Muscle injuries Archives - Opus Biological
Book an appointment
+44 20 8609 7843
Importance of calf capacity

Importance of calf capacity

29 October 2024

The Importance of Good Calf Muscle Capacity in Preventing and Rehabilitating Lower Limb Injuries

Calf muscles, primarily consisting of the gastrocnemius and soleus muscles, play a vital role in lower limb function and overall biomechanics. These muscles are essential for movements such as walking, running, and jumping, contributing to ankle stability, propulsion, and shock absorption. Strong and flexible calf muscles not only enhance athletic performance but also prevent lower limb injuries and support rehabilitation after injury. This article outlines the importance of calf muscle capacity, provides data on its impact on joint loading, and explains how to assess calf capacity in clinical settings.

The Role of Calf Muscles in Lower Limb Function

The calf muscles work as a dynamic powerhouse during movement. The gastrocnemius and soleus muscles, in conjunction with the Achilles tendon, drive plantarflexion, which is the action of pushing the foot off the ground. This movement is crucial for walking, running, and jumping, as it propels the body forward. Additionally, the calf muscles play a role in absorbing the impact forces generated when the foot strikes the ground, thus reducing stress on other structures like the knee, hip, and lower back.

By acting as shock absorbers and stabilizers, the calf muscles influence the load distribution across the entire lower limb. Proper calf function ensures that forces are dispersed evenly, preventing overloading of other structures and contributing to balanced biomechanics. When calf muscles are weak or fatigued, they fail to perform this role efficiently, leading to improper movement patterns and potentially contributing to injuries of the lower limb, such as ankle sprains, Achilles tendinopathy, anterior knee pain, and plantar fasciitis. Weak calf musculature may also exacerbate symptoms such as osteoarthritis in the foot, ankle and knee.  A study by Alshami and Alhassany (2020) 1, found that calf muscle strength was significantly reduced in the patients with knee OA compared with that in the healthy control participants. Therefore it could be a good idea to ensure that within an OA knee patient’s exercise programme, there is targeted calf strengthening.

Impact of Strong Calf Muscles on Knee Joint Loading

Strong calf muscles not only support the ankle but also significantly reduce the load on the knee joint during various activities. Research has shown that adequate calf strength can reduce knee joint loading by absorbing the ground reaction forces that occur during walking or running. The soleus muscle, in particular, is known to play a key role in reducing the stress on the knee by generating posterior shear forces at the tibia, which counteract the forward forces that tend to overwork the knee.

A 2019 study by A. Bohm, 2,  found that the soleus muscle can contribute up to 50% of the force needed to decelerate the body during walking and running, thereby offloading the knee joint considerably. Research indicates that strong calf muscles can reduce the load on the knee by up to 20-25% during activities like walking and stair climbing . This effect is critical in both preventing injuries such as patellofemoral pain syndrome and in managing conditions like osteoarthritis, where reduced joint loading can slow the progression of cartilage wear.

In individuals with weakened calf muscles, this offloading effect is diminished, forcing the knee and other structures to take on additional load, which increases the risk of injury. Athletes, in particular, benefit from strong calf muscles, as these muscles allow them to handle high-impact activities like running and jumping without overstressing the knee joint.

Testing Calf Capacity in Clinical Settings

Given the importance of calf muscle capacity in preventing and rehabilitating lower limb injuries, clinicians need reliable methods to assess both the strength and endurance of the calf muscles. Below are some of the most effective ways to test calf capacity in a clinical setting:

