Anterior Drawer Test: ATFL Sprain

 In Foot

Anterior Drawer Test:

We’re continuing our trail along the various implications of ankle sprains and today we’re looking at a screen called the Anterior Drawer Test, which targets the Anterior Talofibular Ligament – Now if this is the first post you’ve seen from us then we would highly recommend you take a look at our YouTube channel and subscribe…Then it’s most definitely worth you taking a look at our Ligaments of the Foot video! This covers everything you’ll need to know ensuring you’re up to speed for this next screen!

If you’ve just returned from watching our previous videos on our YouTube channel, or you’re already up to speed then welcome back!

Today we are taking a look at one of the most common ligaments involved in an inversion ankle sprain – the ATFL (and if you’ve been watching intently, you’ll know that the ATFL stands for Anterior Talofibular Ligament) This ligament runs from the anterior surface of the talus to the fibula – When sprained, the foot is usually in plantar flexion whilst the sub-talar joint goes into an excessive inversion. This puts that ligament into stretch and depending on the force of the trauma, it can either partially tear or completely rupture the ligament. You’ll often hear doctors referring to sprains in a grade value – and this ties into that.

There are 3 grades of sprain:

  • Grade 1: The ligament has been overstretched but not torn.
  • Grade 2: You have a partial tear in the ligament.
  • Grade 3: This is a full tear of the ankle ligament.

The Anterior Drawer Test as mentioned above is used for testing someone who’s recently suffered from an inversion ankle sprain and you suspect that the ATFL has been injured.

Anterior Talofibular Ligament: 

The Anterior Talofibular Ligament is often abbreviated to the ATFL (much easier to say!) and it’s the most anterior ligament on the lateral side of the ankle. It runs from the anterior surface of the fibula to the talus and therefore it is named the anterior talofibular ligament. This ligament’s function is to restrict the foot from excessively sliding forward in relation to the tibia…Did you know, it’s the most commonly injured ligament in an inversion ankle sprain!

How to Perform the Anterior Drawer Test: 

To perform the Anterior Drawer Test, have your client laying in supine with their feet hanging off the edge of the couch or table. Next, you’re going to hold the talocrural joint with one hand, to fix it so it cannot move. The foot then needs to be taken into plantar flexion and hold the calcaneus in your other hand. You’ll then need to draw the calcaneus towards you – This test would be positive if you felt excessive gapping in the joint or if the client reported any pain during this test.

All of these screens are really helpful when you need to narrow down the source of a sprain – But what we look at on our courses is then how you would help your client to effectively strengthen and rehab the joint using Pilates based exercise. Pilates is all about optimal movement so if we know which area of the body is preventing that and we can work on correctly and strengthening the weak link then the benefits can be huge for you and your clients!

If any of these screens test positively, then it’s best to be safe and refer your client onto their GP or physiotherapist for further investigation before allowing them to participate in your class. As Pilates Therapists, we do not diagnose, nor suggest that they replace Physiotherapy, Osteopathy, Chiropractic treatment or medical treatment of any kind. However, we do have additional skills equipping us to support these practitioners when they are ready to refer them on for Pilates practice.

Once your client has seen a medical practitioner and has been cleared for Pilates exercise, there are many things you can do to help and potentially improve their condition. We delve deeper into this on our Knee and Foot courses and we still have a few spaces free should you wish to join us and learn more! So if you’re interested, please feel free to visit our Courses page or why not drop us an email at

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