Medical Questions > Conditions and Diseases > Muscular and Nerve Disorders Forum

Atrophy of Medial Head of the Gastrocnemius

I am 28 years of age and a full-time Fitness Instructor and PT. I have always been very active and taken part in many different sports and activities. I started training for The London Marathon November last year. Training was going fine and in January this year I started to increase the distance in training. I then noticed my calf muscle on my left leg was significantly smaller than the other. I had no pain at all so I presumed I was favouring one side of my body more than the other so I kept running. I went to see a Physio just to get a 2nd opinion and he could find nothing wrong and said to just reduce the number of running sessions from 4 to 3 per week.
On the Marathon Day I got to 18 miles and my right hip flexor became very strained to the point where I was unable to continue. The hip flexor is fine now, but the calf has not returned. It is the Medial Head of the Gastroc that has atrophied. I went to see my GP and was referred to St Georges to the Nurologist. I have had an MRI on my lower back, which displayed a slight bulge on my L5/S1 disc, but nothing that could affect the Calf muscle. I have also had an EMG surface and intra muscular test carried out and all nerves are functioning fine. I am still awaiting an appointment to have an MRI carried out on the calf muscle, but I feel this is all taking a long time.


The injury is getting me down. I have tried calf strengthening exercises and stretching, but nothing has helped. I am limping slightly when I walk and my whole left leg and glute always feels stiff. If anyone has had a similar injury or has any knowledge in this area and could help that would be very much appreciated.

Matt
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First Helper User Profile Gaelic
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replied October 21st, 2012
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matt84uk,

This is very interesting, but very perplexing.

It is interesting that it involves just the medial head of the gastrocnemius, and not any of the rest of the triceps surae muscle (soleus or plantaris). The gastrocnemius is innervated by the tibial nerve (derived from L4-S3 nerve roots, the tibial nerve is the larger of the two terminal branches of the sciatic nerve. It leaves the popliteal fossa between the heads of the gastrocnemius and supplies all muscles in the posterior compartment of the leg).


You would think, that because just the medial head is involved, there would have to be a lesion in the tibial nerve just as it branches to innervate the medial head. That something is compressing the nerve at that location, be a mass, fascial band of tissue, scar, whatever (which is the reason for the MRI of the knee and calf). But, with normal EMG and NCV (nerve conduction velocity) tests, this is probably not as likely.

The small disc bulge at L5-S1 would not account for this, as it is not compressing any of the nerve roots.

A muscle disease would most likely affect all of the muscles in the body, not just one. However, to figure out what is going on, it may be necessary to do a muscle biopsy, just to look at the structure of the muscle fibers.

As to strengthening of the muscle, you would think that since the electromyography shows that the muscle is receiving impulses from the nerve and the muscle fibers are behaving normally, that you should be able to rebuild the strength in the muscle. It just does not make sense.

Again, from your presentation, the only thing that makes any sense is a lesion in the tibial nerve, supplying the medial head. But, with normal electrical studies, this is indeed a very perplexing problem. Maybe the MRI of the knee/leg will reveal something.


A few totally off-the-wall thought that have come to mind include MS (multiple sclerosis), polio, ALS (amyotrophic lateral sclerosis), or CMT (Charcot-Marie-Tooth). But, you have probably been vaccinated against polio, so that is probably out. One of the hallmarks of MS is neurological symptoms that do not make sense. But, just part of one skeletal muscle involvement would not be a typical presentation for any of these conditions. Again, these are just off-the-wall thoughts.



Try to not get discouraged. It is very difficult, especially when the cause of the problem cannot be found. Continue to work on strengthening as much as possible and maintain the range of motion in all of your joints. If you have access to a pool, you might find water exercises very enjoyable and helpful. In some pools, they have a weighted vest so that patients can “run” in the deep end of the pool. This is a common way for athletes to stay in shape when they have a lower extremity injury. Just something you might want to look into.

