Table of Contents
The heel drop exercise is a safe and effective osteoporosis exercise. In today’s post I discuss why the exercise is effective, provide guidelines for people concerned with the impact that the exercise has on bones, demonstrate and describe how to do the heel drop exercise, and suggest a modified, lower impact, version of the heel drop exercise.
You can find the heel drop exercise in the Beginner level section in the Exercise for Better Bones program. The heel drop exercise targets the muscles in your calf. It also targets the bones in your heel, lower leg, upper leg and hip, including your femoral neck.
Does the Heel Drop Exercise Build Bone?
Yes, the heel drop exercise builds bone.
How?
The heel drop exercise generates ground reaction forces which, in turn, create muscle vibration that stimulate bone growth in both the leg and hip area. The vibrations (or stimuli) also occurs when we do weight-bearing activities such as walking briskly or running.
This stimuli, or stress, encourages bone formation that can lead to an increase in bone density. Research (1) comparing the heel drops to other osteoporosis exercises indicates that it is one of the better exercises you can do to increase bone density.
How Effective is the Heel Drop Exercise?
A study published in 2019 (1) examined mechanical loading and muscle activation of four common osteoporosis prevention exercises in early postmenopausal women. The four osteoporosis prevention exercises studied were:
- Countermovement jumps exercise*.
- Box drops exercise (Double Leg Jump Down in Exercise for Better Bones).
- Heel drops exercise.
- The stomping exercise.
The research team measured and compared exercise effectiveness using continuous and intermittent stimulus frequencies on fourteen postmenopausal women. The researchers ranked the four exercises on a wide range of criteria including how well each exercise maintained the bone health of the postmenopausal women.
They concluded that countermovement jumps, box drops, and the heel drops exercise may exceed stomping in maintaining postmenopausal bone health.
* Illinois Basketball Applied Sport Scientist, Drake Berberet defines “a countermovement … as a downward action followed by a reciprocal upward action.”
In other words, you go down into a squat, take a brief pause, and then explode into your upward jump.
Weight Bearing Exercise and Ground Reaction Forces
Several studies by Bassey and Ramsdale (2) (3) indicate that ground reaction forces from weight bearing exercises improve or maintain bone health.
One of the studies (2) showed a “maintenance effect” of bone density in postmenopausal women who were more than six years postmenopausal.
This means that the patient is not losing bone during menopause. Many women lose bone during this stage. I like to to tell my clients “that if you are maintaining, then you are gaining”.
In the book, AstroFit, the authors refers to Bassey’s work. Her research leads her to believe that “heel drops exercise are an easy way to preserve and increase bone mass in premenopausal women.”
The authors recommends that if you are a premenopausal woman, that you perform the 50 repetitions of the heel drop exercise 5 times a day.
Is the Heel Drop Exercise Safe for Individuals with Osteoporosis?
The ground impact from the heel drop exercise causes force to go through the bones in the lower extremities and the hips. A study that measured force transducers in the hip, indicated that the force of the heel drop exercise was approximately three times the body weight.
As a results, clients and readers with osteoporosis have some concerns about the exercise. They want to know if it is a safe exercise for their bones. The next section provides guidelines for individuals concerned with heel drops and bone health, particularly osteoporosis and fracture risk.
Heel Drop Exercise Guidelines for Osteoporosis
Heel drop exercise is one of many of exercises I provide in Exercise for Better Bones.
However, I do not recommend that individuals with acute vertebral fractures do this exercise without consulting with a licensed healthcare professional, such as their physician or a Physical Therapist, knowledgeable in the treatment and management of osteoporosis.
How hard you want to drop (and cause impact) depends on your fracture risk. Here are my guidelines by degree of fracture risk:
- Low fracture risk. Free fall onto your heels.
- Moderate fracture risk. Control the impact somewhat and drop moderately hard.
- High fracture risk. Drop gently, unless guided otherwise by your healthcare practitioner.
