In this weeks post we’re going to be picking up where we left off last week – the superficial posterior compartment. More specifically we’re going to be digging deeper and talking about what to do when you are stuck battling tight calves. The way I see it, there are essentially two varieties of this: 1) a new calf strain/injury and 2) chronically tight/on again off again symptoms. The first variety means that you have real symptoms that are either keeping you from training/racing or definitely limiting those activities. The second variety means that for the most part your symptoms aren’t severe enough to stop you from training/racing, but they are persistent. I would even place you in this category if you were someone who has had repeated or “annual” calf pulls.

Just to be clear, this post is all about problem solving the second variety. What it’s not talking about are acute/sudden onset injuries where you felt a pop, pull, or sting and are now experiencing brand new symptoms in the form of pain, swelling, bruising etc. That type of injury was covered in detail here (hint hint: this includes a doctor to see what you’re dealing with in terms of severity!).

Evaluation

(here is a PDF sheet you can download and print as you go through all of this. 🙂

That being said, the first place to start is with an evaluation. Any time you have symptoms that persist for long periods of time or become on/off or seasonal, the first step should  always be to address mobility/range of motion. Even if you have perfect mobility before things tightened up, you can be sure that things have changed as compensation started. Because the calf plays such a big role in both phases of the gait cycle (shock absorption/surface adaptation and propulsion), this includes stepping back to look at both ends of the leg chain. It also includes looking at how everything moves in isolation, as well as, how it all moves together.

#1 The Foot

As you’ll remember from our foot self evaluation post, we not only broke the foot up into three parts (rear, mid and fore), but we also broke the toes down into three groups as well (big toe, middle 3 toes and pinky/little toe). The reason for this was to make the intrinsic muscles easier to visualize instead of the more confusing muscle layer approach.

I like to start by looking at the toes as they are the end goal for propulsion. From start to finish we are moving over our feet from outside to inside to get to that big toe. If we can’t get there, then what’s happening upstream really doesn’t matter as it will only ever be compensation.

Evaluation checklist:

 

• Sitting, ankle relaxed: using the first toe joint, look at how the big toe, middle toes, and little/pinky toe flex and extend. Make sure you look at each independently! This is your baseline (pictured above, missing little toe).
• Sitting, pull ankle back into dorsiflexion: recheck extension (pulling toes back). Did the movement change when you moved the ankle?
• Sitting, point ankle down into plantarflexion: recheck flexion (pushing toes down). Did the movement change when you moved the ankle?
• As you go through these motions try to keep the toes straight. This will help keep the focus on the intrinsic muscles versus the long, extrinsic tendons. What we really want to see is how the toes move and how that movement changes with ankle movement.
• If this is at all confusing, here is a video you will find helpful!

 

#2 Mid-Foot

From the toes (forefoot), we move to the midfoot. Measuring range of motion here is trickier, however, and best done by a professional. The reason for this is because that professional would be measuring things like midtarsal joint mobility, metatarsal alignment, subtalar joint mobility, first ray mobility, etc etc.

Instead, let’s focus on what we know and what we can see on our own. Problems in the midfoot start when the foot is unable to make the transition from it’s adaptive/shock absorption phase to it’s rigid lever/stable platform phase. Think of it like a Rubik’s cube.

 

In the beginning, you want each row to be mobile and it really doesn’t matter if the colors are in the right place. As you move forward over that foot and ankle, however, you want everything to line up and lock into place so that you can forcefully push off of that foot. This takes time and coordination as muscles and joints (both above and below the ankle) all work together to screw home each piece. If that doesn’t happen, then you never get to that “stable” position.

 

 

An unstable foot is essentially part of the foot going one way and the rest going the other way. Then it’s a question of whether your foot has gotten stuck like that over time (rigid) or if it’s moving too much to try and compensate (flexible). Either way, you have a foot that is compromising the efficiency and power behind your push off. This is why going by arch height alone is often misleading and why shoe selection advice is so conflicting. It’s not about the arch alone. It’s about how all of the pieces of your foot are working together.

