Spastic Gastroc/soleus

[stacie]

Yesterday I massaged a young man with a slight mental handicap. It is a little bit hard to know if he clearly understands what I am asking him, but it seemed like he knew what I wanted. He is usually massaged by a lady who is now on maternity leave. He has what his mom describes as an incorrect signal from his brain to the muscles in his legs (I think his brother also has this). I don't know exactly what this is. He has painful spasms in his gastrocs/soleus, as well as pain in his kneees, and boy were they rock hard. He says the other therapist uses her forearms/elbows/fists and gets in there with full force ignoring the spasm and just working as deep as she can. Well, I was trying to see what happens with this kind of work and as I expected, each time I went too deep, the spasms returned with full force. I backed off and found better results. I asked him afterwards if he had any relief. He said he has to wait and see, but it seems looser. Does anyone have any suggestions as to how to effectively treat these spasms? I have never had anyone so tightly spasmed as this poor guy.

Thanks! t017

 

[ainawgsd]

OUCH!!!!!! I cannot imagine digging in deep while it is in spasm.....or having that done to me!! I'm glad you worked more gently!

I have best result with spasms when approximating the muscle, stretching aneforum.xxxonist muscles - which in his case I would recommend he do several times a day on his own - and very, very gentle and repetitive strokes towards the heart.

 

[msdixie]

well, if you can communicate with him clearly enough, maybe trying some post isometric relaxation will work.

after getting a good stretch of the gastroc/soleus, ask the client to gently push toes into your hand - plantar flexion, (you can say things like: with 10% of strength, initiate the movement, say "match my pressure", while applying appropriate pressure).
make sure to hold the isometric for 15-20 seconds, and that the client is not pushing too hard. one of my instructors voice always enters my head when doing isometrics. her mantra was "LONGER, NOT STRONGER."
remember to stretch out the grastroc/soleus again following. you should also notice the stretch going further after each isometric. you can repeat this 3-5 times, combining with swedish massage in between to flush out tissues.

also, if you are familiar with reciprocal inhibition, you can show him that actively putting the foot into dorsiflexion - as in pulling tops of feet against bottom of mattress while lying prone - actually disengages over active plantar flexors. this can be done as strong as needed and as long as needed to relieve the cramp/spasm. this will be helpful in dealing with spasming muscles between sessions.

 

[brokendown321]

Petrissage has been shown to help reduce spasticity. I too second the notion of teaching him simple stretching methods, though I would use AIS for this person, focusing on non-weight-bearing stretches. AIS incorporates reciprocal inhibition and may also help his body learn to minimize the tendency to spasm. I know quads that have regained much lost motor function from working with AIS.

 

[Arron]

Thanks for the good suggestions. I think I will also try to incorporate some of the AIS stretches that I learned at the Michael Young "Muscle Release Technique" seminar. Reciprocal inhibition and isometric stretches are great ideas too. I appreciate all of your ideas.

 

[Danielle P]

Denise,
Reading through your description of your client, I wondered whether he showed high tone in any areas of his body or whether his gait was different. My guess is that he may have issues at the pelvis and down through the legs which may cause the calves to go into spasm. You may wish to check and treat these areas as well, if they are indicated. Without addressing other parts of the body, any changes you make to the calves may not last long.

 

[Tmucho]

Walt, your points are very well taken. I guess I was trying to mimic the work of his regular therapist. It didn't help that we only had a 30 minute session. Also, I guess that I was afraid to work elsewhere (even though I know that is what he needed) before I gained his trust, due to his mental handicap. I know that the changes that I made to his calves will fail to last if the other parts of his body are not addressed. I would be able to educate the other clients that I have, but unfortunately all he knows is that he likes deep, deep work and thinks it is the solution for him. It is rather frustrating, but I am not sure I will be coming back as his regular therapist will be returning soon.

Thanks!

 

[bunz88]

Just thought I would throw this out there. First let me say I am a bad speller. Has your client been checked out by a Dr? I managed to rupture my Plantaris muscle in my right leg. Some of my symptoms are as follows. Muscle spasms with needle like pain in the Gastorcs and Solies, some pain in the achelies tendon, some muscle spasms with muscle cramps when my foot is in planter flexion, rock hard Gastroc on the lateral side with some tenseness in the solies. Swelling of the foot and lower leg with heat and cold numbing sensations. Limited ROM in the ankle with the leg extended but full ROM with the knee bent and the inability to bare any weigh standing on my toes or any downward pressure. These are also some of the same symptoms for a blood clot as well.

 

[slt]

Hi blissful

Just thought I'd throw it out that if you happen to know his
MT, that you may want to pass along what the others have said. If not, then you may want to mention to the mother what you percieve would help him out. Unless you know the
regular MT, I would personally feel your responsibility lies with the client & the mother, in this case. IMHO, for what its worth.

 

[Charles]

This may sound counter-intuitive, but, I'll offer it any way...........

Sometimes when I encounter spasticity in any form, I have found that simply holding the "offending" musculature between my hands gently has as much or more effect on relaxation of the spasms as does directly applied massage techniques........... kind of like craniosacral, but, not really...............


for what it's worth,
Me

 

[antivirus]

This may sound counter-intuitive, but, I'll offer it any way...........

Sometimes when I encounter spasticity in any form, I have found that simply holding the "offending" musculature between my hands gently has as much or more effect on relaxation of the spasms as does directly applied massage techniques........... kind of like craniosacral, but, not really...............


for what it's worth,
Me

I totally agree! And instinct says to stretch it out of the cramp...I've found that going with it, shortening the muscle even further than it wants to go, eases it MUCH faster and leaves one with much less pain. It's just SO natural to want to fight it.