Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

• Published in: Journal of athletic training 2017-02, Vol.52 (2), p.89-96
• Main Authors: Revak, Andrew, Diers, Keith, Kernozek, Thomas W, Gheidi, Naghmeh, Olbrantz, Christina
• Format: Article
• Language: English
• Subjects: Academic Achievement; Achilles Tendon - diagnostic imaging; Achilles Tendon - injuries; Ankle; Ankle - physiology; Biomechanical Phenomena; Body Weight; Cross-Sectional Studies; Exercise; Exercise Therapy - methods; Heel - physiology; Humans; Injuries; Male; Males; Mechanical properties; Motion; Movement; Muscular Strength; Original Research; Outcome Measures; Physical Activities; Physical fitness; Posture; Rehabilitation; Scientific Concepts; Statistical Analysis; Teaching Methods; Tendons; Ultrasonic imaging; Ultrasonography; Weight-Bearing; Young Adult
• ISSN: 1062-6050; 1938-162X
• DOI: 10.4085/1062-6050-52.1.04

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. To compare the estimated Achilles tendon loading variables and the ankle range of motion (ROM) using a musculoskeletal model during commonly performed heel-raising and -lowering exercises. Controlled laboratory study. University biomechanics laboratory. Twenty-one healthy men (age = 21.59 ± 1.92 years, height = 178.22 ± 8.02 cm, mass = 75.81 ± 11.24 kg). 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. A repeated-measures multivariate analysis of variance (α = .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. 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. 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.