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tight gastrocnemius muscle

Posted by A Manoli MD on 6/19/02 at 22:37 (088071)

the seattle group has just published a major article showing the association of a tight gastrocnemius muscle with various foot disorders. an abstract is available at:

http://www.ejbjs.org/cgi/gca?sendit=Get+All+Checked+Abstract%28s%29&gca=84%2F6%2F962

they discuss the implications of the tight muscle in the causation/treatment of many foot problems we see.

dr. davis found it 'interesting' that i mentioned that we lengthen the gastroc. muscle as our treatment for pf some months ago.

recently, in another post in 'article' still on the board he just mentioned that he lengthens it apx 50% of the time. seems to catch on rather fast.

in july we are presenting our results at the american orthopaedic foot and ankle society meeting. this report will show what clinical entities we believe it is most useful in. i'm certain the abstract will be posted on the aofas.org site after the meeting.

thanks.

Re: tight gastrocnemius muscle

paula on 6/19/02 at 23:09 (088074)

why can't we stretch our way out of this. why is operation necessary?

Re: tight gastrocnemius muscle

john h on 6/20/02 at 10:42 (088122)

many professional athletes, ballet dancers, etc. develop PF. they of course are as loose as a goose. i would not say that tight gastro muscles could not create foot problems but there are a lot of people who have very good flexability that develop PF. I would have to be very very convinced that any surgery to lengthen a muscle would help before I had such surgery.

Re: tight gastrocnemius muscle

Mike W on 6/20/02 at 11:08 (088129)

Hello Paula,

We 'can't stretch our way out of this' because most traditional lower leg stretches are physiologically incorrect and therefore ineffective.

If more people did correct exercises the operation would not be necessary.

Regards,

Mike W

Re: tight gastrocnemius muscle

paula on 6/20/02 at 11:24 (088132)

mike , what in your opinion are the correct ways to stretch. and are you the guy who sells that foot thing cause i bought one and lost the booklet that tells you what to do. all i can do with it at this point is poke my cat with it (just kidding cat lovers). can you e mail, fax, or mail me another set of instructions?

Re: tight gastrocnemius muscle

Mike W on 6/20/02 at 12:36 (088138)

Hello Paula,

I would be happy to mail you a copy of Foot Trainer Exercises.

Please email your address ((email removed)) and I will send you a copy.

In my opinion the most effective way to RELAX tight posterior calf muscles is to contract the opposing anterior calf muscles in a non-weightbearing position, primarily the Tibialis Anterior, Extensor Digitorum Longus and the Extensor Hallicus Longus muscles.

Regards,

Mike W

Re: tight gastrocnemius muscle

D.Thomas on 6/20/02 at 14:15 (088142)

Doctor Manoli good to hear from you again. This is a great tread for me becuase I am in this debate and somewhat confused.

I went to see Dr. Manoli last month (which was an excellent visit) to which he told me if my new orthotics don't work out that his next step would be to lengthen the gastroc.

When I went to my Pod afterwards here, he told me that he thinks I have enough movement in my gastroc and that he wants to do a fascia release. He told me the patients he has lengthen the gastroc had half the movement I have.

Ah, what is one to do? I just hope something positive happens soon, because I have no idea what to do next. How is a patient suppose to know which one to do?

Re: tight gastrocnemius muscle

Ed Davis, DPM on 6/21/02 at 18:17 (088239)

This is important information since the contribution of a tight gastrosoleus achilles complex to plantar fasciitis and other pedal pathologies has often been overlooked in the past. Sig Hansen, MD and the orthopedists he trains in Seattle have really been pioneers in getting this information disseminated.
Ed

Re: tight gastrocnemius muscle

Ed Davis, DPM on 6/21/02 at 18:22 (088240)

Paula:

I use a physical therapist who is a 'manual therapist' and is very effective at 'lengthening' the tight gastrosoleus via a combination of stretching and myofascial release techniques. I will often add a night splint to the mix. I generally would reserve the surgery for individuals in whom conservative therapy does not work. My patients are lucky to have access to a therapist of his caliber -- I would have to do a lot more surgical lengthenings if not.
Ed

Re: tight gastrocnemius muscle

paula on 6/21/02 at 21:12 (088259)

dr ed does your therapist know a therapist in atlanta or birmingham that does similar work? i would very much like to try that method.

