The Association between Calf Tightness and Back Pain

The muscles of the calf are collectively termed as the Tricep Surae; these comprise of a pair of muscles known as the gastrocnemius and the soleus (along with the plantaris muscle), which work together as plantar flexors.

The tendons of the gastrocnemius and soleus muscles combine to form the Achilles Tendon, which is the strongest tendon in the human body and inserts at the posterior calcaneus. 

Medial and lateral heads of the gastrocnemius originate from the medial and lateral femoral condyles respectively.

During movement such as running or jumping, the gastrocnemius is responsible for creating traction on the femur to pull it toward the tibia, causing the knee to bend.

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The soleus muscle originates at the posterior aspect of the fibular head and the medial border of the tibial shaft. Its main function is to push the toes off the ground while walking and to help maintain posture and stability.

In the event of tightness in the calf muscles, a normal hip swing is prevented and there will be a shortening in stride while walking.

There is limitation in the ankle range of motion and the body’s centre of mass shifts anteriorly.

This causes the thoracolumbar paraspinal muscles to overwork while trying to maintain an erect posture. This leads to an increase in lumbar lordosis.

Postural examination will reveal forward head translation coupled with ipsilateral lateral flexion in the cases of unilateral calf tightness.

Since there is restriction in full ankle dorsiflexion and knee extension, the joints in the foot are forced to flatten in order to compensate for the reduced ankle range of motion.

This sets forth a “domino effect” on the rest of the kinetic chain; the hyperpronation of the foot alters the musculoskeletal system and the arthrokinematics of the body on the whole.

With abnormal foot pronation, there is an excessive internal rotation of the ipsilateral tibia, consequentially leading to an excessive internal rotation of the ipsilateral femur as well.

This medial-rotation of the femur and tibia causes a knee valgus and increase in the Q angle.

The foot and ankle complex is seen to dorsiflex and abduct, causing the knee and subsequently the hip to flex, adduct and rotate internally.

The result of this compensatory abnormality is an anterior ipsilateral pelvic tilt.

This exerts significant pressure on the muscles in the lower back, increasing the risk for lower back pain.

A thorough gait analysis needs to be conducted first to spot any biomechanical discrepancies that could be adding more strain on the calf muscles. If this is the case, foot supportive devices would help in lessening this strain.

This is imperative as the foot posture needs to be supported in its corrected closed-chain posture which allows for full range of motion in the ankle joint complex and realignment of the proximal kinetic chain.

This will help keep any stress off the calf muscles, restore functionality in the ankle and provide for the recovery of the patient.

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