• Michael O Harris-Love, Joseph A Shrader, Todd E Davenport, Galen Joe, Goran Rakocevic, Beverly McElroy, and Marinos Dalakas.
• M.O. Harris-Love, PT, DSc, Research Service/Geriatrics and Extended Care Service, Washington DC Veterans Affairs Medical Center, Department of Veterans Affairs, Washington, DC; Department of Exercise Science, School of Public Health and Health Services, George Washington University, Washington, DC; and Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland. Mailing address: Research Service/Geriatrics and Extended Care Service, Washington DC Veterans Affairs Medical Center, Department of Veterans Affairs, 50 Irving St NW, Room 11G, Washington, DC 20422.
• Phys Ther. 2014 Apr 1; 94 (4): 543-52.

BackgroundRepeated heel raises have been proposed as a method of ankle plantar-flexor strength testing that circumvents the limitations of manual muscle testing (MMT).ObjectiveThe 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.DesignThis 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).MethodsForty-three participants with myositis (13 women; median age=64.9 years) participated. Outcome measures included MVC, predicted MVC, Kendall MMT, and Daniels-Worthingham MMT.ResultsThe 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).LimitationsThe lower half of both MMT grading scales was not represented in the study despite the profound weakness of the participants.ConclusionsBoth 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.

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