The single-leg heel raise does not predict maximal plantar flexion strength in healthy males and females

Abstract

Introduction The single-leg heel raise test (SLHR) is commonly used in clinical settings to approximate plantar flexor strength, yet this is neither validated nor supported physiologically. The purposes of this study were to: determine (1) associations between SLHR repetitions, maximal plantar flexor strength, and reductions in strength; and (2) whether sex differences exist in performance of the SLHR. Methods Twenty-eight young, healthy participants (14 males,14 females, 19–30 years) performed repeated single-leg heel raises to task failure. Pre- and post-task measures included maximal voluntary isometric contractions (MVIC), and voluntary activation and contractile properties of the plantar flexor muscles, assessed using peripheral electrical stimulation of the tibial nerve. Surface electromyography was recorded for the medial and lateral gastrocnemius, soleus, and anterior tibialis muscles. Results The SLHR resulted in 20.5% reductions in MVIC torque (p<0.001). However, the number of SLHR repetitions was not correlated with either the baseline MVIC (maximal strength; p = 0.979) or the reduction in MVIC following the SLHR (p = 0.23). There were no sex differences in either the number of SLHR repetitions (p = 0.14), baseline MVIC torque (p = 0.198), or the reduction of MVIC (p = 0.14). MVIC decline was positively associated with the reduction in voluntary activation (r = 0.841, p<0.001), but was not associated with the change in twitch amplitude (p = 0.597). Conclusions The SLHR was similar in young males and females yet was a poor predictor of maximal plantar flexor strength but evaluates performance fatigability of the lower extremity specific to dynamic contractions. The reduction in maximal strength at task failure was explained by reduced neural drive to the plantar flexor muscles in both males and females. Impact statement SLHR performance is not a clinical assessment of plantar flexor strength but assesses dynamic lower extremity fatigability that is similar in males and females. Alternate clinical measures for maximal plantar flexion strength need to be developed.

Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations

“…Sex-segregated data on voluntary activation have been reported in at least 11 articles (212,236,239,289,305,318,339,369,400,495,498) (Figure 12, Table 16, Supplemental Digital Content, http://links. lww.com/JSCR/A339).…”

“…Sex-segregated data of muscle twitch forces have been reported in at least 11 articles. Muscle twitch forces are greater in men than women (31,32,178,236,240,313,336,394,400,470,499) (Figure 13, Table 17, Supplemental Digital Content, http://links.lww.com/ JSCR/A339). However, the magnitude of the sex difference is not the same for all muscle groups.…”

“…Numerous articles have included sex-segregated data for muscle groups other than those used for hand gripping (5,10,12,14–16,20,22,26–29,31,33–35,45,48,49,53,55,63,64,68,71,75,77,80,81,82,85,93–95, 100,101,109–112,114–116,126,129,142,144,150,156,160,164,166,168,172,174–176,178,180–182,190,192,194,195,199,202,207,208,212–214,219,224,231,236,238–240,246,247,250,252,253,256–259,261,262,267–269,273–277,286,289,291,293,295–301,305,310,313–315,318,319, 323,325,326,335,338–340,342–344,346–349,351,353,354,365,367,369,370,376,377,379–384,386,390,392,394,396,397,400,401,408,410,411,413–415,417,424,425,427–429,442,443,445,447,449–451,453–455,457,460,462–464,468,470,474–476,481,483,485,486,488–490,492,494–496,498,499,502).…”

Devices to measure calf raise test outcomes: A narrative review

“…Four studies (11.4%) used the electrogoniometer alone (Jan et al., 2005; Lunsford & Perry, 1995; Svantesson, Osterberg, Grimby, & Sunnerhagen, 1998; Svantesson, Osterberg, Thomeé, et al., 1998) three studies (8.5%), used the AMES (DeWolf et al., 2018; Sman et al., 2014; Van Cant et al., 2017), and two studies (5.7% each) used the Häggmark and Liedberg light beam electronic device (Häggmark et al., 1986; Möller et al., 2005) and Haberometer (Haber et al., 2004; Pereira et al., 2010). Finally, one study (2.9% each) used the force plate with an electrogoniometer (Österberg et al., 1998), 3D motion capture with a linear encoder (Andreasen et al., 2020), and a custom made CRT device (Sara et al., 2021), as reported in Table 1. These devices were used most often in studies to examine Achilles tendon pathologies ( n = 18, 51.4%) (Andreasen et al., 2020; Annelie Brorsson et al., 2018; A. Brorsson et al., 2021; A. Brorsson et al., 2017; Häggmark et al., 1986; Hamrin et al., 2020; Nawoczenski et al., 2016; Nordenholm et al., 2022; Olsson et al., 2014; Silbernagel et al., 2015; Silbernagel et al., 2006; Silbernagel et al., 2010; Silbernagel et al., 2012; Svensson et al., 2019; Tengman et al., 2015; Westin et al., 2018; Zellers et al., 2018; J.…”

The heel-raise test for ankle plantarflexor strength: a scoping review and meta-analysis of studies providing norms

“…However, articles were rejected based on other criteria listed heretofore. Ultimately, 13 studies qualified for inclusion [5][6][7][11][12][13][14][15][16][17][18][19] (Table 1). Qualified studies were mostly conducted in Sweden (n=5) or North America (n=4), but one study was also completed in Australia, Taiwan, England, and India.…”