Let me tell you a story that will surprise you. It’s about a performance athlete, whose rehab after a calf injury was targeted in a bizarre way and demonstrated extraordinary results. I say this rehab was “bizarre”, because it wasn’t mainstream. The athlete in question was a footballer who had injured his calf and came to me for treatment and rehab. He had a tremendous capacity to run, jump and play in one of the toughest games on the planet – Australian football.

You need strong calves to play a sport like Australian football.

Here’s what he told me:

“My calf hurts, and I can only do 22 slow rep calf raises on that leg, compared to 28 on the other.”

22 to 28 calf raises. A 21% asymmetrical deficit. I got to work, performing a test to demonstrate deficits in control of movement at the limits of stability, then put a handful of targeted correctives in place to improve stabilizing performance after initial assessment. After these stabilizers were put in place, I retested the athlete’s performance.

In three days, we reduced this asymmetry from 20% to 6%, increased load tolerance by 75%, and his speed under load by 9%. If it only matters what I can prove, that’s the proof. Here’s how the story unfolded.

My Problem with the Calf Raise

It turned out the athlete in question had injured his soleus. The soleus muscle has multipennate fibres. This means instead of the fibres converging into one tendon and one point of attachment, the fibres converge on several points on more than one tendon.

Multipennate muscles like the soleus aren’t designed to contract and relax in movement like a slow rep calf raise – they’re designed to contract and hold length, strongly, to give the Achilles tendon something to grab against so it can act like a spring. It’s an isometric muscle. A stabilizing muscle. With this in mind, I would argue the calf raise, this athlete’s test of choice, asks the soleus muscle to work in a way it’s not designed to. So I used another method.

A Better Test: The LQYBT

The test I used was The Lower Quarter Y-Balance Test (LQYBT), an extensively researched and reliable test that highlights increased risk of future injury. A key element the LQYBT tests is whether asymmetries exist between the left and right foot in balance. It tells me how well the athlete can balance on one leg and reach the other foot forward as far as possible without losing balance, then return to the starting position. It also tests how well they can control movement, and how far out of their comfort zone of control they can get. In other words, how good their stabilizing muscles are at providing support as their bigger “prime mover” muscles reach.

This athlete reached 50.5cm on his injured side and 63cm on his other side. We see right away the glaring asymmetry working out at around – you guessed it – 20%. The echo of the calf-raise test is clear, and the LQYBT has far more research supporting its results.

The Hierarchy of Performance Rehab

Now, traditional rehab or training for a calf injury of this nature at this point would be to strengthen the muscle. Calf raises and stretches, right? Well, this established powerhouse running athlete had a mature training body, so strengthening would take about six weeks to see significant improvement.

I took a different approach. I didn’t have six weeks, I didn’t think we needed that long, and I didn’t know that the reason for the calf injury was a strength issue. I also didn’t know that the calf injury wasn’t related to weak links elsewhere in his body.

Training stability is critical to any functional rehabilitation.

The hierarchy of approaching this task is to restore freedom of movement of limited body parts, then retrain the body to control this movement. After restoring mobility in a joint, or set of joints/tissue, there’s a window of opportunity to take the increased feedback from local “movement detecting nerves” and improve control of the joint. The first step is to coach and cue the athlete to demonstrate minimal to no movement at the joint(s) of interest, maintaining appropriate alignment in the presence of other body part movements.

When this static stability is achieved with competence, it’s then essential to coach dynamic stability – where the athlete demonstrates unrestricted freedom of movement in a supportive situation while also maintaining appropriate alignment.

Evaluation, Mobilization, Stabilization

According to this hierarchy, I evaluated the athlete for weak links and attempted to clear them up first. His potential weaknesses fell into three categories:

• Pain: The athlete had local muscle pain. It is well known that pain affects signals to the body, muscle co-ordination, and force output, so I needed to treat this effectively to support full nervous system involvement.
• Blocked movement/mobility problems: The athlete had mobility issues. Limited joint hinging, joint sliding, and joint gliding dampens the movement feedback that the central nervous system receives. If a joint is limited, the small nerves that detect movement in that joint will not send signals to the central nervous system about how to behave around that joint.
• Leaked forces/stability or control-of-movement problems: These issues inevitably lead to inefficient control of movement of that joint and poor stability, and control-of-movement problems were evident in the athlete’s evaluation.

