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Hajar Farhad
Kirran Sikandar Gondal
Muhammad Ali
Iqra Nadeem
Abdullah Warad
Wajahat Haider
Muhammad Ali


Squatting, Heel raise, alignment, trunk angle


Background: A sufficient degree of mobility at the ankle is required to facilitate balance and control in both the ascent and descent of the squat. Insufficient ankle mobility is often compensated with the forward trunk angle.
Aim: To determine the effect of heel raise on trunk angle in healthy non-athletic population.

Design: Cross-sectional study

Intervention(s): Study included both male and female, healthy, physically active adults aged 18 years and above, who were not engaged in organized sports activities. Participants were selected based on their consistent engagement in physical activities, practicing a minimum of three sessions per week, each lasting at least 20 minutes. To measure maximum ankle DF-ROM, a weight bearing lunge test (WBLT) was used for each subject. A wooden block was used for the heel raise. The participants were asked to stand on heel wedge, squat and hold the end of squat position for 3 sec at the end to have sufficient time to record the angle. Motion capture was facilitated using a Samsung A9 device, and subsequent angle calculations were performed utilizing the Kinovea software. Adaptive measures were taken to reduce the chance of measurement error by placing the markers over anatomical landmarks and camera held at a distance of 5m from participant at an angle of 90 degrees. Ankle dorsiflexion with WBLT, trunk angle without heel raise and trunk angle with heel raise were the main outcome measures of this study.

Results: Results showed significant differences on trunk angle with and without heel raise (g= 0.6, 95% CI [0.1 to 1.2]; p= 0.02). The mean and standard deviation was shown to be 3.1±4.6. Hence, trunk angle showed significant differences with and without a heel raise with moderate effect size (g= 0.6).

Conclusion: Facilitation of the ankle dorsiflexion movement with the help of heel raise during squat movement decreased forward trunk angle leading to improvement in spinal alignment.

