Tight Calves – Evaluation

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In this weeks post we’re going to be picking up where we left off last week – the superficial posterior compartment. More specifically we’re going to be digging deeper and talking about what to do when you are stuck battling tight calves. The way I see it, there are essentially two varieties of this: 1) a new calf strain/injury and 2) chronically tight/on again off again symptoms. The first variety means that you have real symptoms that are either keeping you from training/racing or definitely limiting those activities. The second variety means that for the most part your symptoms aren’t severe enough to stop you from training/racing, but they are persistent. I would even place you in this category if you were someone who has had repeated or “annual” calf pulls.

Just to be clear, this post is all about problem solving the second variety. What it’s not talking about are acute/sudden onset injuries where you felt a pop, pull, or sting and are now experiencing brand new symptoms in the form of pain, swelling, bruising etc. That type of injury was covered in detail here (hint hint: this includes a doctor to see what you’re dealing with in terms of severity!).

Evaluation

(here is a PDF sheet you can download and print as you go through all of this. 🙂

That being said, the first place to start is with an evaluation. Any time you have symptoms that persist for long periods of time or become on/off or seasonal, the first step should  always be to address mobility/range of motion. Even if you have perfect mobility before things tightened up, you can be sure that things have changed as compensation started. Because the calf plays such a big role in both phases of the gait cycle (shock absorption/surface adaptation and propulsion), this includes stepping back to look at both ends of the leg chain. It also includes looking at how everything moves in isolation, as well as, how it all moves together.

#1 The Foot

As you’ll remember from our foot self evaluation post, we not only broke the foot up into three parts (rear, mid and fore), but we also broke the toes down into three groups as well (big toe, middle 3 toes and pinky/little toe). The reason for this was to make the intrinsic muscles easier to visualize instead of the more confusing muscle layer approach.

I like to start by looking at the toes as they are the end goal for propulsion. From start to finish we are moving over our feet from outside to inside to get to that big toe. If we can’t get there, then what’s happening upstream really doesn’t matter as it will only ever be compensation.

Evaluation checklist:

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  • Sitting, ankle relaxed: using the first toe joint, look at how the big toe, middle toes, and little/pinky toe flex and extend. Make sure you look at each independently! This is your baseline (pictured above, missing little toe).
  • Sitting, pull ankle back into dorsiflexion: recheck extension (pulling toes back). Did the movement change when you moved the ankle?
  • Sitting, point ankle down into plantarflexion: recheck flexion (pushing toes down). Did the movement change when you moved the ankle?
  • As you go through these motions try to keep the toes straight. This will help keep the focus on the intrinsic muscles versus the long, extrinsic tendons. What we really want to see is how the toes move and how that movement changes with ankle movement.
  • If this is at all confusing, here is a video you will find helpful!

 

#2 Mid-Foot

From the toes (forefoot), we move to the midfoot. Measuring range of motion here is trickier, however, and best done by a professional. The reason for this is because that professional would be measuring things like midtarsal joint mobility, metatarsal alignment, subtalar joint mobility, first ray mobility, etc etc.

Instead, let’s focus on what we know and what we can see on our own. Problems in the midfoot start when the foot is unable to make the transition from it’s adaptive/shock absorption phase to it’s rigid lever/stable platform phase. Think of it like a Rubik’s cube.

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In the beginning, you want each row to be mobile and it really doesn’t matter if the colors are in the right place. As you move forward over that foot and ankle, however, you want everything to line up and lock into place so that you can forcefully push off of that foot. This takes time and coordination as muscles and joints (both above and below the ankle) all work together to screw home each piece. If that doesn’t happen, then you never get to that “stable” position.

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An unstable foot is essentially part of the foot going one way and the rest going the other way. Then it’s a question of whether your foot has gotten stuck like that over time (rigid) or if it’s moving too much to try and compensate (flexible). Either way, you have a foot that is compromising the efficiency and power behind your push off. This is why going by arch height alone is often misleading and why shoe selection advice is so conflicting. It’s not about the arch alone. It’s about how all of the pieces of your foot are working together.

Sooo… if we can’t measure this on our own, how do we know if we have problems here? That’s easy. We pull our socks off and look at our callus patterns.

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Evaluation checklist:

  • By no means is the picture above comprehensive when it comes to calluses. What we’re looking for are clues that our foot is rotating more than it should as it struggles to get to that big toe and stabilize itself before push off.
  • In a foot that is unable to roll all the way in to that big toe, it’s common to see the first metatarsal (aka the first ray) compensating. That’s what the picture above is trying to show you. There are three different callus patterns (blue, red and green in the picture above) that we typically see when the first ray is problematic.
  • Larger, more diffuse calluses under the complete ball of the foot (teal circle) indicate ankle restrictions. Instead of pushing off of your foot, you are rolling off of it.
  • Another pattern not shown above is a callus under the 5th toe. If you are getting stuck on the outside of your foot and not rolling in to the big toe, it’s very common to see a callus there.

Another test is to look at a barefoot heel raise to see how stable the foot is when we go to push off of it.

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Evaluation checklist:

  • When looking at the heel raise we are looking at two things: 1) Is there even weight through the ball of the foot from big toe to little toe, and 2) is the Achilles Tendon straight up and down.
  • As you set up for this, focus on spreading your toes out first. Straighten your knees and slowly raise up onto your toes. As you do so do you find yourself falling to the outside of your feet like the middle picture or do you find yourself mostly on your big toe like the last picture?
  • Once you do both feet, repeat again on one foot. Is your balance good or are you off balance right out of the gates? Is one foot better than the other? Can you not even do it?

