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Heel-raise-lower exercise on a level floor (concentric and eccentric contractions of calf muscles through th einner range of plantarflexion movement only).
Source publication
The objective of this study was to investigate the effects of Heel-Raise-Lower Exercise (HRLE) interventions on the strength of plantarflexion, balance, and gait parameters in people with stroke. Specifically, this study compared the two different HRLEs to identify whether heels raise-lower with forefoot on a block (HRB) is more effective or ineffe...
Context in source publication
Context 1
... plantigrade via an eccentric contraction of plantarflexion) (Grigg, Wearing, and Smeathers, 2009). In the HRL group, subjects were instructed to raise their heels up as high as possible (concentric contraction of plantarflexors) and then drop them until they touched the level floor surface (Figure 2). If they needed assistance, they touched the parallel target bar lightly. ...
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Citations
... [7,9] Strengthening the calf muscles through HO training, alongside functional training, has been shown to enhance functional movement in older adults and stroke patients. [40,41] While there was no difference between HO and HC training in enhancing SC performance itself, we posit that there are likely biomechanical differences. This underscores the importance of considering various parameters such as timing, force, and activation patterns in different lower leg muscles during SC, rather than solely focusing on SC performance. ...
Background
Stair-climbing (SC) is an essential daily life skill, and stair-climbing exercise (SCE) serves as a valuable method for promoting physical activity in older adults. This study aimed to compare the impact of SCEs with heel contact (HC) and heel off (HO) during SC on functional mobility and trunk muscle (TM) activation amplitudes in community-dwelling older adults.
Methods
In the pilot randomized controlled trial, participants were randomly allocated to either the HC group (n = 17; mean age 75.9 ± 6.3 years) or the HO group (n = 17; mean age 76.5 ± 4.6 years). The HC participants performed SCE with the heel of the ankle in contact with the ground, while the HO participants performed SCE with the heel of the ankle off the ground during SC. Both groups participated in progressive SCE for one hour per day, three days per week, over four consecutive weeks (totaling 12 sessions) at the community center. We measured timed stair-climbing (TSC), timed up and go (TUG), and electromyography (EMG) amplitudes of the TMs including rectus abdominis (RA), external oblique (EO), transverse abdominus and internal oblique abdominals (TrA-IO), and erector spinae (ES) during SC before and after the intervention.
Results
Both groups showed a significant improvement in TSC and TUG after the intervention ( P < .01, respectively), with no significant difference between the groups. There was no significant difference in the EMG activity of the TMs between the groups after the intervention. The amplitude of TMs significantly decreased after the intervention in both groups ( P < .01, respectively).
Conclusion
Both SCE methods could improve balance and SC ability in older adults while reducing the recruitment of TMs during SC. Both SCE strategies are effective in improving functional mobility and promoting appropriate posture control during SC in older adults.
... This is in line with research (Lee et al., 2017) which showed a significant increase in increasing strength, walking speed and static and dynamic balance which stated that the heel rises exercise generates most of the energy needed to move body mass forward. Heel rises exercise can train the sensorimotor which controls postural stability by reducing the area based on support. ...
Post-stroke sensory motor disorders will also result in disturbances in the sensory and motor components which cause disturbances in the posture control system so that it is unable to maintain body balance in certain positions. One of the rehabilitation programs that are often used to restore function due to motor deficits is Bridging Exercise and Heel Raises Exercise. Bridging exercise is an exercise to strengthen and stabilize the gluteus, hip and lower back. This exercise is a great way to isolate and strengthen the gluteus and hamstring (back of the upper leg) muscles. Heel raises exercise is an exercise to strengthen the leg muscles, especially the gastrocnemius muscles and plantar flexion muscles which can have effects on the nerves and skeleton. From this stimulation, when it reaches proprioception, the body will maintain balance. The method used is a quasy experiment with a pretest-posttest two-group design. And it was found that the results of this study showed that there was an effect of bridging exercise 0.001 (p<0.05) and heel raises exercise 0.002 (p<0.05) in improving the balance of post-stroke patients. So it can be concluded that the two exercises can improve the balance of post-stroke patients.
... Moreover, older adults who participated in a multifaceted podiatry intervention exhibited a reduced number of falls, and this was predominantly attributed to the foot and ankle exercises [35]. Primarily intended to strengthen the ankle plantar flexor muscles [76], raising the heel off the ground also requires the foot to act as a rigid lever. This may require PIFMs to be active in a similar way as compared to when they contribute to foot stiffening for push-off during gait [18,26]. ...
Background
The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults.
Methods
A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence.
Results
Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics.
Conclusions
This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures.
... 40 Studies from lee et al. showed single heel raise exercise was useful for improving plantar flexor muscle strength. 41 Sprint exercise, which was also part of fiVe program, also had potential effect on lower limb muscle strength improvement. The study from freeman et al. indicated sprint training had a beneficial effect on hamstring strength and sprint performance. ...
Background:
Our previous study has developed FIVE, futsal neuromuscular warm-up program to improve physical performance components and prevent the incidence of futsal injury. Experimental research was needed to verify the effect of FIVE program on physical performance components affecting injury, such as lower limb muscle strength. This study aimed to investigate the effect of FIVE program on the lower limb muscle strength among young futsal players.
Methods:
Ninety-five young male futsal players were recruited using purposive random sampling from futsal clubs in Indonesia. The players were randomized into 2 groups; 42 players were in the experimental (EXP) group, and 53 players were in the control (CON) group. The EXP group performed FIVE exercises in addition to their regular futsal training, and the CON group performed their regular futsal training only. Both groups performed the intervention 3 times per week within 6 weeks. All players completed pre-and post-intervention lower limb muscle strength tests comprising the isometric leg strength, isometric hip abduction strength, and isometric hip adduction. The strength test was conducted using dynamometer. Changes in performance (pre- vs. post-intervention) of each group were analyzed using paired T-test and Wilcoxon test. The pre- and post-strength test changes (Δ post-pre) between EXP and CON group was compared using independent T-test and Mann Whitney test. Statistical significance was set to p < 0.05. Thirty-one players dropped out in this study.