Get your work-up finished and then maybe something will be discovered. Wishing you the best. Good luck.
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Users who thank Gaelic for this post: matt84uk 

replied October 21st, 2012
Thank you very much for your reply Gaelic. This information has definitely given me more avenues to consider / explore. I will post when I've had the results of the MRI of the whole left leg. I just hope that it isn't the result of a disease or something very serious. I am a competitive swimmer and I will keep this up, the swimming is something I can still do (which is great!) I am continuing to strengthen both legs individually. One thing that does spring to mind is the flexibility of my hamstrings. I am not very flexible at all in my hamstrings, to the point where I have a very solid ball of knotted muscle in the middle of my hamstrings half way between my knee and glute. I don't know if this could be affecting the calf in any way? Just something that springs to mind.

Matt
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replied June 1st, 2013
Hey there matt,

I just stumbled on your post. Wondering if you have had any positive results since your last post. I have had a similar issue except mine involves complete foot drop from a fall in a soccer game. If you get this I would like to chat. E-mail me.

Thanks,

Josh
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replied August 28th, 2013
Hi Matt,

I have also suffered a similar injury and would like to know if you have had any success.

I herniated a disc (L5 S1) 19 months ago and I am suffering from weakness in my calf muscle. It appears to be mainly the inside of the calf (the medial gastrocnemius muscle I do believe).

I try to walk daily for about 40mins, with stretching etc.. Calf raises are difficult and I can not perform them on only one leg. I have seen a physio who suggests that I need continue as I am going, and hopefully the strength will return.

Would be great to know if you have had any success.
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replied August 28th, 2013
Hi Matt,

I have also suffered a similar injury and would like to know if you have had any success.

I herniated a disc (L5 S1) 19 months ago and I am suffering from weakness in my calf muscle. It appears to be mainly the inside of the calf (the medial gastrocnemius muscle I do believe).

I try to walk daily for about 40mins, with stretching etc.. Calf raises are difficult and I can not perform them on only one leg. I have seen a physio who suggests that I need continue as I am going, and hopefully the strength will return.

Would be great to know if you have had any success.
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replied January 29th, 2015
I had open heart surgery in june 2014. when i woke up, i had a severe pain in my left calf. no on compartment syndrome. no one knew what it was until i went to a skeletal orthopod. he did an ultrasound and determined that the gastrocnemius had died during the surgery from a blood clot. my ankle plantar flexion is fine (standing on tip toes) but my ankle dorsiflexion (lifting toes during walking) is gone. very frustrating to find out and it took about 4 months before it was figured out. a vascular surgeon checked the blood flow in my legs and it is fine and recommended that i attempt to hypertrophy the surrounding muscles to make up for the deficit. i also tried accupuncture but not sure if it did much. the best solution i found was wearing a special boot that prevented the foot from dropping during sleep and would keep the muscle stretched. i walk mostly normal now, but only have about 1/3 of the normal lift on my left foot.
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replied January 30th, 2015
Hi, very sorry to hear about what happened to you but I'm glad that you have some improvement.
With regards to the gastrocnemius dying is that even possible? I though that muscle could waste away but it could still be revived, for want of a better expression, as long as it was receiving signals from the nerves?
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replied December 27th, 2016
I, too, was a marathoner. I took time off from running to pursue a master's degree. When I tried running once again I was experiencing a great amount of hip pain, to the point where I had to stop running and could barely walk home. I tried going dancing a week later and found my calf muscles to be very tight, which I thought was typical from running after laying off for a while. But it never got better. Soon I couldn't raise up on my toes anymore. Dancing was out. I sought medical help and was told I had spinal stenosis. After two back surgeries which did not help I searched the internet and found Miyoshi myopathy, which sounded exactly like what I had. I had genetic tests done and that was ruled out. So now I have no strength in either calf. No foot fall involved as I can walk on my heels just fine. After 4 years I'm no better off. I am now 58 by the way.
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