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FOR ACCESS TO FREE VIDEOS AND ARTICLES AND THE LATEST NEWS ON UPCOMING TRAININGS, JOIN DR. BENJAMIN ON FACEBOOK AT FACEBOOK.COM/DRBENBENJAMIN. Friction therapy of the gastrocnemius muscle is performed with the person lying in a prone position. Place three or four fingertips over the area of pain, press anteriorly, move with moderate force through the muscle fibers at a 90º angle, and then drag back to the starting position. Repeat this friction movement continuously for 5–6 minutes. Take a break for a minute or so and do the same thing again. You know you are using the right amount of pressure if the client feels mild, annoying discomfort, not pain. After performing the friction therapy, apply effleurage massage to the calf, posterior thigh, foot, anterior thigh, and shin to increase circulation throughout the entire limb. STRETCHING After two weeks of hands-on treatment, gentle stretching should begin, provided that it can be done without pain. This allows for continued healing in the presence of a full range of motion. Start by performing assisted stretches on the gastrocnemius muscle (Image 4). While holding the heel with your fingers, have the person actively pull the toes toward the knee as far as possible. Then, using your forearm, gently take him or her a bit farther for up to 2 seconds. Do not hold the stretch at the end; instead, move slowly and gently, in a continuous motion. When you have completed the stretch, ask the person to extend the foot and repeat the process 8–10 times. Then, have the person evert the foot and perform the same stretch 8–10 times. Finally, repeat with the foot inverted. This gets all the different fibers to participate in the stretching action. (This method of stretching is taken from the Active Isolated Stretching method developed by Aaron Mattes.) After doing this successfully in a few sessions, teach the person how to do the same thing by himself or herself on a daily basis, using a rope or strap of some sort. STRENGTHENING After the acute pain has subsided and the person can walk without discomfort, initiate a strength program for the calves. Start with heel raises on both feet simultaneously, with more weight placed on the good leg if sharing the weight equally is too stressful on the injured leg. Over a few weeks, have the client transfer more and more weight to the injured leg until the heel raises can be performed on the injured leg only. Once the person can perform three sets of 10 heel raises on both legs without pain or fatigue, begin to vary the exercise. Use three different angles—feet parallel, turned slightly inward, and turned slightly outward— with 10 repetitions in each position, for a total of 30. When the client can do these variations easily with the knees straight, add all the same exercises done with the knees bent. That makes a total of 60 reps. In the final stage, the client then repeats this same set of exercises with the balls of the feet on a step, so that the heels can go below the forefoot. This enables the gastrocnemius to move through its full range of motion as it increases in strength. A STRAIGHTFORWARD PATH TO HEALING Once you have a solid understanding of gastrocnemius injuries, they are relatively easy to assess and treat. There are just a few important principles to remember. As mentioned earlier, be sure to have the person see a physician and wait at least three days after the injury has occurred to gently begin treatment. This allows the initial healing to take place without interference. Emphasize the importance of keeping the heels elevated, so the gastrocnemius muscle can relax. Also work to ensure that the client moves the calf through a full range of motion, on a daily basis, in order to maintain full flexibility and help prevent future injuries from occurring. With proper self-care and appropriate treatment, most gastrocnemius muscle tears can heal within 4–6 weeks. in education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than 45 years and has taught communication skills as a trainer and coach for more than 25 years. He teaches extensively across the country on topics including orthopedic massage, Active Isolated Stretching and Strengthening, SAVI communications, and ethics, and is the author of Listen to Your Pain (Penguin, 2007), Are You Tense? (Pantheon, 1978), and Exercise Without Injury (MTI, 1979), and coauthor of The Ethics of Touch (Sohnen-Moe Associates, 2003). He can be contacted at 4bz@mtti.com. Ben E. Benjamin, PhD, holds a doctorate Note 1. There are trainings available that enable massage therapists to become experts in this kind of analysis. For information, visit www.goprimalfitness.com. Editor's note: Massage & Bodywork is dedicated to educating readers within the scope of practice for massage therapy. Essential Skills is based on author Ben E. Benjamin's years of experience and education. The column is meant to add to readers' knowledge, not to dictate their treatment protocols. connect with your colleagues on massageprofessionals.com 95