#3 Rearfoot + Ankle

Next up we’re going to combing the rear foot and ankle. If you remember from our self evaluation posts, by rearfoot I mean the subtalar joint (aka where the talus and calcaneus meet). This is the joint directly below the ankle joint itself. An easy way to visualize it is as the two joints sitting one on top of the other. The ankle joint moves up and down in dorsiflexion and plantarflexion, while the subtalar joint below it is responsible for inversion/eversion and is controlled by the long extrinsic muscles we’ve been talking about.

While it’s easy to focus on the ankle, it’s important to realize that the subtalar joint is just as active throughout the gait cycle. As the foot lands the joint pronates and adducts to help make the joints above and below more efficient. This is essential for shock absorption and that surface adaptation we were talking about. As we move forward over the foot, the joint then starts to supinate as we prepare for push off. This helps stabilize and screw home the mid foot joints so that we have a rigid platform to propel off of.

If the subtalar joint moves too much or too little, this will directly impact the ankle and vice versa! The problems will also trickle down stream into the foot as it will be left scrambling to make up for the rear foot being out of position.

To take a look at the subtalar position, we’re going to do a prone lying test. All you have to do is lay on your stomach with your feet hanging off the edge. If there are muscle restrictions in the extrinsics (long tendons responsible for inversion and eversion), you will be able to see it here.

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Evaluation Checklist:

  • Laying down on your stomach, how do your feet naturally lay?
  • Do your feet point down to the floor like in the first picture (further left)? Or are they tilted in like the second? Or tilted out like the third?
  • If they’re more like the second or third pictures, step back and look at the whole leg? Is it just the ankle/foot that’s tilted or is the whole leg rotated?

Next, let’s look at how the ankle moves into dorsiflexion:

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Evaluation checklist:

  • Sitting, knee straight + heel down.
  • Standing, knee straight + heel down
  • Half kneeling, knee bent + heel down ( ** make sure that the knee goes over the toes, not inside or outside**). How does this compare to when you did it standing up?
  • Is the restriction you feel up in the muscles or is it pressure in the ankle itself? Or somewhere else entirely (the hip for example)?
  • Do you find your feet wanting to rotate in or out when you try to do this?
  • Is one side worse than the other?

#4 Knee

This area is pretty straight forward but often overlooked when it comes to chronic calf problems. The key is to focus on the back of the knee. You have the two heads of the gastroc, the plantaris, and three hamstring tendons all criss-crossing back there. Restrictions in either group will 100% impact the other. Prolonged restrictions here will also result in a loss of full knee extension. A few degrees here or there may not seem like a bad thing, but the front of your knee and hip will definitely disagree.

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Evaluation Checklist:

  • Full extension + heel up. Press the back of your knee down into the floor first. Keep it glued there and try to straighten your knee all the way, lifting the heel off the floor. Your ankle is relaxed.
  • Repeat, except pull the ankle back first before lifting the heel up. The setup is the same. Get the back of your knee down and then get the heel up.
  • How did your mobility change between them? Were you able to get your heel off the floor at all?

#5 Hip

Like the knee, this area is also more straight forward. Then again, isn’t everything compared to the complicated foot?? 🙂 Anyhow, when it comes to the hip we want to make sure that a) it can move into and out of flexion and extension and b) that it is rotating normally both internally and externally. The hip flexion/extension component is well documented and easy to see as an athlete. What’s less talked about is the rotation component.

As we walk and run, there is a large amount of rotation through the hips due to the fact that one leg is always swinging through. For example, as we weightbear on one leg, that leg is rotating in until mid-stance. As the other leg starts to swing, the weightbearing leg is then rotating out, storing energy to push off and let that leg swing through. Restrictions in rotation can eliminate that free energy and make us work when we should be relaxing.

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  • Hip extension in prone. Keep hips flat and pressed into table/floor. Knee straight. Squeeze your glute and lift the leg up. You should be able to lift your leg up about 10 degrees without rolling or lifting the hip up.
  • Hip extension in half kneeling. Start in a lunge position. Squeeze glutes and then push hip forward. Be careful not to let your pelvis fall forward. Activating the glutes will help with this and keep you from getting the motion from your spine instead of your hip!! If you have a friend helping, have them make sure you aren’t arching your back too much.
  • Repeat step two only this time reach back to bend your knee/grab your ankle first like in the second picture. Then again, squeeze the glutes and push forward with the front of your hip.
  • How does the movement change from position to position? Do you feel a stretch in the muscles or does the movement just feel blocked? Do you feel pressure in the joint?
  • To look at rotation, let’s start in sitting. The key is to keep the back of your thigh flat. Use your hands to hold the thigh in place. Then you’re going to rotate the leg in and out as shown in the third picture. Make sure you stay seated without lifting up to try and get more motion.
  • Is one direction easier than the other? Are both legs the same?

Just in case you missed it, here’s the PDF checklist sheet! When you go through the self evaluation, make sure you do it for both legs not just the symptomatic one! You will need a helper for a few of these. 🙂

So that’s it for your little self evaluation! In part two of this post, we’re going to put all of this together so that you know what to work on and how!

Click here to continue to Treatment- part one

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