Re: tight gastrocnemius muscle

Ed Davis, DPM on 6/22/02 at 11:58 (088292)

Paula:

I will ask him. There is an organization of 'manual therapists.' That is the group he belongs to. They do a lot of hands on work.
Ed

Re: tight gastrocnemius muscle

Carole C in NOLA on 6/25/02 at 17:48 (088436)

I wouldn't have either surgery until you feel it is clearly the best next step.

Since you aren't sure at this point, maybe you should consider seeing yet another doctor as a help in making up your mind. Meanwhile, you could focus on conservative (non-surgical) treatments.

I'm glad you got to see Dr. Manoli. From what I've read on these message boards, he's quite good and probably one of the best.

Ultimately the decision as to whether or not to have surgery is yours, and I think you should feel certain that surgery is the right way to go, before having surgery of any kind done.

My father, who is now dead, was a surgeon of a different specialty. Like most surgeons, he tried to warn his patients of any possible problems beforehand, and would only proceed with elective surgeries if the patient felt certain that he/she wanted the surgery performed.

Carole C

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/27/02 at 09:08 (088578)

Dr. Manoli,
On 26 January, you said (message #71359) 'Our theory: tight achilles causes increased strain in tendon, causing autoimmune reaction and tendon becomes fibrocartilage. It no longer works like a tendon, and stretchs out.'
This comment appeared to be associated with research done at UCSD By Dr. Michael Brage who found tendon-bound auto-antibodies in a number of cadavers with known tibialis posterior dysfunction, concluded 'preliminary results indicate that humoral auto-immunity is involved in the disease process of progressive tibialis posterior dysfunction.'
Last year I tried (unsuccessfully I feel)to get the same message across on these boards that PF had an autoimmune basis. My argument is that, using the Grass Juice Factor extracted from wheatgrass, (see the Cereal Grass book (ed. R. Seibold)p.21 at http://www.wheatgrass.com )which was incorporated in a balm that I consider to be a topical immunomodulator, a significant percentage of patients with chronic PF improved or recovered completely. Some of these recoveries have occurred so quickly i.e. in a day or two, the recovery could not possibly have been due to the resolution of 'biomechanical' factors. The fact that not everyone recovered is irrelevant. The PHENOMENON still occurred. A major part of that phenomenon is, I am convinced, due to the reversal of an autoimmune status at or around the plantar fascia.
As to the cause of the autoimmune response, that is anybody's guess. However, with due respect, given my extensive usage and observation of the effects of the extract as a family physician for nearly 8 years, I wonder if it does have an awful lot to do with the tightness of the gastrocnemius. There are many other factors, including major stressors (eg illness, e.g. influenza, psychological, emotional and physical stresses) that occur around the time of onset of a number of these patients. Of course the condition can be aggravated by over use, obesity and other factors, but the actual cause is, and I agree with you, probably auto-immune.
Your remark about Dr. Brage's presentation was also interesting viz:- 'When it was presented, the audience was very skeptical, as with any new concept. Sort of like the guy who cultured stomach ulcers (that nobody ever thought of doing before), and discovered that they were infectious diseases. We now treated them with antibiotics!!!!!!'
Dr. Barry Marshall and I were at med school together at the University of Western Australia.
Kind regards,
Dr. Chris Reynolds
Melbourne, Australia.

Re: tight gastrocnemius muscle

Pauline on 6/28/02 at 09:27 (088667)

Dr. Reynolds,
I'm one of your users and believer in the Jade Cream. For me it really worked. I have posted this fact many times on heelspurs as well as telling others that I have kept journals on my journey with Plantar Fascittis which I've had three different times.

When looking back through these journals one can find a definate flare up pattern in my P.F.at times of stress. I believe I've mentioned this to you in an e-mail.

I have been pain free for quite a few months now, but I can honestly report even some mini flare ups that occur timed with additional stress in my life.

I do have some auto immune issues and personally think additional studies could be very helpful to P.F. patients.

Thank you again for introducing us to your Jade Cream.

Re: tight gastrocnemius muscle

rose w. on 6/28/02 at 16:32 (088700)

Can you tell us more about how to make such a balm from the wheat grass. I llooked at the website, but could not find any information on the book you were referring to. thanks

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/28/02 at 21:05 (088726)

Pauline, thank you for your supportive comments about Jade 168 Balm. I'm very glad it has helped your PF. I hope it continues to work for you as it has for so many of my patients in Australia. I also agree with you about the need for additional studies around stress and other auto-immune related factors.
Kind regards,
Dr. Chris Reynolds.