Sooo… if we can’t measure this on our own, how do we know if we have problems here? That’s easy. We pull our socks off and look at our callus patterns.

 

Evaluation checklist:

• By no means is the picture above comprehensive when it comes to calluses. What we’re looking for are clues that our foot is rotating more than it should as it struggles to get to that big toe and stabilize itself before push off.
• In a foot that is unable to roll all the way in to that big toe, it’s common to see the first metatarsal (aka the first ray) compensating. That’s what the picture above is trying to show you. There are three different callus patterns (blue, red and green in the picture above) that we typically see when the first ray is problematic.
• Larger, more diffuse calluses under the complete ball of the foot (teal circle) indicate ankle restrictions. Instead of pushing off of your foot, you are rolling off of it.
• Another pattern not shown above is a callus under the 5th toe. If you are getting stuck on the outside of your foot and not rolling in to the big toe, it’s very common to see a callus there.

Another test is to look at a barefoot heel raise to see how stable the foot is when we go to push off of it.

Evaluation checklist:

• When looking at the heel raise we are looking at two things: 1) Is there even weight through the ball of the foot from big toe to little toe, and 2) is the Achilles Tendon straight up and down.
• As you set up for this, focus on spreading your toes out first. Straighten your knees and slowly raise up onto your toes. As you do so do you find yourself falling to the outside of your feet like the middle picture or do you find yourself mostly on your big toe like the last picture?
• Once you do both feet, repeat again on one foot. Is your balance good or are you off balance right out of the gates? Is one foot better than the other? Can you not even do it?

#3 Rearfoot + Ankle

Next up we’re going to combing the rear foot and ankle. If you remember from our self evaluation posts, by rearfoot I mean the subtalar joint (aka where the talus and calcaneus meet). This is the joint directly below the ankle joint itself. An easy way to visualize it is as the two joints sitting one on top of the other. The ankle joint moves up and down in dorsiflexion and plantarflexion, while the subtalar joint below it is responsible for inversion/eversion and is controlled by the long extrinsic muscles we’ve been talking about.

While it’s easy to focus on the ankle, it’s important to realize that the subtalar joint is just as active throughout the gait cycle. As the foot lands the joint pronates and adducts to help make the joints above and below more efficient. This is essential for shock absorption and that surface adaptation we were talking about. As we move forward over the foot, the joint then starts to supinate as we prepare for push off. This helps stabilize and screw home the mid foot joints so that we have a rigid platform to propel off of.

If the subtalar joint moves too much or too little, this will directly impact the ankle and vice versa! The problems will also trickle down stream into the foot as it will be left scrambling to make up for the rear foot being out of position.

To take a look at the subtalar position, we’re going to do a prone lying test. All you have to do is lay on your stomach with your feet hanging off the edge. If there are muscle restrictions in the extrinsics (long tendons responsible for inversion and eversion), you will be able to see it here.

Evaluation Checklist:

• Laying down on your stomach, how do your feet naturally lay?
• Do your feet point down to the floor like in the first picture (further left)? Or are they tilted in like the second? Or tilted out like the third?
• If they’re more like the second or third pictures, step back and look at the whole leg? Is it just the ankle/foot that’s tilted or is the whole leg rotated?

Next, let’s look at how the ankle moves into dorsiflexion:

Evaluation checklist:

• Sitting, knee straight + heel down.
• Standing, knee straight + heel down
• Half kneeling, knee bent + heel down ( ** make sure that the knee goes over the toes, not inside or outside**). How does this compare to when you did it standing up?
• Is the restriction you feel up in the muscles or is it pressure in the ankle itself? Or somewhere else entirely (the hip for example)?
• Do you find your feet wanting to rotate in or out when you try to do this?
• Is one side worse than the other?

#4 Knee

This area is pretty straight forward but often overlooked when it comes to chronic calf problems. The key is to focus on the back of the knee. You have the two heads of the gastroc, the plantaris, and three hamstring tendons all criss-crossing back there. Restrictions in either group will 100% impact the other. Prolonged restrictions here will also result in a loss of full knee extension. A few degrees here or there may not seem like a bad thing, but the front of your knee and hip will definitely disagree.

