Gastrocnemius Tendinopathy

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Your calf muscle consists of two main muscles, which are the gastrocnemius and the soleus. Because these two muscles come together above your heel and attach to the Achilles tendon, some providers refer to the gastrocnemius and soleus as one of the large muscles with two different sections. Additionally, a small muscle called the plantaris runs between the gastrocnemius and soleus down the length of the lower leg. Most doctors call these three muscles the triceps surae.

Below are the two main muscles:

  • Soleus – The soleus is a wide, flat muscle that sits slightly deeper than the gastrocnemius. It begins below your knee, runs down your lower leg, and connects to the Achilles tendon above the heel. Soleus injuries are much less common because the muscle only crosses the ankle joint.
  • Gastrocnemius – This muscle is under your skin at the back of your lower leg. Because the gastrocnemius is near to the skin’s surface, you can commonly see its outline. The top part of the gastrocnemius has two heads that start on the inside and the outside of the femur. The gastrocnemius goes down the back of the leg and attaches to the Achilles tendon. Gastrocnemius strains are common because the muscle connects to two joints (the knee joint and the ankle joint).

The general function of the gastrocnemius muscle is to plantarflex your ankle. This means that as your gastrocnemius muscle contracts, your ankle and toes point down. When walking, running, or climbing stairs, the muscle works to flex your ankle and propel you forward.

Gastrocnemius tendinopathy is inflammation of the gastrocnemius tendon where it originates from the back of the knee joint. It is normally the result of overuse of the gastrocnemius tendon. This specific tendon sends forces from the large gastrocnemius muscle right to the femur. Additionally, repetitive use of the gastrocnemius muscle and tendon may cause microscopic tears within the tendon.

Causes & Symptoms

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Gastrocnemius tendinopathy can be caused by activities involving the overuse of the medial area of the calf muscle. It is an acute injury that occurs when the calf muscle is abruptly overstretched, thus causing swelling and inflammation. This can also cause small tears in the calf muscle fibers.  Gastrocnemius strains and overuse often happen during sports or exercise activities that involve sprints or jumps.

It is one of the common types of calf muscle pain. Some people / athletes may hear a pop when the injury occurs, and you may not feel pain at the moment. Typically, pain sets in after you take a few steps, and it can be described as a sharp or tearing sensation. If the pain is severe, there may be swelling and bruising around the area. In some cases, the pain may be too intense to walk.

Usually, you may feel a “stricken” sensation in your calf once you have experienced inflammation. Accompanying this feeling is an audible pop or snap when the pain to the back of the calf occurred is normally reported. Other symptoms usually develop gradually and include the following:

  • Pain – After the first few hours of developing gastrocnemius tendinopathy you may feel intense pain located at the back of the knee.
  • Tenderness – You will feel a great amount of tenderness when pressing in at the origin of the muscle, behind your knee.
  • Limited range of motion – It is likely to be very painful when you perform a straight leg calf raise exercise. This can lead to a decreased range of motion, which may limit your calf movement. In addition, hopping on your injured leg will also be painful.
  • Bruising and swelling – There may be obvious signs of swelling and bruising due to overusing your gastrocnemius tendon.

Who gets Gastrocnemius Tendinopathy?

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Anyone can overuse their gastrocnemius tendon. However, these injuries are more common in athletes who perform lots of stop-and-go movements with quick bursts of speed. Sprinters, football players, soccer players, and tennis players are prone to calf muscle injuries. Other types of risk factors for gastrocnemius tendinopathy include:

  • Gender – Studies have shown that men are more susceptible to get gastrocnemius tendon injuries than women.
  • Age – People over the age of 40 may be more prone to get inflammation in their gastrocnemius tendinopathy due to general wear and tear (osteoarthritis).
  • Lack of conditioning – Athletes who do not warm up before sports activities will most likely experience early inflammation located at the back of their calf muscles. It is important to warm up and stretch before physical activity and condition your muscles before the start of a sports match.
  • Muscle quality – People with tight or short calf muscles have a higher risk of gastrocnemius tendon strains.
  • Improper footwear – Wearing incorrect or poorly fitting footwear can increase your risk of injuring your gastrocnemius tendon.

How Does it Affect You? How Serious is it?

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In severe cases, some patients may surgically require the gastrocnemius tendon to be released to avoid further chronic pain that can lead to infection. This surgery is known as a gastrocnemius release. A gastrocnemius release lengthens the gastrocnemius tendon. This is done to increase the flexibility of the calf muscle, which can decrease pressure at the front of the foot, improve function, and decrease deformity.

After a gastrocnemius release, some patients experience nerve injury that results in irritation or numbness over the outside of the heel. This type of symptom is usually temporary, however, some patients may also notice a difference in the appearance of one calf compared to the other and temporary calf weakness.

In addition, all surgeries require incisions (cuts that allow surgeons to open an area of the body and make repairs). Therefore, this means there is a chance of infection but with a low percentage of it happening. When infections do arise, however, they are considered serious. That is why it’s very important to follow the care instruction given to you by your doctor, including keeping your wound clean and dry and taking any prescribed antibiotics.