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/28/02 at 21:21 (088728)

Rose, I regret that I am not in a position to tell you how the balm is formulated. However, if you go to http://www.jade168balm.com you can learn more about Jade and you purchase it if you wish.
What the Cereal Grass Book tells you though is a lot about the proven effectiveness over many years of wheatgrass in treating inflammation, wound healing and many other conditions. The healing effects of wheatgrass have after all been known for thousands of years. The fact that I discovered that the wheatgrass extract worked on PF in some patients was simply by trying it. After all, I knew it was completely safe. When it actually worked on the first patient I tried it on, I was astounded. Naturally, because it is cheap compared to most other treatments and free of adverse effects, I have continued using it ever since. Of course it doesn't work on everyone, but nothing does.
Kind regards,
Dr. Chris Reynolds.

Re: tight gastrocnemius muscle

BrianJ on 6/28/02 at 21:38 (088730)

Dr. Reynolds --

Just wanted to say hello and thank you for your continued presence on the board. Whether or not some PF sufferers turn out to have an autoimmune issue, your analyses are always respected and welcomed by us.

Re: tight gastrocnemius muscle

john h on 6/29/02 at 07:55 (088750)

I still use the balm Dr. Reynolds.

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/29/02 at 10:54 (088759)

Brian, thank you for your kind remarks. It's people like you who make the world go around.
Even though I was unable to help you, you have been a stalwart in supporting not so much the concept of 'cure', but of at least trying to envision the possibility that if we keep trying, then we may be able to come up with something that will help. I have never promised anything, and I would be foolish if I did. But at least some people have been relieved of their symptoms from using Jade.
Kind regards,
Dr. Chris Reynolds.

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/29/02 at 11:11 (088760)

John, nice to hear from you again, and I'm glad you're still finding the Jade useful. I use it every day also in my clinic. In fact, one of the main reasons I come to work is to use it on my patients because it helps so many of them as a topical anti-inflammatory, a wound healer and as a hemostatic agent. In other words, it may not cure, but it can certainly improve peoples' quality of life. Also, there are many more ways to use Jade than just for PF.
John, I'm still waiting for that email telling me you're heading for Melbourne and the Great Sandy Desert. After hours the airport may be closed, but the bar will be open.
Kind regards,
Dr. Chris Reynolds.

Re: tight gastrocnemius muscle

paula on 6/19/02 at 23:09 (088074)

why can't we stretch our way out of this. why is operation necessary?

Re: tight gastrocnemius muscle

john h on 6/20/02 at 10:42 (088122)

many professional athletes, ballet dancers, etc. develop PF. they of course are as loose as a goose. i would not say that tight gastro muscles could not create foot problems but there are a lot of people who have very good flexability that develop PF. I would have to be very very convinced that any surgery to lengthen a muscle would help before I had such surgery.

Re: tight gastrocnemius muscle

Mike W on 6/20/02 at 11:08 (088129)

Hello Paula,

We 'can't stretch our way out of this' because most traditional lower leg stretches are physiologically incorrect and therefore ineffective.

If more people did correct exercises the operation would not be necessary.

Regards,

Mike W

Re: tight gastrocnemius muscle

paula on 6/20/02 at 11:24 (088132)

mike , what in your opinion are the correct ways to stretch. and are you the guy who sells that foot thing cause i bought one and lost the booklet that tells you what to do. all i can do with it at this point is poke my cat with it (just kidding cat lovers). can you e mail, fax, or mail me another set of instructions?

Re: tight gastrocnemius muscle

Mike W on 6/20/02 at 12:36 (088138)

Hello Paula,

I would be happy to mail you a copy of Foot Trainer Exercises.

Please email your address ((email removed)) and I will send you a copy.

In my opinion the most effective way to RELAX tight posterior calf muscles is to contract the opposing anterior calf muscles in a non-weightbearing position, primarily the Tibialis Anterior, Extensor Digitorum Longus and the Extensor Hallicus Longus muscles.

