MEDIAL AND LATERAL GASTROCNEMIUS ACTIVATION

DIFFERENCES DURING HEEL-RAISE EXERCISE WITH

THREE DIFFERENT FOOT POSITIONS
BRYAN L. RIEMANN, G. KEN LIMBAUGH, JAYME D. EITNER,

AND

ROBERT G. LEFAVI

Biodynamics Center, Department of Health Sciences, Armstrong Atlantic State University, Savannah, Georgia

ABSTRACT

INTRODUCTION

Riemann, BL, Limbaugh, GK, Eitner, JD, and LeFavi, RG. Medial
and lateral gastrocnemius activation differences during heelraise exercise with three different foot positions. J Strength
Cond Res 25(3): 634639, 2011Despite little objective
support, heel-raise exercises are commonly performed using
varying foot positions in an attempt to alter medial (MG) and
lateral (LG) gastrocnemius involvement. This investigation
compared MG and LG activation during the concentric phase
(CP) and eccentric phase (EP) of the heel-raise exercise using
neutral (NE), internally rotated (IR), and externally rotated (ER)
foot positions. Twenty healthy subjects (10 men, 10 women;
age = 23.7 6 3.1 years) with resistance training experience
performed free-weight (130135% body mass) heel-raise
exercise on a 3.81-cm block. Surface electromyography activity
was recorded during 10 repetitions of each foot position.
Electromyography activity from 5 successful repetitions was
normalized to maximum voluntary isometric contraction, ensemble averaged within phase (CP, EP), and the mean amplitude
determined. Significant (p , 0.05) muscle-by-foot position
interactions were revealed for both phases. The ER position
prompted significantly greater MG activation than LG during
both phases, whereas the IR position elicited significantly
greater LG activation than MG. These data support the notion
that altering foot position during heel-raise exercise will prompt
varying degrees of MG and LG activation. Although this study
cannot predict whether muscle-activation differences between
foot positions will translate into greater training adaptations, it
does provide some initial objective evidence upon which practitioners can base the selection of gastrocnemius exercises.

KEY WORDS plantar flexion, electromyographical activity,

resistance training, biomechanical specificity

Address correspondence to Dr. Bryan L. Riemann, bryan.riemann@

armstrong.edu.
25(3)/634639
Journal of Strength and Conditioning Research
2011 National Strength and Conditioning Association

634

the

eel raises, also referred to as calf raises, are

common exercises included in resistance training programs for increasing the size, strength,
and power of the gastrocnemius and soleus
muscles (11,24). Many different populations are concerned
with training these muscles, such as sprinters (2) and jumpers
for improving performance (5), bodybuilders for increasing
muscular symmetry of the lower extremity (24), older adults
for maintaining mobility (11), and patients recovering from
Achilles tendinopathy (17,23). Both muscles function as ankle
plantar flexors; however, differences in fiber type (1),
architecture (13,16), and function (24) support the notion
that they be considered independently (9). Although the
soleus muscle may be targeted independent of knee position,
the contribution of the gastrocenmius to ankle plantar
flexion, being a biarticular muscle, is dependent upon both
the knee and ankle joints (16,24). Thus, from an exercise
training perspective, variations of heel-raise exercises involving the knee in a straight (soleus and gastrocnemius) and
flexed (soleus) position should be incorporated to fully
promote soleus and gastrocnemius function (24).
Similar to other multiheaded muscles, such as the hamstrings (8) and quadriceps (7), evidence has also suggested
that functional differences exist between the medial (MG)
and lateral (LG) heads of the gastrocnemius as a result of
architectural characteristics (16,18). For example, Kawakami
et al. examined the architectural features of the MG and LG
at several different ankle and knee-flexion angles under both
passive and active states (16). Although the LG was revealed
to have longer fascicle lengths independent of ankle or knee
position and activation state, the MG demonstrated more
fibers within a certain volume secondary to shorter fascicle
lengths and fascicle angles. As knee flexion increased,
the MG became increasingly more disadvantaged regardless
of ankle position. These results suggest functional differences
in the force-producing capabilities between the MG and LG
depending upon ankle and knee-joint position. From
a resistance training perspective, understanding how different
ankle and knee angular positions, and how other mechanical
alterations, affect the MG and LG functions may provide
evidence to support heel-raise variations as efficacious ways