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1. ADOUNI, M., SHIRAZI-ADL, A. J. C. M. I. B. & ENGINEERING, B. 2009. Knee joint biomechanics in closed-kinetic-chain exercises. 12, 661-670.
2. ALTER, M. J. 2004. Science of flexibility, Human Kinetics.
3. BALSALOBRE-FERNÁNDEZ, C., TEJERO-GONZÁLEZ, C. M., DEL CAMPO-VECINO, J., BAVARESCO, N. J. T. J. O. S. & RESEARCH, C. 2014. The concurrent validity and reliability of a low-cost, high-speed camera-based method for measuring the flight time of vertical jumps. 28, 528-533.
4. BENNELL, K., TALBOT, R., WAJSWELNER, H., TECHOVANICH, W., KELLY, D. & HALL, A. J. J. A. J. O. P. 1998. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. 44, 175-180.
5. BERTELSEN, M. L., JENSEN, J. F., NIELSEN, M. H., NIELSEN, R. O., RASMUSSEN, S. J. G. & POSTURE 2013. Footstrike patterns among novice runners wearing a conventional, neutral running shoe. 38, 354-356.
6. BISHOP, C., READ, P., WALKER, S., TURNER, A. N. J. P. S. & CONDITIONING 2015. Assessing movement using a variety of screening tests. 17-26.
7. BROWN, C., HILLMAN, S., RICHARDSON, A., HERMAN, J., ROBB, J. J. G. & POSTURE 2008. Reliability and validity of the Visual Gait Assessment Scale for children with hemiplegic cerebral palsy when used by experienced and inexperienced observers. 27, 648-652.
8. CERULLI, G., CARAFFA, A., PONTEGGIA, F. J. S. M. & REVIEW, A. 2002. Rehabilitation issues in women with anterior cruciate ligament deficiency. 10, 76-82.
9. CHARLTON, J. M., HAMMOND, C. A., COCHRANE, C. K., HATFIELD, G. L., HUNT, M. A. J. T. J. O. S. & RESEARCH, C. 2017. The effects of a heel wedge on hip, pelvis and trunk biomechanics during squatting in resistance trained individuals. 31, 1678-1687.
10. CROSBIE, J., VACHALATHITI, R., SMITH, R. J. G. & POSTURE 1997. Patterns of spinal motion during walking. 5, 6-12.
11. D’AMICO, M., KINEL, E., RONCOLETTA, P. J. F. I. B. & BIOTECHNOLOGY 2022. Leg Length Discrepancy and Nonspecific Low Back Pain: 3-D Stereophotogrammetric Quantitative Posture Evaluation Confirms Positive Effects of Customized Heel-Lift Orthotics. 9, 743132.
12. DAMSTED, C., LARSEN, L., NIELSEN, R. J. G. & POSTURE 2015. Reliability of video-based identification of footstrike pattern and video time frame at initial contact in recreational runners. 42, 32-35.
13. DE ALMEIDA, M. O., SARAGIOTTO, B. T., YAMATO, T. P. & LOPES, A. D. J. P. T. I. S. 2015. Is the rearfoot pattern the most frequently foot strike pattern among recreational shod distance runners? 16, 29-33.
14. DIONISIO, V. C., ALMEIDA, G. L., DUARTE, M., HIRATA, R. P. J. J. O. E. & KINESIOLOGY 2008. Kinematic, kinetic and EMG patterns during downward squatting. 18, 134-143.
15. ESCAMILLA, R. F., FLEISIG, G. S., LOWRY, T. M., BARRENTINE, S. W., ANDREWS, J. R. J. M., SPORTS, S. I. & EXERCISE 2001a. A three-dimensional biomechanical analysis of the squat during varying stance widths. 33, 984-998.
16. FERNÁNDEZ-GONZÁLEZ, P., KOUTSOU, A., CUESTA-GÓMEZ, A., CARRATALÁ-TEJADA, M., MIANGOLARRA-PAGE, J. C. & MOLINA-RUEDA, F. J. S. 2020. Reliability of kinovea® software and agreement with a three-dimensional motion system for gait analysis in healthy subjects. 20, 3154.
17. ESCAMILLA, R. F., FLEISIG, G. S., ZHENG, N., LANDER, J. E., BARRENTINE, S. W., ANDREWS, J. R., BERGEMANN, B. W., MOORMAN III, C. T. J. M., SPORTS, S. I. & EXERCISE 2001b. Effects of technique variations on knee biomechanics during the squat and leg press. 33, 1552-1566.
18. ESCAMILLA, R. F. J. M., SPORTS, S. I. & EXERCISE 2001c. Knee biomechanics of the dynamic squat exercise. 33, 127-141.
19. FERRARIN, M., RIZZONE, M., BERGAMASCO, B., LANOTTE, M., RECALCATI, M., PEDOTTI, A. & LOPIANO, L. J. E. B. R. 2005. Effects of bilateral subthalamic stimulation on gait kinematics and kinetics in Parkinson’s disease. 160, 517-527.
20. FLEMING, B. C., OHLÉN, G., RENSTRÖM, A., PEURA, G. D., BEYNNON, B. D. & BADGER, G. J. J. T. A. J. O. S. M. 2003. The effects of compressive load and knee joint torque on peak anterior cruciate ligament strains. 31, 701-707.
