Kinesiology THURSDAY – Getting To The Root of Recurrent Calf Strains

Calf muscle strain injuries (CMSI) can occur in any sport involving running, with a reported recurrence rate of 19-31%. If you consider strains occur when a muscle is loaded in a long weak position, it is valuable to understand what that position is and what predisposes one it.
Let’s talk about the position first. If you look at the gastrocnemius, the fully stretched position would be: ankle dorsiflexion, femoral internal rotation (for lateral head), femoral external rotation (for medial head). Excessive femoral internal rotation would tend to occur with weakness in the gluteus maximus or tightness in the medial gastrocnemius (check for trigger point). Excessive femoral external rotation would occur with weakness in the anterior gluteus medius or trigger point in the lateral gastrocnemius (more common).

If you look at the soleus, the fully lengthened position would be: ankle dorsiflexion and tibial internal rotation. Excessive tibial internal rotation would occur with a tight medial hamstring (test and fix with the triangle pose) or a lack of ankle dorsiflexion (test with calf stretch with knee flexion and rotation opposite).

An article discussing the kinematics of male runners with recurrent CMSI noted some key things that seem to coincide:
- Increased in contralateral pelvic drop during mid stance
- Increased anterior pelvic tilt and hip flexion during mid stance
- Longer stance time
- Greater distance between the heel and center of mass at heel strike
Kinematics | Possible Cause | Test | Intervention |
Contralateral pelvic drop | Weak gluteus medius | Side plank | Mini-band lateral step; side plank |
Anterior pelvic tilt | Weak gluteus maximus | Ant cone touch | Walking anterior lunges; Lateral low rows |
Longer stance time | Weak quad, glute max or glute med | Single leg wall sit (quad); ant cone touch (glute max); side plank (glute med) | (The test becomes the fix) |
Greater distance between heel and center of mass at heel strike | Weakness of the opposite lower extremity (lack of push off in late stance), causing over reach to lengthen stride | Test opposite quad and glute strength (see above) | (The test becomes the fix) |
Solving recurrent CMSI
Risk factors for recurrent CMSI are repeatedly listed as: age and previous lower extremity injury. But it is the kinematics of injury that can lead one to real solutions for this problem. That might seem like a lot to have to consider, but testing the key factors only takes a few minutes. Your time will be worth it to you and your patients.
Because nobody has time to be in pain.
Until next time…

Kind Regards,
MoveWell Academy
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