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to bring about separate morphological and functional adaptations in the medial and lateral heads of the gastrocnemius.
Measuring muscle activation using electromyography
(EMG) provides additional insight into functional differences
between muscles. Specific to the MG and LG muscles, several
studies have examined differences in activation between modes
of exercise, such as cycling (3) and running (15), and levels of
activation (submaximal to maximal) during plantar flexion
with varying degrees of knee flexion (6,9,10). Using EMG in
this manner provides objective rationale on which practitioners can base exercise-mode and intensity decisions (4).
Exercisers are often observed performing heel raises with
the foot pointing in 3 different positions, inward (internally
rotated [IR] leg), outward (externally rotated [ER] leg),
and forward (neutral [NE] leg). The rationale for altering
foot positions is based on the assumption that the different
foot positions will prompt maximal activation of both the
MG and LG across sets involving these variations. This
notion is similar to variations of other exercises such as
squats (20,22). Because research has not established whether
foot position affects MG and LG muscle activity during heelraise exercise, the purpose of this study was to compare
MG and LG activation during the concentric (CP) and
eccentric (EP) phases of the heel-raise exercise using neutral,
IR, and ER foot positions.

ample time to become proficient with the free-standing heel

raises using all 3 foot positions. Subjects completed 1 set of
12 repetitions using each foot position, with the set order
counterbalanced between subjects. All heel raises began with
the subjects adopting a comfortable stance width with their
unshod (barefoot) forefeet elevated onto a 3.81-cm wooden
block while holding 130135% of their body mass that
included a 16-kg Olympic weightlifting bar (Figure 1). This
block height and load level were selected as a compromise
between stimulating muscular activation without promoting
excessive challenge to retaining postural equilibrium. The
neutral stance position involved the subject maintaining both
feet pointing anterior. During the IR position, subjects were
instructed to point their toes inward by internally rotating
their legs as far as possible (Figure 2), whereas for the ER
position, subjects were instructed to point their toes outward
by externally rotating their legs as far as possible (Figure 3).
For all 3 foot positions, subjects were instructed to maintain
the knee in full extension. The 12 repetitions under each foot
position condition were self-initiated and completed within
a 30-second period, with each repetition on an up-one
thousand, down-one thousand cadence. Between sets,
subjects placed the barbell on a squat rack and were given
3 minutes of rest.

METHODS

Data Collection and Reduction

Experimental Approach to the Problem

Heel raises are frequently used as gastrocnemius- and soleusstrengthening exercise often performed with 3 different foot
positions, neutral, IR, and ER. The rationale for using different
foot positions centers on attempting to maximize the activation of both the MG and LG during an exercise bout. This
study was designed to investigate whether the 3 foot positions
prompt different MG and LG activation during free-standing
weighted (130135% of body weight) heel raises. A repeatedmeasures counterbalanced design was used to answer the
question: During heel raises, will varying foot position significantly change the levels of MG and LG activation?

Using the Bagnoli-8 System (Delsys, Inc, Boston, MA), raw

EMG data were sampled at 1,000 Hz, filtered (20450 Hz),
and amplified with a minimum common mode rejection ratio
.84 dB and input impedance . 10 kV. The gain of each
channel was adjusted (100; 1,000; or 10,000) to maximize

Subjects

Twenty physically active subjects (10 men, 10 women,

1.71 6 .07 m, 23.7 6 3.1 years, and 72.75 6 14.24 kg) voluntarily participated in this study. All subjects participated in
some physical activity 3 times a week for at least 30 minutes,
including a recent history of using heel-raise exercise. Additionally, all participants were void of previous-injury history
prohibiting performance of free-standing heel-raise exercise
or conditions that could confound MG and LG activation.
Before participation, each subject received a verbal overview
of the studys purpose followed by time to read, review, and
sign an Institutional Review Board approved consent form.
Heel-Raise Procedures

Subjects completed all study procedures during a single,

1-hour session. Before data collection, subjects were given

Figure 1. Participants completed standing heel-raise exercise with a bar

weighted with 130135% body mass.