  • Calf-Raise Test (Repetitive Heel-Raise Test): The single-leg calf-raise test is a simple and widely used method to assess calf muscle endurance. In this test, the patient stands on one leg and performs heel raises, lifting the heel off the ground as high as possible with the number of repetitions completed before fatigue, recorded. This test evaluates both the gastrocnemius and soleus muscles, providing a measure of endurance, which is critical for injury prevention. Hebert et. Al (2017) 2, carried out a great study which generated a guide to target rep ranges for different patient groups based on age and sex.
  • Maximal Voluntary Isometric Contraction (MVIC): This test measures the maximum force a person can generate during an isometric contraction of the calf muscles. Using a dynamometer, clinicians can measure the force output when the patient pushes against resistance in a fixed position. The MVIC is a reliable method to assess the maximal strength of the calf muscles, especially useful in identifying deficits that may contribute to injury risk or delay rehabilitation.
  • Single-Leg Hop Test: This test is used to evaluate functional strength and power in the calf muscles. The patient is asked to perform a series of single-leg hops for distance or height. A significant discrepancy between the two legs indicates potential calf muscle weakness or imbalance. This test is particularly useful for athletes who need to perform explosive movements during sport, as it mimics the high-force demands placed on the calf muscles.
  • Functional Movement Assessments: Assessing how the calf muscles function during movements like squats, walking, or running is also valuable in clinical settings. Analysing gait or performing functional movement screens allows clinicians to observe whether the calf muscles are functioning optimally during dynamic activities. This type of assessment is particularly relevant for athletes and individuals recovering from injury, as it highlights any biomechanical deficiencies related to calf muscle performance.

Rehabilitation of Lower Limb Injuries: Calf Strengthening

Injury rehabilitation programs often include exercises aimed at restoring calf muscle strength, endurance, and flexibility. Isometric calf exercises can be used early in rehabilitation to improve muscle activation without placing too much strain on the injured tissue. Over time, patients progress to more dynamic exercises such as calf raises, hopping, and plyometric drills, depending on the severity of their injury and their physical goals. Green et. Al (2022) 3, break up the involvement of calf specific exercises into 4 nice stages which a patient or player should go through in order to go from day 1 to return to play. These stages are: Early loading and foundation calf and lower limb function, Loaded strengthening, loaded power, plyometrics and ballistics and finally, Locomotion.

Conclusion

Good calf muscle capacity is vital for preventing lower limb injuries and supporting effective rehabilitation. Strong and flexible calf muscles reduce the load on the knee joint by as much as 20-25%, play an essential role in stabilizing the ankle, and help prevent common injuries such as Achilles tendinopathy, plantar fasciitis, and knee injuries. Clinicians can use a variety of tests, such as the calf-raise test and MVIC, to assess calf muscle strength and endurance. By incorporating calf training and flexibility exercises into rehabilitation and prevention programs, individuals can improve their lower limb function, reduce the risk of injury, and ensure a quicker recovery following injury.

Reference List

 

  • Alshami, A.M. and Alhassany, H.A. (2020). Girth, strength, and flexibility of the calf muscle in patients with knee osteoarthritis: A case–control study. Journal of Taibah University Medical Sciences, 15(3), pp.197–202. doi:https://doi.org/10.1016/j.jtumed.2020.04.002.
  • Bohm S, Mersmann F, Santuz A, Arampatzis A.. 2019. The force–length–velocity potential of the human soleus muscle is related to the energetic cost of running. Proc. R. Soc. B Biol. Sci. 286, 20192560 ( 10.1098/rspb.2019.2560)
  • Hébert-Losier, K., Wessman, C., Alricsson, M. and Svantesson, U. (2017). Updated reliability and normative values for the standing heel-rise test in healthy adults. Physiotherapy, 103(4), pp.446–452. doi:https://doi.org/10.1016/j.physio.2017.03.002.
  • Green, B., McClelland, J.A., Semciw, A.I. et al. The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. Sports Med – Open 8, 10 (2022). https://doi.org/10.1186/s40798-021-00364-0
Runner in shorts and trainers on an outdoor athletics track
Recovering from Delayed Onset Muscle Soreness