Evaluation Checklist:

• Full extension + heel up. Press the back of your knee down into the floor first. Keep it glued there and try to straighten your knee all the way, lifting the heel off the floor. Your ankle is relaxed.
• Repeat, except pull the ankle back first before lifting the heel up. The setup is the same. Get the back of your knee down and then get the heel up.
• How did your mobility change between them? Were you able to get your heel off the floor at all?

#5 Hip

Like the knee, this area is also more straight forward. Then again, isn’t everything compared to the complicated foot?? 🙂 Anyhow, when it comes to the hip we want to make sure that a) it can move into and out of flexion and extension and b) that it is rotating normally both internally and externally. The hip flexion/extension component is well documented and easy to see as an athlete. What’s less talked about is the rotation component.

As we walk and run, there is a large amount of rotation through the hips due to the fact that one leg is always swinging through. For example, as we weightbear on one leg, that leg is rotating in until mid-stance. As the other leg starts to swing, the weightbearing leg is then rotating out, storing energy to push off and let that leg swing through. Restrictions in rotation can eliminate that free energy and make us work when we should be relaxing.

 

 

• Hip extension in prone. Keep hips flat and pressed into table/floor. Knee straight. Squeeze your glute and lift the leg up. You should be able to lift your leg up about 10 degrees without rolling or lifting the hip up.
• Hip extension in half kneeling. Start in a lunge position. Squeeze glutes and then push hip forward. Be careful not to let your pelvis fall forward. Activating the glutes will help with this and keep you from getting the motion from your spine instead of your hip!! If you have a friend helping, have them make sure you aren’t arching your back too much.
• Repeat step two only this time reach back to bend your knee/grab your ankle first like in the second picture. Then again, squeeze the glutes and push forward with the front of your hip.
• How does the movement change from position to position? Do you feel a stretch in the muscles or does the movement just feel blocked? Do you feel pressure in the joint?
• To look at rotation, let’s start in sitting. The key is to keep the back of your thigh flat. Use your hands to hold the thigh in place. Then you’re going to rotate the leg in and out as shown in the third picture. Make sure you stay seated without lifting up to try and get more motion.
• Is one direction easier than the other? Are both legs the same?

Just in case you missed it, here’s the PDF checklist sheet! When you go through the self evaluation, make sure you do it for both legs not just the symptomatic one! You will need a helper for a few of these. 🙂

So that’s it for your little self evaluation! In part two of this post, we’re going to put all of this together so that you know what to work on and how!

Click here to continue to Treatment- part one

 

In this weeks post, we finish up our posts on the intrinsic and extrinsic muscles of the foot. My rationale for going muscle by muscle and layer by layer is show you how many things can actually be contributing to your injury. It’s also why I saved the most popular muscles for last. By now you should already be thinking are these muscles really the problem or is my chronically tight calf a reflection of something else?

During the foot self evaluation we talked about three areas of the foot and how they work together in terms of normal gait. Each step starts with impact to the rear foot. From there the midfoot and forefoot play two roles. The first is to create a mobile and flexible foot that is capable of adapting to the surface you are walking on. This is what shock absorption is all about and what allows us to move on even and uneven terrain without thinking about it. The second role is to take the energy absorbed from impact and use it to create a stable lever for us to powerfully push off of. This takes time which is where the soleus and gastroc come in. They slow down our forward movement over our feet to allow things to lock into place. They also transfer work up the leg, setting up the big muscles in the thigh and hip.

Before we get into all of that, let’s start we always do- with the anatomy! There are three muscles in this compartment: the gastroc, the soleus, and the plantaris.