Recommended Treatment & Rehabilitation

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During a diagnosis for gastrocnemius tendinopathy, a healthcare provider will begin by performing a physical exam and reviewing your symptoms. It is important to describe in detail how you developed the condition and how your calf feels. You may need additional imaging tests to help determine if there are any partial or complete tears in your calf muscles (gastrocnemius tears). These tests can also rule out other conditions that cause lower leg pain, such as Achilles tendonitis or deep vein thrombosis. Therefore, he or she will perform the following tests below:

  • Magnetic Resonance Imaging (MRI) – These are used to check for any blood clots tears, or internal bleeding present in your affected area.
  • Ultrasound – This type of imaging test is used to check for tears or fluid buildup around the calf muscles.

If somehow you experienced a tear in your gastrocnemius tendon, your doctor might classify a grade for you depending on how severe the injury was due to overuse:

  • Grade 1 – A grade 1 injury is mild, and people usually experience sharp pain during and / or after activity. There may be microscopic tears in the muscle. Recovery from a grade 1 injury takes approximately 2-4 weeks.
  • Grade 2 – A grade 2 gastrocnemius injury is moderate. These people experience pain while at rest and are unable to continue any usual activity. There is partial tearing of muscle fibers and full recovery can take 4-8 weeks with proper treatment.
  • Grade 3 – Grade 3 injuries are the most severe with complete tearing of muscle fibers. People with grade 3 gastrocnemius injuries experience severe, constant pain. Full recovery can take 3-6 months and a gastrocnemius release may be required.

After you have finished a diagnosis with your doctor, a physiotherapy session may be advised for further treatment plans. A physiotherapist will be able to design a targeted program to speed your recovery. Therefore, some of these treatment plans may include:

  • Patient education – Your physiotherapist will work with you to identify and change any external factors causing your pain. The type and amount of exercises you perform, your regular daily activities, or your footwear may be discussed. Next, your therapist will recommend improvements to your activities and design a personalized exercise program to help ensure a pain-free return to your desired activity level.
  • Pain management – Your physiotherapist will develop a treatment plan to address your pain that includes applying ice to the affected area. He or she may also use ultrasound, electrical stimulation, and other methods to help manage your pain. Your therapist may recommend decreasing some activities that cause pain.
  • Range-of-motion exercises – Inflammation due to overuse can decrease your ability to use your full range of motion. Your physiotherapist may teach you movement techniques to restore normal motion in your calf muscles.
  • Muscle-strengthening – Muscle weaknesses or imbalances can contribute to gastrocnemius tendon pain. They can also be a result of your injury. Based on your condition, your physiotherapist will design a safe muscle strengthening program just for you. It will likely include your core and lower body muscles. Your therapist will choose activities that are perfect for you based on your age and physical condition.
  • Manual therapy – Your physiotherapist may use hands-on treatments to gently move your muscles and joints. These techniques help improve motion and strength. They often address areas that are difficult to treat on your own.
  • Functional training – Once your pain, strength, and motion greatly improve, you will need to safely return back to your activities that involve more demanding movements. To reduce tension at the back of your calf muscles, you must learn safe, controlled movements. Therefore, your physiotherapist will create a series of activities based on your unique condition to teach you how to move correctly and safely.

Below are a few great exercises that are specifically targeted to your gastrocnemius tendon. Performing the following methods below will provide a recovery boost when developing tendinopathy located in your calf:

 

Band stretch

In the seated position, loop a resistance band or a towel around the ball of foot on the injured side. Next, gently and steadily pull on the band or towel whilst keeping your knee straight. You will feel the stretch in the calf muscles in the back of the leg. Hold the stretch for 20 seconds before repeating it 5 times a day.

Stair stretch

Begin by standing on a small step or the bottom stair of a staircase. Hold on to the banister or rail to help maintain balance. Then, take your injured foot and place it just behind you so that the ball of the foot remains on the step but the heel hands over the edge of the step. Keeping the knee of your injured side straight, lean your body weight through the injured leg, and allow the heel to sign below the level of the step. As the heel sinks lower, you will feel the calf muscles stretch in the back of the leg. Hold this position for 20 seconds and then relax before repeating it 5 times a day.

Wall stretch

Begin by standing upright facing a wall over an arm’s length away. Take a large step forward with your uninjured leg and place your hands on to the wall. Now, straighten the knee on your injured leg whilst keeping the heel flat on the floor. Then lean your body towards the wall so that you feel a stretch down the back of your calf. Hold this position for 20 seconds and repeat 5 times a day.

Alternative & Homeopathic Treatment

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Immediate homeopathic treatments for gastrocnemius tendinopathy typically includes the RICE principles, which stands for:

  • Rest – Avoid physical activity that involves the use of your calf in order to reduce further recurrence.
  • Ice application – Apply an ice pack or cold compress for 20 minutes every two hours.
  • Compression – Reduce swelling and fluid buildup by applying a compression bandage or wrap to the injured area.
  • Elevation – Lift your leg into an elevated position, preferably above the level of your upper chest. This is used to increase blood flow within your injured area for a better recovery.