Lower Back Pain The Role Of Calf Muscles

Lower back pain causes calf muscle pain and tightness and the calf muscles play a huge role in the development and maintenance of lower back pain.These calf muscles (gastrocnemius and soleus) are usually tight in most people especially in women wearing shoes with high heels. Calf muscle cramps are extremely painful and often awaken people during sleep. These cramps are a warning that there is nerve related muscle problems stemming from spinal nerve root involvement in the lower back. This is usually the case if you have calf muscle tightness and frequent night cramps even if you have no complaints of lower back pain or lower limb pain.

There are three calf muscles, two of them are called the gastrocnemius muscles (inner and outer muscles known respectively as medial and lateral) and the third is called the soleus muscle.

The gastrocnemius arise from the lower part of the thigh bone just above the knee. The soleus muscle arises from the leg bones known as the tibia and fibula bones and does not cross the knee joint. All three muscles insert into the heel bone through the heel cord. The tibial nerve supplies primarily S1 nerve root fibers to the inner gastrocnemius muscle (medial) and the L5 nerve root fibers to the outer gastrocnemius muscles (lateral) and primarily S1 nerve fibers to the soleus.
The gastrocnemius and soleus muscles are responsible chiefly for bending the ankel and foot down so that the toes can point toward the ground. However when the foot is flat on the ground as in the sitting, crouching or squatting positions, the gastrocnemius muscles can bend the knee but not the soleus. Those who have tightness of the calf muscles will note that they are unable to place the heels flat on the floor.

During ambulation, people with tight calf muscles are unstable and prone to falls since there is difficulty with the heel striking the ground. They also have difficulty with the push-off phase of ambulation. The only muscle that is active during relaxed standing is the soleus muscle. It is responsible for stabilizing the leg so that the weight line can fall in front of the knee. Otherwise, the knee can buckle.
Tight calf muscles play a significant role in causing and aggravating lower back pain due to increasing the stress on the low back muscles. Since these calf muscles are chronically tight, trying to reduce or release spasms within these muscles is very difficult. In addition, there is also nerve related muscle tightness and weakness in these muscles due to presence of aging of the L5 and S1 spinal nerve roots.
To make the situation worse, the muscles that lift the foot and ankle up of the ground in the front of the leg are chronically weak. The weakness is primarily of nerve related origin since these muscles are supplied by the L5 nerve root which is the most commonly injured nerve root. The injury or irritation stems from presence of degenerative arthritis of the spine, slipped disc, bulging disc, etc. The L5 nerve root fibers are mainly carried through the peroneal nerve which also is vulnerable to trauma from habitual crossing of knees and/or ankles making the foot and ankle dorsiflexors even more weak.

Therefore to treat calf muscle tightness, muscles in the front of the leg called the dorsiflexor muscles of the foot and ankle have to be treated before treating the calf muscles. The dorsiflexor muscles of the foot and ankle are chronically subjected to lengthening contractions during ambulation. Therefore selective activation of these muscles by inducing shortening contractions is needed. Walking on the heels is one of the ways to induce shortening contractions of the foot and ankle dorsiflexors.

Optimal treatment for the tight calf muscles cannot be isolated to just treating the calf muscles symptomatically. The treatment must include treating the root cause of the tightness which is spinal nerve root problems primarily at the L5 and S1 levels.

All the related muscles that are continuously subjected to lengthening contractions need to be treated. Return of strength for these muscles is achieved through shortening contractions. Treatments must include treating the spinal extensor muscles, gluteus maximus, adductor magnus, tensor fascia lata, rectus femoris and the foot and ankle dorsiflexors. Selective activation for these muscles is most effective through motor point stimulation using the eToims Twitch Relief Method.

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