#1 Gasctrocnemius

 

• Let’s start with the obvious. The gastroc is a BIG muscle. It has two separate heads and attaches to the Achilles tendon. Picture the two heads like two hands. They cross the knee joint and wrap around the two big knobs (aka the femoral condyles). The two heads then meet together in the middle where they attach to the achilles.
• Anatomically, the big take away from the attachment points is that the gastroc moves not one, but three joints. It is responsible for plantarflexing the ankle, inverting the foot at the tarsal joints, and flexing the knee. Those are the common functions listed. However… this muscle also plays a role in rotation. As we come forward over the ankle the tibia is rotating externally. This is in part because the other leg is swinging forward, but it is also to help improve range of motion and mechanical efficiency in the foot and ankle. To decrease the torsional strain on the knee, the gastroc helps by rotating the femur in as well.
• Another lesser known function is that the gastroc helps push the knee up, helping to promote normal clearance as we start the swing phase. This happens because as we load the gastroc and lift the heel, the gastroc has the dual function of bending the knee and plantarflexing the ankle. In other words, it propels us forward, but also pushing that knee up and out of the way. Without it, the hip flexors have to physically pull the leg up and forward (which they are not designed to do).
• Bottom line? Chronic calf pain/tightness means a shortened stride/pedal stroke/etc. Not only do you have to loosen that muscle up, but you need to find out what is keeping you from getting to that end stage of motion. Is it because the foot and ankle are preventing you from getting there or is it because of restrictions in the hip. Either way… the calf is getting stuck in the middle.
• As you can see in the picture above, there are two pain referral areas for this muscle, one for each muscle head. The medial head as a much bigger area due the muscles role in rotation.
• Trigger points/restrictions in this muscle are commonly misdiagnosed as posterior compartment syndrome, Achilles tendinitis, bakers cyst, and referred S1 pain from the low back.
• The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

#2 Plantaris

 

• In your googling, you may have encountered “the triceps surae”. It’s a term that refers to the three muscles in this compartment. The gastroc and soleus should be familiar. The third refers to this little muscle- the plantaris.
• This muscle sits beneath the gastroc, but above the soleus. As you can see in the picture, the muscle belly itself is small while the tendon is very long. It wraps around the lateral femoral condyle and crosses to the inside of the achilles where it attaches to the calcaneus (heel).
• In terms of function, it acts with the gastroc, though it is neither a major knee flexor or ankle plantar flexor. This is because of it’s size in relation to the larger gastroc and soleus.
• This muscle is commonly injured and even ruptured with quick directional changes or accelerations. In other words, if the foot is planted and you quickly rotate or push off it, that torsion can result in an injury if forceful enough. This is common enough in tennis that a torn plantaris has been named “tennis leg”. Typical symptoms include and sharp pain/stinging in the upper calf/back of the knee and swelling/bruising. If you have any of those symptoms, time to see a doctor to see what you’re dealing with!
• Because this muscle is in between the others, restrictions here will impact the layers above (gastroc) and the layer below (soleus).
• The common pain referral area for this muscle due to trigger points/muscle restrictions is the purple circle pictured above.
• Problems in this muscle are commonly misdiagnosed as posterior compartment syndrome, bakers cyst, and achilles tendinitis.
• The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

#3 Soleus

• Last but not least- the Soleus!
• While the gastroc often gets top billing in the calf, the soleus is equally important. The main difference between the two lies in it’s attachments. The soleus does NOT cross the knee joint. It originates on the fibular head, upper fibula and the tibia and travels down to join the Achilles tendon.
• This is why when you stretch the gastroc you keep the knee straight and when you stretch the soleus you keep the knee bent.
• Function wise, the soleus is responsible for plantarflexing the ankle and inverting the foot at the tarsal joints. It is also responsible for slowing down the movement of the tibia over the ankle. As stated above it also assists with rotating the tibia in to promote knee flexion and increased shock absorption from the quads. As the foot changes gears to prepare for push off, the soleus then reverses this rotation and helps position the subtalar joint to create that rigid platform to push off of.
• The common pain referral area for trigger points/muscle restrictions in this muscle include the purple area above, as well as, two areas not pictured. The first is the bottom of the foot along the entire heel. The second is up in the back of the hip at the SI joint (with your hands on the top of hip bones, it’s the area where your thumb falls. It’s also the location of the “dimples” in your low back.)
• Problems in this muscle are commonly misdiagnosed as posterior compartment syndrome, posterior shin splints, plantar fasciitis, and heel spurs.
• The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

Video #1 : How to find and stretch these muscles

Initially I had planned to make this into a mega post, but I changed my mind! Instead I’m going to make next weeks post all about evaluating and treating calf injuries with new videos and self evaluation tips. Stay tuned!

