08/14/09
Calf Care
Need help with a sore lower leg?? Here are some tips for taking care of your calves.....
Category: Your Body
Posted by: ryan
Calf Care
This past week I had the opportunity to be a part of the World Police and Fire Games. As a sports chiropractor I was part of a multi-disciplinary team of healthcare practitioners at the main polyclinic for the games. It was a warm-up for the Olympics that will come to Vancouver in 2010, and a testing ground for how the polyclinic model works, as well as communication, mass transportation, etc.
Being a sports chiropractor here in Vancouver meant that the vast majority of musculoskeletal injuries that came into the clinic were directed to me as I could both diagnose and treat most of them, and this freed up the MD for suturing and other patients with non-musculoskeletal problems.
As such, I was presented with three cases in the same day of calf pain or Achilles tendon pain. Unfortunately, two of the cases ended up being full Achilles tendon ruptures, so for those athletes the games came to a premature end. This motivated me to go over some basics on calf care in this month’s recovery article.
The posterior lower leg (aka, calf area) is made up of three muscles – the soleus, and 2 heads of the gastrocnemius muscle. The soleus has often been referred to as the “soul” of the lower leg, since it does the lion’s share with respect to creating plantar flexion forces (toeing off). It attaches to the tibia and crossed the ankle joint only, allowing it to only point the toes.
The two heads of the gastrocnemius are the glory muscles – the ones that create the nice “W” shape in the calf that everyone sees as you blow by them on the bike. They attach to the lower femur and cross both the knee and the ankle, and can therefore generate forces to flex then knee and point the toes.
All three muscles feed into an extremely strong structure called the Achilles tendon. The Achilles then attaches to the back of the heel. A number of small fluid filled sacs surround the Achilles and provide cushioning and lubrication to counteract the friction created by constant toeing off (think of how many times this happens during a long training run – amazing!)
As such an important muscle with so many forces being transmitted through it, it can often be the site of breakdown from overtraining or maximal contraction.
Before treatment, it’s important to identify which muscle is injured (soleus, medial or lateral gastrocnemius head, or Achilles tendon itself). If it is purely a muscle injury, then a number of treatments can be helpful – rest, self massage, deep tissue massage from a massage therapist, light stretching, trigger point therapy, ultrasound and kinesiotaping.
If the tendon is irritated it may present with a bump on the tendon where it is inflamed and painful, or it may even feel or sound squeaky with movement. Again, ice is helpful during the acute inflammatory stage, as well as the above treatments for the muscles that attach to the tendon in order to keep them relaxed and decrease the tension on the tendon.
To ice your calf or Achilles area, sit with your legs out in front of you, and place an ice/gel pack in front of you with a tea towel or thin t-shirt on top of the ice. Now place your heel and Achilles on the gel pack. Use a towel looped around your foot to apply some very light tension on the tendon and muscles – this helps keep the area in a stretched position so it doesn’t tighten up too much during the ice session. Only ice for about 15 minutes, followed by a full hour of no ice to allow the area to warm back up to room temperature.
Cycling is great rehab for calf pain and Achilles irritation, as long as you avoid hills and high force pedaling. The cycling motion encourages ankle range of motion as well as calf flexibility, and also pumps fluid and nutrition through the ankle. Most patients find that their Achilles feels much looser after a light spin and an ice session.
Trigger point therapy tools can also be used to loosen up the calf muscles and Achilles, along with using the Stick on a consistent basis to keep the muscles flexible.
When you feel the area is stable and not painful with a simple calf raise, move to calf raise negatives. Stand on a step and rise up on the toes of both feet. Shift to standing on one foot and gradually lower yourself down to the bottom of your range of motion. Use the other foot to assist you with returning to the up position and repeat up to 15-20x, according to how it feels (if painful, stop and perform 2 fewer reps than the number that brought on the pain). This exercise has been shown to increase ankle range of motion and strengthen the calf.
Stretching the calf should be done cautiously, especially when injured. I tell patients to decrease their stretching at times, since too much stretching can aggravate an injured area, cause it to tighten, and create a negative cycle that keeps the athlete injured and leads to chronic tissue changes in the calf and Achilles – definitely something to avoid! If your calf or Achilles has just been injured, stay away from stretching for about a week, then start back with light stretching for 45 seconds only. Perform this only 1-2x/day. Any more than 45 seconds and you risk irritating the area and causing a reflex tightening of the muscle, which further complicates the recovery!
The calf muscles and Achilles are critical for the propulsion and power phases of running and cycling, and they play a huge role in balance when walking. If you have a nagging injury in this area – get it looked at pronto, or your training will suffer. Muscle compensation happens quickly after injury, so minimizing down time will minimize compensations that can be hard to break and can easily create other injuries down the line. Take care of your calves, and they will take care of you.