- You have a history of compression fracture. You should consult with your physician before doing this or any other exercise. You need to be fully healed before you start or restart and exercise program. If you receive their clearance, drop gently when doing the heel drop exercise, unless guided otherwise by your healthcare practitioner.
For those of you in the moderate to high fracture risk, I encourage you to look at the Modified Heel Drops 8 Brocade Exercise video later in this post.
How to Do the Heel Drop Exercise
The heel drop is exactly what it sounds like: you rise up onto the balls of your feet, then let your heels drop to the floor. That impact sends a gentle force up through the skeleton to stimulate bone in the lower body. Here is how to do it safely.
What You Need for The Heel Drop Exercise
The only equipment you need is a sturdy support surface to rest your fingertips on. Heel drops fit easily into daily life — many people do them at the kitchen sink while doing the dishes, with their hands on the edge of the counter.
Footwear is your choice, and it should suit your feet. I demonstrate barefoot, on two layers of yoga mat, so that you can see the position of my feet — I have no history of foot problems and I stretch my calves regularly. If you have tight calf muscles, a history of plantar fasciitis, wear orthotics, or have been advised to keep your shoes on, then do the exercise in your footwear and on a surface that keeps you safe and your feet comfortable. I cannot see your feet or know your situation, so choose the setup that is right for you.
Step by Step Instructions
- Stand in an athletic stance (feet about hip-width apart, pointing forward), about an arm’s length from your support surface, and rest your fingertips lightly on it to balance. Keep your legs straight, with your knees unlocked — not bent, but not locked or hyperextended either.
- Set your posture: back straight, chest high, body tall, eyes looking forward, and your head stacked over your shoulders rather than in front of them.
- Rise up onto the balls of your feet, as high as you comfortably can, and inhale.
- Exhale and gently tighten your lower tummy as you drop your heels back to the floor, keeping your body tall and letting the impact travel up through your body.
- Feel a gentle vibration move up through your skeleton, then rise back up and repeat until your set is complete.
You Are in Control
Prefer a softer landing? Take control of the descent of your heels.
- Come down gently if you want to get the benefits of strengthening your calf muscles, but without the pounding to the skeleton.
- A controlled heel drop is referred to as a heel raise or heel lift. I will cover this exercise in detail in a later post.
Protect Your Knees and Spine
Two alignment points keep this exercise safe.
- Keep your legs straight, but do not lock or hyperextend your knees. Locking or hyperextending the knee removes your natural cushioning and drives the force straight into the ligaments of the knee, so keep the joint straight and unlocked rather than rigid.
- Keep your head over your spine. Your head weighs roughly 11 to 12 pounds, and you want that weight loading straight down through the spine as your heels land, not in front of it. Dropping your heels with your head forward of your shoulders loads the spine in an unsafe position, which is the opposite of what you are trying to achieve.
A Note on Joint Pain and Compression Fractures
If you have any joint pain in your lower body, or you have had a previous compression fracture, lower your heels gently rather than dropping quickly. If your fracture is recent or acute, or you are unsure whether heel drops are right for you, do not perform the exercise until you have checked with a physical therapist or doctor experienced in osteoporosis — once they are comfortable with it and can guide your form, you can proceed gently.
How Many Heel Drops Should You Do Per Day?
There is no single number that is right for everyone — how many heel drops you should do, and how hard, depends on your fracture risk. It helps to know where the research numbers come from. In Bassey’s work, premenopausal women performed 50 repetitions up to five times a day, and the modified Qigong “Eight Brocade” sequence I demonstrate later in this post used just seven repetitions, three times a day — and that gentler protocol still produced measurable bone density gains in both the spine and the hip.
If you have osteoporosis, I would not start at the higher end of those numbers. I recommend you begin with a small number of repetitions performed gently, build up gradually as your body adapts, and let your fracture risk — not a rep target — set the intensity, using the fracture-risk guidelines above. Done that way, even a modest daily amount is enough to load the bone and signal it to build.
For a structured progression that tells you exactly how often to do heel drops alongside the rest of a complete bone-building routine, follow the plan in Exercise for Better Bones.