One of the big things to remember as we make our way through the extrinsic muscles is that they ALL control not one, but two joints – the ankle (talocrural) joint and the subtalar joint. These two joints are essentially stacked right on top of each other. This is important because it’s the long tendons of the extrinsics that determine the position of the subtalar joint. Whether the muscle is stuck in a long or short position, it will 100% impact how the foot lands and how the ankle and foot function in terms of shock absorption, stability, and propulsion.

Last week we talked about the peroneals and their role as everters of the foot. This week we will be shifting our focus to their counterpart- the muscles responsible for inversion. They also play a huge role in supporting the medial arch and stabilizing the foot to prepare for push off. Like the peroneals, problems/restrictions in these muscles are a sign of bigger problems elsewhere in the leg chain. Before we dive into all of that though, let’s talk anatomy!

While the peroneals wrap around the lateral malleolus on the outside of the ankle, the three muscles found in the deep posterior compartment, wrap around behind the medial malleolus (the inside ankle bone). They are commonly referred to as the “Tom, Dick and Harry” muscles (Tom – tibialis posterior, Dick- Flexor digitorum longus, and Harry- flexor hallicus longus). A reason that this nickname is helpful is that it tells you the order you find the tendons behind the bone. The tibialis posterior is the first tendon to wrap behind the malleolus while the flexor hallicus longus is the last.

#1 Tibialis Posterior (aka Posterior Tib)

• The tibialis posterior muscle is the deepest of the three muscles found in this group. It originates off of the upper tibia and fibula and travels down the lower leg before crossing over behind the medial malleolus and wrapping around the arch to attach to the bottom of the foot.
• The attachments on the sole of the foot are important! This muscle attaches to almost everything (middle three metatarsals and every tarsal bone in the foot except the talus). Cadaver studies have also found a large of amount of variability in terms of intrinsic muscle attachments to this tendon. My point? Problems on the bottom of the foot ALWAYS warrant a look at the posterior tib muscle.

 

• In terms of function, the posterior tib is the primary stabilizing force in the midfoot. It works throughout the gait cycle to help shock absorb and adapt to the ground surface and then switches gears to stabilize the foot to create a solid platform to push off of.
• It’s official function is to plantarflex the ankle and to invert the foot.
• Like the peroneals, the post tib is a common injury site. Problems here will start as pain/swelling in the arch and if allowed to continue will develop into deformities in the foot where the heel everts and the forefoot abducts. In other words, instead of that stable foot you want, you end up with a flexible foot that decreases the efficiency of the entire leg.
• The common pain referral areas is the purple circle pictured above. This area extends to include the entire plantar surface of the foot (not shown in the picture above).
• Problems in this muscle are commonly misdiagnosed as compartment syndrome, tarsal tunnel syndrome, and medial shin splints.
• The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

#2 Flexor Digitorum Longus (FDL)

• The FDL is the innermost muscle in this compartment, lying above the posterior tib. It starts on the tibia and follows the same path down the leg to wrap behind the medial malleolus.
• Unlike the posterior tib which has no direct intrinsic attachments, the FDL has two attached to it as it travels to toes 2-4 (the four lumbricals and the quadratus plantae). That means that restrictions in either will directly affect the other!