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Heel-Raise Exercise

Figure 2. Subjects internally rotated their legs as much as possible when

completing heel raises during the internal-rotation foot position.

signal resolution. Data were then analog to digital converted

(ComputerBoards PCM16S/12, ComputerBoards, Inc., Middleboro, MA) and stored on a desktop computer using the
Motion Monitor data acquisition software (Innovative Sports
Training, Inc., Chicago, IL). Additionally, a digital video
camera (Sony Handycam DCR-HC52), synchronized with
the EMG data collection, captured all repetitions.
After practicing and becoming proficient with heel raises
using the 3 foot positions, rectangular-shaped bipolar (1-cm
interelectrode distance) (DelSys DE-2.1, Delsys, Inc, Boston,
MA) 99.9% Ag electrodes were secured over the MG and LG
muscles. Subjects lay prone on a plinth with feet overhanging
the edge to keep their knees straight. Subjects were asked
to plantarflex against resistance to determine the center of
the MG and LG muscle bellies. A mark was made where
electrodes would be placed according to the recommendations of SENIAM (12). To prepare the skin surface for the
electrodes, hair was shaved, skin brushed with an abrasive
cloth followed by an isopropyl alcohol wipe. A common
reference electrode was placed on the superior-medial tibial
crest. Prewrap and elastic tape were applied over the
electrodes to provide strain relief for the electrode cables.
A 10-second quiet baseline was taken of the MG and LG
activities with the subjects supine on the plinth. Six-second
maximum voluntary isometric contractions (MVICs) were
then collected during a standing unilateral isometric

636

the

Figure 3. Subjects externally rotated their legs as much as possible

during the external-rotation foot position.

maximum plantar flexion contraction. With the ankle

positioned midway between neutral and full plantar flexion,
subjects were instructed to contract the calf muscles as hard
as possible. Once baseline and MVIC data were collected,
subjects began heel-raise exercises according to their assigned
order while the EMG data were saved for offline analysis.
Using the video data collected, the frame numbers
corresponding to initiation, midpoint (concentriceccentric
phase transition), and completion of 5 repetitions were
recorded for analysis. Initiation began when heels first
elevated off floor; midpoint was the end of the CP; and
repetition completion defined as when the heels rested on the
floor. All EMG data reduction procedures were conducted
offline using MatLab (The Mathworks Inc., Natick, MA)
-based routines. Before calculation of EMG variables, EMG
data from the MVIC and heel raises were full-wave rectified
and smoothed by low-pass filtering at 10 Hz using a zerophase-lag Butterworth filter. For the MVIC data, the mean
amplitude was calculated for the middle 5 seconds and used
for amplitude normalizing the heel-raise data. To reduce the
heel-raise data, the data for each selected repetition were
separated into concentric and eccentric phases and interpolated to 100 points. Ensemble averages within each
phase, using the dominant leg, were calculated across the
5 selected repetitions with the mean amplitude of the
ensemble average for each phase used for statistical analysis.

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Separate 2-factor (muscle by

foot position) repeated-measures
analysis of variance (ANOVA)
was used to statistically analyze
each heel-raise phase (concentric, eccentric). Before conducting the ANOVAs, compliance
with normality and sphericity
assumptions was verified. Simple main effect post hoc tests,
with a Bonferroni adjustment,
between MG and LG at each
foot position were used to
examine the significant interactions. Statistical significance was
considered at p # 0.05.

