PTH 633 CLINICAL EDUCATION I GROUP

Fired
PRESENTATION UP & Focused on
Scottie Feldpausch, Lauren Hofman, Hannah Kalis, Rachel Lipka Physical Therapy
MUSCLE: Gastrocnemius

Muscle: Gastrocnemius muscle Fiber type: 50/50 split with fast and
Attachment: Posterior surface of slow twitch fibers (Ramsden, 2020)
calcaneus Histology:
Origin: Lateral femoral condyle
and popliteal surface of femur
Blood supply: Posterior Tibial
Artery
Nerve supply: Tibial Nerve

Origin Attachment Action Functional Common Common

Movements Injuries Dysfunctions
Lateral femoral condyle, Posterior surface of Plantarflexes ankle Raises heel during -Achilles tendinopathy -Knee buckling
popliteal surface of calcaneus via calcaneal when knee is extended, walking -Achilles rupture -Shorter step length on
femur tendon flexes leg at the knee -Muscle strain contralateral side
● Purpose: To compare the effectiveness of 3
management strategies (eccentric loading, repetitive
low-energy SWT, and a “wait and see” control group) in
patients with chronic Achilles tendinopathy.
● 75 patients with chronic (>6 months) non-insertional
Achilles tendinopathy. All had received unsuccessful
management for >3 months.
● Eccentric loading group: 3 sets of 15 reps, twice a day,
7 days a week, for 12 weeks. Began with one set and
gradually progressed to 3 sets.
● Results: At the 4-month follow up, the eccentric loading
group and low-energy shock wave therapy groups
showed comparable results. The wait and see method
was ineffective for management of chronic Achilles
tendinopathy.
RESEARCH EVIDENCE #1: (Rompe, 2007)
● Purpose: To investigate the physiological recruitment
strategies employed by the triceps surae muscles
during sustained, low-level activation.
● 8 healthy individuals (7 female, 1 male), ages 23, and
average BMI of 21.2 who had no history of
musculoskeletal injury to the low back, ankle, or knee
● Surface recorded EMG data was recorded from the
medial gastrocnemius (MG), lateral gastrocnemius
(LG), and medial soleus (MS).
● Sustained isometric contractions at 10% MVC for 1
hour.
● Results: EMG amplitude in LG and MS increased
linearly. This indicates a tendency for co-activation of
the LG and MS during sustained plantar flexion
contractions. Strengthening the triceps surae as a
whole is recommended.
RESEARCH EVIDENCE #2: (Linda McLean &
Nicola Goudy, 2004)
EXERCISE

◼ The patient will start by standing bilaterally on the edge of a

step with their heels unsupported. They will then perform heel
raises by engaging the gastroc. This exercise can be progressed
by doing single leg or not holding onto a supportive surface.
◼ Some precautions would be any knee or ankle pathologies, as
well as any issues with balance.
◼ This exercise of the gastroc relates to everyday activities such
as walking and going up stairs.
◼ Make sure they are just trying to target the gastroc (not
assisting by pushing up with arms, keeping leg straight).
◼ This is an exercise against gravity and their own body weight.
◼ Considerations could include using a gait belt with assistance
for additional support in older populations.
EXERCISE

◼ The patient would stand on an unsupported surface such as a

foam pad or pillow. The clinician would apply perturbations
which would require the patient to activate this muscle.
◼ Precautions would include excessive weakness of hip
ER/abductors, or balance/coordination problems.
◼ This exercise relates to ankle strategy when trying to keep
balance when walking on uneven surfaces or preventing falls.
◼ Therapist may have to remind the patient to focus on engaging
this muscle and not using external support.
◼ This exercise would be considered resistance against gravity
and their own body weight.
◼ Considerations would include using a gait belt in addition to
external supports for older populations.
EXERCISE

◼ The patient will stand on the treadmill with an incline of 3-5%,

or enough of an incline to activate the gastroc. Patient will then
start walking at a comfortable pace on the treadmill.
◼ Some precautions would be decrease in balance, knee or ankle
pathologies or diabetic neuropathy. Cognitive impairments can
also be a precaution.
◼ This exercise relates to functional activities such as walking in
general. But this also relates to walking up an incline.
◼ Some cues that the therapist might give the patient would be to
not bend at the hips and push through the hands.
◼ This is a gravity resisted exercise.
◼ Considerations would be using a gait belt for added support for
the patient.
◼ Moore KL, Dalley AF, Agur AMR. Lower limb. In: Moore KL, Dalley AF, Agur AMR. Clinically oriented anatomy. 8th ed. Philadelphia, PA: Wolters Kluwer; 2018:
742-763.
◼ Rompe, J. D., Nafe, B., Furia, J. P., & Maffulli, N. (2007). Eccentric Loading, Shock-Wave Treatment, or a Wait- and-See Policy for Tendinopathy of the Main
Body of Tendo Achillis: A Randomized Controlled Trial. The American Journal of Sports Medicine, 35(3), 374–383. https://doi.org/10.1177/0363546506295940.

◼ McLean L, Goudy N. Neuromuscular response to sustained low-level muscle activation: within- and between-synergist substitution in the triceps surae muscles.
Eur J Appl Physiol. 2004;91(2-3):204–216. doi:10.1007/s00421-003-0967-3.

◼ Ramsden G. Gastrocnemius (Calf Muscle) – Neglected, Stubborn or Misunderstood? MuscleTalk. https://www.muscletalk.co.uk/gastrocnemius/. Published
March 27, 2020. Accessed April 24, 2020.

RESOURCES FOR GASTROCNEMIUS ASSIGNMENT