Plantar Fasciitis, Achilles Tendonitis, Shin Splints, Calf Cramps, Knee Pain, Hip Pain, Low Back Pain… What Do These All Have In Common?
Monday, June 26, 2017 at 10:42AM
Dr. Martin Dziak in Physiotherapy, achilles tendonitis, calf cramps, hip pain, knee pain, low back pain, plantar fasciitis, shin splints, tight calves

As a population with an ever increasing number of hours spent sitting, tight calves (the muscles at the back of our leg basically above our heels and below our knees that give us the power to lift our body weight and go up on our tip toes) have never been so common.  When we are sitting our calf muscles are allowed to be in a shortened position because of the slightly plantar flexed position (especially if your foot is not flat on the ground while seated if you are of short stature) and particularly because of the flexed position of our knees.

One of the calf muscles, the longer calf muscles, the one with the most obvious definition as it is closest to the surface of the skin, known as the gastrocnemius, crosses the knee.  When our knee is flexed at 90’ in sitting, the gastrocs are in a shortened position.  The less obvious calf muscle, the soleus, which is deeper beneath the gastrocs begins below the knee, so it is not susceptible to shortening due to the knee position in sitting, but it is susceptible (as are the gastrocs) to shortening due to the ankle position in sitting if the foot is held in a slightly plantar flexed position which is inevitable if our heels are positioned slightly further forward than our knees.  In addition to the sitting position, of concern to ladies is wearing high heels.  High heels will have both your calf muscles in the shortened position whether you are sitting, standing or walking.
So what… so what if I have tight calves?  Well, there are a number of fairly common conditions that I see clinically that often have their root in tight calves!  When the calves are tight, the arrangement of the ankle bones changes and this eventually leads to fallen arches and plantar fasciitis.  The plantar fascia, a strip of connective tissue running on the sole of the foot from the heel to the balls of the feet, is actually continuous with the Achilles tendon.  The Achilles tendon is how the calf muscles attach to the heel.  This altered positioning and movement of the ankle bones often also gives rise to Achilles Tendonitis.  Tight calves also can result in cramping of the calves experienced most often at night when you are sleeping.  In bed the weight of the blankets pushes our foot down which has the calves again in the shortened position all night and that can precipitate the cramping.  Tight calves also mean the ankle may become stiff because it is no longer moving through its full intended range of motion.  The opposite muscle to the calf that pulls the foot up may now have to work excessively to achieve its function resulting in shin splints, especially with running.
The body is a biomechanically dynamic and inter-related system.  When you change the mechanics at the ankles because of tight calves, the arches in the feet fall and the shin bone rotates internally to compensate and in many individuals the thigh bone rotates externally to compensate for the change in the position of the shin.  This creates undue torsion on the knee cap often resulting in patella femoral (knee cap pain) syndrome and strain on the true knee joint which over time can cause meniscus break down and osteo-arthritis.  The changed position of the thigh bone can also result in restricted internal rotation of the hip, bursitis in the hip and early osteo-arthritis.  Moreover, the change in position of the thigh bone and the muscle tightness that ensues over time can change the position, alignment and symmetry of the pelvis resulting in eventual low back pain.  
How do I know if I have tight calves?  Well, while sitting in a chair, if you put your leg out straight and try and bring your toes towards you with your own muscle power, you should be able to bring the foot at least 15’ greater than a right angle bend.   In sitting with your knee bent to 90’ and your heel on the floor, you should be able to raise your foot into the air by at least 15’.
So, what is the answer to tight calves?  Well, there are a number of potential preventions and solutions.  The easiest is to stretch the two calf muscles (which are stretched differently by the way… the soleus is often forgotten in common calf stretches).  To properly stretch them, one should hold the stretch for a minute or longer and not stretch into pain.  Getting up from your work place for a walk to the water fountain every hour is a good idea for a number of reasons not limited to moving and stretching the calves.  If you already have a pain syndrome, orthotics may be helpful at alleviating your fallen arches when you are weight bearing, but in the absence of proper stretching, the orthotics are unlikely to be an adequate stand- alone treatment.   Ladies, limit your time in high heels.  For ergonomic reasons, sit – stand work stations are becoming more popular and this will help reduce the risk of tight calves.  Even basic ergonomic modifications to your sitting work station can be effective (your feet should be flat on the floor in sitting at your desk… if you are short and this is not possible, you should have a foot rest a few inches high under your desk).  If you have tried these suggestions and still have pain that you believe may be related to tight calves, it is time for you to see a physiotherapist.  Over my 20 years of clinical experience, I have found acupuncture and micro-currents to be very helpful in loosening and lengthening the calf muscles when combined with a stretching routine that addresses both the gastrocs and the soleus.  In some circumstances a restriction in the ankle joint may be the cause of tight calves or the limiting factor in alleviating tight calves.  I have great success with ankle joint mobilization and manipulation when this is the case.
Lee Quenneville
Registered Physiotherapist
Orthopaedic Acupuncturist

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