Heel Drop Exercise Research Articles

Increased muscle force does not induce greater stretch-induced damage to calf muscles during work-matched heel drop exercise

PurposeTo investigate the effect of muscle force during active stretch on quantitative and qualitative indicators of exercise-induced muscle damage (EIMD) in the medial gastrocnemius (MG) muscle.MethodsTwelve recreationally active volunteers performed two trials of an eccentric heel drop exercise. Participants performed a single bout of low-load (body weight) and high-load (body weight + 30% body weight) exercises on separate legs. The total mechanical work output for each condition was matched between legs. Before, two hours and 48 h after each bout of eccentric exercise, electrically stimulated triceps surae twitch torque, muscle soreness, MG active fascicle length at maximum twitch torque and muscle passive stiffness were collected. Triceps surae electromyographic (EMG) activity, MG fascicle stretch and MG muscle–tendon unit (MTU) length were measured during the eccentric tasks.ResultsThe high-load condition increased triceps surae muscle activity by 6–9%, but reduced MG fascicle stretch (p < 0.001). MTU stretch was similar between conditions. The greater muscle force during stretch did not give rise to additional torque loss (5 vs 6%) or intensify muscle soreness.ConclusionsAdding 30% body weight during eccentric contractions has a modest impact on exercise-induced muscle damage in the medial gastrocnemius muscle. These results suggest that muscle load may not be an important determinant of stretch-induced muscle damage in the human MG muscle. The muscle investigated does exhibit large pennation angles and high series elastic compliance; architectural features that likely buffer muscle fibres against stretch and damage.

Cyclic eccentric stretching induces more damage and improved subsequent protection than stretched isometric contractions in the lower limb.

Controversy remains about whether exercise-induced muscle damage (EIMD) and the subsequent repeated bout effect (RBE) are caused by the stretching of an activated muscle, or the production of high force at long, but constant, muscle lengths. The aim of this study was to determine the influence of muscle fascicle stretch elicited during different muscle contraction types on the magnitude of EIMD and the RBE. Fourteen participants performed an initial bout of lower limb exercise of the triceps surae. One leg performed sustained static contractions at a constant long muscle length (ISO), whereas the contralateral leg performed a bout of eccentric heel drop exercise (ECC). Time under tension was matched between the ECC and ISO conditions. Seven days later, both legs performed ECC. Plantar flexor twitch torque, medial gastrocnemius (MG) fascicle length and muscle soreness were assessed before, 2h and 2days after each exercise bout. MG fascicle length and triceps surae surface electromyography were examined across the bouts of exercise. We found that both ECC and ISO conditions elicited EIMD and a RBE. ISO caused less damage 2h after the initial bout (14% less drop in twitch torque, P = 0.03) and less protection from soreness 2days after the repeated bout (56% higher soreness, P = 0.01). No differences were found when comparing neuromechanical properties across exercise bouts. For MG, the action of stretching an active muscle seems to be more important for causing damage than a sustained contraction at a long length.

Effects of the Functional Heel Drop Exercise on the Muscle Architecture of the Gastrocnemius.

The architectural characteristics of a muscle determine its function. To determine the architectural adaptations of the lateral gastrocnemius (LG) and medial gastrocnemius (MG) muscles after a functional eccentric strength training protocol consisting of heel drop exercises, followed by a subsequent detraining period. Pretest and posttest. Training rooms and laboratory. The participants (N = 45) who were randomly divided into an experimental group (EG, n = 25) and a control group (CG, n = 20). The 13-week intervention included participants (N = 45) who were randomly divided into an EG (n = 25) and a CG (n = 20). The EG performed a week of control and training, 8 weeks of eccentric training, and 4 weeks of detraining. The CG did not perform any type of muscular training. The architectural characteristics of the LG and MG muscles were evaluated at rest in both groups using 2-D ultrasound before (pretest-week 1) and after (posttest-week 9) the training, and at the end of the detraining period (retest-week 13). One-way repeated measures analysis of variance was used to determine training-induced changes in each of the variables of the muscle architecture. After the training period, the members of the EG experienced a significant increase in the fascicle length of LG (t = -9.85, d = 2.78, P < .001) and MG (t = -8.98, d = 2.54, P < .001), muscle thickness (t = -6.71, d = 2.86, P < .001) and (t = -7.85, d = 2.22, P < .001), and the pennation angle (t = -10.21, d = 1.88, P < .05) and (t = -1.87, d = 0.53, P < .05), respectively. After the detraining period, fascicle length, muscle thickness, and pennation angle showed a significant decrease. In the CG, no significant changes were observed in any of the variables. The heel drop exercise seems to generate adaptations in the architectural conditions of LG and MG, which are also reversible after a detraining period. These results may have practical implications for injury prevention and rehabilitation programs.

Effect of eccentric Heel-Drop exercise on pennation angle and thickness of the calf muscle in young peoples

Effect of eccentric Heel-Drop exercise on pennation angle and thickness of the calf muscle in young peoples

Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography.

