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Test–Retest Reliability of the Standing Heel-Rise Test
Abstract
Context: The standing heel-rise test has been recommended as a means of assessing calf-muscle performance. To the authors' knowledge, the reliability of the test using intraclass correlation coefficients (ICCs) has not been reported. Objective: To determine the test-retest reliability of the standing heel-rise test. Design: Single-group repeated measures. Participants: Seventeen healthy subjects. Settings and Intervention: Each subject was asked to perform as many standing heel raises as possible during 2 testing sessions separated by 7 days. Main Outcome Measures: Reliability data for the standing heel-rise test were studied through a repeated-measures analysis of variance, ICC2,1, and SEMs. Results: The ICC2,1 and SEM values for the standing heel-rise test were .96 and 2.07 repetitions, respectively. Conclusions: The standing heel-rise test offers clinicians a reliable assessment of calf-muscle performance. Further study is necessary to determine the ability of the standing heel-rise test to detect functional deficiencies in patients recovering from lower leg injury or surgery.
... improvements in HRT scores reflect improvements in plantar flexor strength and endurance, and functional abilities of individuals). Overall, the HRT has demonstrated good to excellent reliability [intraclass correlation coefficients (ICC) 0.78 to 0.99] [14][15][16][17][18], with the standard error of measurements ranging from two to six repetitions [14,[16][17][18]. The difference in the reliability of the HRT across studies most likely reflects differences in testing protocols and populations investigated, highlighting the importance of documenting the reliability of specific testing protocols in research to assist readers and test users to interpret data. ...
... improvements in HRT scores reflect improvements in plantar flexor strength and endurance, and functional abilities of individuals). Overall, the HRT has demonstrated good to excellent reliability [intraclass correlation coefficients (ICC) 0.78 to 0.99] [14][15][16][17][18], with the standard error of measurements ranging from two to six repetitions [14,[16][17][18]. The difference in the reliability of the HRT across studies most likely reflects differences in testing protocols and populations investigated, highlighting the importance of documenting the reliability of specific testing protocols in research to assist readers and test users to interpret data. ...
... On the basis of commonly used thresholds[25] and consistent with previous investigations[14][15][16][17][18], the HRT protocol exhibited excellent test-retest reliability when performed 1 week apart. As hypothesised, older age, female sex and lower physical activity level had a negative effect on HRT outcome, with the sampled population of nearly 600 individuals completing a similar number of median heel-rise repetitions when tested on their left side compared with their right side. ...
Objectives
The heel-rise test is used to assess the strength and endurance of the plantar flexors in everyday clinical practice. However, several factors may affect outcomes, including sex, age, body mass index and activity level. The aims of this study were to revisit the reliability and normative values of this test, and establish normative equations accounting for several factors.
Design
Cross-sectional observational study with test–retest.
Setting
Community.
Participants
Volunteers (n = 566, age 20 to 81 years).
Interventions
Subjects performed single-legged heel rises to fatigue, standing on a 10° incline. A subset of subjects (n = 32) repeated the test 1 week later. Reliability was quantified using intraclass (ICC) correlation coefficients and Bland-Altman plots {mean difference [95% confidence interval (CI)]}, whereas the impact of sex, age, body mass index and activity level on the number of heel rises was determined using non-parametric regression models.
Results
The test showed excellent reliability (ICC = 0.96), with mean between-day differences in the total number of heel-rise repetitions of 0.2 (95% CI −6.2 to 6.5) and 0.1 (95% CI −6.1 to 6.2) for right and left legs, respectively. Overall, males completed more repetitions than females (median 24 vs 21). However, older females (age >60 years) outperformed older males. According to the model, younger males with higher activity levels can complete the most heel rises.
Conclusions
The heel-rise test is highly reliable. The regression models herein can be employed by clinicians to evaluate the outcomes of heel-rise tests of individuals against a comparable normative population.
... Clinicians and researchers in sports science and medicine often use the calf-raise test to assess properties of the calf muscle-tendon unit (MTU). [1][2][3][4][5][6] The test was originally developed in the 1940s during the poliomyelitis epidemic to grade * Corresponding author. ...
... 19,20 The calf-raise test has traditionally been used to assess various calf MTU properties including endurance, strength, fatigue, function, and performance. [1][2][3][4][5][6][7]9,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] The test has also been employed to assist diagnosis, quantify injury, grade impairment, and measure treatment outcomes of the lower extremity. 17,[37][38][39] A wide range of administrative protocols are currently available and detail multiple parameters, such as starting position, height of raise, pace of execution, balance support, termination criteria, and outcome measurements. ...
... The research literature commonly recommends 25 raises as norm clinical performance targets for healthy subjects, 9,34 although higher and lower values have also been suggested. 1,2,5,14,35,36,[41][42][43][44][45][46] Conversely, musculoskeletal assessment textbooks generally recommend lower target values ranging from 7 to 15 raises. 22,26,28 In sports medicine, it has been suggested that as high as 30-50% of all sporting injuries are related to overuse tendon disorders. ...
The calf-raise test is used by clinicians and researchers in sports medicine to assess properties of the calf muscle-tendon unit. The test generally involves repetitive concentric-eccentric muscle action of the plantar-flexors in unipedal stance and is quantified by the number of raises performed. Although the calf-raise test appears to have acceptable reliability and face validity, and is commonly used for medical assessment and rehabilitation of injuries, no universally acceptable test parameters have been published to date. A systematic review of the existing literature was conducted to investigate the consistency as well as universal acceptance of the evaluation purposes, test parameters, outcome measurements and psychometric properties of the calf-raise test. Nine electronic databases were searched during the period May 30th to September 21st 2008. Forty-nine articles met the inclusion criteria and were quality assessed. Information on study characteristics and calf-raise test parameters, as well as quantitative data, were extracted; tabulated; and statistically analysed. The average quality score of the reviewed articles was 70.4+/-12.2% (range 44-90%). Articles provided various test parameters; however, a consensus was not ascertained. Key testing parameters varied, were often unstated, and few studies reported reliability or validity values, including sensitivity and specificity. No definitive normative values could be established and the utility of the test in subjects with pathologies remained unclear. Although adapted for use in several disciplines and traditionally recommended for clinical assessment, there is no uniform description of the calf-raise test in the literature. Further investigation is recommended to ensure consistent use and interpretation of the test by researchers and clinicians.
... The Standing Heel Rise Test was used to examine calf muscle performance. Testing protocol followed the procedure outlined by Ross and Fontenot [17], which required the participant to stand on one leg and repeatedly lift the stance limb through a maximum plantar flexion ROM until fatigue ( Figure 2). Due to the repetitive nature of the procedure, the test is thought to predominantly assess the endurance capabilities of the calf musculature [17] and therefore the number of heel raises achieved was used as a measure of calf endurance. ...
... Testing protocol followed the procedure outlined by Ross and Fontenot [17], which required the participant to stand on one leg and repeatedly lift the stance limb through a maximum plantar flexion ROM until fatigue ( Figure 2). Due to the repetitive nature of the procedure, the test is thought to predominantly assess the endurance capabilities of the calf musculature [17] and therefore the number of heel raises achieved was used as a measure of calf endurance. To ensure that the test was a true indication of calf endurance, participants from the case group were asked to indicate whether heel pain or calf muscle fatigue limited their performance. ...
... The test has been shown to have excellent retest reliability (ICC = .96, SEM = 2.07 repetitions) [17]. ...
Chronic plantar heel pain (CPHP) is common and is thought to have a detrimental impact on health-related quality of life. However, no study has used normative data or a control data set for comparison of scores. Therefore, we describe the impact of CPHP on foot-specific and general health-related quality of life by comparing CPHP subjects with controls.
Foot Health Status Questionnaire scores were compared in 80 subjects with CPHP and 80 sex- and age-matched controls without CPHP.
The CPHP group demonstrated significantly poorer foot-specific quality of life, as evidenced by lower scores on the foot pain, foot function, footwear, and general foot health domains of the Foot Health Status Questionnaire. The group also demonstrated significantly poorer general health-related quality of life, with lower scores on the physical activity, social capacity, and vigor domains. In multivariate analysis, CPHP remained significantly and independently associated with Foot Health Status Questionnaire scores after adjustment for differences in body mass index. Age, sex, body mass index, and whether symptoms were unilateral or bilateral had no association with the degree of impairment in people with CPHP.
Chronic plantar heel pain has a significant negative impact on foot-specific and general health-related quality of life. The degree of negative impact does not seem to be associated with age, sex, or body mass index.
... The standing heel-rise test was used to assess the isotonic endurance of the ankle joint plantar flexor muscles and was based on the methodology described by Ross and Fontenot. 26 Participants stood barefoot between two parallel uprights. Connecting the two uprights together was nylon string (0.5 mm diameter). ...
... The test-retest reliability of the standing heel-rise test has been shown to be excellent in healthy populations (ICCs range = 0.78-0.96) 26,28,29 and in a sample of participants with history of deep vein thrombosis (ICC = 0.88) 28 and chronic heart failure (ICC = 0.93). 30 However, the standing heel-rise test has not been assessed for reliability in people with MTSS. ...
... A sample size of 30 per group was determined to have an 80% chance of detecting a 25% (eight repetitions) difference in ankle joint plantar flexor muscle endurance. The sample size calculation assumed a standard deviation of 11 (repetitions) 26 and an alpha level of 5%. ...