21. FRIGO, C., CARABALONA, R., DALLA MURA, M. & NEGRINI, S. J. C. B. 2003. The upper body segmental movements during walking by young females. 18, 419-425.
22. FRY, A. C., SMITH, J. C., SCHILLING, B. K. J. T. J. O. S. & RESEARCH, C. 2003. Effect of knee position on hip and knee torques during the barbell squat. 17, 629-633.
23. FUGLSANG, E. I., TELLING, A. S., SØRENSEN, H. J. T. J. O. S. & RESEARCH, C. 2017. Effect of ankle mobility and segment ratios on trunk lean in the barbell back squat. 31, 3024-3033.
24. GOR-GARCÍA-FOGEDA, M. D., DE LA CUERDA, R. C., TEJADA, M. C., ALGUACIL-DIEGO, I. M., MOLINA-RUEDA, F. J. A. O. P. M. & REHABILITATION 2016. Observational gait assessments in people with neurological disorders: a systematic review. 97, 131-140.
25. HEIJNE, A., FLEMING, B. C., RENSTROM, P. A., PEURA, G. D., BEYNNON, B. D., WERNER, S. J. M., SPORTS, S. I. & EXERCISE 2004. Strain on the anterior cruciate ligament during closed kinetic chain exercises. 36, 935-941.
26. HEMMERICH, A., BROWN, H., SMITH, S., MARTHANDAM, S. & WYSS, U. J. J. O. O. R. 2006. Hip, knee, and ankle kinematics of high range of motion activities of daily living. 24, 770-781.
27. HERTEL, J. J. S. M. 2000. Functional instability following lateral ankle sprain. 29, 361-371.
28. HOCH, M. C. & MCKEON, P. O. J. J. O. O. R. 2011. Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. 29, 326-332.
29. JOSEPH, L., REILLY, J., SWEEZEY, K., WAUGH, R., CARLSON, L. A. & LAWRENCE, M. A. J. J. O. H. K. 2020. Activity of trunk and lower extremity musculature: Comparison between parallel back squats and belt squats. 72, 223-228.
30. KATHIRESAN, G., JALI, N., AFIQAH, N. R., AZNIE, N. A., FIDIEYANA, N. & OSOP, N. J. W. J. O. S. S. 2010. The relationship between ankle joint flexibility and squatting knee flexion posture in young malaysian men. 3, 226-230.
31. KINGMA, I., BOSCH, T., BRUINS, L. & VAN DIEËN, J. H. J. E. 2004. Foot positioning instruction, initial vertical load position and lifting technique: effects on low back loading. 47, 1365-1385.
32. KRAMERS-DE QUERVAIN, I. A., MÜLLER, R., STACOFF, A., GROB, D. & STÜSSI, E. J. E. S. J. 2004. Gait analysis in patients with idiopathic scoliosis. 13, 449-456.
33. KRITZ, M., CRONIN, J., HUME, P. J. S. & JOURNAL, C. 2009. The bodyweight squat: A movement screen for the squat pattern. 31, 76-85.
34. KUSTER, M. S. J. S. M. 2002. Exercise recommendations after total joint replacement: a review of the current literature and proposal of scientifically based guidelines. 32, 433-445.
35. LEARDINI, A., BIAGI, F., MERLO, A., BELVEDERE, C. & BENEDETTI, M. G. J. C. B. 2011. Multi-segment trunk kinematics during locomotion and elementary exercises. 26, 562-571.
36. LEE, S.-P., GILLIS, C. B., IBARRA, J. J., OLDROYD, D. F., ZANE, R. S. J. T. J. O. S. & RESEARCH, C. 2019. Heel-raised foot posture does not affect trunk and lower extremity biomechanics during a barbell back squat in recreational weight lifters. 33, 606-614.
37. LIST, R., GÜLAY, T., STOOP, M., LORENZETTI, S. J. T. J. O. S. & RESEARCH, C. 2013. Kinematics of the trunk and the lower extremities during restricted and unrestricted squats. 27, 1529-1538.
38. LLOYD, R. S., FAIGENBAUM, A. D., STONE, M. H., OLIVER, J. L., JEFFREYS, I., MOODY, J. A., BREWER, C., PIERCE, K. C., MCCAMBRIDGE, T. M. & HOWARD, R. J. B. J. O. S. M. 2014. Position statement on youth resistance training: the 2014 International Consensus. 48, 498-505.
39. LORENZETTI, S., GÜLAY, T., STOOP, M., LIST, R., GERBER, H., SCHELLENBERG, F., STÜSSI, E. J. T. J. O. S. & RESEARCH, C. 2012. Comparison of the angles and corresponding moments in the knee and hip during restricted and unrestricted squats. 26, 2829-2836.
40. LU, Z., LI, X., XUAN, R., SONG, Y., BÍRÓ, I., LIANG, M. & GU, Y. J. B. 2022. Effect of heel lift insoles on lower extremity muscle activation and joint work during barbell squats. 9, 301.
41. LUBANS, D. R., MORGAN, P. J., CLIFF, D. P., BARNETT, L. M. & OKELY, A. D. J. S. M. 2010. Fundamental movement skills in children and adolescents: review of associated health benefits. 40, 1019-1035.
