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Gastrocnemius Injury during Running: A Case Report

Article  in  International Journal of Sports Medicine · February 2009

DOI: 10.1055/s-2008-1038793 · Source: PubMed

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46 Orthopedics & Biomechanics

Gastrocnemius Injury during Running: A Case Report

Author P. W. Kong

Affiliation Department of Kinesiology, University of Texas at El Paso, El Paso, Texas, United States

Key words Abstract creased muscle-tendon complex length and

" speed
l ! shortening rate, and indifferent patterns in
" ground reaction force
l Incidence rate of running related injuries is high ground reaction forces, joint angles, moments
" joint angle
l
" joint moment
but forces acting on the body during injury are and powers. Both kinetic and kinematic data sug-
l
" joint power
hardly known. During a data collection session gest that the injury occurred during the early
l
" muscle-tendon complex
l in the investigator’s laboratory, one subject sus- stance phase, which is in agreement with the
tained a medial gastrocnemius muscle strain in- subject’s description. These data are unique and
jury while running across a force platform. This invaluable to the understanding of internal and
case report aimed to investigate the causes of this external loads during acute traumatic running
acute running injury by comparing the running injuries. The findings suggest that the injury oc-
speed, external forces, joint kinetics and kine- curred soon after touchdown and may be caused
matics, and muscle-tendon complex length of by a faster than usual running speed and inap-
the injured trial to five preceding noninjured tri- propriate body posture at touchdown, which lead
als. The injured trial was characterized by faster to altered muscle length and actions to attenuate
running speed, higher external loading rate, in- impact shock.

Introduction jured his lower leg while running across a force

accepted after revision
June 18, 2008
Bibliography
DOI 10.1055/s-2008-1038793
Published online July 24, 2008
Int J Sports Med 2009; 30: 46 –
52 © Georg Thieme Verlag KG
Stuttgart • New York •
ISSN 0172-4622
Correspondence
Dr. Pui Wah Kong, Ph.D.
University of Pittsburgh
Department of Emergency
Medicine
230 Mckee Place, Suite 400
Pittburgh, PA 15213
United States
Phone: + 1 91 53 55 05 76
Fax: + 1 41 26 47 46 70
venikong@yahoo.com
! platform. This accident gave the investigator an
Running is a popular competitive and recreation-
al activity and it has been estimated that 30 mil-
lion Americans participate in some level of run-
ning [23]. In conjunction with the many positive
effects on health and fitness provided by running,
it is important to consider the risk of injuries be-
cause the incidence rate of running related inju-
ries has been reported to be as high as 59 per
1000 hours of running [13]. Despite the high risk
of injuries, no definitive cause-and-effect rela-
tionships have been found between specific run-
ning characteristics and injuries [13, 23]. Pro-
spective studies have shown that poor running
mechanics predisposed individuals to ankle
sprains and exercise-related lower leg pain [25,
26]. Impact force and its relationship to running
injuries have received a considerable amount of
attention in the literature (e.g., [1, 27]). Yet, the
internal and external forces acting on the body
during an actual running injury are hardly known
because these data cannot be obtained from con-
trol experiments. During a data collection session
in the investigator’s laboratory, one subject in-
opportunity to examine the forces acting on the
body during an acute injury. Although runners
suffer from chronic injures more often, acute
traumatic injuries cannot be overseen since they
make up approximately 27% of all running inju-
ries [15]. It is also reported that acute musculo-
skeletal injuries are common among marathon
runners during and immediately after a race [19].
Muscle strain injury is not the result of muscle
contraction alone but excessive stretch or stretch
while the muscle is being activated [5]. In animal
experiments, the threshold of initiation of micro-
failure has been suggested to be 16.5% of strain,
which corresponds to 16.6% of maximal sustain-
able force [20]. Others reported between 12% to
20 % strain as a threshold for eccentrically in-
duced muscle injury [22]. It is generally believed
that muscle strain injuries occur during eccentric
contraction due to excessive sacromere stress
[12], though the only case report on human gas-
trocnemius strain injury does not support this
[18]. Rather, the strain injury appeared to occur
when the muscle-tendon complex was almost