RESULTS
All 20 subjects were able to
successfully complete 12 repetitions under the 3 foot position
conditions.
A significant muscle by foot
position interaction (F[2,38] =
16.85, p , 0.001, partial h2 =
0.470) was revealed for the
concentric phase (Figure 4).
There was no significant difference between MG and LG (p =
0.460) for the neutral position.
During the IR position, significantly greater LG than MG
(p = 0.003) activation occurred,
whereas during the ER position, significantly greater MG
than LG (p = 0.026) activation
occurred. Additionally, LG activation during the IR position
was significantly different than
LG activation during the ER
position (p = 0.014).
A significant muscle by foot
position interaction (F[2,38] =
9.43, p , 0.001, partial h2 =
Figure 5. Percent maximal voluntary isometric contraction for the medial (black) and lateral (gray) gastrocnemius for
the 3 foot positions during the eccentric phase. Error bars indicate SDs. Significantly greater medial gastrocnemius
0.332) was revealed for the
activation compared with the lateral gastrocnemius existed for the external foot position.
eccentric phase (Figure 5).
During the ER position, there
was significantly greater MG
than LG (p = 0.019) activation. There were no significant
Statistical Analyses
differences between MG and LG for the neutral (p = 0.108)
Determining sample size was based on the assumption that
and IR (p = 0.564) positions.
10% differences between muscles and foot positions would be
relevant. Using pilot data to estimate variability, conducting
DISCUSSION
a power analysis with the adoption of alpha of 0.05 revealed
that 20 participants would provide a minimum power of 0.78
The current results support the notion that altering foot
for all main effects and interactions.
position during the heel-raise exercise will prompt varying
Figure 4. Percent maximal voluntary isometric contraction for the medial (black) and lateral (gray) gastrocnemius for
the 3 foot positions during the concentric phase. Error bars indicate SDs. Significant differences between the medial
and lateral gastrocnemius existed for the internal (lateral . medial) and external (medial . lateral) foot positions.

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Heel-Raise Exercise
degrees of MG and LG activation. Heel raises using a neutral
stance elicited similar levels of MG and LG activation during
both the concentric and eccentric phases. During both the
concentric and eccentric phases, ER prompted significantly
greater MG activity compared with the LG, whereas the
concentric phase with IR provoked significantly greater
LG activity compared with MG. Although this study cannot
predict whether muscle-activation differences between
foot positions will translate into greater adaptations, they
do provide some initial objective evidence upon which
practitioners can base gastrocnemius exerciseselection
decisions.
Previous studies have investigated MG- and LG-activation
differences during isometric (8,10) and isotonic (24) nonweight bearing and isometric weight-bearing (9) plantar
flexion. During weight-bearing plantar flexion (9), the MG
contributed a significantly greater percentage of the total
EMG signal than the LG at the lowest resistance level (30%
body weight). As the percentage of body weight increased,
the MGLG activation difference became significantly less
to the point at which no significant difference existed during
maximal isometric plantar flexion. Although the methodologies were quite different (i.e., the current investigation used
a dynamic plantar flexion contraction, whereas the former
used an isometric plantar flexion contraction), our results also
yielded no significant difference between the MG and LG
during the neutral foot position. This result was expected
because the cross sectional area of the MG is twice the size of
the LG (14). Collectively, the 2 studies would suggest that the
MG and LG are equally activated in a standing neutral stance
plantar flexed position during both isometric and dynamic
contractions at intensities above body weight. Furthermore,
the nonweight-bearing results of previous studies (6,10,24)
also support no significant activation differences between the
MG and LG during plantar flexion.
To obtain the IR and ER positions, we asked subjects to
point their toes inward and outward as much as possible while
completing the repetitions with the knee extended. Our
directions prompted subjects to produce combinations of
ankle, knee, and hip-joint rotations. We did not quantify how
much rotation each subject selected or maintained across the
ankle, knee, and hip joints throughout a set or the level of
inversion and eversion achieved at the ankle. Normative data
concerning active rotation limits between the ankle, knee, and
hip joints (19,21) show that the hip demonstrates the greatest
range of motion followed by the ankle and then the knee.
Although the range of motion data is only provided for non
weight-bearing assessments, it is reasonable to assume that
the rank order would remain the same (hip . ankle . knee).
Subjectively, several subjects reported that initiating and
maintaining the IR position was more difficult than the ER
position. These subjective reports are consistent with the
observation that active hip range of motion demonstrates
approximately 10 greater for external rotation than internal
rotation when the hip is 0 extension (25).