42. MCCURDY, K. W., LANGFORD, G. A., DOSCHER, M. W., WILEY, L. P., MALLARD, K. G. J. T. J. O. S. & RESEARCH, C. 2005. The effects of short-term unilateral and bilateral lower-body resistance training on measures of strength and power. 19, 9-15.
43. MESTELLE, Z., KERNOZEK, T., ADKINS, K. S., MILLER, J. & GHEIDI, N. J. I. J. O. S. P. T. 2017. Effect of heel lifts on patellofemoral joint stress during running. 12, 711.
44. MILLS, K. J. J. O. P. 2015. Motion analysis in the clinic: There's an app for that. 1, 49-50.
45. NEGRINI, S., PIOVANELLI, B., AMICI, C., BOVI, G., CAPPELLINI, V., FERRARIN, M., ZAINA, F. & BORBONI, A. J. E. J. P. R. M. 2016. Trunk Movements Analysis: a Systematic Review.
46. PUIG-DIVÍ, A., ESCALONA-MARFIL, C., PADULLÉS-RIU, J. M., BUSQUETS, A., PADULLÉS-CHANDO, X. & MARCOS-RUIZ, D. J. P. O. 2019. Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. 14, e0216448.
47. MYER, G. D., FAIGENBAUM, A. D., FORD, K. R., BEST, T. M., BERGERON, M. F. & HEWETT, T. E. J. C. S. M. R. 2011. When to initiate integrative neuromuscular training to reduce sports-related injuries in youth? 10, 155.
48. MYER, G. D., KUSHNER, A. M., BRENT, J. L., SCHOENFELD, B. J., HUGENTOBLER, J., LLOYD, R. S., VERMEIL, A., CHU, D. A., HARBIN, J., MCGILL, S. M. J. S. & JOURNAL, C. 2014. The back squat: A proposed assessment of functional deficits and technical factors that limit performance. 36, 4.
49. POWDEN, C. J., HOCH, J. M. & HOCH, M. C. J. M. T. 2015. Reliability and minimal detectable change of the weight-bearing lunge test: a systematic review. 20, 524-532.
50. SAHRMANN, S., AZEVEDO, D. C. & VAN DILLEN, L. J. B. J. O. P. T. 2017. Diagnosis and treatment of movement system impairment syndromes. 21, 391-399.
51. SATO, K., FORTENBAUGH, D., HYDOCK, D. S. J. T. J. O. S. & RESEARCH, C. 2012. Kinematic changes using weightlifting shoes on barbell back squat. 26, 28-33.
52. SAYERS, M. G., BACHEM, C., SCHÜTZ, P., TAYLOR, W. R., LIST, R., LORENZETTI, S. & NASAB, S. H. J. J. O. S. S. 2020. The effect of elevating the heels on spinal kinematics and kinetics during the back squat in trained and novice weight trainers. 38, 1000-1008.
53. SCHOENFELD, B. J. J. T. J. O. S. & RESEARCH, C. 2010. Squatting kinematics and kinetics and their application to exercise performance. 24, 3497-3506.
54. SENTER, C. & HAME, S. L. J. S. M. 2006. Biomechanical analysis of tibial torque and knee flexion angle: implications for understanding knee injury. 36, 635-641.
55. TURNER, A. N., PARMAR, N., JOVANOVSKI, A., HEARNE, G. J. S. & JOURNAL, C. 2021. Assessing group-based changes in high-performance sport. Part 2: effect sizes and embracing uncertainty through confidence intervals. 43, 68-77.
56. TITUS, A. W., HILLIER, S., LOUW, Q. A. & INGLIS-JASSIEM, G. J. A. J. O. D. 2018. An analysis of trunk kinematics and gait parameters in people with stroke. 7, 1-6.
57. SHARIFNEZHAD, A., RAISSI, G. R., FOROGH, B., SOLEYMANZADEH, H., MOHAMMADPOUR, S., DALIRAN, M. & BAGHERZADEH CHAM, M. J. I. R. J. 2021. The Validity and Reliability of Kinovea Software in Measuring Thoracic Kyphosis and Lumbar Lordosis. 19, 129-136.
58. VAZIRIAN, M., VAN DILLEN, L., BAZRGARI, B. J. P. T. & REHABILITATION 2016. Lumbopelvic rhythm during trunk motion in the sagittal plane: A review of the kinematic measurement methods and characterization approaches. 3.
59. WHITTLE, M. W., LEVINE, D. J. G. & POSTURE 1997. Measurement of lumbar lordosis as a component of clinical gait analysis. 5, 101-107.
60. WITVROUW, E., LYSENS, R., BELLEMANS, J., PEERS, K. & VANDERSTRAETEN, G. J. T. A. J. O. S. M. 2000. Open versus closed kinetic chain exercises for patellofemoral pain. 28, 687-694.
61. WOLF, P., LIST, R., UKELO, T., MAIWALD, C. & STACOFF, A. J. J. O. A. B. 2009. Day-to-day consistency of lower extremity kinematics during walking and running. 25, 369-376.
62. ZAWADKA, M., SMOLKA, J., SKUBLEWSKA-PASZKOWSKA, M., LUKASIK, E., GAWDA, P. J. J. O. S. S. & MEDICINE 2020. How are squat timing and kinematics in the sagittal plane related to squat depth? 19, 500.

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