 

• The FDL muscle is responsible for flexing toes 2-5, plantarflexing the ankle and inverting the foot. The toe flexion part is a little misleading. A more functional way to think of this is that when the FDL contracts, it helps keep those toes on the ground to help increase the base of support and subsequently your push off.
• The common pain referral area for this muscle is pictured above. Like the post tib, this area extends to the bottom of the foot where it is follows the tendon path.
• Problems in this muscle are commonly misdiagnosed as posterior compartment syndrome, tarsal tunnel syndrome and medial shin splints.
• The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

#3 Flexor Hallicus Longus (FHL)

 

• Like the FDL, the FHL is also superficial to the posterior tib which is the deepest of the three muscles. However, the FHL starts on the fibula, traveling down the back of the leg and crossing over to wrap behind the medial malleolus.
• This muscle is responsible for flexing the big toe, plantar flexing the ankle and inverting the foot. It has no intrinsics attached to it.
• Again, think of the toe flexors as helping to keep the toes on the ground to provide a wide base of support. These muscles also assist in slowing down the bodies movement over the ankle (dorsiflexion) to assist with heel off. These two functions help provide an efficient and powerful push off.
• Unlike the other two muscles in this group, the pain referral area for the FHL is on the bottom of the foot under the big toe.
• Problems in this muscle are commonly misdiagnosed as posterior compartment syndrome, tarsal tunnel syndrome and medial shin splints.
• The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

How to find these muscles (palpate them) and stretch them:

 

Click here to go back to part one on the extrinsics- the shin

Click here to go back to part two on the extrinsics – the peroneals

Click here to continue to part four on the extrinsics- the superficial calf (coming soon)

One of the big things to remember as we make our way through the extrinsic muscles is that they ALL control not one, but two joints – the ankle (talocrural) joint and the subtalar joint. These two joints are essentially stacked right on top of each other. This is important because it’s the long tendons of the extrinsics that determine the position of the subtalar joint. Whether the muscle is stuck in a long or short position, it will 100% impact how the foot lands and how the ankle and foot function in terms of shock absorption, stability, and propulsion.

In other words, there will be compensation in the leg chain for problems in the extrinsics. In this regard, the peroneals are a perfect example of a compensation injury. Any time you have problems here, you should automatically be thinking about the why. If you simply fix the symptoms without fixing the why, you will be battling this for a long time or worse, something harder to fix will break. Before we dive into all of that, let’s talk anatomy!

 

There are two muscles along the outside of the lower leg- the peroneal longus and the peroneal brevis. However, you may remember from last weeks post that we talked about a third peroneal muscle located along the lower shin- the peroneal tertius. We’ll be including that muscle here again and explain why it’s important to remember! Just as a reminder- when it comes to these muscles the words “peroneal” and “fibularis” are used interchangeably. To me they will always be the peroneals, but I do use both. 🙂

#1 Peroneal Longus

 

• Both the peroneal longus and peroneal brevis start along the fibula. The difference is that the longus starts on the upper half and brevis starts on the lower half. Both then wrap around behind the lateral malleous enroute to the fifth metatarsal.
• The longus does not stop when it hits the outside of the foot however. It wraps under the cuboid and crosses all the way to first toe where it attaches to the first metatarsal and first cuneiform.
• Like the other intrinsics, this muscle moves two joints. Essentially you have a long tendon with two big lever arms. By wrapping behind the ankle joint, it helps plantar flex the ankle (point the toes down). By wrapping under the outside of the foot, it everts the foot.

 

• In addition to that long tendon, the PL also has two muscles that directly attach to it’s long tendon. The FDM works at the little toe and the AH works at the big toe. Restrictions in the peroneal will directly affect these two muscles and vice versa!
• Mobility restrictions/trigger points in this muscle are the same as those for the brevis. There are two areas (the purple circles in the picture above).
• Problems in this muscle are commonly misdiagnosed as lateral compartment syndrome and as referred nerve pain coming from the low back.
• The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

#2 Peroneal Brevis

 

• As stated above, the PB sits on the lower half of the fibula. It wraps around the lateral malleolus with the PL tendon. However, it does not wrap under the bottom of the foot. It attaches to the outside of the fifth metatarsal.
• Like the PL, this muscle is responsible for plantarflexing the ankle and everting the foot.
• Like the PL, this muscle also shares the same pain referral areas and common misdiagnoses.
• While it may be easy to write off this muscle as being the smaller, less important peroneal, that would be wrong. If the PL is restricted/stuck, then the PB will be stuck with the bigger workload trying to make up for that. That’s a tall order for a smaller muscle that doesn’t have the same long lever/mechanical advantage.
• That being said, problems in one peroneal mean that you need to look at all three!
• The video below will show you how to palpate/find this muscle as well as how to stretch it.