Recovering from Delayed Onset Muscle Soreness

26 June 2024

Delayed onset muscle soreness (DOMS) is defined as ‘ultrastructural damage of muscle cells due to unfamiliar sporting activities or eccentric exercise, which leads to further protein degradation, apoptosis and local inflammatory response’ (Hotfiel et. al 2018) The micro tears caused by eccentric movements can impact performance by reducing joint range of motion and alter muscle recruitment patterns. This can increase risk of a soft tissue injury but treatment strategies for DOMS remain uncertain. Common treatment strategies include anti-inflammatories, massage and cryotherapy. Seidel et. al investigated the optimum treatment for DOMS and found non-steroidal anti-inflammatory drugs did reduce the pain but delayed the recovery.  Other interventions were examined (nutritional and physical) and found that there was a reduction in inflammation but no treatment aided muscle regeneration. (Seidel et. al, 2012)

Massage can be an effective tool to aid recovery from DOMS, however most research states the type and timing of the massage is important.  Hilbert et. al found that there was a reduction in muscle soreness 48 hours post exercise when massage is administered 2 hours after exercise, (Hilbert et. al, 2003). However, Visconti et. al found massage to be an effective tool to reduce DOMS during the onset of symptoms (Visconti et. al, 2015).

Cryotherapy has conflicting research on the effectiveness to alleviate DOMS. For example, Eston and Peters studied the use of cold-water immersion for recovery. They found 2-3 days post exercise, participants who used cold water immersion had increased joint range and reduced creatine kinase activity compared to the control group. However, both groups presented with muscle tenderness, swelling and reduced isometric strength 3 days following exercise. Howaston and Van Someren investigated the impact of ice massage therapy on DOMs, however discovered it is not an effective treatment due to only noticing creatine kinase reduction at 72 hours (Bishop et. al, 2008).

Evidence suggests adapting your exercise programme is the most efficient method to alleviate DOMS however the analgesic effect has been shown to be temporary (Zainuddin et. al, 2011). Cheung et. al suggests when exercising on a daily basis, one should reduce intensity and duration of exercise 1-2 days following DOMS. Training body parts that are less affected by DOMS and progressively overloading eccentric exercises over a 1 to 2 week period are efficient methods to manage DOMS (Cheung et. al 2003).

Reference List

Bishop, P.A., Jones, E. and Woods, A.K. (2008). Recovery From Training: A Brief Review. Journal of Strength and Conditioning Research, [online] 22(3), pp.1015–1024. doi:https://doi.org/10.1519/jsc.0b013e31816eb518.

Cheung, K., Hume, P.A. and Maxwell, L. (2012). Delayed Onset Muscle Soreness. Sports Medicine, [online] 33(2), pp.145–164. doi:https://doi.org/10.2165/00007256-200333020-00005.

Hilbert, J.E., Sforzo, G.A. and Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine, [online] 37(1), pp.72–75. doi:https://doi.org/10.1136/bjsm.37.1.72.

Hotfiel, T., Freiwald, J., Hoppe, M., Lutter, C., Forst, R., Grim, C., Bloch, W., Hüttel, M. and Heiss, R. (2018). Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletzung · Sportschaden, 32(04), pp.243–250. doi:https://doi.org/10.1055/a-0753-1884.

Seidel, E., Rother, M., Hartmann, J., Rother, I., Schaaf, T., Winzer, M., Fischer, A. and Regenspurger, K. (2012). Eccentric Exercise and Delayed Onset of Muscle Soreness (DOMS) – an Overview. Physikalische Medizin, Rehabilitation Medizin, Kurortmedizin, 22(02), pp.57–63. doi:https://doi.org/10.1055/s-0032-1304576.

Visconti, L., Capra, G., Carta, G., Forni, C. and Janin, D. (2015). Effect of massage on DOMS in ultramarathon runners: A pilot study. Journal of Bodywork and Movement Therapies, [online] 19(3), pp.458–463. doi:https://doi.org/10.1016/j.jbmt.2014.11.008.

Zainuddin, Z., Sacco, P., Newton, M. and Nosaka, K. (2006). Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Applied Physiology, Nutrition, and Metabolism, 31(2), pp.126–134. doi:https://doi.org/10.1139/h05-010.