Kong PW Gastrocnemius Injury during … Int J Sports Med 2009; 30: 46 – 52


isometric [18]. It is, however, difficult to identify the exact mo-
ment of injury or muscle length from regular video footage
which is typically sampled at a low frequency and from which
joint positions can only be roughly estimated.
In light of understanding the mechanism of acute traumatic run-
ning injuries, this case report presented data on running speed,
external forces, joint angles, joint moments, joint powers and
muscle-tendon complex length of the injured trial as well as
those of five preceding noninjured trials. It was hypothesized
that the injured trial would display indifferent kinetic and kine-
matic characteristics compared to the noninjured trials, and that
these characteristics would allow the identification of the cause
of injury and the timing of injury occurrence.
Material and Methods
! further analyzed. Each trial was time normalized to 100 % stance
Subject
The subject was a male kinesiology major student (age = 37 yrs,
height = 1.69 m, mass = 91.0 kg) who was free from recent low-
er-extremity injury or pain. The experimental procedures the
subject was participating in were approved by the institutional
review board. Informed consent was obtained prior to experi-
mental procedures. After the injury happened, the subject
agreed to have his data published in this case report.
Protocol
The subject ran at a self-selected speed across a force platform
(Advanced Mechanical Technology Inc., Model OR6-6 – 2000,
Watertown, MA, USA) while ground reaction force (GRF) data
were measured at 2400 Hz. In order to obtain kinematic data,
31 reflective markers were placed on the subject based on the
Plug-in-Gait marker set and the running trials were recorded at
240 Hz using an eight-camera motion analysis system (Vicon,
Centennial, CO, USA). The footwear used in the study was a
light-weight cushioning shoe model (SpiraTM Clarion, El Paso,
USA). In the original protocol, the subject was asked to run 10
times across the force platform located in the middle of a 20-m
runway at his own pace. A successful contact was defined as the
subject’s right foot striking the force platform without altering
his running technique. Sufficient time was given for familiariza-
tion before data collection started.
The injury
The subject completed five successful trials consecutively. On
the sixth trial, the subject sustained an injury on his right lower
leg while making contact with the force platform. The subject
explained that upon landing on the force platform, he felt a
“snap” in his calf. Immediately after the injury, the subject expe-
rienced difficulty in ankle dorsiflexion and felt extreme pain in
his calf when he attempted to walk. The following day, a certified
physical therapist evaluated the subject’s injury as a partial tear
of the medial gastrocnemius and advised him to treat it with
rest, ice, compression and elevation. This assessment was based
on the fact that the subject experienced sharp pain in the medial
calf, showed marked weakness in force production but was still
able to produce movement. Initially, the subject received various
modality treatments including hot/cold packs, ultrasound and
gentle stretching three times per week and was on crutches for
approximately 20 days. Once the pain diminished, he performed
strengthening and stretching exercise and began to resume
strength in about six weeks. In a follow-up approximately two
Orthopedics & Biomechanics 47
months after the injury, the subject continued to experience mi-
nor pain while walking for extended time periods.
Data analysis
The following data of the injured trial and the five preceding
noninjured trials were analyzed:
Ground reaction forces
All GRF data were low-pass filtered at 100 Hz using a 4th order
zero lag Butterworth filter and normalized to the subject’s body
weight. From the GRF data, touchdown and toe-off were identi-
fied and stance time was calculated. Loading rates from touch-
down to the peak force was computed by differentiating the
force-time histories of the vertical, anteroposterior and medio-
lateral GRFs. l" Fig. 1 illustrates 10 temporal and force variables
at critical moments of the stance phase and these variables were
time to facilitate comparison between trials.
Running speed
Running speed was calculated from the center of mass position
in the anteroposterior direction at touchdown and five frames
prior to touchdown onto the force platform.
Joint angles
Joint angle time histories were low-pass filtered at 13 Hz using a
4th order zero-lag Butterworth filter. Sagittal plane angles of the
right hip, knee and ankle, together with the frontal plane rear-
foot angle, were analyzed. All joint angle data were time normal-
ized to 100% stance phase and were expressed in reference to an
anatomical position such that a positive angle referred to one of
the following: (i) hip flexion, (iii) knee flexion, (iii) ankle dorsi-
flexion, and (iv) ankle inversion. The sagittal plane joint angle
variables of interest included the angle at touchdown for each
joint, maximum hip flexion, maximum knee flexion and maxi-
mum ankle dorsiflexion. Further, the joint angles at maximum
joint moment and joint power (described below) were also iden-
tified.
Joint moments
Sagittal plane joint moments at the hip, knee and ankle calcu-
lated using the Vicon Plug-in-Gait model in the Workstation
software were used to estimate internal joint loads. This com-
mercial 3D model was based on previous studies including stud-
ies by Davis and colleagues [3] and Kadaba and coworkers [9].
Details of the model and reduction technique are described else-
where (www.vicon.com). All joint moment data were time nor-
malized to 100 % stance phase. Positive moments referred to ex-
tension moments at the hip and the knee, and plantarflexion
moment at the ankle. The moment at touchdown and maximum
extension moment at each joint were identified.
Joint powers
Sagittal plane joint powers at the hip, knee and ankle were cal-
culated from the joint moment and angular velocity time histor-
ies. All joint power data were time normalized to 100% stance
phase. Maximum powers for energy absorption (negative) and
energy generation (positive) and their corresponding time of oc-
currence at each joint were identified.
Kong PW Gastrocnemius Injury during … Int J Sports Med 2009; 30: 46 – 52
48 Orthopedics & Biomechanics
Fig. 1 Ten temporal and force variables obtained from GRF data:
1) stance time from touchdown to toe-off (t), 2) peak vertical impact force
(Fimp), 3) peak vertical active force (Fact), 4) peak loading rate of the verti-
cal force (Gz), 5) peak anteroposterior braking force (Fbrak), 6) peak ante-
roposterior propulsive force (Fprop), 7) peak loading rate of the braking
force (Gy), 8) peak lateral force (Flat), 9) peak medial force (Fmed), and
10) peak loading rate of the lateral force (Gx).
Muscle-tendon complex length
The length of the gastrocnemius muscle-tendon complex was
calculated from the knee and ankle angles using regression
equations [6]. All length changes were expressed as deviation
from the reference length when the knee and ankle were at 908
and were normalized to percentage of the shank length. The rate
of change in length was calculated by differentiating the length-
time curve. During the initial 50 % of the stance phase, the length
at touchdown, maximum change in length (Dl) and the maxi-
mum rate of change in length (lrate) were identified.
Kong PW Gastrocnemius Injury during … Int J Sports Med 2009; 30: 46 – 52
Results
!
Good consistency can be seen in GRF (l " Fig. 2) and joint angles,
moments and power (l " Fig. 3) among the five noninjured trials.
During the injured trial, the subject ran faster than the nonin-
jured trials. The injured trial was also characterized by a higher
peak vertical impact force, braking force, peak loading rate in
both braking and lateral forces (l " Table 1), and an unusual dou-
ble-peak pattern in both mediolateral and anteroposterior GRFs
(l" Fig. 2). Sagittal plane kinematics at critical events clearly dif-
fered between the injured and noninjured trials for all three
joints (l " Table 2) while higher joint moment and power vari-
ables were mainly observed at the hip and the knee (l " Table 3).
Similar or lower maximum moment and power values during
the injured trial were seen at the ankle.
At touchdown of the injured trial, the subject displayed less knee
flexion, more hip flexion and similar ankle dorsiflexion com-
pared to the noninjured trials (l " Fig. 3). There was insufficient
initial hip extension moment, though knee and ankle moments
appeared to be within the normal range. The unusual touch-
down configuration was followed by insufficient knee flexion
and ankle dorsiflexion during the early stance phase. In contrast,
the hip showed increased flexion and remarkably higher exten-
sion moment. Furthermore, the knee displayed flexion moment
and positive power (energy generation) instead of extension mo-
ment and negative power (energy absorption) following the
touchdown. During the first 40 % of stance phase, the hip power
was much higher for both energy absorption and generation,
whereas the ankle power curve did not differ from those of the
noninjured trials. For the rearfoot movement, the general pat-
tern, touchdown angle and maximum inversion/eversion angles
of the injured trial were comparable to the other trials though
the inversion movement during the early stance phase was
slightly delayed.
The gastrocnemius muscle-tendon complex length during the
injured trial was clearly distinct from the five preceding trials
(l" Fig. 4). The muscle-tendon complex was 6.6 % more length-
ened at touchdown in the injured trial (9.7 % stretch) compared
to the noninjured trials (9.1 ± 0.5 % stretch). From touchdown to
the first minimum length during early stance phase, the injured
muscle-tendon complex shortened at a faster rate (lrate =
103.1% • s–1) and to a greater extent (Dl = 3.5%) and compared to
the noninjured trials (lrate = 54.3 ± 11.4 % • s–1, Dl = 1.7 ± 0.8 %).
Discussion
!
This case report presents unique kinetic and kinematic data ob-
tained during an actual running injury of the gastrocnemius.
These data are invaluable to the understanding of acute trau-
matic running injuries which make up approximately 27% of all
running injuries [15]. Many running related injuries are of the
lower extremity [7, 23], within which two-joint muscles includ-
ing the gastrocnemius are more susceptible to muscle strain in-
juries [5]. One study reported two gastrocnemius muscles strain
injuries out of 55 injuries in 60 runners for a one-year period
[14].
Cause of injury
Physical characteristics
The subject in this case report was classified as clinically obese
with a body mass index (BMI) of 31.9 kg • m–2, though previous

