam rolling also excels in short-term gains, while static stretching aids long-term active range of motion maintenance.
Area of Science:
- Sports Medicine
- Rehabilitation Science
- Biomechanics
Background:
- Ankle dorsiflexion range of motion (ROM) is crucial for athletic performance and injury prevention.
- Various flexibility interventions exist, but their comparative effectiveness on ankle ROM requires synthesis.
- Understanding optimal methods is key for clinicians and athletes.
Purpose of the Study:
- To systematically review and network meta-analyze the effectiveness of five flexibility interventions on ankle dorsiflexion ROM.
- To compare static stretching (SS), dynamic stretching (DS), ballistic stretching (BS), proprioceptive neuromuscular facilitation (PNF), and foam rolling (FR).
- To rank interventions based on their impact on passive and active ROM.
Main Methods:
- Systematic review and random-effects network meta-analysis following PRISMA 2020 guidelines.
- Included 41 RCTs with 1,670 participants.
- Intervention ranking using surface under the cumulative ranking curve (SUCRA).
Main Results:
- For passive ROM (PROM), PNF (SUCRA 76.8%) and FR (67.8%) were most effective overall and in long-term protocols (>1 month).
- For active ROM (AROM), FR (SUCRA 87.2%) showed the largest short-term improvement.
- Static stretching (SS) demonstrated favorable long-term AROM maintenance (SUCRA 72.4%). No adverse events were reported.
Conclusions:
- PNF and FR are optimal for long-term flexibility gains in ankle dorsiflexion.
- FR is recommended for short-term improvements and pre-exercise preparation.
- SS may be beneficial for sustained AROM maintenance over extended periods.