Heel Drop Exercise Tips
A few more tips to keep in mind when doing this exercise:
- Do not let your hips move forward or backward.
- If you experience stiffness or pain in your toes, you can wear running shoes while doing the heel drops.
- Lower your heels gently if you have had a hip or knee replacement.
- Consult a pelvic health physiotherapist before doing this exercise if you experience incontinence or if you have had a prolapse. They will likely prescribe a set of exercises specific to your pelvic health.
- Be sure to regularly massage and stretch your feet and lower legs.
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Modified Heel Drop Exercise for Osteoporosis
A few years ago, a study took the final movement of the Qigong “Eight Brocade” sequence, modified it, and had participants perform seven repetitions three times a day. Over the course of the study, participants saw measurable improvements in bone mineral density in both the spine and the hip. It builds on the heel drop you already know, adding a gentle mini-squat, and it is a calming, accessible way to keep your bones strong. Here is how to do it.
Set Up and Settle
Find a comfortable spot, somewhere that feels good to you. Stand in a small mini-squat with your arms relaxed by your sides. For the first couple of minutes, simply let a gentle smile come to your face and allow your worries to leave your mind, turn your attention to the things you are grateful for: the people you love, the sun on a bright day, a warm shower, whatever brings you joy. Then bring your awareness to your stance: feel your weight supported evenly through the base of your big toe, your fifth toe, and the centre of your heel, with a long line of alignment through your body.
The Movement
- Reach both palms up toward the sky, and as your arms rise, come up onto the balls of your feet. Enjoy the balance challenge as you rise.
- As your arms lower, let your heels drop to the floor, just as you would in a standard heel drop, settling back into the gentle mini-squat.
- Inhale as you rise; release as you drop.
- Keep the squat shallow: a small bend in the knees, not a deep squat, so your legs help absorb the impact as you come down.
- Start with just one or two repetitions and build gradually toward seven.
How Often, and Why Frequency Matters
In the study, participants performed seven repetitions three times a day, and that is not the same as doing twenty-one all at once. Bone responds best to frequent stimulation, so spreading the repetitions across the day does more for your bones than a single longer session. It is the same principle as walking: if you have an hour to give, three 20-minute walks, or six 10-minute walks, do more for you than one unbroken hour.
A lovely way to build it into your day is to pause before a meal, take a moment of calm and gratitude, then do your seven heel drops. And if you do not have the energy to do all of your exercises in one go, take heart: spreading them through the day is actually better for your bones.
Modified Heel Drop Tips
Stand beside or in front of a sturdy support until you know you can perform the move with confidence.
If a 2-minute mini squat at the beginning of the sequence is difficult, begin with the amount of time you are comfortable with. Gradually build up your endurance until you reach 2-minutes. You’ll be surprised how quickly you will progress.
Just as with the heel drops mentioned in the beginning of the blog, wear footwear with or with our orthotics if you are accustomed to doing so with all your activities. If you wish to wean yourself from your shoes, it is best to do so under the guidance of your foot care professional or physical therapist.
As with all new exercises, no matter how gentle they appear, it is wise to start slowly and evaluate how your body responds.
Heel Drop Exercise: Frequently Asked Questions
How many heel drops should I do per day for osteoporosis?
There is no single prescription that suits everyone — the right number depends on your fracture risk. In the research, premenopausal women in Bassey’s work performed 50 repetitions up to five times a day, and the modified Qigong “Eight Brocade” protocol that improved spine and hip bone density used just seven repetitions, three times a day. If you have osteoporosis, I recommend you start with a small number performed gently, build gradually, and let your fracture risk guide the intensity rather than chasing a rep count. The structured progression is set out in Exercise for Better Bones.
Do heel drops actually increase bone density?