638

the

With respect to the IR and ER heel raises, the effect of hip

rotation, independent of ankle and knee rotation, would cause
the line of force being projected through the ankle joint to
shift laterally during IR and medially during ER. These shifts
could partially explain the significantly greater LG activation
during IR and the significantly greater MG activation during
ER. Supporting this speculation is a report in which healthy
subjects demonstrated statistically smaller vastus medialis
oblique to vastus lateralis activation ratios during step ups and
stepdowns with the leg in external rotation compared with
neutral or internal-rotation positions (20). It is also very
plausible that ankle and knee rotation occurred concurrently
with hip rotation in our study. We speculate that the
combined rotation of the ankle and the knee during the IR
and ER foot positions altered several MG and LG architectural features such as line of action, angle of pennation, and
fascicle lengths. Altering these architectural features may
have influenced the MG and LG force-generating capabilities, which in turn could explain the changes in muscle
activations observed.
Several factors related to our study design need to be
considered with regard to the generalizability of our results.
First, subject-inclusion criteria to this study consisted of
moderately active college-aged men and women with experience of performing heel-raise exercises and no history of
musculoskeletal injury or pathology that could have influenced MG and LG activation. Whether similar results would
be obtained with other populations such as older adults or
persons with gastrocnemius pathology will need to be further
investigated. Secondly, although heel raises are commonly
performed with shoes, in the absence of standardized shoes,
the heel raises in the current study were performed unshod.
All heel raises in the current study were also performed free
standing with 130135% body mass. Because the MGLGactivation differences appear to be related to the level of
activation during isometric plantar flexion (9), we can only
conservatively generalize our results to standing heel raises
performed with 130135% body mass. Thirdly, our methods
asked the subjects to internally and externally rotate their legs
as far as they could. Because we did not standardize or
quantify the leg rotation, we cannot define how much
internal and external rotation is needed to elicit the changes
in activation we identified. Finally, the heel raises in our study
were performed free standing using a 3.81-cm block height.
We can only speculate that the effect foot position has on
MG and LG activation would be larger as a result of not
having to rely on the MG and LG muscles, and secondary
muscles such as posterior tibialis and peroneals, for balance.
These latter 4 factors, unshod feet, external load magnitude,
self-selected internal and external rotation, and free-standing
exercise all represent recommendations for future research.
Finally, including a 3-dimensional kinematic analysis in
future heel-raise research is recommended to quantify the
ankle, knee, and hip rotations accompanying the internal and
external rotation variations, and provide an insight regarding

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the underlying sources of muscle-activation differences
yielded in the current investigation.

PRACTICAL APPLICATIONS
Heel raises are often used by persons interested in increasing
gastrocnemius muscle size, strength, and power. The results
of this study provide some initial support to the common
practice of using different foot positions during the heel-raise
exercise in an attempt to promote maximal adaptations in the
MG and LG. Specifically, during the free-standing heel-raise
exercise with 130135% body mass, it appears that using an
ER foot position prompts MG activation, whereas using an IR
foot position prompts LG activation. Whether these
activation differences translate into greater MG and LG
training adaptations, or whether the results extend to other
variations of heel-raise exercise (i.e., machine, seated), loading
conditions (.130135% body mass), and block height (.3.81
cm) remains to be studied.

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