6.3 GASTROCNEMIUS
6.3 GASTROCNEMIUS
Figure 6. Pain pattern referred from TrPs at commonly observed locations in the gastrocnemius muscle (Travell & Simons, 1992).
Symptoms• TrP1 and TrP2 are very commonly associated with nocturnal calf cramping, whereas the others rarely present with this complaint.
• TrP1 is the most common, with latent TrPs manifesting primarily as nocturnal calf cramps and active TrPs usually result in the pattern of referred pain seen above.
• There is rarely weakness or restricted range of motion with gastrocnemius TrPs.
Trigger Point Examination
• If the subcutaneous tissues are lax and the adipose layer is relatively thin, the gastrocnemius is best examined by pincer palpation.
• It is important to examine the patient with the ankle in a resting position.
Associated Trigger Points
• Secondary TrPs may develop in the soleus, peroneals and hamstring muscles.
• TrPs in the medial head of the gastrocnemius are associated with TrPs in tibialis posterior and flexor digitorum and hallucis longus.
Differential diagnoses
• 'Tennis leg' (partial tear of the medial muscle belly).
• Posterior compartment syndrome
• Phlebitis
• Baker's cyst
• Achilles tendonitis
• Retrocalcaneal bursitis
• Intermittent claudication and nocturnal pain of the calf muscles.
