Calf Raise Test

The calf raise test for measuring strength of plantarflexors in Achilles tendon pathology

Luke Dowse, Lisa Friend, Bronwyn Hemiak

& Darryn Lobo

The Calf-Raise Test

• The calf-raise test is a manual muscle test

• It measures:

STRENGTH, ENDURANCE, FATIGUE, FUNCTION and PERFORMANCE

of the MTU

• It involves repetitive concentric & eccectric muscle contractions

• Test parameter: Total number of raises

The 'down' phase of the calf-raise

ASSESSMENT TASK 3: Assessing the reliability of a physiotherapy measurement tool.

The task:

This is a group assignment. The group is required to conduct a simple study evaluating the

reliability of their measurement tool in a sample of 10 fellow students. The group may choose

to evaluate any one of the following types of reliability a) test-retest reliability; b) intra-rater

reliability or c) inter-rater reliability. The group must decide how they will conduct the study

(ie the methodology) and then collect the data, using their allocated measurement tool, on 8-

10 fellow students. Some prac time on two occasions (24th March & 6th April) will be

allocated to this task. If additional time is required for data collection, it is the group’s

responsibility to organise this out of class time. Data must then be entered into a database and

analysed with appropriate statistics using PASW Statistics software. Throughout the exercise,

the group must consider and reflect upon potential sources of error that may influence the

reliability of their particular measurement tool.

Presenting your findings:

The group will give an oral presentation of 15 minutes duration + 5 minutes of questions. The

presentation should be supported by the use of PowerPoint slides. A maximum of 10 slides is

permitted, including the title slide. It is expected that the following information will be

presented:

• Brief introduction as to what the measurement tool is/does/population it is intended for

• Outline of the methods you used to collect and analyse your data

• Summary of the results (including sample demographics, descriptive statistics and reliability statistics)

• Discussion of your findings and comparison with other findings reported in the literature.

• Discussion of the potential sources of error identified with the measurement tool & recommendations for its optimal use in clinical practice

Marking criteria:

This assignment is worth 45% of the marks in this subject. A single mark for the entire group

will be determined and all students in the group will receive the same mark. Marks will be

allocated on the following basis:

• Professional and engaging presentation, including use of language appropriate to the

audience- 5 marks

• Clear and appropriate use of Powerpoint slides, that support rather than overwhelm,

the presentation- 5 marks

• Demonstrated understanding of the measurement tool and its application to

physiotherapy practice- 5 marks

• Demonstrated understanding of the basic methodology of a reliability study, including

appropriate use of relevant statistics- 10 marks

• Clear and succinct presentation of study results- 5 marks

• Demonstrated ability to compare and contrast results with the findings of other

studies- 5 marks

• Recognition and discussion of potential sources of error associated with the

measurement tool- 6 marks

• Appropriate recommendations for use in clinical practice- 4 marks

The 'up' phase of the calf-raise

Methods

Results

Number of calf-raises performed by physiotherapy students over two trials

Subjects

• Ten University of Melbourne physiotherapy students
• Five female and five male
• Aged between 21 and 26 with a mean of 22.5

Rater

• Video recording via iPhone and observation (but ultimately

we used the iPhone data)

• Ten able-bodied physiotherapy students (five females and five males)

• Dominant leg determined by kicking a ball

• Maximum raise height measured

• Practised on non-dominant leg

• Metronome used to set the pace

• Subjects completed as many calf raises using dominant leg as they could

until fatigue

• Subjects were stopped when they performed two raises in a row below 50%

of their max height OR put excess pressure through their hands

• Trials recorded using an iphone

*21% increase

F4 - Trial 2

F1 - Trial 1

*22% increase

Population mean: trial 1 = 21.3 ; trial 2 = 25.8

Female mean: trial 1 = 21 ; trial 2 = 25.6

Male mean: trial 1 = 21.6 ; trial 2 = 26

*20% increase

Statistics

Limitations

Discussion

F2 vs. M4

Potential sources of error include:

• Learning effect (except F4)

• Competition between subjects

• Motivation to do better in trial 2

• Higher motivation from experimentors

• Use of electrical tape as a marker

• Measurement tape error

• Cut-off criteria

• Timing with metronome

Noticable difference in ROM between subjects M3 (above) and F1 (below)

• Originally collected data for both test-retest and inter-rater reliability using video-analysis and observation

• Chose to use test-retest reliability as inter-rater reliability was found to be 100% reliable

• Total (males & females) increase between Trial 1 and Trial 2; 21.1%

- Females; 21.9% increase Trial 2 compared to Trial 1.

- Males; 20.3% increase Trial 2 compared to Trial 1.

• Trial 1 vs Trial 2; increased number of heel raises performed in Trial 2.

• In contrast with previous studies, this test produced a low ICC, Pearson's correlation and a significant difference between trials

• No significant difference between number of raises performed by males and females

• Techniques may need to be standardised for each individual

• Outliers may have affected results

Implications for Physiotherapy

• Easy to administer

• Inexpensive

• Minimal equipment/space

• Mulit-dimensional test parameters

• Standardization of protocols

• Application of easily accessable new technologies

• Future implications for physio students

Images taken from www.physioadvisor.com.au

References

Calf strengthening exercises. (2008). Retrieved May 31, 2011, from

http://www.physioadvisor.com.au/8284550/calf-exercises-calf

strengthening-exercises-ph.htm

Hebert-Losier, K., Newsham-West, R.J., Schneiders, A.G., & Sullivan,

S.J. (2009). Raising the standards of the calf-raise test: A

systematic review. Journal of Science and Medicine in Sport,12(6), 594-602.

Maurer, C., Finley, A., Martel, J., Ulewicz, C., & Larson, C.A. (2007).

Ankle plantarflexor strength and endurance in 7-9 year old children as

measured by the standing single leg heel-rise test. Physical Occupational

Therapy in Pediatrics, 27(3), 37-51.

Ross, M.D., & Fontenot, E.G. (2000). Test-retest reliability of the standing

heel-rise test. Journal of Sport Rehabilitation, 9(2), 117-123.