Medial tibial stress syndrome (MTSS) is a common overuse leg injury seen in athletes and can be recalcitrant to management. This cross-sectional study aimed to determine if there are differences in the isotonic endurance of the ankle joint plantar flexor muscles in athletes with MTSS compared to athletes without MTSS. The isotonic endurance of the ankle joint plantar flexors was measured in 30 participants diagnosed with MTSS, and 30 reference participants that were matched to MTSS participants on the basis of age (+/-5 years), gender, BMI (+/-5%) and type of sporting activity. The number of heel-rise repetitions of the participants in each group was compared for differences. There were no significant differences between participants with and without MTSS for age (p=0.34), height (p=0.40) or BMI (p=0.27). The mean number of heel-rise repetitions performed by participants in the MTSS group was significantly less than the reference group (mean 23, S.D. 5.6, versus mean 33, S.D. 8.6; p<0.001). These results suggest that athletes with MTSS have endurance deficits of the ankle joint plantar flexor muscles. Rehabilitation of athletes with MTSS should comprise training designed to enhance endurance of the lower limb musculature, including the ankle joint plantar flexors. It is not known whether a lack of endurance of the ankle joint plantar flexor muscles is the cause or effect of MTSS.
... The Standing Heel Rise Test was used to examine calf muscle performance. Testing protocol followed the procedure outlined by Ross and Fontenot [17], which required the participant to stand on one leg and repeatedly lift the stance limb through a maximum plantar flexion ROM until fatigue ( Figure 2). Due to the repetitive nature of the procedure, the test is thought to predominantly assess the endurance capabilities of the calf musculature [17] and therefore the number of heel raises achieved was used as a measure of calf endurance. ...
... Testing protocol followed the procedure outlined by Ross and Fontenot [17], which required the participant to stand on one leg and repeatedly lift the stance limb through a maximum plantar flexion ROM until fatigue ( Figure 2). Due to the repetitive nature of the procedure, the test is thought to predominantly assess the endurance capabilities of the calf musculature [17] and therefore the number of heel raises achieved was used as a measure of calf endurance. To ensure that the test was a true indication of calf endurance, participants from the case group were asked to indicate whether heel pain or calf muscle fatigue limited their performance. ...
... The test has been shown to have excellent retest reliability (ICC = .96, SEM = 2.07 repetitions) [17]. ...
Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors.
Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched by age (+/- 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test.
Univariate analysis demonstrated that the CPHP group had significantly greater BMI (29.8 +/- 5.4 kg/m2 vs. 27.5 +/- 4.9 kg/m2; P < 0.01), a more pronated foot posture (FPI score 2.4 +/- 3.3 vs. 1.1 +/- 2.3; P < 0.01) and greater ankle dorsiflexion ROM (45.1 +/- 7.1 degrees vs. 40.5 +/- 6.6 degrees; P < 0.01) than the control group. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. Multivariate logistic regression revealed that those with CPHP were more likely to be obese (BMI > or = 30 kg/m2) (OR 2.9, 95% CI 1.4 - 6.1, P < 0.01) and to have a pronated foot posture (FPI > or = 4) (OR 3.7, 95% CI 1.6 - 8.7, P < 0.01).
Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress may not play a role in CPHP.
... A valid and reliable endurance test to assess calf muscle performance (Ross & Fontenot, 2000) was conducted to focus on the muscle group most affected by the CS. Players stood with their arms extended parallel to the floor with their hands against a wall to ensure balance without assistance. ...
... Previously, compression garments showed reduced muscle damage (measured by muscle biopsy) and delayed the onset of muscle soreness in amateur soccer players following decline treadmill running (Valle et al., 2013). In the current study, muscle damage was indirectly assessed by the standing heel-rise test, an endurance test that assesses the resilience of the triceps surae muscle within a closed kinetic chain (Ross & Fontenot, 2000). Our results indicated that the soccer match reduced (p < 0.0001) the number of heel-rise repetitions in both groups, (CS = -14.8% vs. control = -32%) most likely due to match-induced muscle damage and fatigue Souglis, Papapanagiotou, et al., 2015). ...
... A valid and reliable endurance test to assess calf muscle performance (Ross & Fontenot, 2000) was conducted to focus on the muscle group most affected by the CS. Players stood with their arms extended parallel to the floor with their hands against a wall to ensure balance without assistance. ...
... Previously, compression garments showed reduced muscle damage (measured by muscle biopsy) and delayed the onset of muscle soreness in amateur soccer players following decline treadmill running (Valle et al., 2013). In the current study, muscle damage was indirectly assessed by the standing heel-rise test, an endurance test that assesses the resilience of the triceps surae muscle within a closed kinetic chain (Ross & Fontenot, 2000). Our results indicated that the soccer match reduced (p < 0.0001) the number of heel-rise repetitions in both groups, (CS = -14.8% vs. control = -32%) most likely due to match-induced muscle damage and fatigue Souglis, Papapanagiotou, et al., 2015). ...
... A valid and reliable endurance test to assess calf muscle performance (Ross & Fontenot, 2000) was conducted to focus on the muscle group most affected by the CS. Players stood with their arms extended parallel to the floor with their hands against a wall to ensure balance without assistance. ...
... Previously, compression garments showed reduced muscle damage (measured by muscle biopsy) and delayed the onset of muscle soreness in amateur soccer players following decline treadmill running (Valle et al., 2013). In the current study, muscle damage was indirectly assessed by the standing heel-rise test, an endurance test that assesses the resilience of the triceps surae muscle within a closed kinetic chain (Ross & Fontenot, 2000). Our results indicated that the soccer match reduced (p < 0.0001) the number of heel-rise repetitions in both groups, (CS = -14.8% vs. control = -32%) most likely due to match-induced muscle damage and fatigue Souglis, Papapanagiotou, et al., 2015). ...
Soccer-induced fatigue and performance are different between the sexes. The effect of compression stockings (CS) use on fatigue during the soccer match in females is unknown. Thus, we evaluated the impact of CS use during a female soccer match on match-induced fatigue. Twenty soccer players were randomly allocated to two groups (n = 10 for each group): CS and Control (regular socks), and equally distributed within two teams. At rest (baseline 48-h before the match) and immediately post-match, we assessed agility T-test, standing heel-rise test and YoYo Intermittent Endurance Test level 2 (YoYoIE2) performance. Effort during the match (heart rate and rating of perceived exertion) was similar (p > 0.05) between groups. The YoYoIE2 performance was decreased post-match (p < 0.05) equally for both groups. Otherwise, the CS group exhibited a greater post-match performance (p < 0.05) for the agility T-test and heel-rise test (large effect sizes). Therefore, we conclude that the use of CS during an amateur female soccer match resulted in less match-induced fatigue.
... The number of successful repetitions performed within a certain time frame is used as an indicator of ankle PF muscle strength [21]. The SHRT has been found to be a reliable and valid measure of ankle PF muscle strength in older adults and has been applied in clinical and research settings to evaluate muscle strength, balance, and mobility [22,45]. The test has also been used as an outcome measure in studies investigating the effects of various interventions, such as exercise and balance training on lower extremity function in older adults. ...
The senior population is at increased risk of falling due to a reduction in ankle muscle strength. Evaluating the strength of the ankle muscles in older adults is of paramount importance. The purpose of this study was to formulate an equation to estimate ankle muscle strength by utilizing the basic physical characteristics of the subject and the variables related to their ability to perform the standing heel-rise test (SHRT). One hundred and thirty-two healthy elderly participants (mean age 67.30 ± 7.60) completed the SHRT and provided demographic information. Ankle plantar flexor (PF) muscle strength was evaluated using a push-pull dynamometer. Multiple regression analysis was utilized to develop a prediction equation for ankle PF muscle strength. The study revealed that the ankle PF strength equation was derived from variables including the power index of the SHRT, gender, age, calf circumference, and single-leg standing balance test. The equation exhibited a strong correlation (r = 0.816) and had a predictive power of 65.3%. The equation is represented as follows: ankle PF strength = 24.31 − 0.20(A) + 8.14(G) + 0.49(CC) + 0.07(SSEO) + 0.20(BW/t-SHRT). The equation had an estimation error of 5.51 kg. The strength of ankle PFs in elderly individuals can be estimated by considering demographic variables, including gender, age, calf circumference, single-leg standing balance test, and the power index of the SHRT. These factors were identified as significant determinants of ankle PF strength in this population.
... The heel-raise test involves repetitive concentric-eccentric muscle action of the plantar-flexors in a single leg stance and is quantified by the total number of raises performed. This test demonstrates good reliability and has traditionally been used to assess various calf MTU properties including muscular strength, endurance and fatigue [82][83][84][85]. It is acknowledged that the ankle plantar flexors (gastrocnemius and soleus muscles) will not be subjected to high contracting forces during the leg press and knee extension exercises and are therefore not under a comparable biological stimulus as the quadriceps muscle. ...
Background
Muscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual’s one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to ‘conventional’ heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain.
Methods
This is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18–55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study.
Discussion
LL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI.
Trial registration
ClinicalTrials.org reference number, NCT05719922
... [27] Therefore, these findings suggest that the standing HR test causes fatigue of the calf musculature. [28] In the present study, participants who were able to perform a minimum of 25 HR were recruited because, according to Lunsford and Perry, [25] individuals performing a minimum of 25 HR can be considered normal. ...
Background:
Fatigue is a common phenomenon encountered by athletes in ordinary life and sports. Fatigue results in decreased muscle strength, balance, agility, and an increased risk of injury, which together results in hampered sports performance. Several studies have examined the effects of Kinesio Tape (KT) application on muscle fatigue however, contradictory findings are reported. This study aimed to examine the effects of the application of KT on calf muscle fatigability.
Methods:
A three-arm parallel pretest-post-test experimental design was used. Forty-five collegiate female athletes (mean age of 20.57 years) were randomly assigned to three groups. For the experimental group, KT with 50% tension; for the sham group, KT without any tension; and for the placebo group, rigid tape without any tension was applied. The number of heel rises (HRn) was measured before and after taping in the three groups, using Haberometer and Metronome. The tapes were applied in the Y shape to the calf muscle region.