Here’s what we did to address these issues.

• Dry needles were used for the trigger points in the calf to address pain.
• Mobility problem areas were addressed with manual therapy and self-directed tissue desensitization via foam rolling.
• Finally, we incorporated some static stability and mobility drills, including leg lowering, toe touch progressions, half-kneeling presses, farmer’s walks racked with a kettlebell, and lunges forward single arm down with a kettlebell. Note that all of these drills included elements of mobility, static stability, and dynamic stability work.

No performance training was included at this point -yet.

The Result: Asymmetry Abated

After treatment concluded, we re-tested the athlete’s performance capacity.

Here are the results of the LQYBT testing:

To summarise:

Single leg movement control capacity (measured in the LQYBT) improved from a 20% asymmetry to a 1.5% asymmetry in just 11 days.

This is Not a Hypothesis

I put it to you that training stabilizers can improve performance. Training mobility, static stability, and dynamic stability of the whole body improved this athlete’s performance and reduced his injury risk. I can hear the detractors gathering. They can argue with those numbers. This is not a hypothesis anymore. This actually happened.

Here is the continuum of performance rehab:

1. Remove pain – it interferes with control of movement.
2. Restore mobility.
3. Create tasks and environments to challenge static stability and dynamic stability.
4. Measure to ensure the rehabilitation and training is on track to release the athlete to higher levels of testing.

What came next for our athlete?

• Reconditioning his running specifically so he could adapt to the imposed demands of running, with a body that is better prepared.
• Continuing to work his single leg capacity.

Prepare to perform. Measure it to prove you’re on track. Follow a system. Simple.

More Like This:

• Let’s Kill the Calf Raise
• Complex Drills For Better Human Movement
• Everything Is Connected: Fix Weak Links to Prevent Injury
• New on Breaking Muscle

Photo 1 courtesy of Wikimedia Commons.

Photo 2 courtesy of Greg Dea.

The post Stability For Symmetry: The Continuum of Performance Rehab appeared first on Breaking Muscle.

Whatever type of calves you possess, you can alter them, but if they’re short or thin it’s doubtful they’ll ever become bodybuilder-massive. Either you have them or not. If you don’t have them it’s going to take hard and smart work. (Thank you, heredity.)

Take a gander at the muscles on the back of your lower leg. Which category applies to you: Are they short and bulky? Long and bulky? Average size? Long and thin? Short and thin?

Whatever type of calves you possess, you can alter them, but if they’re short or thin it’s doubtful they’ll ever become bodybuilder-massive. Either you have them or not. If you don’t have them it’s going to take hard and smart work. (Thank you, heredity.)

Most trainees’ quest for well-developed calves zeroes in on heel raises and toe presses. That makes sense because the bulk of your lower leg muscles lie in the gastrocnemius and soleus, two muscles targeted in those exercises.

But in addition to these more prominent backside calves, there are other muscles that govern ankle joint movement.

They are often neglected because they are obscure. To minimize ankle issues and fortify the lower leg, it is prudent to address these muscles. I know this article is all about developing the backside, but it is important to understand how the lower leg and ankle function to assure you have balanced development.

Note the four different movements that occur at your foot:

1. You can rise up on your toes.
2. You can pull your toes toward the knees.
3. You can rotate the bottom of your foot inward.
4. You can attempt to rotate the foot outward.

What are the muscles responsible for each of these four movements?

1. Rising up on your toes is called plantarflexion. This involves the gastrocnemius, soleus, plantaris, and tibialis posterior.
2. Pulling your toes toward your knees is called dorsiflexion. This involves the tibialis anterior, extensor hallicus longus, extensor gigitorum longus, and peroneus teritus.
3. Rotating the bottom of your foot inward is called inversion. This involves the gastrocnemius, soleus, tibialis anterior, tibialis posterior, and plantaris.
4. Rotating the bottom of your foot outward is called eversion. This involves the peroneus longus, peroneus brevis, and peroneus tertius.

A lot of funky names, I know. But in your program for optimal calf development via plantar-flexing exercises, don’t neglect the other ankle actions.

Similar to other joints of the body, if you perform a pushing exercise, then an opposite pulling movement should be incorporated to emphasize joint stability. The ankle is no different. If you work the backside, work the front side. If you work the inside, work the outside.

