Techniques For The Calf Area32

The calf area is often involved in conditions of dysfunction in the foot and the knee. Conditions of the calf muscles themselves such as muscle tears and direct trauma sometimes need addressing. Contracture due to postural conditions and occupational disorders can also occur.

Particular care should be taken in phlebitis or varicose vein cases where there is the possibility of thrombosis, haemorrhage and haematoma formation. If a clot is present, there is a distinct possibility of it being shifted and subsequently lodging in heart, lung or brain with potentially disastrous results.

Technique to be used on the soft tissues can be cross-fibre, stretching or muscle energy.

It is performed with the knee extended to reach the gastrocnemius, and flexed to take the gastrocnemius off stretch and make it easier to reach the deeper muscles. Calf muscles are closely concerned with posture, which means that there may be only partly reversible contracture and fibrosis present. Techniques should usually be slow and deep to produce the best result. Control of rhythm is also important. There may be remote causes of calf muscle hypertonicity, such as nerve root pressure in the lumbar spine or circulatory deficit in the arterial supply. Initial attention to these extraneous causes should be considered to get the best result from any later work on the calf.

32.1 • Kneading of lateral calf supine Sit on the end of the table, stabilizing the patient's foot by resting your thigh on it. Hold the ankle to prevent movement of the leg. Apply deep cross-fibre kneading to the calf muscles with the pads and tips of the fingers.

Tips: Most useful where it is necessary to reach the lateral muscles of the calf. Extra considerations: Try varying the angle of knee flexion and rotation.

32.3 • Kneading of medial part of calf supine

Sit on the table stabilizing the patient's foot with your thigh. Hold against the knee with your stabilizing hand. The medial aspect of the calf is available to the fingertips of the kneading hand.

Tips: Most useful when working on the musculo-tendinous junctions deep in the calf. Try varying the angles of knee flexion and rotation to achieve the optimum for the technique.

32.2 • Kneading of lateral calf supine Sit at the end of the table. Stabilize the patient's foot with your thigh. Fix the knee with one hand and knead the muscles around the fibular head with the other.

Tips: Most useful when it is necessary to stabilize the knee when working on the upper part of the calf. Extra considerations: Try varying the angles of flexion and rotation of the knee to vary the tension on the muscles before the technique is applied.

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