Results:
In the experimental group: The HRn significantly increased by 18.76 % (P = .000) after applying KT. In the sham and placebo groups: There was no change in HRn before and after Taping (P > .05).
Conclusion:
Y-shaped application of KT with 50% tension over the calf muscle region is effective in reducing its fatigability.
... Heel raise to failure endurance test was assessed by measuring the number of consecutive single leg heel raises in standing using a previously established, reliable protocol (Ross & Fontenot, 2000). Briefly, participants performed as many single leg heel raises, through the entire available range of motion from ankle neutral position, in response to external metronome pacing (two seconds per cycle: 1-second concentric and 1-second eccentric). ...
Objectives
To confirm what impairments are present in runners with Achilles tendinopathy (AT) and explore the variance of AT severity in an adequately powered study.
Design
Case-control study.
Setting
Two private physiotherapy clinics in Australia and Spain.
Participants
Forty-four recreational male runners with AT and 44 healthy controls matched by age, height, and weight.
Main outcome measures
Demographics, activity (IPAQ-SF), pain and function (VISA-A), pain during hopping (Hop pain VAS), hopping duration, psychological factors (TSK-11, PASS20), and physical tests regarding lower-limb maximal strength and endurance.
Results
Body mass index (BMI), activity, VISA-A, pain, and duration of hopping, TSK-11, PASS20, standing heel raise to failure, seated heel raise and leg extension 6RM, hip extension and abduction isometric torque were significantly different between groups (P < 0.05) with varied effect sizes (V = 0.22, d range = 0.05–4.18). 46% of AT severity variance was explained by higher BMI (β = −0.41; p = 0.001), weaker leg curl 6RM (β = 0.32; p = 0.009), and higher pain during hopping (β = −0.43; p = 0.001).
Conclusion
Runners with AT had lower activity levels, lower soleus strength, and were less tall. BMI, pain during hopping, and leg curl strength explained condition severity. This information, identified with clinically applicable tools, may guide clinical assessment, and inform intervention development.
... Araştırmadaki popülasyonda amaç, kalkaneal epin nedeniyle belirli bir mesafe yürümeyi takiben ortaya çıkacak ayak ağrısı ve/veya bacaklardaki kassal yorgunluk şikayetinin hastaların fonksiyonel performansını ne ölçüde olumsuz etkilediğinin ortaya konulması olduğu için, hastalardan ağrı ya da yorgunluk nedeniyle yürümeyi daha fazla tolere edemediklerinde testi sonlandırmaları istenmiş ve ağrısız/yorgunluk olmaksızın kat ettikleri yürüme mesafesi metre cinsinden kaydedilmiştir. Fonksiyonel performansın değerlendirilmesi amacıyla kullanılan diğer test ise endurans, güç, fonksiyon, yorgunluk ve performansı aynı anda değerlendirebilen "Topuk Yükseltme Testi"dir (TYT) (15,16). Bu test ayak bileği plantar fleksör kaslarının tekrarlayan konsentrik-eksentrik kas aktivitesini ve ön ayak zeminde sabitken tibialis posterior kasının arka ayaktaki inversiyonun devam ettirilmesini sağlamadaki yeterliliğini değerlendirmektedir. ...
AMAÇ: Kalkaneal epin, hastalara ciddi anlamda rahatsızlık vererek günlük yaşam aktivitelerini kısıtlar. Çalışmamızın amacı bu bireylerde fiziksel aktivite düzeyinin ağrı ve fonksiyonellik yanıtları üzerindeki etkisini araştırmaktı. GEREÇ VE YÖNTEM: Çalışma kalkaneal epin tanısı konmuş 41 birey ile yapıldı. Bireylerin yaş, cinsiyet, boy, kilo, beden kütle indeksi (BKİ) ve topuk ağrılarına ilişkin niteliksel ve niceliksel özellikleri sorgulandı. Bireylerin fiziksel aktivite düzeylerini değerlendirmek için Uluslararası Fiziksel Aktivite Anketi (UFAA) kullanıldı. Ayak ağrısını değerlendirmek için algometre, fonksiyonel performanslarını belirlemek için 6 dakika yürüme testi ve topuk yükseltme testi kullanıldı. BULGULAR: Bireylerin 8’i (% 19,5) düşük düzeyde aktivite, 26’sı (% 63,4) orta düzeyde aktivite ve 7’si (% 17,1) yüksek düzeyde aktiviteye sahipti. Fiziksel aktivite düzeylerine göre sınıflandırılan bireylerde ayak ağrısı ve fonksiyonel performans parametreleri açısından anlamlı bir fark görülmedi. SONUÇ: Yüksek düzeyde fiziksel aktivitenin özellikle yüksek BKİ'li bireylerde topuk ağrısı/ plantar fasiit/ kalkaneal epin gelişimi için önemli bir risk faktörü olduğu bilinmektedir. Bununla birlikte, aktif bir yaşamın ve egzersiz alışkanlığının gerek sistemik endokrin yanıtlar vasıtası ile ve gerekse kas iskelet sistemi ve vücut kompozisyonu üzerindeki olumlu etkileri ile söz konusu şikayetlerin görülme sıklığını azaltabileceği unutulmamalıdır. Daha geniş katılımlı ve kanıt düzeyi yüksek ileri çalışmalara ihtiyaç vardır.
... The protocol employed for Gastrocnemius Calf Raises (GCR) was to repeatedly raise up onto toes off a flat floor, with the measure being the number of repetitions. The test was stopped when the therapist identified a functional change in the movement pattern (Ross & Fontenot, 2000). ...
Objectives:
The aim of this study is to identify if intrinsic factors tested in the preseason screening (PSS) can identify an elevated risk of injury. This aim has two aspects; to assess whether previous injury is associated with ongoing deficits in performance, and to assess if the PSS can identify differences in intrinsic factors that profile risk of future injury.
Design:
A cohort of state level field hockey players were tested on a screening test battery including proprioception, postural stability, muscular strength and range of motion, to establish if these intrinsic factors were useful in identifying elevated risk of injury. Retrospective injury data was collated to determine association with previous injury and prospective injury data was collated to determine association with future injury.
Participants:
A total of 130 field hockey players were included in this study, from state level squads (age ± SD = 20.96 (3.75); height = 176.09 cm). Groups for prescreening and post screening injury status (injured/not injured) were established for comparison to screening test results.
Results:
Right Active Movement Extent Discrimination Assessment (AMEDA), left AMEDA and right Y-balance test (YBT) anterior direction (Ant) were significantly associated (p < 0.05) with injury prior to screening. Right YBTAnt and right and left hip internal rotation (IR) were significantly associated (p < 0.05) with injury post screening. The YBTAnt and YBT posteromedial (PMed) reach directions and Hip IR are associated with previous hamstring injury and show a difference between post screening injured and non-injured groups.
Conclusions:
AMEDA, R YBTAnt, Hip IR tests should be a focus for recovery after previous injury and during season preparation. Full recovery may improve readiness to return to play and reduce risk of primary injury or re-injury. YBTAnt and YBTPmed and Hip IR show a performance deficit link between previous injury and subsequent re-injury of hamstrings. Since these are the most common re-injury types in this cohort, these tests are clinically useful in informing return to play decisions for hockey players.
... Foot motor performance was evaluated with single leg heel rise test [24]. During the test, the cases were asked to stand on their one legs in flat position and were allowed to touch the examiner or a wall with a finger tip to maintain their balance. ...
BACKGROUND: Hallux valgus (HV) is one of the most common deformities of the foot, and it causes great difficulties for the patients.
OBJECTIVE: We aimed to investigate the effects of different rigid taping techniques on HV angle, foot motor performance, balance and walking parameters.
METHODS: Twenty-two voluntary individuals (12 males, 10 females) with flexible HV deformities between 18 and 35 years of age were included in the study. All measurements were done before and after placebo, athletic and Mulligan tapings were applied. After a three-day interval, new taping was applied on the same subject. HV angle was measured by goniometer. Foot motor performance (single leg heel rise test), balance (unilateral stance, limits of stability, sensory integration of balance) and temporospatial parameters of gait (step length, stride length, step width, foot angle and cadence) were evaluated.
RESULTS: HV angles were reduced in all taping groups(p <0.05).The Mulligan taping method was the most effective method in reducing HV angle. Foot motor performance was not effected by any type of taping (p > 0.05). Athletic taping increased step length and step width but reduced foot angle and cadence. The Mulligan taping increased cadence and reduced foot angle (p < 0.01). Both taping methods did not affect the postural stability and fall risk (p > 0.05). Stability limits were increased in Mulligan taping group (p < 0.05).
CONCLUSION:It can be concluded that Mulligan taping method may be an alternative treatment method for HV rehabilitation especially as it increased the limits of stability and maintaining the balance. Mulligan method is more effective than athletic taping in terms of reducing instant HV angle.
Keywords: Hallux valgus, taping, gait, balance
... Standing heel rise test is found to be reliable and valid test to assess strength of plantarflexors. 3 Various studies are performed to find out the average number of repetitions of complete heel rise. Age, sex, body mass index, activity level may affect the performance. ...
Background: Standing heel rise test is used to check the strength of plantar flexors. Available literature suggests wide range of repetition of heel rise during manual muscle testing of plantar flexors. Objective: To estimate the average number of repetitions of complete heel rise in college going students. Subjects: Observational type of study was done in randomly selected 180 healthy college going students in age group of 18-22 years. Methodology: Subjects were in one leg standing position with trunk erect and hands clasped behind the back. The subject was asked to perform complete heel rise and number of repetitions were counted, in both legs one after the other. Any fatigue, pain or deviation in posture was considered for termination of test. Metronome was used during the procedure. The procedure was repeated three times and best of them was used for analysis. Maximum number of compete heel rise without rest and fatigue in between were determined in the subjects. Rest time between the repetitions was 5 minutes. Analysis: Mean, Standard deviation (SD) and median for number of complete heel rise were determined. Results: Mean (SD) for complete heel rise for male and female is 32.85(12.68) and 27.96(13.54) respectively. Median is 32 for males and 26 for females. Conclusion:-A recommendation for change in criteria for grading normal strength of plantarflexors can be made in our population.
