Are repeated single-limb heel raises and manual muscle testing associated with peak plantar-flexor force in people with inclusion body myositis?

Document Type

Journal Article

Publication Date



Physical Therapy


Volume 94, Issue 4



Inclusive Pages



Aged; Ankle; Cross-Sectional Studies; Exercise Therapy; Female; Heel; Humans; Isometric Contraction; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Myositis, Inclusion Body; Predictive Value of Tests


BACKGROUND: Repeated heel raises have been proposed as a method of ankle plantar-flexor strength testing that circumvents the limitations of manual muscle testing (MMT).

OBJECTIVE: The study objective was to examine the relationships among ankle plantar-flexion isometric maximum voluntary contraction (MVC), repeated single-limb heel raises (SLHRs), and MMT in people with myositis.

DESIGN: This was a cross-sectional study with a between-group design. The ability to complete 1 SLHR determined group assignment (SLHR group, n=24; no-SLHR group, n=19).

METHODS: Forty-three participants with myositis (13 women; median age=64.9 years) participated. Outcome measures included MVC, predicted MVC, Kendall MMT, and Daniels-Worthingham MMT.

RESULTS: The Kendall MMT was unable to detect significant ankle plantar-flexor weakness established by quantitative methods and was unable to discriminate between participants who could and those who could not perform the SLHR task. Ankle plantar-flexion MVC was not associated with the number of heel-raise repetitions in the SLHR group (pseudo R(2)=.13). No significant relationship was observed between MVC values and MMT grades in the SLHR and no-SLHR groups. However, a moderate relationship between MVC values and MMT grades was evident in a combined-group analysis (ρ=.50-.67).

LIMITATIONS: The lower half of both MMT grading scales was not represented in the study despite the profound weakness of the participants.

CONCLUSIONS: Both Kendall MMT and Daniels-Worthingham MMT had limited utility in the assessment of ankle plantar-flexor strength. Repeated SLHRs should not be used as a proxy measure of ankle plantar-flexion MVC in people with myositis.


PMCID: PMC3973819 [Available on 2014/10/1]

Peer Reviewed