Heel drops are an exercise used in physical therapy to address pain and weakness in the lower leg. The exercise involves standing on the edge of an elevated surface, like a step, and carefully lowering the heel below the level of the forefoot. This controlled movement applies a measured load to the calf muscles and the Achilles tendon.
Defining the Eccentric Movement
The therapeutic effectiveness of the heel drop lies in its focus on the eccentric phase of muscle contraction. An eccentric contraction occurs when a muscle lengthens while resisting a load, opposite to the shortening action of a standard lift. This loading is beneficial for addressing chronic tendon issues known as tendinopathies.
Applying controlled, lengthening tension stimulates cellular changes within the tendon tissue. This specific loading is thought to promote improved tendon tolerance to force and reduce pain over time, building the capacity of the tendon to withstand the stresses of daily activity and exercise.
Step-by-Step Guide to Execution
To begin, find a stable step or ledge and place the balls of your feet on the edge while holding a railing for balance. Start by rising onto your toes using both legs. This initial lift (the concentric phase) should not require the target leg to perform the full work.
Once elevated, lift the non-exercising leg off the step, shifting all weight onto the leg being worked. Slowly lower your heel toward the floor in a controlled manner for a count of approximately three to five seconds. This slow, deliberate descent is the eccentric movement that provides the therapeutic load.
Lower the heel until you feel a gentle stretch. Place your non-exercising foot back onto the step to assist in raising your body back up to the starting position. The injured leg must not perform the upward, concentric lift, as this minimizes stress and focuses effort entirely on the beneficial lengthening phase. Repeat this process for the prescribed number of repetitions and sets, maintaining the slow tempo throughout the downward motion.
Targeting Different Tendon Areas
The Achilles tendon connects the gastrocnemius and the soleus to the heel bone, and variations in heel drop technique can selectively emphasize these muscles.
Straight-Knee Variation
Performing the heel drop with a straight knee primarily loads the gastrocnemius, the calf muscle that crosses both the knee and ankle joints. This variation is used when treating tendinopathy in the mid-portion of the Achilles tendon.
Bent-Knee Variation
The alternative involves performing the slow lowering motion with the knee slightly bent, maintaining a flexion of about 15 to 20 degrees. Bending the knee places the gastrocnemius in a shortened position, which increases the load emphasis on the soleus muscle. This variation targets the lower, insertional area of the tendon.
Once a patient can comfortably perform the exercises without pain, the load must be progressively increased to continue stimulating adaptation. This progression involves holding a weighted object, such as a dumbbell, while performing the slow, single-leg eccentric drops. Utilizing both the straight-knee and bent-knee variations ensures comprehensive strengthening across the entire muscle-tendon unit.