KEYWORDS: Plantarflexors, Manual muscle testing, Standing heel Rise
... Lower limb muscle endurance will be assessed bilaterally using a heel raise test described by Ross et al. [52]. Following familiarisation with the protocol, each participant will attempt to perform as many single leg heel raises as possible. ...
Background
Medial tibial stress syndrome (MTSS) is a lower leg injury with a reported incidence rate of up to 35% in active individuals. Although numerous prospective studies have tried to identify risk factors for developing MTSS, managing the syndrome remains difficult. One risk factor yet to be extensively explored in MTSS development is reduced lower leg girth. Further investigation of reduced lower leg girth is required due to the important role lower leg musculature plays in attenuating ground reaction forces during the gait cycle. Therefore, the primary aim of this study is to ascertain whether lower leg muscle morphology and function contribute to the development of MTSS. Our ultimate aim is to identify potential risk factors for MTSS that can be targeted in future studies to better manage the injury or, preferably, prevent individuals developing MTSS.
Methods
This study will be prospective in design and will recruit asymptomatic distance runners. All participants will be tested at base line and participants will have their training data longitudinally tracked over the following 12 months to assess any individuals who develop MTSS symptoms. At base line, outcome measures will include bilateral measures of lower limb anthropometry; cross sectional area (CSA) and thickness of the tibialis anterior, peroneals, flexor digitorum longus, flexor hallucis longus and thickness of soleus, medial and lateral head of gastrocnemius. Tibial bone speed of sound, ankle dorsiflexion range of motion, strength of the six previously described muscles, foot alignment and ankle plantar flexor endurance will also be assessed. Participants will also complete a treadmill running protocol where three-dimensional kinematics, plantar pressure distribution and electromyography data will be collected.
Discussion
This study will aim to identify characteristics of individuals who develop MTSS and, in turn, identify modifiable risk factors that can be targeted to prevent individuals developing this injury.
... 21 Moreover, the unilateral heel-lift test showed excellent reliability with an ICC value of 0.84, which is slightly less compared with the same previous study of patients with congestive heart failure and healthy adults, where the ICC values were 0.98 and 0.94 for the right leg and 0.94 and 0.93 for the left leg respectively. 21 Similarly, Ross and Fontenot 35 reported an ICC value of 0.96 when testing healthy subjects. The present study followed the SEPHIA protocol, stating that only one shoulder and one leg as chosen by the patient are tested, which might have influenced our result, as compared with previous studies. ...
Background:
To maximise the benefits obtainable from exercise-based cardiac rehabilitation, an evaluation of physical fitness using reliable, clinically relevant tests is strongly recommended. Recently, objective tests of physical fitness have been implemented in the SWEDEHEART register. The reliability of these tests has, however, not been examined for patients with acute coronary syndrome.
Aims:
The aim of this study was to assess the test-retest reliability and responsiveness to change of the symptom-limited bicycle ergometer test, the dynamic unilateral heel-lift test and the unilateral shoulder-flexion test in patients with acute coronary syndrome.
Methods:
In a longitudinal study design, a total of 40 patients (mean age 63.8 ± 9.5 years, five women), with ACS, aged < 75 years, were included at a university hospital in Sweden. The intra-class correlation coefficient (ICC) with a 95% confidence interval, standard error of measurement (SEM) and responsiveness in terms of the minimal detectable change were calculated.
Results:
Excellent reliability was found, showing ICC values of 0.98 (0.96-0.99), SEM 4.71 for the bicycle ergometer test, ICC 0.87 (0.75-0.93), SEM 4.62 for the shoulder-flexion test and ICC 0.84 (0.71-0.91), SEM 2.24 for the heel-lift test. The minimal detectable change was 13 W, 13 and 6 repetitions for the bicycle ergometer test, shoulder-flexion and heel-lift tests respectively.
Conclusions:
The test-retest reliability of clinical tests evaluating physical fitness in patients with acute coronary syndrome included in the SWEDEHEART register was excellent. This makes the future comparison and evaluation of treatment effects in large unselected clinical populations of acute coronary syndrome possible.
... The heel rise has been used to assess calf muscle function [17]. This exercise involves the muscle action of plantar flexion and it can be used reliably [18]. After an acute ankle sprain, this exercise has also been used for ankle sprain rehabilitation, especially during neuromuscular training [19,20]. ...
Background: The purpose of this study was to investigate the differences in the kinematics of the ankle joint and the activity of the lower leg muscles in subjects with functional ankle instability (FAI) during a double-leg heel rise.Methods: Ten male athletes with FAI (age=19.9 ± 1.4 years; height=1.71 ± 0.04 m, weight=66.5 ± 3.6 kg) and ten male control athletes (age=20.1 ± 1.1 years; height=1.74 ± 0.03 m, weight=67.1 ± 4.5 kg) performed the heel rise on a force plate. The kinematic data and the electromyography (EMG) activity of the tibialis anterior (TA), gastrocnemius lateralis (GL), peroneus longus (PL), peroneus brevis (PB) and tibialis posterior (TP) muscles during the heel rise were recorded. Ankle movement was divided into two phases, a heel rise phase and a pause phase, and the data collected for each motion was compared between the two groups.Results: During the pause phase, subjects with FAI tended to present a more abducted position and a less inverted position compared with that of the controls, which was accompanied by decreased peroneus brevis activity during the same period. An altered movement of the ankle joint due to deficits of muscle function was observed in subjects with FAI. The kinematic and kinetic differences observed in subjects with FAI may lead to recurrent ankle sprain.
... While the construct validity of the single leg heel raise has yet to be established, there is acceptable reliability (test-retest ICC = 0.96). 68 The test was performed bilaterally and subjects were required to keep pace with a metronome set at 80 beats per minute. Subjects were instructed that they may lightly place their hands on ballet bars for balance purposes only but no weight was allowed to be placed through upper extremities to aid in the test. ...
Background:
Dance performance requires not only lower extremity muscle strength and endurance, but also sufficient core stabilization during dynamic dance movements. While previous studies have identified a link between core muscle performance and lower extremity injury risk, what has not been determined is if an extended core stabilization training program will improve specific measures of dance performance.
Hypothesis/purpose:
This study examined the impact of a nine-week core stabilization program on indices of dance performance, balance measures, and core muscle performance in competitive collegiate dancers.
Study design:
Within-subject repeated measures design.
Methods:
A convenience sample of 24 female collegiate dance team members (age = 19.7 ± 1.1 years, height = 164.3 ± 5.3 cm, weight 60.3 ± 6.2 kg, BMI = 22.5 ± 3.0) participated. The intervention consisted of a supervised and non-supervised core (trunk musculature) exercise training program designed specifically for dance team participants performed three days/week for nine weeks in addition to routine dance practice. Prior to the program implementation and following initial testing, transversus abdominis (TrA) activation training was completed using the abdominal draw-in maneuver (ADIM) including ultrasound imaging (USI) verification and instructor feedback. Paired t tests were conducted regarding the nine-week core stabilization program on dance performance and balance measures (pirouettes, single leg balance in passe' releve position, and star excursion balance test [SEBT]) and on tests of muscle performance. A repeated measures (RM) ANOVA examined four TrA instruction conditions of activation: resting baseline, self-selected activation, immediately following ADIM training and four days after completion of the core stabilization training program. Alpha was set at 0.05 for all analysis.
Results:
Statistically significant improvements were seen on single leg balance in passe' releve and bilateral anterior reach for the SEBT (both p ≤ 0.01), number of pirouettes (p = 0.011), and all measures of strength (p ≤ 0.05) except single leg heel raise. The RM ANOVA on mean percentage of change in TrA was significant; post hoc paired t tests demonstrated significant improvements in dancers' TrA activations across the four instruction conditions.
Conclusion:
This core stabilization training program improves pirouette ability, balance (static and dynamic), and measures of muscle performance. Additionally, ADIM training resulted in immediate and short-term (nine-week) improvements in TrA activation in a functional dance position.
Level of evidence:
2b.
... A clinical algorithm combining standard MMT and repetitions of the SLHR test ostensibly avoids the ceiling and floor effects demonstrated by these methods, respectively (Tab. 1). 5 The assessment properties of the SLHR test are becoming better known; the test has been shown to have acceptable interrater reliability, 18,19 normative performance values have been suggested, 14,20,21 and age-and sexadjusted scoring criteria have been proposed. 22 However, the construct validity of the SLHR test has yet to be established. ...
Background
Repeated heel raises have been proposed as a method of ankle plantar flexor strength testing that circumvents the limitations of manual muscle testing (MMT). Objective
To examine the relationship among ankle plantar flexor isometric maximum voluntary contraction (MVC), repeated single-limb heel raises (SLHR), and MMT in participants with myositis.DesignA cross-sectional study with a between-groups design. Group assignment was based on the ability to complete one SLHR (SLHR group, n=24; No SLHR, n=19).Methods
Forty-three participants with myositis (13 female, median age = 64.9 years) participated. Outcome measures included MVC, predicted MVC, Kendall MMT, and Daniels and Worthingham MMT. ResultsThe Kendall MMT was unable to detect significant ankle plantar flexion weakness established via quantitative methods and was unable to discriminate between participants who could or could not perform the SLHR task. Ankle plantar flexor MVC was not associated with the number of heel raise repetitions in the SLHR group (psuedo R(2) = .13, p = .24) No significant relationship was observed between MVC values and MMT grades within the SLHR and No SLHR groups. However, a moderate relationship between MVC values and MMT grades was evident for the combined groups analysis (ρ= .50 - .67, p≤.001).LimitationsThe lower half of both MMT grading scales were not represented in our study despite the profound weakness of our participants.Conclusions
Both the Kendall and Daniels and Worthingham MMT have limited utility in the assessment of ankle plantar flexor strength. Repeated SLHR should not be used as a proxy measure of ankle plantar flexor MVC in people with myositis.