To maximally develop your calves and concurrently fortify the ankle to protect against injury, examine the four movements and associated muscles that are most applicable to this goal.

The two main plantar-flexors, the gastrocnemius and soleus, are the primary target for bulk.

The main dorsiflexor, the tibialis anterior, and the main everter, the peroneus longus, need attention for balanced strength and to augment the injury-prevention factor. Understand the gastrocnemius and soleus are also ankle inverters. They will also assist in joint stability.

Before we move further into this discussion, here is a bit more education relative to the origin and insertion points of these muscles to show the intricacies of the entire lower-leg muscular system.

Gastrocnemius:

• Origin – lateral and medial condyles of the femur (thigh) bone.
• Insertion – Calcaneus (Achilles) tendon at the ankle.

Soleus:

• Origin – The head and upper third on the shaft and middle third border of the tibia.
• Insertion – Like the gastrocnemius, the calcaneus tendon at the ankle.

Tibialis Anterior:

• Origin – Lateral condyle of the tibia and proximal ⅔ point of the tibia.
• Insertion – First metatarsal of the foot.

Peroneous Longus:

• Origin – The head and proximal ⅔ surface of the fibula.
• Insertion – Lateral margin of the plantar surface of the first cuneiform and bas of the first metatarsal.

Okay, onward we go in the pursuit of those elusive, well-developed calves.

Exercises

The gastrocnemius and soleus naturally take up the most space in the lower leg. To grow larger calves, you need to work the crap out of them, especially if you are genetically challenged down there.

These are the ankle plantar-flexing and inverting exercises you can employ to accomplish this:

• Standing calf machine heel raise (gastrocnemius and soleus)
• Standing dumbbell or barbell heel raise (gastrocnemius and soleus)
• Toe press on a leg press with the knees extended (gastrocnemius and soleus)
• Seated calf machine (soleus)
• Toe press on a leg press with the knees flexed (soleus)

The tibialis anterior is that crucial front side muscle that provides joint balance, due to the fact most people beat their gastrocnemius and soleus to death like a rental car.

Please return the favor to the tibialis anterior with these ankle exercises:

• The D.A.R.D. device
• Band or manual resistance dorsi-flexion of the ankle

The peroneus longus can be trained in its role in ankle eversion. It is a very short range of motion muscle. This training can be accomplished optimally with a resistance band, as depicted here.

Now you now know the exercises for optimal calf and lower leg development. What are the most effective exercise prescriptions to follow? Regarding muscle fiber type composition, heed these averages:

• Gastrocnemius, medial head = comprised of 51% slow and 49% fast fibers
• Gastrocnemius, lateral head = comprised of 46.5% slow and 53.5% fast fibers
• Soleus = comprised of 89% slow and 11% fast fibers
• Tibialis anterior = comprised of 73.4% slow and 26.6% fast fibers
• Peroneus longus = comprised of 62.5% slow and 37.5% fast fibers

Based on this data, use these repetition guidelines for the listed exercises:

• Standing calf machine, dumbbell, and barbell heel raise, and toe press on a leg press with the knees extended to target the gastrocnemius and soleus – use a repetition range of 15 to 25.
• Seated calf machine and toe press on a leg press with the knees flexed to target the soleus only – use a repetition range of 50 to 75.
• The D.A.R.D. device, band, or manual resistance dorsi-flexion of the ankle – use a repetition range of 25 to 50.
• Peroneus Longus resistance band exercises – use a repetition range of 20 to 40.

Exercise Proper Form

All ankle movements have relatively short ranges of motion. Unlike other joints of the body that allow movement over many inches, you’re moving a minimal distance at the ankle, especially with inversion and eversion.

Because of this, take each repetition performed to its extreme (but safe) point of the range of motion – a safe stretch at one end and a hard static contraction at the other.

To maximize your calf muscle size, work each lower leg muscle as hard as you possibly can in the four basic ranges of motion: ankle plantar-flexion (the largest muscles of the lower leg), dorsi-flexion, inversion, and eversion knowing that each has a limited range of motion.

Photo 2 courtesy of Shutterstock.

The post Building Better Calf Muscles: How the Calf Works and How to Work It appeared first on Breaking Muscle.