Results:
This study showed all measurements on lower limb muscle strength improved significantly in the EXP group (p < 0.05) while hip abduction and hip adduction strength were significantly decreased in the CON group. Improvement of isometric hip abduction and adduction strength in the EXP group was significantly different from the CON group (p = 0.00 and p = 0.00, respectively).
Conclusions:
Results suggest that FIVE could be an alternative warm-up program to improve lower limb muscle strength among young futsal players.
... The heel-raise exercise is commonly applied in clinical settings to strengthen the plantar flexors in the standing position and can be performed without the use of any equipment [12,13]. Fujiwara et al. [14] reported a significant increase in the strength and thickness of the plantar flexors and a decrease in postural sway in elderly subjects after eight weeks of heel-raise exercise. ...
... Another study reported a significant increase in plantar flexor power, walking speed, and cadence in stroke patients who performed a heel-raise exercise using a block to achieve dorsiflexion of the forefoot compared with those who performed the same exercise on a flat surface. The authors explained that the use of a block enables concentric and eccentric contractions of the plantar flexors over the full range of motion of the ankle [13]. However, dorsiflexion is difficult in patients with stroke who have plantar flexor spasticity [15]. ...
... To promote the contraction of the affected plantar flexors, the participants were instructed to symmetrically support their weight during exercise. Since the speed is different for each patient, the amount of exercise was set with the goal of repeating 100 times rather than time in order to equalize the amount of exercise [13]. Training was conducted 5 times a week for 6 weeks. ...
Objective:
This study was conducted to investigate the effect of the heel-raise-lower exercise on spasticity, strength, and gait speed after the application of 30 min of transcutaneous electrical nerve stimulation (TENS) in patients with stroke.
Methods:
The participants were randomly divided into the TENS group and the placebo group, with 20 participants assigned to each group. In the TENS group, heel-raise-lower exercise was performed after applying TENS for six weeks. The placebo group was trained in the same manner for the same amount of time but without electrical stimulation. The spasticity of the ankle plantar flexors was measured using the composite spasticity score. A handheld dynamometer and a 10-m walk test were used to evaluate muscle strength and gait speed, respectively.
Results:
Spasticity was significantly more improved in the TENS group (mean change -2.0 ± 1.1) than in the placebo group (mean change -0.4 ± 0.9) (p < 0.05). Similarly, muscle strength was significantly more improved in the TENS group (6.4 ± 3.3 kg) than in the placebo group (4.5 ± 1.6 kg) (p < 0.05). Moreover, participants assigned to the TENS group showed a significant greater improvement in gait speed than those in the placebo group (mean change -5.3 ± 1.4 s vs. -2.7 ± 1.2 s).
Conclusions:
These findings show the benefits of heel-raise-lower exercise after TENS for functional recovery in patients with stroke.
... Bouts of 100 heel raises have been demonstrated to be viable in elderly, non-clinical population. 13,14 Participants will record their daily adherence to the heel raise intervention. ...
... Simple exercises, such as heel raises, may have the potential to decrease sedentary time after stroke, improve cardiovascular health and improve cognition. Heel raises have previously been demonstrated to improve muscle strength, gait speed and balance, [13][14][15] but the effect on central and peripheral hemodynamic variables are yet to be investigated. Furthermore, interventions such as heel raises may lead individuals to feel more confident in their ability to perform physical tasks, and may attenuate impaired cognition as a result of sedentary behaviours. ...
Background: Physical therapists use verbal cueing extensively during gait rehabilitation. Nevertheless, little is known about the ability of individuals post-stroke to make immediate changes to targeted spatiotemporal gait parameters from verbal commands. Additionally, adequate muscle strength may be necessary to promote positive alterations in gait.
Objectives: To determine the influence of targeted verbal cues on spatiotemporal gait parameters for individuals with chronic stroke. Further, we assessed the potential of a relationship between cue-induced gait modifications and paretic lower limb strength.
Methods: Using a within-subjects design, twenty-seven adults with chronic stroke walked over a pressure mat with verbal cues to walk at (1) comfortable and (2) fast speeds, with increased (3) arm swing, (4) foot height, (5) step length, (6) push off, and (7) cadence. We also assessed lower extremity strength using a hand-held dynamometer. We measured gait speed, step length, stance time, and cadence for comparisons between conditions and performed correlational analyses to assess the influence of strength on gait alterations.
Results: Specific cues elicited increased walking speed, cadence, step lengths and paretic limb stance time. Only greater paretic hip and knee flexion strength was related to the ability to increase cadence when cued to do so (r > 0.41).
Conclusion: With targeted verbal cueing, clinicians can improve step length, gait speed, stance time and cadence for individuals with chronic stroke. Lower extremity strength does not appear to be related to the ability to alter gait with verbal cueing in individuals with chronic stroke.
Muscular power is an important performance component to emphasize in older adults following stroke. Aging affects neuromuscular function reducing strength and power; in turn, this loss is exacerbated in clients with stroke. Stroke can impact both ipsilateral and contralateral extremity power production, which correlates with reduced function in gait, transfers, and impaired hand use. A variety of objective clinical tests assess lower extremity power production. Studies demonstrate that exercise regimens that improve muscular power improve function poststroke. Future research should focus on best practice interventions to maximize extremity power in this population of older adults.