... 35,36 Standing Heel Rise Test: The isotonic endurance of the ankle joint plantar flexor muscles was measured by this test based on the methodology described by Ross and Fontenot. 37 The test-retest reliability of the standing heel-rise test has been shown to be excellent in healthy populations (ICCs range = 0.780.96). 38 Subjects were allowed to touch their fingers to the wall at shoulder level to help them keep their balance. ...
Chronic inversion ankle sprains are common in basketball players. The effect of taping on functional performance is disputed in the literature. Kinesiotaping® (KT®) is a new method that is being used as both a therapeutic and performance enhancement tool. To date, it appears that no study has investigated the effect of ankle KT® on functional performance.
To investigate the effects of different types of taping (KT® using Kinesio Tex®, athletic taping) on functional performance in athletes with chronic inversion sprains of the ankle.
Crossover Study Design
Fifteen male basketball players with chronic inversion ankle sprains between the ages of 18 and 22 participated in this study. Functional performance tests (Hopping test by Amanda et al, Single Limb Hurdle Test, Standing Heel Rise test, Vertical Jump Test, The Star Excursion Balance Test [SEBT] and Kinesthetic Ability Trainer [KAT] Test) were used to quantify agility, endurance, balance, and coordination. These tests were conducted four times at one week intervals using varied conditions: placebo tape, without tape, standard athletic tape, and KT®. One-way ANOVA tests were used to examine difference in measurements between conditions. Bonferroni correction was applied to correct for repeated testing.
There were no significant differences among the results obtained using the four conditions for SEBT (anterior p=0.0699; anteromedial p=0.126; medial p=0.550; posteromedial p=0.587; posterior p=0.754; posterolateral p=0.907; lateral p=0.124; anterolateral p=0.963) and the KAT dynamic measurement (p=0.388). Faster performance times were measured with KT® and athletic tape in single limb hurdle test when compared to placebo and non-taped conditions (Athletic taping- placebo taping: p=0.03; athletic taping- non tape p=0.016;KT®- Placebo taping p=0.042; KT®-Non tape p=0.016). In standing heel rise test and vertical jump test, athletic taping led to decreased performance. (Standing heel rise test: Athletic taping- placebo taping p=0.035; athletic taping- non tape p=0.043; athletic tape- KT® p<0.001) (Vertical jump test: Athletic taping- placebo taping p=0.002: athletic taping- non tape p=0.002; KT®- athletic tape p<0.001)
Kinesiotaping® had no negative effects on a battery of functional performance tests and improvements were seen in some functional performance tests.
Ankle taping using Kinesio Tex® Tape did not inhibit functional performance.
... A custom-made adjustable frame with an integrated dynamometer (Chatillon CSD200 Series Dynamometer, Ametek Inc.; Largo, FL, USA) was used for balance support. The subjects were allowed to place their index fingertips on the dynamometer handles positioned at shoulder height in front of them and use a maximum force equivalent to 2% of their body weight (36). The threshold value was individually established before heel-raise testing, and the subjects used the displayed force readings from the dynamometer to selfmonitor the applied force. ...
Triceps surae and Achilles tendon injuries are frequent in sports medicine, particularly in middle-aged adults. Muscle imbalances and weakness are suggested to be involved in the etiology of these conditions, with heel-raise testing often used to assess and treat triceps surae (TS) injuries. Although heel raises are recommended with the knee straight for gastrocnemius and bent for soleus (SOL), the extent of muscle selectivity in these positions is not clear. This study aimed to determine the influence of knee angle and age on TS muscle activity during heel raises. Forty-eight healthy men and women were recruited from a younger-aged (18-25 years) and middle-aged (35-45 years) population. All the subjects performed unilateral heel raises in 0° and 45° knee flexion (KF). Soleus, gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) surface electromyography signals were processed to compute root-mean-square amplitudes, and data were analyzed using mixed-effects models and stepwise regression. The mean TS activity during heel raises was 23% of maximum voluntary isometric contraction when performed in 0° KF and 21% when in 45°. Amplitudes were significantly different between TS muscles (p < 0.001) and KF angles (p < 0.001), with a significant interaction (p < 0.001). However, the age of the population did not influence the results (p = 0.193). The findings demonstrate that SOL activity was 4% greater when tested in 45° compared with 0° KF and 5% lower in the GM and GL. The results are consistent with the recommended use of heel raises in select knee positions for assessing, training, and rehabilitating the SOL and gastrocnemius muscles; however, the 4-5% documented change in activity might not be enough to significantly influence clinical outcome measures or muscle-specific benefits. Contrary to expectations, TS activity did not distinguish between middle-aged and younger-aged adults, despite the higher injury prevalence in middle age.
... The intraclass correlation coefficient (ICC), which has been previously calculated for this measure, demonstrated high reliability (ICC = 0.96) for the assessment of calf strength via dynamometry. 39 The Physical Activity Scale (PAS) was used as a selfreported measure of the amount of activity performed on an average weekday. The PAS, measured in METS, has been determined to be a reliable and valid measure of self-reported activity (r = 0.74). 1 The Global Rating Scale (GRS), completed only at 6month followup, was used as a self reported outcome measure to assess the participant's 6-month post-intervention status with their condition prior to treatment. ...
Morphology and vascularization of painful tibialis posterior (TP) tendons before and after an intervention targeting the degenerated tendon were examined. Functional status and pain level were also assessed.
A10-week twice daily, progressive eccentric tendon loading, calf stretching program with orthoses was implemented with ten, early stage TP tendinopathy subjects. TP tendons were imaged by grayscale and Doppler ultrasound at INITIAL and POST evaluations to assess the tendon's morphology and signs of neovascularization. The Foot Functional Index (FFI), Physical Activity Scale (PAS), 5-Minute Walk Test, and single heel raise (SHR) test were completed at INITIAL and POST evaluations. The Global Rating Scale (GRS) was completed at 6 months followup. One-way ANOVA was used to compare the FFI at INITIAL, POST, and 6-MONTH time points. Paired t-tests were used to compare means between the remaining variables. The level of significance was p = 0.05.
There was a significant difference in FFI total, pain, and disability at the three time-points. Post-hoc paired t-tests revealed that the FFI scores were lower for the total score and pain and disability subcategories when comparing from INITIAL to POST and INITIAL to 6-MONTH evaluations (p < 0.05 for all). The number of SHR increased significantly on the involved side from INITIAL to POST evaluation (p = 0.041). The GRS demonstrated minimum clinically important differences for improvements in symptoms at 6-MONTH. Tendon morphology and vascularization remained abnormal following the intervention.
A 10-week tendon specific eccentric program resulted in improvements in symptoms and function without changes in tendon morphology or neovascularization.
... The intraclass correlation coefficient (ICC), which has been previously calculated for this measure, demonstrated high reliability (ICC = 0.96) for the assessment of calf strength via dynamometry. 39 The Physical Activity Scale (PAS) was used as a selfreported measure of the amount of activity performed on an average weekday. The PAS, measured in METS, has been determined to be a reliable and valid measure of self-reported activity (r = 0.74). 1 The Global Rating Scale (GRS), completed only at 6month followup, was used as a self reported outcome measure to assess the participant's 6-month post-intervention status with their condition prior to treatment. ...
Tibialis posterior tendinopathy can lead to debilitating dysfunction. This study examined the effectiveness of orthoses and resistance exercise in the early management of tibialis posterior tendinopathy.
Thirty-six adults with stage I or II tibialis posterior tendinopathy participated in this study.
Participants were randomly assigned to 1 of 3 groups to complete a 12-week program of: (1) orthoses wear and stretching (O group); (2) orthoses wear, stretching, and concentric progressive resistive exercise (OC group); or (3) orthoses wear, stretching, and eccentric progressive resistive exercise (OE group). Pre-intervention and post-intervention data (Foot Functional Index, distance traveled in the 5-Minute Walk Test, and pain immediately after the 5-Minute Walk Test) were collected.
Foot Functional Index scores (total, pain, and disability) decreased in all groups after the intervention. The OE group demonstrated the most improvement in each subcategory, and the O group demonstrated the least improvement. Pain immediately after the 5-Minute Walk Test was significantly reduced across all groups after the intervention.
People with early stages of tibialis posterior tendinopathy benefited from a program of orthoses wear and stretching. Eccentric and concentric progressive resistive exercises further reduced pain and improved perceptions of function.
Background:
The calf raise test (CRT) is commonly administered without a device in clinics to measure triceps surae muscle function. To standardise and objectively quantify outcomes, researchers use research-grade or customised CRT devices. To incorporate evidence-based practice and apply testing devices effectively in clinics, it is essential to understand their design, applicability, psychometric properties, strengths, and limitations. Therefore, this review identifies, summarises, and critically appraises the CRT devices used in science.
Methods:
Four electronic databases were searched in April 2022. Studies that used devices to measure unilateral CRT outcomes (i.e., number of repetitions, work, height) were included.