#3 Peroneal Tertius

• Unlike the other two peroneal muscles, the tertius is located IN FRONT of the fibula and lateral malleolus. That means that instead of pointing the toes down, it pulls them up into dorsiflexion.
• The tertius muscles does however help to evert the foot, making it one of the four muscles that does so.
• Where the tertius goes, the extensor digitorum longus (EDL) goes! The tertius is technically the lowest portion of the EDL. However, instead of traveling all the way to the toes, it stops and inserts on the top of the fifth metatarsal. On top you have the tertius, and on the side you have the brevis. Then you have the longus tendon wrapping around. That’s a lot of tendon involvement right there! Very easy to jam up the outside of the foot and cause pain/inflammation.
• As you can see, the areas where this muscle refers pain follow both tendon paths around the lateral malleolus. It’s very easy to mistake this muscle for the other peroneals if you’re going strictly by location.
• The video below will show you how to palpate/find this muscle and how to stretch to it.

Video #1: How to find and stretch the peroneals

 

Video #2: Mechanics behind peroneal injuries

 

Video #3: Treating the peroneals as a group [old case study + treatment video]

Video #4: Crossfriction technique (included peroneal tertius + EDL) using a massage/tennis ball (new)

Sample Treatment Plan:

1) Warm up: this can be with a foam roller, stick or massage ball. 30 seconds each for the peroneal longus, brevis and tertius. Don’t worry about killing yourself here. Easy pressure to flush out the area and get some slack by working in the same direction of the muscle fibers.

2) Main set: cross friction 1 minute per muscle. Break this down into two spots per muscle. If a spot is too tender to work on for 30 seconds? Move the ball up or down slightly. You’re still working the muscle this way without making an area too “hot” too touch.

3) Stretches. 20 seconds x 3 reps. Peroneal longus and brevis can be done together using a belt or strap. Stand up and stretch the tertius/EDL. Twenty second hold per stretch. Give me three of each.

4) The first three steps will help loosen up the peroneals so they can heal. Step four is all about you taking the time to look for the cause.

• Test your mobility using the foot self eval. Are there restrictions in the toes or ankle? Do your feet point in or out like in the biomechanics video above?
• Test your knee mobility. Are you able to straighten your knee all the way? Yes means that you can sit on the floor with your legs straight in front of you and press the back of your knee down so that your heel comes up off the ground.
• Test your hip mobility. With your foot flat and knee straight, how far forward can you move over that foot? Does it look like what I’m doing in the video or do you get stuck?

These are all things you should be thinking about with a peroneal injury instead of focusing strictly on what hurts! I always here athletes talking about their strength routines, not their mobility routines…

Click here to go back to part one on the extrinsics- the shin

Click here to continue to part three on the inside of the lower leg (coming soon)

The next step in building your body maintenance/recovery routine is to determine when you are going to actually use it. Like I said in the first few posts, this is not stuff you need to do around every workout or even every day. The goal is to create a routine that is manageable and repeatable.

What it looks like when you’re in the green zones:

(don’t know what the green zones are? catch up here )

So let’s talk about your training. When are you most likely to overload your muscles? Will it be during that easy, volume workout or will it be during the intense interval sessions and long workouts? It will be the latter when the muscles will fatigue and stiffen and you will still have work left to do before the workout is over. These are the days you want to build your routine around.

Ideally you want to perform your maintenance workout after:

1) intense workouts and 2) long workouts.

This does not mean the second your workout is over. Immediately following your workout, focus on what you normally do. Rehydrate, refuel, rest. In other words let everything calm down. If you’re an ice bath fan, ice away.