BackgroundMechanical loading is crucial for muscle and tendon tissue remodeling. Eccentric heel drop exercise has been proven to be effective in the management of Achilles tendinopathy, yet its induced change in the mechanical property (i.e., stiffness) of the Achilles tendon (AT), medial and lateral gastrocnemius muscles (MG and LG) was unknown. Given that shear wave elastography has emerged as a powerful tool in assessing soft tissue stiffness with promising intra- and inter-operator reliability, the objective of this study was hence to characterize the stiffness of the AT, MG and LG in response to an acute bout of eccentric heel drop exercise.MethodsForty-five healthy young adults (36 males and nine females) performed 10 sets of 15-repetition heel drop exercise on their dominant leg with fully-extended knee, during which the AT and gastrocnemius muscles, but not soleus, were highly stretched. Before and immediately after the heel drop exercise, elastic moduli of the AT, MG and LG were measured by shear wave elastography.ResultsAfter the heel drop exercise, the stiffness of AT increased significantly by 41.8 + 33.5% (P < 0.001), whereas the increases in the MG and LG stiffness were found to be more drastic by 75 + 47.7% (P < 0.001) and 71.7 + 51.8% (P < 0.001), respectively. Regarding the AT, MG and LG stiffness measurements, the inter-operator reliability was 0.940, 0.987 and 0.986, and the intra-operator reliability was 0.916 to 0.978, 0.801 to 0.961 and 0.889 to 0.985, respectively.DiscussionThe gastrocnemius muscles were shown to bear larger mechanical loads than the AT during an acute bout of eccentric heel drop exercise. The findings from this pilot study shed some light on how and to what extent the AT and gastrocnemius muscles mechanically responds to an isolated set of heel drop exercise. Taken together, appropriate eccentric load might potentially benefit mechanical adaptations of the AT and gastrocnemius muscles in the rehabilitation of patients with Achilles tendinopathy.

Comparison of the thickness of the gastrocnemius through ultrasonography during heel-drop exercise performance

Objective: This study was aimed to compare the thickness and pennation angle of gastrocnemius through ultrasonography during the heel-drop exercise on ankle dorsiflexion angle. Design: Cross-sectional study. Methods: Nineteen normal adults in their 20s had voluntarily participated in this study. All subjects performed the ankle heel-drop exercise with ankle dorsiflexed to 0°, 10°, and 20°: heel-drop exercise with ankle dorsiflexed to 0° was executed on floor-level, heel-drop exercise with ankle dorsiflexed to 10° on a wooden-block of 2.3 cm in height, and heel-drop exercise with ankle dorsiflexed to 20° on a wooden-block of 5.5 cm in height. In each regimen, the subjects completed a session of 100 heel-drop exercises (10 repetitions×10 sets; with 30 seconds rest following each set; with 24 hours rest following each exercise). Before and immediately after each heel-drop exercise, the thickness and pennation angle of gastrocnemius were measured using an ultrasonography. Results: After the performance of the heel drop exercises with ankle dorsiflexed to 0°, 10°, and 20°, the thickness of the gastrocnemius was significantly higher than pre-exercise (p<0.05), and furthermore heel-drop exercise with ankle dorsiflexed to 10° was significantly higher than exercise with the ankle dorsiflexed to 0° (p<0.05). However, as for the pennation angle of the gastrocnemius, there were no significant changes after each heel-drop exercise. Conclusions: This finding suggest that the heel-drop exercise with ankle dorsiflexed to 0°, 10°, and 20° is effective on the strengthening of the gastrocnemius. Furthermore, the heel-drop exercise with the ankle dorsiflexed to 10° is more effective than with the ankle dorsiflexed to 0°.

Changes in Achilles tendon mechanical properties following eccentric heel drop exercise are specific to the free tendon

Mechanical loading of the Achilles tendon during isolated eccentric contractions could induce immediate and region-dependent changes in mechanical properties. Three-dimensional ultrasound was used to examine the immediate effect of isolated eccentric exercise on the mechanical properties of the distal (free tendon) and proximal (gastrocnemii) regions of the Achilles tendon. Participants (n = 14) underwent two testing sessions in which tendon measurements were made at rest and during a 30% and 70% isometric plantar flexion contractions immediately before and after either: (a) 3 × 15 eccentric heel drops or (b) 10-min rest. There was a significant time-by-session interaction for free tendon length and strain for all loading conditions (P < 0.05). Pairwise comparisons revealed a significant increase in free tendon length and strain at all contraction intensities after eccentric exercise (P < 0.05). There was no significant time-by-session interaction for the gastrocnemii (medial or lateral) aponeurosis or tendon for any of the measured parameters. Immediate changes in Achilles tendon mechanical properties were specific to the free tendon and consistent with changes due to mechanical creep. These findings suggest that the mechanical properties of the free tendon may be more vulnerable to change with exercise compared with the gastrocnemii aponeurosis or tendon.

Three-dimensional morphology and strain of the human Achilles free tendon immediately following eccentric heel drop exercise.