Results:
Thirty-five studies met inclusion, from which seven CRT devices were identified. Linear encoder (n = 18) was the most commonly used device, followed by laboratory equipment (n = 6) (three-dimensional motion capture and force plate). These measured the three CRT outcomes. Other devices used were electrogoniometer, Häggmark and Liedberg light beam device, Ankle Measure for Endurance and Strength (AMES), Haberometer, and custom-made. Devices were mostly used in healthy populations or Achilles tendon pathologies. AMES, Haberometer, and custom-made devices were the most clinician-friendly, but only quantified repetitions were completed. In late 2022, a computer vision mobile application appeared in the literature and offered clinicians a low-cost, research-grade alternative.
Conclusion:
This review details seven devices used to measure CRT outcomes. The linear encoder is the most common in research and quantifies all three CRT outcomes. Recent advances in computer-vision provide a low-cost research-grade alternative to clinicians and researchers via a n iOS mobile application.
[Purpose] The heel-raise test (HRT) is sometimes used to quantify ankle plantarflexion strength. However, descriptions of the test vary and normative values are limited. This paper, therefore was generated to summarize procedures and provide normative values for the HRT in a younger and older age group of adults. [Methods] Electronic and hand searches were conducted to identify relevant literature. Meta-analysis was used to provide norms. [Results] Among 439 nonduplicative articles identified, 13 qualifying articles were ultimately included. Procedures for the HRT described in the studies varied considerably. The mean number of HRT repetitions was 28.7 for adults with a mean age less than 40 years and 11.8 for adults with a mean age greater than 60 years. [Conclusion] This study provides information on HRT performance and norms derived with them for younger and older adults.
This paper describes a method for estimating core body temperature from radiation heat of the caruncle and an eyeglass-type device for measuring the temperature of the caruncle to prescreen for infectious diseases such as COVID-19. As a precise prescreening method, monitoring a person's continuous core body temperature is desired. By monitoring the continuous core body temperature, including circadian rhythm, in our daily life, infections can potentially be discovered when body temperature is higher than normal. Although monitoring the core body temperature is effective, continuous and precise monitoring requires the use of an invasive instrument. To overcome this, we (1) design an eyeglass-type device for measuring the caruncle temperature and (2) model the correlation between the caruncle temperature and the core body temperature. Experimental results revealed that hypothalamic temperature could be estimated within ± 0.3 °C between 20 and 30 °C by using the eyeglass-type device.
Objective
To summarize evidence in the last decade regarding the efficacy of physical therapy interventions to treat tendinopathy, as a single disease entity, as determined in systematic reviews (SRs) and/or meta-analyses (MAs).
Methods
Electronic search of PubMed, PEDro, and Scopus database was performed from year 2010 to January 2020. The methodological quality of the identified studies was assessed using the AMSTAR 2 tool. Studies scoring 9 points or higher were further analyzed using GRADE principles.
Results
40 SRs and/or MAs were included in qualitative synthesis, whereas only 5 MAs were included in quantitative synthesis. Low-level laser therapy (LLLT) intervention showed a pooled improvement in pain reduction of 1.53 cm; 95% CI, [1.14, 1.91] (I²=1.9%, p=0.361) on visual analogue scale, and grip strength of 9.59 kg; 95% CI, [5.90, 13.27].
Conclusions
Moderate-quality evidence may support these following interventions: LLLT revealed a statistically and potentially clinically significant improvement in pain and function on the short-term. Extracorporeal shockwave therapy showed a statistically significant enhancement in pain and function at all follow-up durations; however, its clinical significance was undetermined. Eccentric exercise was supported by qualitative evidence only. Caution is advised when interpreting results due to possible pathological differences in tendinopathy at each region.
Amaç: Bu çalışma, unilateral plantar fasciitis (PF)'li hastalarda sağlam taraf ve etkilenmiş taraf ayağın esneklik, denge, endurans ve propriyosepsiyon duyusu açısından karşılaştırılması amacıyla yapıldı. Yöntem: Çalışmaya 32-65 yaş aralığında 56 PF'li kadın hasta dahil edildi. Hastaların sağlam ve etkilenmiş taraf gastrocnemius tendon esnekliği, plantar fasya esnekliği, tek ayak üzerindeki statik dengeleri, topuk kaldırma enduransları ve ayak bileği propriyosepsiyon duyuları değerlendirildi. Kişilerin statik dengeleri tek ayak üzerinde durma testiyle, enduransları topuk yükseltme testiyle, propriosepsiyon duyuları ise Biodex III ® izokinetik cihazı kullanılarak değerlendirildi. Bulgular: Hastaların sağlam ve etkilenmiş taraf ayağın gastrocnemius tendon esnekliği, plantar fasya esnekliği, topuk kaldırma skorları ve ayak bileği propriyosepsiyon duyuları arasında anlamlı farklılık bulunurken (p<0,001), tek ayak üzerinde durma süresi bakımından iki taraf arasında anlamlı bir farklılık bulunmadı (p>0,05). Sonuç: Çalışmamız sonucunda unilateral PF'li hastaların etkilenmiş taraf gastroknemius ve plantar fasya esnekliğinin, topuk kaldırma enduranslarının ve ayak bileği propriyosepsiyon duyularının sağlam tarafa göre daha az olduğu belirlendi. Bu sonuçlar, PF'li hastalarda etkili rehabilitasyon programının hazırlanmasında yardımcı olacaktır. Anahtar kelimeler: Esneklik, Postüral denge, Plantar fasciitis, Propriyosepsiyon, Fiziksel endurans. Comparison of the unaffected and affected side in patients with unilateral plantar fasciitis Purpose: This study was conducted to compare the affected side and unaffected side of patients with unilateral plantar fasciitis (PF) in terms of flexibility, balance, endurance, and proprioception sense. Methods: The study was carried out with the participation of 56 female patients with unilateral PF aged between 32 and 65 years. Patient's unaffected and affected side flexibility of gastrocnemius tendon and plantar fascia, single-leg static balance, heel rise endurance and ankle proprioception sense were evaluated. Static balance was evaluated by using single-leg stance test, heel rise endurance by using heel-rise test and ankle proprioception by using Biodex III ® isokinetic device. Results: No statistically significant difference was found between the two sides in terms of the duration of single leg standing (p>0.05), while there was a significant difference between flexibility of gastrocnemius tendon and plantar fascia, heel-rise scores and ankle proprioception sense (p<0.001). Conclusion: As a result of our study, it was determined that in patients with unilateral PF, flexibility of gastrocnemius and plantar fascia, heel-rise performance, and ankle proprioception of the affected side were less than the unaffected side. These results will assist in the preparation of an effective rehabilitation program for patients with PF. Akınoğlu B, Köse N, Soylu Ç. Unilateral plantar fasciitisli hastalarda sağlam taraf ve etkilenmiş tarafın karşılaştırılması. J Exerc Ther Rehabil. 5(2):89-95. Comparison of the unaffected and affected side in patients with unilateral plantar fasciitis patients.
Introduction:
Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP.
Purpose:
The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1-2-year follow-up.
Implications:
This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP.
Zusammenfassung
Kriterienbasierte Rehabilitationsmodelle unter Berücksichtigung der Wundheilungsphasen rücken in der Nachbehandlung von Sportlern immer weiter in den Vordergrund. Dabei orientiert sich die Rehabilitation einerseits an der verletzten Struktur, andererseits an den Anforderungen der entsprechenden Zielsportart. Die Autoren stellen anhand eines Fallbeispiels aus dem Leistungsfußball einen möglichen Therapiealgorithmus nach Verletzungen des Sprunggelenks vor und zeigen, wie funktionelle Tests ergänzt durch einen spezifischen Fragebogen in der Rehabilitation eingesetzt werden können.
Purpose
This study aimed to develop a new field test protocol with a standardized measurement of strength and power in plantar flexor muscles targeted to functionally independent older adults, the calf-raise senior (CRS) test, and also evaluate its reliability and validity.
Patients and methods
Forty-one subjects aged 65 years and older of both sexes participated in five different cross-sectional studies: 1) pilot (n=12); 2) inter- and intrarater agreement (n=12); 3) construct (n=41); 4) criterion validity (n=33); and 5) test–retest reliability (n=41). Different motion parameters were compared in order to define a specifically designed protocol for seniors. Two raters evaluated each participant twice, and the results of the same individual were compared between raters and participants to assess the interrater and intrarater agreement. The validity and reliability studies involved three testing sessions that lasted 2 weeks, including a battery of functional fitness tests, CRS test in two occasions, accelerometry, and strength assessments in an isokinetic dynamometer.
Results
The CRS test presented an excellent test–retest reliability (intraclass correlation coefficient [ICC] =0.90, standard error of measurement =2.0) and interrater reliability (ICC =0.93–0.96), as well as a good intrarater agreement (ICC =0.79–0.84). Participants with better results in the CRS test were younger and presented higher levels of physical activity and functional fitness. A significant association between test results and all strength parameters (isometric, r=0.87, r²=0.75; isokinetic, r=0.86, r²=0.74; and rate of force development, r=0.77, r²=0.59) was shown.
Conclusion
This study was successful in demonstrating that the CRS test can meet the scientific criteria of validity and reliability. The test can be a good indicator of ankle strength in older adults and proved to discriminate significantly between individuals with improved functionality and levels of physical activity.
