Science chiropractor, Dr. Alexander Jimenez investigates the methods described in treating a tight calf muscle.
Assess The Calf Complex
In the calf complex, the medial sural nerve descends between the two gastrocnemius heads and also at mid-calf level combines with a branch of the peroneal nerve to form the sural nerve(1,2). As we get older, the body’s connective tissue gets less pliable. Nerves are naturally surrounded by connective tissues — sometimes they even run through connective tissues, so with aging the nerves can get trapped, trapped or tethered to surrounding muscle or fascia(3).
This can manifest as a feeling of tightness deep in the calf muscle that never changes, no matter how much the customer stretches the muscles.
Action! Evaluate The Calf
The perfect method to appraise the calf is to palpate the muscle in a relaxed position (see Fig 1. below). Begin with your patient’s unaffected calf; palpate (feel) deeply between the gastroc heads supporting the knee and work down the calf into the Achilles tendon. This will give you a sensation of the deep neuro-myofascial tissue enclosing the tibial nerve, and what ‘normal’ feels like in this patient. Beware: it’s generally quite uncomfortable to do so because of the sensitive neural structures.
Then feel the affected calf in the exact same way. If there is a difference in the deep center section (eg tightness, pain, lumpiness) and if, when you press, then it replicates their usual ‘pain’ or ‘tightness’, it might indicate a nerve tethering problem that needs hands-on intervention.
Assess the nerves of the lower limb by using the slump test (see Fig 2, below) or the straight leg raise test to cross-check your client’s neural system and compare sides.
Treat The Neural Calf Complex
Once you’ve found something asymmetrical, you can treat the problem.
Warning: this therapy could be painful, but in my experience you need to treat very firmly to get results. Warn your patient.
Action! — Friction The Deep Structures
In the exact same position (see Fig 3, below), ensure finger tips are together and palpating right on the tight, painful area. With firm pressure, friction across the line of the nerve with your finger tips going into the left with both hands and then to the right (firm treatment is essential).
Repeat this along the length of the tibial nerve down the area where the patient has identified a difference in the feel compared to the other side. After you have loosened the neuro-myo-fascial constructions, get your client to walk or jog to see how it feels.
Action! Educate Your Client To Self-Treat
Sitting with knees bent, they should use their thumbs to palpate; ensure they can replicate the sensation you produced with your treatment. This way, your active patient can make chronically tight and painful calves a thing of the past.
Mark Alexander was sports physiotherapist to the 2008 Olympic Australian triathlon team, is lecturer and coordinator of the Master of sports physiotherapy degree at Latrobe University (Melbourne) and managing director of BakBalls (www.bakballs.com).
Scott Smith is an Australian physiotherapist. He works at Albany Creek Sports Injury Clinic in Brisbane, specialising in running and golf injuries. He is currently working with Australian Rules football teams in Brisbane.
Sean Fyfe is the strength and conditioning coach and assistant tennis coach for the Tennis Australia National High Performance Academy based in Brisbane. He also operates his own sports physiotherapy clinic.
Mark Palmer is a New Zealand-trained physiotherapist who has been working in English football for the past five years. He has spent the past three seasons as head physiotherapist at Sheffield Wednesday FC.