Flexibility-Enhancing Interventions for Ankle Range of Motion: A Network Meta-Analysis

This systematic review and network meta-analysis compared the effectiveness of five flexibility-enhancing interventions —static stretching (SS), dynamic stretching (DS), ballistic stretching (BS), proprioceptive neuromuscular facilitation (PNF), and foam rolling (FR)—on ankle dorsiflexion range of motion (ROM) in physically active healthy adults. A comprehensive search of multiple databases was conducted up to August 4, 2025. The review followed PRISMA 2020 guidelines and was registered in PROSPERO. Effect sizes were synthesized using a random-effects network meta-analysis, and intervention rankings were based on the surface under the cumulative ranking curve (SUCRA). Forty-one RCTs (n = 1,670) were included. For passive ROM (PROM), PNF (SUCRA 76.8%) and FR (67.8%) were the most effective overall. In long-term protocols (>1 month), both PNF (SMD 1.04 [0.64–1.44] and FR (SMD 1.03 [0.53–1.53]) remained superior to controls. For active ROM (AROM), FR ranked highest (SUCRA 87.2%) and demonstrated the largest short-term improvement, while SS showed the most favorable long-term maintenance (SUCRA 72.4%). No intervention-related adverse events were reported. PNF and FR are optimal for long-term flexibility enhancement, whereas FR is recommended for short-term, pre-exercise movement preparation. SS may support sustained AROM across extended training periods. Intervention selection should align with specific performance goals and training timelines.