Gastrocnemius and Soleus Manual Static Release

Differentiation

1. The medial and lateral head of the gastrocnemius are superficial muscles that extend from the knee down to about 1/3rd the length of the lower leg.
2. Approximately half the soleus lies deep to the gastrocnemius , but the lateral edges of the proximal half of the muscle can be palpated, as well as the distal half which is superficial as it invests in the Achilles Tendon.
3. The fibers of the gastrocnemius and soleus course vertically from the Achilles tendon to the knee .
4. If you are new to palpation and the differentiation between the gastrocnemius and soleus does not seem obvious, it is possible to note the difference in gastrocnemius contraction strength (density) during standing and sitting calf raise.
5. During a standing calf raise both the gastrocnemius and soleus will contract hard, whereas during a seated calf raise the soleus will contract hard, but the gastrocnemius will seem soft in comparison. Note, doing a seated calf raise with more than 90° of knee flexion will aid in putting the gastrocnemius in a position of "active insufficiency" and aid in further reducing gastrocnemius activity.

Potentially Sensitive Tissues

• Although the posterior tibial vein, artery, and nerve lie deep to the calf, they are well protected by layers of muscle and fascia. Further, these structures are nestled in-between the tibia and fibula. The sensitive structures most likely to be insulted during calf release techniques are the peroneal nerve when addressing a soleus trigger point that lies near the fibular head, and the possible stretching of branches of the sural cutaneous nerve when searching the gastrocnemius for trigger points.

Trigger Points

• Common gastrocnemius trigger points are in the middle of the muscle bellies of the medial and lateral head.
• Common soleus trigger points occur just medial the fibular head, and in the middle of the muscle belly - between the distal ends of the heads of the gastrocnemius .

Release Technique

1. Start with the patient in prone, standing at the foot of the table.
2. The patient's feet should be dangling off the end of the table so that both feet may be pressed into end-range dorsiflexion without pressing the top of the patient's foot into the table.
3. Identify the gastrocnemius and soleus , taking a moment to differentiate between the head of the gastrocnemius , the lateral border of the soleus , and the musculotendinous junction with the Achilles tendon.
4. Use a thumb over thumb hand position to press into the fascicles, and use medial to lateral strokes (perpendicular to the fiber direction) to identify taut bands in the tissue.
5. Once a taut band is located, explore the length of the band for dense nodules.
6. Apply consistent pressure. Adding a distal to proximal, and a small amount of dorsiflexion using your thigh, to the compression applied by your thumbs may aid in pinning the dense nodule.
7. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).