Regards,

Mike W

Re: tight gastrocnemius muscle

D.Thomas on 6/20/02 at 14:15 (088142)

Doctor Manoli good to hear from you again. This is a great tread for me becuase I am in this debate and somewhat confused.

I went to see Dr. Manoli last month (which was an excellent visit) to which he told me if my new orthotics don't work out that his next step would be to lengthen the gastroc.

When I went to my Pod afterwards here, he told me that he thinks I have enough movement in my gastroc and that he wants to do a fascia release. He told me the patients he has lengthen the gastroc had half the movement I have.

Ah, what is one to do? I just hope something positive happens soon, because I have no idea what to do next. How is a patient suppose to know which one to do?

Re: tight gastrocnemius muscle

Ed Davis, DPM on 6/21/02 at 18:17 (088239)

This is important information since the contribution of a tight gastrosoleus achilles complex to plantar fasciitis and other pedal pathologies has often been overlooked in the past. Sig Hansen, MD and the orthopedists he trains in Seattle have really been pioneers in getting this information disseminated.
Ed

Re: tight gastrocnemius muscle

Ed Davis, DPM on 6/21/02 at 18:22 (088240)

Paula:

I use a physical therapist who is a 'manual therapist' and is very effective at 'lengthening' the tight gastrosoleus via a combination of stretching and myofascial release techniques. I will often add a night splint to the mix. I generally would reserve the surgery for individuals in whom conservative therapy does not work. My patients are lucky to have access to a therapist of his caliber -- I would have to do a lot more surgical lengthenings if not.
Ed

Re: tight gastrocnemius muscle

paula on 6/21/02 at 21:12 (088259)

dr ed does your therapist know a therapist in atlanta or birmingham that does similar work? i would very much like to try that method.

Re: tight gastrocnemius muscle

Ed Davis, DPM on 6/22/02 at 11:58 (088292)

Paula:

I will ask him. There is an organization of 'manual therapists.' That is the group he belongs to. They do a lot of hands on work.
Ed

Re: tight gastrocnemius muscle

Carole C in NOLA on 6/25/02 at 17:48 (088436)

I wouldn't have either surgery until you feel it is clearly the best next step.

Since you aren't sure at this point, maybe you should consider seeing yet another doctor as a help in making up your mind. Meanwhile, you could focus on conservative (non-surgical) treatments.

I'm glad you got to see Dr. Manoli. From what I've read on these message boards, he's quite good and probably one of the best.

Ultimately the decision as to whether or not to have surgery is yours, and I think you should feel certain that surgery is the right way to go, before having surgery of any kind done.

My father, who is now dead, was a surgeon of a different specialty. Like most surgeons, he tried to warn his patients of any possible problems beforehand, and would only proceed with elective surgeries if the patient felt certain that he/she wanted the surgery performed.

Carole C

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/27/02 at 09:08 (088578)

Dr. Manoli,
On 26 January, you said (message #71359) 'Our theory: tight achilles causes increased strain in tendon, causing autoimmune reaction and tendon becomes fibrocartilage. It no longer works like a tendon, and stretchs out.'
This comment appeared to be associated with research done at UCSD By Dr. Michael Brage who found tendon-bound auto-antibodies in a number of cadavers with known tibialis posterior dysfunction, concluded 'preliminary results indicate that humoral auto-immunity is involved in the disease process of progressive tibialis posterior dysfunction.'
Last year I tried (unsuccessfully I feel)to get the same message across on these boards that PF had an autoimmune basis. My argument is that, using the Grass Juice Factor extracted from wheatgrass, (see the Cereal Grass book (ed. R. Seibold)p.21 at http://www.wheatgrass.com )which was incorporated in a balm that I consider to be a topical immunomodulator, a significant percentage of patients with chronic PF improved or recovered completely. Some of these recoveries have occurred so quickly i.e. in a day or two, the recovery could not possibly have been due to the resolution of 'biomechanical' factors. The fact that not everyone recovered is irrelevant. The PHENOMENON still occurred. A major part of that phenomenon is, I am convinced, due to the reversal of an autoimmune status at or around the plantar fascia.
As to the cause of the autoimmune response, that is anybody's guess. However, with due respect, given my extensive usage and observation of the effects of the extract as a family physician for nearly 8 years, I wonder if it does have an awful lot to do with the tightness of the gastrocnemius. There are many other factors, including major stressors (eg illness, e.g. influenza, psychological, emotional and physical stresses) that occur around the time of onset of a number of these patients. Of course the condition can be aggravated by over use, obesity and other factors, but the actual cause is, and I agree with you, probably auto-immune.
Your remark about Dr. Brage's presentation was also interesting viz:- 'When it was presented, the audience was very skeptical, as with any new concept. Sort of like the guy who cultured stomach ulcers (that nobody ever thought of doing before), and discovered that they were infectious diseases. We now treated them with antibiotics!!!!!!'
Dr. Barry Marshall and I were at med school together at the University of Western Australia.
Kind regards,
Dr. Chris Reynolds
Melbourne, Australia.