Instead of targeting this post workout window, lets use the recovery time that you already have built into your training schedule to determine when you do your maintenance routine. Most athletes do not schedule consecutive hard days back to back. In fact, most schedules have rest or active recovery days following harder sessions. This gives you a nice window to be able to fit your routine in. Ideally you want to perform your maintenance routine before the following workout. This means that you will use the massage/mobilization techniques to break restrictions up, stretch, and then use that easier “recovery” workout to flush the system out. If you do schedule consecutive hard days, then wait until you have an easy day coming up. For example, it’s not uncommon for multi-sport athletes to schedule consecutive hard days in different sports. If this is similar to your setup, finish up the hard days and then get to work before that easy day.
Let’s use me as an example. Here is my typical training week.

• Monday – swim
• Tuesday – hard bike
• Wednesday – hard run
• Thursday – long run
• Friday – swim
• Saturday – long bike
• Sunday – medium bike

I like to stack up my hard days into blocks. Tuesday through Thursday are my hard days on the bike, in the pool and out on the run. My long workouts are on the weekends when I have the most time. Monday and Friday are my easy recovery days. This means that I want to target Thursday night/Friday morning before that swim and Sunday night/Monday morning before that swim.

Here’s a different example (weekly schedule of a long distance runner):

• Monday – off/cross train
• Tuesday – Hill work
• Wednesday- short/easy run
• Thursday – speed work
• Friday – off/ cross train
• Saturday – short/easy
• Sunday – Long run

With this schedule there are three possibilities to target- Hill work, speed work and the long run. At a minimum you will want to schedule your routine for Sunday night/Monday morning and Thursday night/Friday morning. If you have the time and are putting in lots of miles/volume, you can add in Tues night/Wed morning as well.

What if I’m in the yellow zones??

Then all of the above goes out the window. The green zones are truly a maintenance program, while the yellow and red shift to recovery/return to sport programs. Think of the yellow zones as you’re wake up call. If you continue to train/ignore the symptoms, they will stick around and potentially worsen. If you consider it a warning shot and get to work, on the other hand, you can heals thing up sooner and without a full sidelining injury.

So what does it actually look like scheduling wise:

• Once you’re in the yellow zone, we eliminate any intensity in your training program right away. If the symptoms worsen, we eliminate any volume or frequency changes as well. This means that above examples won’t work.
• Instead, it’s okay to foam roll everyday and stretch every day (basic guidelines for the green zones as described in the last post). When working with an actual injury, remember to work around the injury. The fastest way to heal it isn’t to attack that area and only that area, it’s to work all of the muscles groups in the chain around it so that you give slack to the injury and let it heal with out flaring it up even more.
• Every other day, try to use the deeper techniques around the injury (mobilizations, cross friction, etc). If things are too sore, skip it and try again the next day.
• In terms of doing this stuff before your workout/after your workout etc. Try to make it separate if you can
• Stick with this plan for the first week. Use tenderness/pain in those muscles as your guide. You’ll know when things start loosening up. When they do then you can start working over the injury, but not until (typically this is 7-10 days after starting daily rolling/stretching).
• Since you’re healing an injury, make it a routine of icing after you self treat. 5-10 minutes, especially if you have any swelling.
• Whenever you’re in the yellow zones, kinesiology tape is worth trying. I know it looks silly, etc etc, but it does work!
• Feel like you’re stuck or not making any progress on your own after that first 7-10 days? Get some help! Sports massage, PT, chiropractor, etc. You want hands on treatment. Things that I look for when I google who’s in my area? Active release technique + Graston Technique. Both have websites with provider locators. Why these two techniques? You are guaranteed someone who understands biomechanics and who will spend the session working on you, not assigning exercises and telling you to take time off.

What if I’m in the red zones?

If you’re in that red zones, then you should not be self treating. You need to be evaluated by a doctor and treated!!

Up next week?

In part six we’re going to dig more into how to find the right health care professional for you as an athlete. With technology today, it’s easier than ever.