Our understanding of the immediate effects of exercise on Achilles free tendon transverse morphology is limited to single site measurements acquired at rest using 2D ultrasound. The purpose of this study was to provide a detailed 3D description of changes in Achilles free tendon morphology immediately following a single clinical bout of exercise. Freehand 3D ultrasound was used to measure Achilles free tendon length, and regional cross-sectional area (CSA), medio-lateral (ML) diameter and antero-posterior (AP) diameter in healthy young adults (N=14) at rest and during isometric muscle contraction, immediately before and after 3×15 eccentric heel drops. Post-exercise reductions in transverse strain were limited to CSA and AP diameter in the mid-proximal region of the Achilles free tendon during muscle contraction. The change in CSA strain during muscle contraction was significantly correlated to the change in longitudinal strain (r=-0.72) and the change in AP diameter strain (r=0.64). Overall findings suggest the Achilles free tendon experiences a complex change in 3D morphology following eccentric heel drop exercise that manifests under contractile but not rest conditions, is most pronounced in the mid-proximal tendon and is primarily driven by changes in AP diameter strain and not ML diameter strain.

Acute effect of heel-drop exercise with varying ranges of motion on the gastrocnemius aponeurosis-tendon’s mechanical properties

The objectives of this study was to investigate the acute effects of various magnitudes of tendon strain on the mechanical properties of the human medial gastrocnemius (MG) in vivo during controlled heel-drop exercises. Seven male and seven female volunteers performed two different exercises executed one month apart: one was a heel-drop exercise on a block (HDB), and the other was a heel-drop exercise on level floor (HDL). In each regimen, the subjects completed a session of 150 heel-drop exercises (15 repetitions×10 sets; with a 30 s rest following each set). Before and immediately after the heel-drop exercise, the ankle plantar flexor torque and elongation of the MG were measured using a combined measurement system of dynamometry and ultrasonography and then the MG tendon strain and stiffness were evaluated in each subject. The tendon stiffness measured prior to the exercises was not significantly different between the two groups 23.7±10.6N/mm and 24.1±10.0N/mm for the HDB and HDL, respectively (p>.05). During the heel-drop exercise, it was found that the tendon strain during the heel-drop exercise on a block (8.4±3.7%) was significantly higher than the strain measured on the level floor (5.4±3.8%) (p<.05). In addition, the tendon stiffness following the heel-drop exercise on a block (32.3±12.2N/mm) was significantly greater than the tendon stiffness measured following the heel-drop exercise on the level floor (25.4±11.4N/mm) (p<.05). The results of this study suggest that tendon stiffness immediately following a heel-drop exercise depends on the magnitude of tendon strain.

A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy

A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy

A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy

BackgroundEccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term (>3 years) results.AimTo evaluate the...

A painful heel

Achilles tendon pain developed in a 35-year-old runner, but initially failed to clear with heel-drop, eccentric exercise. The further assessment and management of the case is discussed together with the appropriate application of heel-drop exercise and other therapeutic approaches which resulted in a successful result.

Eccentric calf muscle training in athletic patients with Achilles tendinopathy

Purpose. To evaluate the effects of eccentric strengthening exercises (ESE) in athletic patients with Achilles tendinopathy.Methods. Forty-five athletic patients (29 men, average age 26 years ± 12.8, range 18 – 42; 16 women, average age 28 years ± 13.1, range 20 – 46; average height: 173 ± 16.8, range 158 – 191; average weight 70.8 kg ± 15.3, range 51.4 – 100.5) with a clinical diagnosis of unilateral tendinopathy of the main body of the Achilles tendon completed the VISA-A questionnaire at first attendance and at their subsequent visits. The patients underwent a graded progressive eccentric calf strengthening exercises programme for 12 weeks.Results. The mean pre-management VISA-A scores of 36 (SD 23.8; 95% CI: 29 – 46) improved to 52 (SD 27.5; 95% CI: 41.3 – 59.8) at the latest follow up (p = 0.001). Twenty seven of the 45 patients responded to the eccentric exercises. Of the 18 patients who did not improve with eccentric exercises, 5 (mean age: 33 years) improved with two peritendinous aprotinin and local anaesthetic injections. 10 of the 18 patients (9 men, mean age 35 years; 1 woman aged 40 years) who did not improve with eccentric exercises and aprotinin injections proceeded to have surgery. The remaining three patients (3 women, mean age 59.6 years) of the 18 non-responders to eccentric exercises and aprotinin injections declined surgical intervention.Conclusions. ESE in athletic patients provide comparable clinical outcome compared to our previous results in non-athletic patients. ESE are a viable option for the management of AT in athletes, but, in our hands, only around 60% of our athletic patients benefited from an intensive, heavy load eccentric heel drop exercise regimen alone. If ESE fail to improve the symptoms, aprotinin and local anaesthetic injections should be considered. Surgery is indicated in recalcitrant cases after 3 to 6 months of non operative management.