3 47 Normative Calf Muscle Strength-Endurance Values: An International Study INTRODUCTION The strength-endurance of the plantar flexors is frequently assessed in clinical practice and research using the single-leg heel rise endurance test (HRET).1,2 The results obtained from this test are valuable for evaluating impairment severity, tracking recovery of Achilles tendon injuries, assessing exercise program effects on functional abilities and guiding return-to-sport recommendations.2-4 Normative values of tests are often used as a reference for evidence-based clinical practice.5 The contralateral limb cannot always be used as a reference for comparison as it does not always reflect optimal function.6,7 Consequently, it is important to have HRET normative values for both limbs. The existing literature suggests that a "normal" HRET performance comprises approximately 25 heel raises, with age, sex, body mass index (BMI), and activity level influencing the results in Swedish individuals.6,8 Although the HRET has good test-retest reliability, a limitation of the test is that it relies on the total number of repetitions performed, without taking into account the quality of movement.6,9 For example, individuals can complete numerous repetitions, but not raise the heel very high. More objective metrics, such as total work or peak height, are considered scientifically more robust than the number of repetitions and are deemed important measures of calf muscle tendon unit function.10-13 The recently developed Calf Raise Application can reliably assess these metrics.14 However, normative values for these HRET metrics in the general population are lacking.2,12 The primary objective of this study was to establish normative HRET values in a large population of healthy individuals, using objective metrics such as number of repetitions, total work (J), total displacement (cm) and peak height (cm). The secondary aim was to assess how HRET metrics are influenced by personal characteristics, including age, gender, BMI and activity level.
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