Man raising his arm behind his head while his shoulder is assessed
The Posterior Oblique Sling

The Posterior Oblique Sling

29 May 2024

The posterior oblique sling (POS) comprises the latissimus dorsi and contralateral gluteus maximus which is connected through thoracolumbar fascia, erector spinae, multifidus and bicep femoris. This activation pattern provides stability of the lumbopelvic region by transferring force through the trunk. For insistence, erectus spinae generates force whereas the multifidus creates stability. The posterior oblique sling is thought aid recovery from lower back pain (LBP) and is often a fundamental part of rehabilitation despite minimal research on the topic (Kang and Hwang, 2019). However, most recent research suggests patients with LBP have abnormal motor recruitment in the lumbopelvic region (Kim et. al, 2014); therefore, activating the POS may offer spinal mobility, stability and prevent LBP (Kang and Hwang, 2019).

Prone hip extension (PHE) is a useful measure to assess and activate the POS. In healthy individuals, one should be able to maintain neutral lumbar and pelvic position during PHE, however patients with LBP have been found to have altered lumbar and pelvic movement. This in turn can cause lumbopelvic dysfunction, spinal instability and postural disturbance (Kim et. al, 2014). For example, Kang and Hwang found patients with LBP often have delayed onset of gluteus maximus and earlier onset of bicep femoris (Kang and Hwang, 2019).  When the gluteus maximus does not activate, there is a loss of pelvis control which can cause the contralateral latissimus dorsi to become dominant. Therefore, to aid lumbopelvic control, practitioners can manipulate the PHE to focus on the less dominant muscle (Kim et. al, 2014).

Lee et. al altered the PHE technique to assess the impact this has on POS. The PHE was compared to abdominal drawing in maneuverer prone hip extension (ADIM PHE). The ADIM PHE had increased contralateral latissimus dorsi and ipsilateral gluteus maximus compared to hip extension, whereas PHE had increased ipsilateral erector spinae and ipsilateral bicep femoris ((Lee et. al, 2020). Lee et. al also compared PHE to PHE with hip abduction and knee flexion. They discovered the contralateral latissimus dorsi, ipsilateral erector spinae and gluteus maximus electromyography was higher with phone hip extension with hip abduction and knee flexion than PHE (Lee et. al, 2019). Therefore, depending on the clinical presentation of the patient, practitioners can isolate specific muscle groups within the POS. PHE with hip internal rotation and shoulder internal rotation and shoulder extension with 1lb dumbbell was found to be the optimal PHE variation for POS activation to aid recovery with LBP (Kang and Hwang, 2019).

This research highlights the importance of using PHE as an assessment and treatment tool to identify weakness within the POS and then adapting the PHE to support recovery from LBP.

Reference List

Kang, D. and Hwang, Y.-I. (2019). Comparison of Muscle Activities of the Posterior Oblique Sling Muscles among Three Prone Hip Extension Exercises with and without Contraction of the Latissimus dorsi. Journal of The Korean Society of Physical Medicine, 14(3), pp.39–45. doi:https://doi.org/10.13066/kspm.2019.14.3.39.

Kim, J.-W., Kang, M.-H. and Oh, J.-S. (2013). Patients With Low Back Pain Demonstrate Increased Activity of the Posterior Oblique Sling Muscle During Prone Hip Extension. PM&R, 6(5), pp.400–405. doi:https://doi.org/10.1016/j.pmrj.2013.12.006.

Lee, J.-K., Hwang, J.-H., Kim, C.-M., Lee, J.K. and Park, J.-W. (2019). Influence of muscle activation of posterior oblique sling from changes in activation of gluteus maximus from exercise of prone hip extension of normal adult male and female. Journal of Physical Therapy Science, 31(2), pp.166–169. doi:https://doi.org/10.1589/jpts.31.166.

Lee, J.-K., Lee, J.-H., Kim, K.-S. and Lee, J.-H. (2020). Effect of abdominal drawing-in maneuver with prone hip extension on muscle activation of posterior oblique sling in normal adults. Journal of Physical Therapy Science, 32(6), pp.401–404. doi:https://doi.org/10.1589/jpts.32.401.

Athlete lifting a barbell in a dimly lit gym