Yes. Heel drops create ground reaction forces that load the bones of the heel, lower leg, upper leg and hip, and that mechanical stress signals the bone to build. A 2019 study comparing four common bone-building exercises found heel drops to be one of the more effective options for maintaining postmenopausal bone health, and earlier randomised work by Bassey and Ramsdale showed a bone-maintenance effect in postmenopausal women.
Are heel drops safe if I have osteoporosis?
For most people with osteoporosis, heel drops are safe when the impact is matched to fracture risk. The force through the hip is roughly three times body weight, so I scale the drop accordingly: free-fall onto the heels at low fracture risk, a controlled moderate drop at moderate risk, and a gentle drop at high risk. If you have an acute or a history of vertebral compression fracture, do not perform this exercise without first consulting a physical therapist experienced in osteoporosis.
How hard should I drop my heels?
Match the impact to your fracture risk, not to how energetic you feel. Low fracture risk: a free fall onto the heels. Moderate risk: control the descent and drop moderately hard. High risk or a history of compression fracture: drop gently unless your healthcare practitioner advises otherwise. When in doubt, choose the gentler option or use the controlled heel lift instead.
Are heel drops the same as stomping for bone density?
They are related but not the same, and the difference matters. Stomping drives impact through a forward step, while a heel drop loads symmetrically through both heels from a raised position. In the 2019 comparison study, countermovement jumps, box drops and heel drops were judged to exceed stomping for maintaining postmenopausal bone health, so heel drops are my preferred starting point for most clients.
What are “Japanese heel drops”?
“Japanese heel drops” is a popular name for the same heel-drop movement, often linked to the modified Qigong “Eight Brocade” sequence shown later in this post. The mechanics are identical — rise onto the balls of the feet, then drop the heels — performed here in a relaxed, mini-squat posture with calm breathing. It is a gentler way to introduce the exercise.
What is the difference between heel drops and calf raises?
A calf raise (or heel raise) ends when you lower under control; a heel drop adds a deliberate drop onto the heels to create bone-building impact. In other words, a controlled heel drop is a calf raise — you get the calf-strengthening benefit without the skeletal loading. Choose the calf raise if you want to protect your joints or are at higher fracture risk, and the heel drop when you want the bone-building impact.
Are heel drops also called heel dips?
Yes, “heel dips” and “heel drops” refer to the same osteoporosis exercise. Whatever the name, the instruction is the same: rise onto the balls of your feet, then let your heels drop back to the floor with an impact suited to your fracture risk.
Are eccentric heel drops the same as the osteoporosis heel drop?
No — they are different exercises with different goals, so it is worth being clear which one you need. “Eccentric heel drops” usually describes an Achilles-tendon rehabilitation exercise: you stand on a step, rise onto both feet, then slowly lower one heel below the step, emphasising the controlled lowering to load the tendon. The osteoporosis heel drop on this page is the opposite emphasis — you rise onto the balls of your feet and let the heels drop to the floor so the impact loads the bone. If your aim is bone density, the heel drop described above is the one you want; if you are rehabilitating an Achilles tendon, ask your physiotherapist about the eccentric step version.
Can I do heel drops with a joint replacement, plantar fasciitis or pelvic floor concerns?
Often yes, with sensible modifications. Lower your heels gently if you have had a hip or knee replacement. If you have or have had plantar fasciitis, start very gradually and consider supportive footwear or a soft surface. If you experience incontinence or have had a prolapse, see a pelvic health physiotherapist before starting — they will likely tailor a programme to your pelvic health.
Margaret Martin
Further Readings
References
- Montgomery G. Et al. The mechanical loading and muscle activation of four common exercises used in osteoporosis prevention for early postmenopausal women. Journal of Electromyography and Kinesiology. Volume 44. February 2019, Pages 124-131
- Bassey J, Ramsdale S. Weight-bearing exercise and ground reaction forces: a 12-month randomized controlled trial of effects on bone mineral density in healthy postmenopausal women. Bone, 1995 Apr;16(4):469-76
- Bassey J, Ramsdale S. Increases in femoral bone density in young women following high impact exercise. Osteoporosis Int, 1994;4:72-75
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