This week I had a new client come into open clinic who has tightness in their gastrocnemius’s. I completed the subjective assessment to see if any parts of their lifestyle were causing the achiness and to see how it could be prevented in the future. As part of the objective assessment I noticed that they had increased muscle bulk on the left side, the knee crease was higher on the left side and they had slight Varus knees. On palpation not only was the lateral side of the right calf tight but the same occurred on the left side. We would expect the left side to be tighter as this is the client’s dominant leg. Once the client signed for consent I explained to them that I would perform soft tissue massage on the lower legs to release some tension and then use muscular energy techniques (METs) to increase flexibility. As part of soft tissue massage I used effleurage as a starter to create heat and to feel for any possible areas of hypersensitiveness. I then used petrissage to increase the circulation, aiming to release some of the tightness. I then finished the treatment by using METs to stretch, strengthen and break down fibrous adhesions. There are 2 types of METs; I used post isometric contraction (PIR), which is where the target muscle is contracted (gastrocnemius). I would only use reciprocal inhibition (RI) which contracts the antagonist if the target muscle was injured as it would put less strain on it.

Areas for further improvement 

My first area of improvement would be to use the VAS pain scale at regular intervals throughout the soft tissue massage and other treatments such as soft tissue release (STR). For this particular treatment I only used the scale twice so at times I was unsure if the pressure was appropriate. The VAS pain scale is more specific because if the client says an 8 or over you know you are applying too much pressure whereas any number lower than a 7 you can push a bit harder. Another weakness that could be addressed would be when performing METs of the gastrocnemius to check to make sure that the client has no ankle injuries or weaknesses around this area. I should have checked this with the client in the subjective section of the form as part of clearing the joints above and below.

Things to remember

1. Do not massage over open wounds as it could spread any infections
2. When observing a client in a static position get them to remove their shoes
3. Get them to lie flat when massaging so they are relaxed as possible