Study Design Controlled laboratory study. Background Plantar heel pain is one of the most common foot and ankle conditions seen in clinical practice and many individuals continue to have persisting or recurrent pain after treatment. Impaired foot plantar flexor muscle performance is a factor that may contribute to limited treatment success, but reliable methods to identify impairments in individuals with plantar heel pain are needed. In addition, foot orthoses are commonly used to treat this condition, but the implications of orthosis use on muscle performance have not been assessed. Objectives To assess ankle plantar flexor and toe flexor muscle performance of individuals with plantar heel pain using clinically-feasible measures and to examine the relationship between muscle performance and duration of foot orthosis use. Methods The rocker board plantar flexion test (RBPFT) and modified paper grip test for the great toe (mPGTGT) and lesser toes (mPGTLT) were used to assess foot plantar flexor muscle performance in 27 individuals with plantar heel pain and compared to 27 individuals without foot pain that were matched according to age, sex, and body mass. Pain ratings were obtained before and during testing, and self-reported duration of foot orthosis use was recorded. Results Compared to the control group, individuals with plantar heel pain demonstrated lower performance in the RBPFT (P = 0.001), the mPGTGT (P = 0.037) and the mPGTLT (P = 0.022). Longer duration of foot orthosis use was moderately correlated to lower performance on the RBPFT (r = -0.52, P = 0.02), the mPGTGT (r = -0.54, P = 0.01), and the mPGTLT (r = -0.43, P = 0.03). Conclusion Ankle plantar flexor and toe flexor muscle performance was impaired in individuals with plantar heel pain and associated with longer duration of self-reported foot orthosis use. J Orthop Sports Phys Ther, Epub 3 Jul 2016. doi:10.2519/jospt.2016.6482.
Objective
To determine the relationship between asymmetries in lower leg girth and standing heel-rise after anterior cruciate ligament (ACL) reconstruction.
Design
Single-group posttest.
Participants
15 at a mean of 30 d after ACL reconstruction.
Measurements
Lower leg girth and number of repetitions performed on the standing heel-rise test.
Results
A significant decrease in lower leg girth and number of repetitions performed on the standing heel-rise test for the involved leg. There was also a low correlation between asymmetries in lower leg girth and standing heel-rise test ( r = .25).
Conclusion
Ankle plantar-flexor endurance should be considered when developing rehabilitation programs for the early stages after ACL reconstruction. In this study the ankle of the involved leg attained a significantly smaller angle of maximal standing plantar flexion, suggesting that ankle range of motion should also be assessed. Caution should be used in predicting standing heel-rise asymmetries from asymmetries in lower leg girth in ACL-reconstructed patients.
Background/aims:
Survival for patients on renal replacement therapy (RRT) has been shown to correlate to the level of physical activity and exercise capacity. We examined whether composite measures of functional status at the start of RRT predict survival.
Methods:
In this retrospective study, the same physiotherapist, using a standardized battery of tests for functional status, tested 134 patients at the start of RRT.
Results:
At the end of the observation period, 112 patients (84%) were still alive. Age (p < 0.0001), co-morbidity (p = 0.028), hand grip strength (right: p = 0.0065; left: p = 0.0039), standing heel rise (right: p = 0.011; left: p = 0.004) and functional reach (p = 0.015) were significant predictors of survival. After adjustment for sex, age and co-morbidity, hand grip strength left (p = 0.023) was a significant predictor of survival.
Conclusion:
Hand grip strength, standing heel rise and functional reach at the start of RRT seem to affect survival. A 50% reduction in hand grip strength left was associated with an almost 3-fold increase in mortality. Deterioration of function in small distal muscles and balance may be early signs of uraemic myopathy. A relatively simple and clinically feasible battery of tests can help detect patients at risk.
Background and Purpose: Falls on stairs are a common cause of injury and death among older adults. Although stair climb-ing is a component of some instruments that assess activities of daily living, normal speeds for safe stairway ambulation have not been established. Furthermore, little is known about which components of functional mobility are most highly asso-ciated with stair-climbing speed. The purposes of this study were to determine the range of normal stair-climbing speeds for ambulatory, community-dwelling older adults and identify which functional mobility tests could best explain this speed. Methods: Twenty men and 34 women older than 65 years completed 6 functional mobility tests, including timed heel rises, timed chair stands, functional reach, one-legged stance time (OLST), a timed step test (alternately touching a step 10 times), and self-selected gait speed. Participants were then timed as they ascended and descended a fl ight of 8 to 10 steps. Combined ascent-descent times were used to calculate stair-climbing speed in steps per second. Step-wise regression techniques determined the best functional predictors for stair-climbing speed. Results: Participants ascended and descended stairs at an average speed of 1.3 steps per second; men tended to ambulate stairs more quickly than women. The best predic-tors of stair-climbing speed were usual gait speed and OLST (R = 0.79; P = .01), which explained 63% of the variance in stair-climbing speed. Discussion: Our results were similar to others who reported stair-climbing speeds ranging from 1.1 to 1.7 steps per second for older adults. However, the 2 predictors identifi ed in this study provide a simpler and more accurate model for estimating stair-climbing speed than has been previously reported. Further research is needed to determine whether this speed is suffi cient for negotiating stairs in an emergency. In addition, further study is needed to determine which tests/ measures best differentiate individuals who can and cannot independently climb a typical fl ight of stairs. Conclusions: An older adult's stair-climbing speed can be accurately estimated by using a model that includes his or her usual gait speed and OLST. This information will help health care professionals and directors of residential facilities make appropriate decisions related to living accommodations for their older adult clients. This study was presented as a poster at the American Physical Therapy Association Combined Sections Meeting (Section for Geriatrics) in Chicago, Illinois, on February 2012. The authors declare no confl icts of interest. Address correspondence to:
Falls on stairs are a common cause of injury and death among older adults. Although stair climbing is a component of some instruments that assess activities of daily living, normal speeds for safe stairway ambulation have not been established. Furthermore, little is known about which components of functional mobility are most highly associated with stair-climbing speed. The purposes of this study were to determine the range of normal stair-climbing speeds for ambulatory, community-dwelling older adults and identify which functional mobility tests could best explain this speed.
Twenty men and 34 women older than 65 years completed 6 functional mobility tests, including timed heel rises, timed chair stands, functional reach, one-legged stance time (OLST), a timed step test (alternately touching a step 10 times), and self-selected gait speed. Participants were then timed as they ascended and descended a flight of 8 to 10 steps. Combined ascent-descent times were used to calculate stair-climbing speed in steps per second. Stepwise regression techniques determined the best functional predictors for stair-climbing speed.
Participants ascended and descended stairs at an average speed of 1.3 steps per second; men tended to ambulate stairs more quickly than women. The best predictors of stair-climbing speed were usual gait speed and OLST (R = 0.79; P = .01), which explained 63% of the variance in stair-climbing speed.
Our results were similar to others who reported stair-climbing speeds ranging from 1.1 to 1.7 steps per second for older adults. However, the 2 predictors identified in this study provide a simpler and more accurate model for estimating stair-climbing speed than has been previously reported. Further research is needed to determine whether this speed is sufficient for negotiating stairs in an emergency. In addition, further study is needed to determine which tests/measures best differentiate individuals who can and cannot independently climb a typical flight of stairs.
An older adult's stair-climbing speed can be accurately estimated by using a model that includes his or her usual gait speed and OLST. This information will help health care professionals and directors of residential facilities make appropriate decisions related to living accommodations for their older adult clients.
Objectives: Hip and groin pain are common problems in Australian football. Although indigenous (I) players are at greater risk of soft tissue injury than their non-indigenous (non-I) counterparts, Aboriginal descent has not previously been identified as a risk factor for hip and groin injury. The aim of this study was to investigate if hip and groin screening tests would demonstrate differences between indigenous and non-indigenous junior elite AF players. Design: Cross-sectional study. Method: Two hundred and seventy elite junior Australian football players were screened using five hip and groin musculoskeletal tests. Results: Thirty-three players (12%) were indigenous. Differences were demonstrated between the two groups for right prone hip internal rotation (I X = 27.60 ± 9.16, non-I X = 33.39 ± 8.88, p < 0.001) and left prone hip internal rotation (I X = 25.83 ± 10.25, non-I X = 31.36 ± 8.75, p < 0.001), pressure on squeeze test with knees at 90 • (I X = 165.71 ± 40.32, non-I X = 188.17 ± 62.32, p = 0.001) and pressure on squeeze tests with knees at 0 • (I X = 172.57 ± 35.98, non-I X = 202.57 ± 49.14, p = 0.049), and pain provocation during squeeze test with knees at 90 • (I X = 3.19 ± 2.26, non-I X = 1.03 ± 1.78, p > 0.001). Conclusions: The indigenous players displayed less range of passive hip internal rotation with the hip in neutral, reduced adductor squeeze force and higher levels of groin pain with the squeeze test at 90 •. The differences observed between indigenous and non-indigenous players suggest indigenous players are at greater risk of hip and groin injuries in Australian football.
The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP).
Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries.
Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP.
While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2-38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1-48.9) more likely to develop an in-season occurrence of ERLP.
While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP.
2b.
The triceps surae (TS) muscle-tendon unit is 1 of the most commonly injured in elite and recreational athletes, with a high prevalence in middle-aged adults. The performance of maximal numbers of unilateral heel raises is used to assess, train, and rehabilitate TS endurance and conventionally prescribed in 0° knee flexion (KF) for the gastrocnemius and 45° for the soleus (SOL). However, the extent of muscle selectivity conferred through the change in the knee angle is lacking for heel raises performed to volitional fatigue. This study investigated the influence of knee angle on TS muscle fatigue during heel raises and determined whether fatigue differed between middle-aged and younger-aged adults. Forty-eight healthy individuals aged 18-25 and 35-45 years performed maximal numbers of unilateral heel raises in 0° and 45° KF. Median frequencies and linear regression slopes were calculated from the SOL, gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) surface electromyographic signals. Stepwise mixed-effect regressions were used for analysis. The subjects completed an average of 45 and 48 heel raises in 0° and 45° KF, respectively. The results indicated that the 3 muscles fatigued during testing as all median frequencies decreased, and regression slopes were negative. Consistent with muscle physiology and fiber typing, fatigue was greater in the GM and GL than in the SOL (p < 0.001). However, knee angle did not influence TS muscle fatigue parameters (p = 0.814), with similar SOL, GM, and GL fatigue in 0° and 45° KF. These findings are in contrast with the traditionally described clinical use of heel raises in select knee angles for the gastrocnemius and the SOL. Furthermore, no difference in TS fatigue between the 2 age groups was able to be determined, despite the reported higher prevalence of injury in middle-aged individuals.
