Let us begin the series on stretching from the ground upwards. One of the most common stretches in the lower extremity is the calf stretch or the Achilles tendon stretch.
The Achilles tendon is made up of the gastrocnemius and soleus muscles, as they form a common tendon that inserts into the heel bone or calcaneus.
• The gastrocnemius originates from the femoral condyles (medial and lateral heads) above the knee joint.
• The soleus originates from below the knee joint, the fibular head and upper quarter of fibula bone, from the medial surface of tibia and parts of anterior muscular septum.
• As the muscles progress to the heel bone, they transition histologically into anterior and posterior aponeurosis, which are whitish, flat broad tendon-like structures.
• Eventually the aponeuroses transform to the tendon which inserts into the heel bone.
The different ways to stretch the muscle are as follows:
1) Passive stretch: here the patient/client is in supine-lying on a mat or is in long sitting position. The physical therapist stabilizes the neutral knee with one arm and the other arm cups the heel with the therapist forearm supporting the sole of the foot. The distal arm is slightly extended at the wrist for ergonomic grip and with the body movement moves the foot upwards with the forearm to dorsiflex the foot. It is important to get an end-feel of the soft tissue stretching and hence a slow, gentle stretch is essential initially to determine the stretch force to be applied for optimal results.
2) Active static stretch- The patient/client is in supine-lying on a mat or in long sitting position with the knee in neutral position and well supported. The patient keeps the knee and leg stable and dorsiflexes the foot with the calf-muscle being stretched by pointing the toes upwards in the direction of the face/nose (“toes to nose” as it is popularly addressed), till a stretch is felt in the back of the lower leg or calf. This position is held for as long as possible from 5 seconds up to 30 seconds. Release stretch and rest the muscle for 15-30 seconds and repeat 2-3 times.
3) Active dynamic stretch- There are several ways to do this. For example to stretch the right calf:
i) The patient/client is in half-kneeling position. The right foot is in front, resting on the floor, with knee and shin of the left leg resting on the floor. With the trunk upright and neutral, stabilize it as you flex the hip and knee of the right leg. The foot should be flat and firmly rooted to the floor as the body weight shifts onto the leg. This brings about dorsiflexion of the right foot, as the tibia/lower leg moves forward over a stationary foot on the floor, stretching the soleus primarily.
ii) In standing position, with the right foot behind and toes pointing forward both feet, lean forward from the ankles, keeping the right knee straight. This can be done while facing a wall. The left leg must allow hip and knee flexion as body weight (body moves as one unit from ankle up) moves forward maintaining a firmly planted right foot behind with the heel on the floor. It is ok to lean forward and rest the open palms on the wall.
iii) Another way to stretch the right calf in standing is to stand facing a wall. Bring the right foot and place the ball of foot on wall with the heel on the floor. Make sure to move the ball of foot as far up as you can by inching it upward along the wall, with the heel still on floor. Lean forward towards the wall deepening the stretch at the calf.
4) Stretching with tools or equipment:
i) Stretch using a strap or thera- band- in the long sitting position, loop a long strap or sturdy thera-band around the sole from mid-foot to ball of foot. Hold the two ends of the strap/band in hands. Gradually pull up the strap, thus dorsiflexing the foot and stretching the calf muscles.
ii) When seated on a chair with hip knee flexion and left foot on floor, you can use rocker board placed on floor with right foot on it and push the right heel to floor, thus tilting the rocker board up and dorsiflexing the right foot.
Ami Gandhi is a licensed physical therapist in the state of California. She is the owner of StableMovement Physical Therapy, a small boutique practice in San Jose that offers patient centered, one-on-one, hands-on physical therapy.