Trigger Points in the Lower Legs-Working Your Calves

This is from a post that I drafted on October 21st, but I am finally getting it posted.

I've been focusing on working my calves for the past few days, and it is amazing what a ripple effect it has.  I feel more flexible and lighter on my feet.

Trigger points in the lower leg can send pain to the foot, the lower leg and up to the lower back.  If you have had back pain that has not responded to other trigger points, you may want to check your soleus muscle in the back of your lower leg (See p. 239 in the Trigger Point Therapy Workbook.  You can also click on the trigger point map link in the right column of this blog.)

The soleus is a very broad muscle that covers the upper two thirds of the back of the leg.  Much of the soleus is covered by the gastrocnemius which is a very thick muscle that has two branches.  The gastrocs (that is what I will call them--I have no idea if this is a typical term) form the part of the calf that bulges out in the back.  The Tibialis Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus are narrower muscles that are located under the soleus and gastrocs.  (See pp. 234-243 in The Trigger Point Therapy Workbook for diagrams and details.)

It takes a lot of strength to work these muscles because of the thickness of the outer muscles and their location on the back of the leg.

There are several ways to work the lower leg muscles.  It is tempting to use your fingers, but you can soon end up with sore fingers, arms, and shoulders.  Another way is to lie on your back, or sit up, and rest one calf on the knee of the opposite leg.  By sliding the top leg back and forth, you locate the trigger points.  When you find a trigger point, massage it by pressing your leg in a little deeper.  This is effective, but can get quite exhausting, particularly for your quads .

If you are lucky enough to have an older armchair that has solid wood in the arm instead of cardboard, you can sit in the chair, place a lacrosse ball on the chair arm, lift up your leg and move your calf around on top of the ball.  This can also be quite effective.

I have recently come upon an idea that is working well for me, so I will share it with you.

Lie down on the floor next to a bare coffee table or side table.  Place a lacrosse ball on the table and place your calf on top of the ball.  Move your leg around the ball and work trigger points as you find them.

If you need to push a little harder for some of the trigger points, bring your opposite ankle over and rest it on top of the ankle of the leg you are working.   This takes the least effort and is the most effective of the ways I have tried to massage my calves.

Some of you may not be able to get down on the floor to do this.  I know that I would not have been able to get on the floor when I first started doing trigger point therapy.  One idea is to get a lightweight table (like the LACK side tables that IKEA sells for around $10). If your bed has enough room, place the table on one end of the bed and you can do the same procedure while lying on your bed.  You can also place the table in front of a chair and do the procedure that way, but you may not have quite as much leverage.

You may have something else that works for you around your house already.  The idea is to make working your calves as easy as possible.

One note.  The ball may roll off the table from time to time, especially when you are first learning.  It is mildly annoying, but easy enough to put back up.  It is easier to control the ball if you have bare legs, or fairly snug pant legs, since there is a tendency for it to get entangled in your pant leg.

I won't go into detail for each muscle in this post, but just to get an idea of what types of symptoms are caused by or contributed to by your calf muscles:  calf cramps; pain in ankles and calves, on the bottom of the foot, Achilles tendon, back of ankle, in long arch of foot, back of thigh, knee, inner ankle, outer side of heel, heel; hard to straighten knee; deep pain in sacroiliac area; spasms in lower back; hypersensitivity to touch in lower back; pain in jaw, knob of inner ankle; plantar fasciitis pain; low blood pressure; unexpected fainting; posterior compartment syndrome; circulatory problems; pain in metatarsal arch, undersides of toes, under the big toe, head of first metatarsal; numbness underside of big toe; cramps in the bottom of the foot; contribute to hammertoe and claw toe.  (Take a breath here!)

In later posts, we will address some of these more specifically.

What I've been doing - Part I

Note:  Refer to the "What Happened..." post for background information.  

One of the first things that I did once we got my arm stabilized in a sling and once we had given me some ibuprofen, was to work any trigger points that I thought would have been affected by my fall.

I visualized what might have happened in the fall. I pictured my elbow hitting the ground. I could imagine that muscles and bones in my upper arms and my forearms would be jarred quite hard. I could see that all of my shoulder muscles were probably affected. They would have to work hard to keep my shoulder in place.

I steered clear of working trigger points in my arm in the beginning because I did not want to inadvertently put pressure on the broken bone, wherever it might be.

I started out working my infraspinatus, supraspinatus, and my pecs.

The infraspinatus and supraspinatus are the muscles that lie on top of the shoulder blade, or scapula. There is a raised part of the shoulder blade that goes across the upper half of the shoulder blade. It is sometimes referred to as the scapular spine. The infraspinatus is the muscle that lies below the scapular spine. (Infraspinatus means "below or under the spine.") The supraspinatus is a muscle that lies above the scapular spine.

I worked the infra- and supra- spinatus with a lacrosse ball against the wall. I was very careful to keep my injured arm from moving.  It felt good, not only because it felt good to work the trigger points, which did need work, but also because working the trigger points released endorphins; my pain was partially relieved.

Since I was already up, I decide to work my gluts, lower back, and quads, too. A fall like I had probably involved most of my body, now that I thought about it.

I also worked my pecs. I could feel that they were very tight.

During our first visit to the doctor, the practitioner suggested that I unwrap my arm from time-to-time and work on trying to extend my range of motion.  Later, when I was getting zero pain relief from the meds, I wondered if I had a pinched nerve somewhere.  It felt very much like pinched nerves I've had in the past.  I knew that working my trigger points would help to release something if it were pinched, so I began to work on the upper arm and lower arm muscles.  I had also been working on my scalenes and sternocleidomastoids.

The only measurable pain relief that I got during this time period (between the first doctor's visit and the ER visit), was when I worked my trigger points in my arms.  I worked from the top of the upper arm down toward my elbow, and from the wrist area up toward the elbow.  I used supported thumb or supported fingers, and sometimes used a pinching technique, which I know is not very ergonomic, but I was trying to be careful to avoid the bones as much as possible.  I could feel each muscle relax and the pain subside as I released its trigger points.  It became more difficult, however, as I got closer to the elbow. I was so exhausted but so happy that my pain had subsided enough for me to get to sleep. I would get to sleep, but I'd wake up an hour or two later with screaming pain again. The muscles that had just been loose and relaxed were now tight as a spring.

I knew there must be something else going on. At this point, I wondered if anyone would be able to help me with my pain at all. Here I was taking Lortab (I did not realize that I had been prescribed a half dose), and it was not helping at all. The only thing that had helped me up to that point was trigger point therapy, and that was only temporary. Plus, I was exhausted from no sleep, and from tensing up against the pain. I could feel the tightness going further up my arm, into my shoulder and neck muscles. I could also feel that my abdomen was as hard as a rock, and my hips and upper legs were tensing up, too. I felt like a giant corkscrew.

In the middle of the night on Wednesday/Thursday, my husband and I decided to try the ER. I really didn't know if they would be able to help. I anticipated them trying to take an x-ray of my elbow again. I hadn't been able to extend my elbow enough at the on-call doctor and the technician there was not very sympathetic. She said, "I warned you that it would not be fun."

Before we left for the ER, I worked my upper arm, shoulder, and pec muscles. I wanted to have as much flexibility coming into that experience as possible.

(To be continued...)