asana: programme for pulled muscles

yoga book / functional exercises / programm bei zerrung

Calf muscle strain injury (CMSI) is a functional disorder of the soleus or gastrocnemius without a detectable macroscopic equivalent on imaging. It is based on a disorder of the muscle spindle that leads to neuromuscular dysregulation and causes extreme painful hypertonicity of circumscribed muscle areas. Once the resulting oedema has subsided at the latest, it is advisable to break through the dysregulation through rehabilitative training and get the muscle used to working physiologically again. An acute strain may build up in pain within a few steps when running or may occur suddenly within one step, which can hardly be distinguished from a tear if you have not already experienced both. After the tear occurs, the muscle is painful under pressure, oedema develops, there is moderate to pronounced stretching pain and strain pain, which can be up to NRS 10. Continued strain can then lead to a tear and must be avoided at all costs.

These are particularly valuable for the soleus. By moving the knees forwards, any dorsiflexion can be achieved and the precise weight distribution on the foot between the heel and ball of the foot allows the load on this muscle to be controlled very well.It is not uncommon for strain pain to be much more pronounced than stretch pain, especially in flexible people. Rehabilitative training consists of stretching the calf muscles, which, if it is unknown whether it affects the soleus or gastrocnemius, must be performed with both the knee joint flexed and extended. If the gastrocnemius is known to be affected, the stretches are performed with the knee joint extended, and with the soleus flexed to at least 20 degrees if the knee joint is affected. The stretches should be held for longer, for at least half a minute to a minute, and repeated throughout the day. The soleus stretches include the soleus stretch on the block or the malasana. For the gastrocnemius, a one-legged or two-legged dog pose head down, a 1st warrior pose or a parivrtta trikonassana are suitable. In analogy to the soleus stretch on the block, there is also a gastrocnemius stretch on the block with an extended knee joint. Instead of a block, a sufficiently high kerb can also be used to stretch the gastrocnemius or soleus. It is often found that when a person wants to leave the stretch from the very same musculature by a concentric contraction of the musculature from the furthest sarcomere length, the full and disproportionately higher painfulness under stress of up to NRS 10 is triggered, while the painfulness during stretching was perhaps only NRS three or four. The full onset of pain should be spared to the muscle at this stage by leaving the posture in a different way. At this stage, shortly after the strain occurs, loading the forefoot with body weight is also often associated with pain triggering up to NRS 10. If a therapist tests dorsiflexion and plantar flexion with only very moderate force, the pain triggering may be so low that the therapist considers the two tests to be without findings. After one or two days of predominantly stretching, partial weight-bearing should be gradually introduced. This can be done, for example, by integrating partial weight-bearing on the affected side, depending on the pain sensation, into the gait, which was initially characterised by complete pain avoidance and therefore tends to cause problems on the side with more weight-bearing. A very good loaded eccentric contraction is walking down the stairs, which should be done without rolling over the balls of the feet, as this would reduce dorsiflexion and therefore stretching. The foot can therefore be placed on the heel, but the entire sole of the foot and not the ball of the foot is lifted off the step. If there are no stairs available, walking downhill on steep terrain still achieves something comparable, but the stretch is correspondingly less because the same dorsiflexion is not achieved. As a wide-range movement that reacclimatises the triceps surae to load, high metabolism and adequate innervation, a small-step gait is suitable, the propulsion of which is primarily derived from plantar flexion. The heel is therefore placed on the ground for a rolling movement of the foot, which is performed slowly to the widest plantar flexion 
knee bends are also very easy to control in terms of angle and load.

It is also helpful to cycle, where you try to achieve propulsion mainly from the triceps surae, i.e. with a powerful wide-range movement in the OSG. This allows for intensive training, especially uphill.

The strengthening training described can be performed once or twice a day. Once the triceps surae is completely pain-free using this method and the tone of the affected muscles has been reduced to a normal level, at least two days of gastrocnemius training without significant strain should be carried out before the first gentle and short running training is tried. Under no circumstances should intensive efforts be made on the gastrocnemius before running training, but the lower leg should definitely be warmed up sufficiently without stretching it intensively. Over the next few days, an attempt can be made to carefully increase running training, whereby the affected person must listen very carefully to the signals from their calf muscles and stop training immediately at the first sign of a noticeable increase in tone; after all, the probability of recurrence is relatively high with a calf strain, especially if the injury has not healed properly. The loss of training due to a recurrence is always many times higher than a few more days of rest or moderate, adapted training.

Particularly in the initial period, care should be taken to ensure that neither a lack of fluids nor a lack of electrolytes can impair muscle metabolism and innervation, i.e. sufficient fluids should be consumed throughout the day before a sports session and electrolytes should also be consumed sufficiently in advance. It should also be borne in mind that infections that are in the process of subsiding also predispose to muscle injuries. See also the predisposing factors described for strain. Preventing strain and recurrence also includes not sitting or sleeping in an instep-foot position for long periods of time.

It should also be noted that muscular imbalances or restrictions also increase the risk of strains, especially if they affect the dorsal part of the lower limb kinetic chain, if they affect the dorsal part of the kinetic chain of the lower limb, i.e. outside the triceps surae the ischiocrural group or into the foot and its  plantar fascia.