This past week I had the opportunity to be a part of the World Police and Fire Games. As a sports chiropractor I was part of a multi-disciplinary team of healthcare practitioners at the main polyclinic for the games. It was a warm-up for the Olympics that will come to Vancouver in 2010, and a testing ground for how the polyclinic model works, as well as communication, mass transportation, etc.
Being a sports chiropractor here in Vancouver meant that the vast majority of musculoskeletal injuries that came into the clinic were directed to me as I could both diagnose and treat most of them, and this freed up the MD for suturing and other patients with non-musculoskeletal problems.
As such, I was presented with three cases in the same day of calf pain or Achilles tendon pain. Unfortunately, two of the cases ended up being full Achilles tendon ruptures, so for those athletes the games came to a premature end. This motivated me to go over some basics on calf care in this month’s recovery article.
The posterior lower leg (aka, calf area) is made up of three muscles – the soleus, and 2 heads of the gastrocnemius muscle. The soleus has often been referred to as the “soul” of the lower leg, since it does the lion’s share with respect to creating plantar flexion forces (toeing off). It attaches to the tibia and crossed the ankle joint only, allowing it to only point the toes.
The two heads of the gastrocnemius are the glory muscles – the ones that create the nice “W” shape in the calf that everyone sees as you blow by them on the bike. They attach to the lower femur and cross both the knee and the ankle, and can therefore generate forces to flex then knee and point the toes.
All three muscles feed into an extremely strong structure called the Achilles tendon. The Achilles then attaches to the back of the heel. A number of small fluid filled sacs surround the Achilles and provide cushioning and lubrication to counteract the friction created by constant toeing off (think of how many times this happens during a long training run – amazing!)
As such an important muscle with so many forces being transmitted through it, it can often be the site of breakdown from overtraining or maximal contraction.
Before treatment, it’s important to identify which muscle is injured (soleus, medial or lateral gastrocnemius head, or Achilles tendon itself). If it is purely a muscle injury, then a number of treatments can be helpful – rest, self massage, deep tissue massage from a massage therapist, light stretching, trigger point therapy, ultrasound and kinesiotaping.
If the tendon is irritated it may present with a bump on the tendon where it is inflamed and painful, or it may even feel or sound squeaky with movement. Again, ice is helpful during the acute inflammatory stage, as well as the above treatments for the muscles that attach to the tendon in order to keep them relaxed and decrease the tension on the tendon.
To ice your calf or Achilles area, sit with your legs out in front of you, and place an ice/gel pack in front of you with a tea towel or thin t-shirt on top of the ice. Now place your heel and Achilles on the gel pack. Use a towel looped around your foot to apply some very light tension on the tendon and muscles – this helps keep the area in a stretched position so it doesn’t tighten up too much during the ice session. Only ice for about 15 minutes, followed by a full hour of no ice to allow the area to warm back up to room temperature.
Cycling is great rehab for calf pain and Achilles irritation, as long as you avoid hills and high force pedaling. The cycling motion encourages ankle range of motion as well as calf flexibility, and also pumps fluid and nutrition through the ankle. Most patients find that their Achilles feels much looser after a light spin and an ice session.
Trigger point therapy tools can also be used to loosen up the calf muscles and Achilles, along with using the Stick on a consistent basis to keep the muscles flexible.
When you feel the area is stable and not painful with a simple calf raise, move to calf raise negatives. Stand on a step and rise up on the toes of both feet. Shift to standing on one foot and gradually lower yourself down to the bottom of your range of motion. Use the other foot to assist you with returning to the up position and repeat up to 15-20x, according to how it feels (if painful, stop and perform 2 fewer reps than the number that brought on the pain). This exercise has been shown to increase ankle range of motion and strengthen the calf.
Stretching the calf should be done cautiously, especially when injured. I tell patients to decrease their stretching at times, since too much stretching can aggravate an injured area, cause it to tighten, and create a negative cycle that keeps the athlete injured and leads to chronic tissue changes in the calf and Achilles – definitely something to avoid! If your calf or Achilles has just been injured, stay away from stretching for about a week, then start back with light stretching for 45 seconds only. Perform this only 1-2x/day. Any more than 45 seconds and you risk irritating the area and causing a reflex tightening of the muscle, which further complicates the recovery!
The calf muscles and Achilles are critical for the propulsion and power phases of running and cycling, and they play a huge role in balance when walking. If you have a nagging injury in this area – get it looked at pronto, or your training will suffer. Muscle compensation happens quickly after injury, so minimizing down time will minimize compensations that can be hard to break and can easily create other injuries down the line. Take care of your calves, and they will take care of you.