Re: tight gastrocnemius muscle

Pauline on 6/28/02 at 09:27 (088667)

Dr. Reynolds,
I'm one of your users and believer in the Jade Cream. For me it really worked. I have posted this fact many times on heelspurs as well as telling others that I have kept journals on my journey with Plantar Fascittis which I've had three different times.

When looking back through these journals one can find a definate flare up pattern in my P.F.at times of stress. I believe I've mentioned this to you in an e-mail.

I have been pain free for quite a few months now, but I can honestly report even some mini flare ups that occur timed with additional stress in my life.

I do have some auto immune issues and personally think additional studies could be very helpful to P.F. patients.

Thank you again for introducing us to your Jade Cream.

Re: tight gastrocnemius muscle

rose w. on 6/28/02 at 16:32 (088700)

Can you tell us more about how to make such a balm from the wheat grass. I llooked at the website, but could not find any information on the book you were referring to. thanks

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/28/02 at 21:05 (088726)

Pauline, thank you for your supportive comments about Jade 168 Balm. I'm very glad it has helped your PF. I hope it continues to work for you as it has for so many of my patients in Australia. I also agree with you about the need for additional studies around stress and other auto-immune related factors.
Kind regards,
Dr. Chris Reynolds.

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/28/02 at 21:21 (088728)

Rose, I regret that I am not in a position to tell you how the balm is formulated. However, if you go to http://www.jade168balm.com you can learn more about Jade and you purchase it if you wish.
What the Cereal Grass Book tells you though is a lot about the proven effectiveness over many years of wheatgrass in treating inflammation, wound healing and many other conditions. The healing effects of wheatgrass have after all been known for thousands of years. The fact that I discovered that the wheatgrass extract worked on PF in some patients was simply by trying it. After all, I knew it was completely safe. When it actually worked on the first patient I tried it on, I was astounded. Naturally, because it is cheap compared to most other treatments and free of adverse effects, I have continued using it ever since. Of course it doesn't work on everyone, but nothing does.
Kind regards,
Dr. Chris Reynolds.

Re: tight gastrocnemius muscle

BrianJ on 6/28/02 at 21:38 (088730)

Dr. Reynolds --

Just wanted to say hello and thank you for your continued presence on the board. Whether or not some PF sufferers turn out to have an autoimmune issue, your analyses are always respected and welcomed by us.

Re: tight gastrocnemius muscle

john h on 6/29/02 at 07:55 (088750)

I still use the balm Dr. Reynolds.

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/29/02 at 10:54 (088759)

Brian, thank you for your kind remarks. It's people like you who make the world go around.
Even though I was unable to help you, you have been a stalwart in supporting not so much the concept of 'cure', but of at least trying to envision the possibility that if we keep trying, then we may be able to come up with something that will help. I have never promised anything, and I would be foolish if I did. But at least some people have been relieved of their symptoms from using Jade.
Kind regards,
Dr. Chris Reynolds.

Re: tight gastrocnemius muscle

Dr. Chris Reynolds on 6/29/02 at 11:11 (088760)

John, nice to hear from you again, and I'm glad you're still finding the Jade useful. I use it every day also in my clinic. In fact, one of the main reasons I come to work is to use it on my patients because it helps so many of them as a topical anti-inflammatory, a wound healer and as a hemostatic agent. In other words, it may not cure, but it can certainly improve peoples' quality of life. Also, there are many more ways to use Jade than just for PF.
John, I'm still waiting for that email telling me you're heading for Melbourne and the Great Sandy Desert. After hours the airport may be closed, but the bar will be open.
Kind regards,
Dr. Chris Reynolds.