This case report demonstrates the use of the tissue stress model to develop an examination, evaluation, and management plan for a patient with an 8-week history of plantar fasciitis. The patient history focused on determining which tissues were being excessively stressed, and the physical examination was used to apply controlled stresses to these tissues and to determine factors contributing to the patient's condition. After it was confirmed that the patient's plantar fascia was under excessive mechanical stress, treatment first focused on reducing pain, inflammation, and stress on the plantar fascia and then on returning the patient to her running program while maintaining symptoms at a diminished level. The patient reported being free of pain 7 weeks after the initial physical therapy examination and at the 11-week telephone follow-up. Although no experimental evidence is given, this report suggests that this patient responded positively to treatment based on the tissue stress model.
To investigate the efficacy of a topical wheatgrass cream for improving pain and function in patients with chronic plantar fasciitis.
Randomized, double-blind, placebo-controlled trial.
Eighty participants with chronic plantar fasciitis were randomly assigned to a treatment group (wheatgrass cream) or a control group (placebo cream). All participants applied a cream twice daily for 6 weeks. Follow up was conducted at 6 and 12 weeks.
Visual Analogue Scale (VAS) for daily first-step pain and the Foot Health Status Questionnaire (FHSQ) for overall foot function. Secondary measures of foot posture, calf muscle strength and range of ankle dorsiflexion were also assessed.
No significant differences were found between groups with respect to main outcomes of first-step pain or foot function at any time. Both groups improved significantly from baseline to 6 weeks, and these improvements were maintained at 12 weeks.
The topical application of wheatgrass cream is no more effective than a placebo cream for the treatment of chronic plantar fasciitis.
Patellar tendon injury, a chronic overuse injury characterised by pain during tendon loading, is common in volleyball players and may profoundly restrict their ability to compete. This cross-sectional study investigated the association between performance factors and the presence of patellar tendon injury. These performance factors (sit and reach flexibility, ankle dorsiflexion range, jump height, ankle plantarflexor strength, years of volleyball competition and activity level) were measured in 113 male and female volleyball players. Patellar tendon health was determined by measures of pain and ultrasound imaging. The association between these performance factors and patellar tendon health (normal tendon, abnormal imaging without pain, abnormal imaging with pain) was investigated using analysis of variance. Only reduced ankle dorsiflexion range was associated with patellar tendinopathy (p<0.05). As coupling between ankle dorsiflexion and eccentric contraction of the calf muscle is important in absorbing lower limb force when landing from a jump, reduced ankle dorsiflexion range may increase the risk of patellar tendinopathy.
Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among 6 different forms of the intraclass correlation for reliability studies in which n targets are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability study and the applications to be made of the reliability results. Confidence intervals for each of the forms are reviewed. (23 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
The objective was to investigate the fatigue process in the triceps surae during the heel-rise test (eccentric and concentric phases) in comparison with a walking test and muscle strength. Eight men with prior stroke and 8 age-matched healthy men participated. The electromyographic activity in form of root mean square and mean power frequency of the gastrocnemius and soleus muscles were measured and work estimated. Walking speed and maximal peak torque were measured and differed significantly between the patient and reference groups. There were no significant differences between the groups nor legs concerning the number of heel-rises or work performed. In the eccentric phase, mean power frequency decreased significantly more in the gastrocnemius than in the soleus muscle in the reference group, while mean power frequency in the soleus muscle tended to decrease more, though non-significantly, in the affected leg. The conclusion is that the capacity to perform the heel-rise test in patients with prior stroke is better than plantarflexor peak torque and walking speed.
The purpose of this study was to compare the injured versus noninjured lower extremity on three single-leg hop tests following inversion ankle sprain. Twenty-two subjects with a history of unilateral inversion ankle sprain participated in this study. Subjects performed the three single-leg hop tests (hop for distance, hop for time, and agility hop). An independent t test was used to compare extremities. No significant differences existed on any hop test for the 22 subjects. In 8 of the 22 subjects who reported pain with activities of daily living and/or sports activities, an independent t test revealed no significant difference on hop test performance between extremities. We conclude that these three single-leg hop tests lack sensitivity (validity) in detecting lower extremity performance deficits as reported by the subjects following inversion ankle sprain.
The purpose of this study was to compare the injured versus noninjured lower extremity on three single-leg hop tests following inversion ankle sprain. Twenty-two subjects with a history of unilateral inversion ankle sprain participated in this study. Subjects performed the three single-leg hop tests (hop for distance, hop for time, and agility hop). An independent t test was used to compare extremities. No significant differences existed on any hop test for the 22 subjects. In 8 of the 22 subjects who reported pain with activities of daily living and/or sports activities, an independent t test revealed no significant difference on hop test performance between extremities. We conclude that these three single-leg hop tests lack sensitivity (validity) in detecting lower extremity performance deficits as reported by the subjects following inversion ankle sprain.
Locomotor patterns of running were studied using computerization to synchronize electromyography (EMG) and cinematography (CMG). Surface electrodes monitored the muscle action potentials from rectus femoris, vastus lateralis, vastus medialis, biceps femoris, semitendinosus, semimembranosus, triceps surae and tibialis anterior muscles as 10 female subjects ran on a treadmill at speeds of 2.5 m/s and 3.5 m/s. Averaged integrated electromyograms were formulated to represent action potential levels for various sub-sections of the running cycle. Beginning at foot contact, the running cycle was dominated initially by muscle activity concerned with stabilization. The co-contraction of vastus medialis, vastus lateralis, semimembranosus, tibialis anterior, biceps femoris and triceps surae were associated with clockwise rotation (running from left to right) of the thigh, leg and foot in providing a stable base during the early support phase. Lower limb stabilization then gave way to the powerful driving thrust of the mid and late support phases. This period was characterized by increases in the activity levels from triceps surae and biceps femoris. The co-ordination of inertial effects and secondary muscular activity was associated with leg flexion as the thigh changed direction and with leg extension during the swing phase of running. This conclusion was supported by both EMG and resultant muscle moment of force date. Increased activity from semimembranosus and semitendinosus occurred with cessation of thigh flexion and leg extension prior to the subsequent heel strike. Tibialis anterior also eccentrically contracted to place the foot on the treadmill under control. The increase in the running speed was related to an increase in muscle action potential (in parts of the cycle) where the particular muscle was functional. This increase was paralleled kinetically by an increase in the resultant muscle moment of force level.
Manual muscle testing with the examiner providing the resistance has long been a standard test of muscle strength. Through the use of extremities acting as levers, clinicians have been able to effectively apply resistance to all muscle groups except the ankle plantar flexors. As a result, a standing heel-rise test that uses body weight as the resistance has been substituted. The number of heel-rises that represent normal plantar-flexor "strength" and the ability of subjects to repeatedly use that "strength" remain unresolved. Because walking is an endurance task, the hypothesis tested by this study was that individuals without known weakness would be able to perform more than the standard recommended one to five standing heel-rises. The purpose of this study was to measure the number of standing heel-rises that individuals without known weakness could accomplish.
Two hundred three subjects were studied for their ability to do standing heel-rises, as is done when testing plantar-flexion strength using the upright test. There were 122 male subjects and 81 female subjects, ranging in age from 20 to 59 years.
Each subject was asked to do as many standing heel-rises as he or she could, with careful monitoring of body and limb alignment and of ankle motion, with specific criteria for stopping.
The average number of heel-rises was 27.9 (SD = 11.1, minimum = 6, maximum = 70) for all groups and both genders, with no differences between male and female subjects. The lower 99% confidence interval was 25.
A recommendation is made to change the standard of testing plantar-flexion function, when using the standing heel-rise test, to require 25 repetitions for a grade of Normal. [Lunsford BR, Perry J. The standing heel-rise test for ankle plantar flexion: criterion for normal.
The aim of the study was to introduce and evaluate a standardized test protocol and scoring scale for evaluation of ankle injuries. After evaluation of 11 different functional ankle tests, questionnaire answers, and results of clinical ankle examination, the final test protocol consisted of 3 simple questions describing the subjective assessment of the injured ankle, 2 clinical measurements (range of motion in dorsiflexion, laxity of the ankle joint), 1 ankle test measuring functional stability (walking down a staircase), 2 tests measuring muscle strength (rising on heels and toes), and 1 test measuring balance (balancing on a square beam). Each selected test showed excellent reproducibility when tested with a reference group of 100 uninjured persons. According to the test results of a population of 148 patients with an operatively treated grade III lateral ligament injury of the ankle, each test could significantly differentiate healthy controls and patients with excellent overall healing from those with poor or fair recovery. The final total test score correlated significantly with the isokinetic strength results of the ankle, subjective opinion about the recovery, and subjective-functional assessment. The scale presented is recommended for studies evaluating functional recovery after ankle injury.
The fatigue process of the triceps surae was evaluated during a standing heel-rise test, comprising of eccentric and concentric muscle actions. Ten healthy women with a mean age of 24 years participated. The heel-rise test was performed until exhaustion. Work and electromyographic activity expressed as root mean square and mean power frequency of the gastrocnemius and soleus muscles were calculated. The average number of heel-rises performed was 25 +/- 1. Work decreased significantly during the test. Mean power frequency decreased significantly in both phases. During the eccentric phase the decrease was significantly larger in the gastrocnemius than in the soleus muscle. There were no significant changes in root mean square except for a decrease in the soleus muscle during the eccentric phase. The present results, showing different fatigue patterns in the two muscles, could be used as reference when testing the fatigue process in different clinical conditions. Recommendations for standardization of a heel-rise test are given.