Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

Abstract

Context: Achilles tendinopathies are common injuries during sport participation, although men are more prone to Achilles tendon injuries than women. Heel-raising and -lowering exercises are typically suggested for Achilles tendon rehabilitation.Objective: To compare the estimated Achilles tendon loading variables and the ankle range of motion (ROM) using a musculoskeletal model during commonly performed heelraising and -lowering exercises.Design: Controlled laboratory study. Setting: University biomechanics laboratory.Patients or Other Participants: Twenty-one healthy men (age ¼ 21.59 6 1.92 years, height ¼ 178.22 6 8.02 cm, mass ¼ 75.81 6 11.24 kg).Intervention(s): Each participant completed 4 exercises: seated heel raising and lowering, bilateral standing heel raising and lowering, bilateral heel raising and unilateral lowering, and unilateral heel raising and lowering.Main Outcome Measure(s): A repeated-measures multivariate analysis of variance (a ¼ .05) was used to compare Achilles tendon stress, force, and strain and ankle ROM for each exercise. Kinematic data were recorded at 180 Hz with 15 motion-analysis cameras synchronized with kinetic data collected from a force platform sampled at 1800 Hz. These data were then entered in a musculoskeletal model to estimate force in the triceps surae. For each participant, we determined Achilles tendon stress by measuring cross-sectional images using ultrasound.Results: Peak Achilles tendon loading was lowest when performing the seated heel-raising and -lowering exercise and highest when performing the unilateral heel-raising and -lowering exercise. Loading was greater for the unilateral exercise or portions of the exercise that were performed unilaterally.Conclusions: Bilateral and seated exercises with less weight-bearing force resulted in less Achilles tendon loading. These exercises may serve as progressions during the rehabilitation process before full-body weight-bearing, unilateral exercises are allowed. Ankle ROM did not follow the same order as loading and may need additional monitoring or instruction during rehabilitation.Key Words: kinematics, kinetics, strain, therapeutic exercise, rehabilitation Key PointsBilateral and seated heel-raising and -lowering exercises resulted in less Achilles tendon loading. Unilateral exercises and the unilateral phase of the bilateral heel-raising and unilateral heel-lowering exercise resulted in more Achilles tendon loading.

Measurement of Gender Differences of Gastrocnemius Muscle and Tendon Using Sonomyography during Calf Raises: A Pilot Study

“…The subjects were instructed to rise onto their toes as high as possible and followed a rhythm of 1 Hz produced with an electronic metronome. The subjects raised and lowered their heels each for approximately 1 second, which was similar to the previous studies [ 35 , 43 ]. The examination was repeated three times with a rest of 1 minute between two consequent trials, and each trial lasted for about 20~30 seconds.…”

Modelling and in vivo evaluation of tendon forces and strain in dynamic rehabilitation exercises: a scoping review

“…57 The strain values obtained (expressed in %) were between 0.71±0.35 and 8.80±0.35, corresponding to the seated heel raising and lowering and the unilateral heel raising and lowering exercises, respectively. 57 Type of exercises Different types of exercises were analysed in the included studies. Heel raising and lowering exercises, involving concentric or eccentric plantarflexion, are commonly applied in Achilles tendinopathy rehabilitation.…”

The influence of aging on the insertion of the Achilles tendon: A magnetic resonance study

“…In particular, we found that (1) the distance between the most inferior point of the CB and the most inferior part of the AT insertion into the CB increases with age, (2) the height of the AT insertion into the posterior aspect of the CB decreases with age, and (3) the length of the AT insertion into the posterior aspect of the CB decreases with age. Knowledge of the relationships among the AT's insertion point, age, and pathologies could help in the development of novel strategies for the treatment and prophylaxis of AT injuries specifically tailored to different age groups, and in improving operative techniques and reducing the risk of iatrogenic injuries (Beitzel et al, ; Revak et al, ). This study is a key step toward constructing a computed model that can be used by sports doctors and trainers to increase the awareness of individual differences in the loading anatomy of the AT.…”

“…Pathologies of the foot and ankle involving the AT are a common orthopedic problem, mostly encountered among athletes and older adults (Beitzel et al, ; Yilmaz et al, ; Gärdin et al, ; Revak et al, ; Docking et al, ; Risch et al, ; Wengler et al, ). Several factors such as age and sex could account for this heterogeneity in the population.…”

“…Fundamental to the treatment of pathologies of the foot and ankle is a good understanding of the anatomical relationships between the AT and its surrounding structures. Knowledge of the connections among anatomical variation, age, and pathologies could improve the prevention and treatment of AT dysfunctions (Edama et al, ), improve operative techniques, and reduce the risk of iatrogenic injuries (Roos et al, ; Beitzel et al, ; Revak et al, ). Accurate anatomical data about the AT are also necessary for building and improving computer models of the AT for sports, research, and other clinical applications (Sheehan, ; Alexander et al, ).…”