Fig. 3 Sagittal plane joint angles, moments and powers of the hip, knee
and ankle angles during the stance phase of the injured trial (solid line) and
five noninjured trials (dotted lines). Positive angles refer to hip flexion, knee
studies suggest that running injuries are not associated with rel-
ative body weight [15, 23]. One prospective study showed that a
BMI greater than or equal to 26 kg • m–2 put men at a lower risk of
running injuries [21] although it is unclear how much mileage
was accumulated over the observed period. Thus, the relation-
ship between weight and running injuries seems unclear be-
Orthopedics & Biomechanics 49
Fig. 2 Ground reaction forces during the stance
phase of the injured trial (solid line) and five non-
injured trials (dotted lines).
flexion or ankle dorsiflexion. Positive moments refer to hip extension, knee
extension or ankle plantarflexion moments. Positive powers refer to energy
generation; negative powers refer to energy absorption.
cause mileage has been consistently shown to be associated
with running injuries [14,15, 24].
Running speed
The subject was recreationally active and had systematic run-
ning training when he was attending high school. However, at
the time of the present study, he did not run regularly. While
Kong PW Gastrocnemius Injury during … Int J Sports Med 2009; 30: 46 – 52
50 Orthopedics & Biomechanics

subject accelerated at a slower rate initially which forced him to

Table 1 Running speed, stance time and force variables of interest
increase the speed later on in order to land on the force platform.
Variable Noninjured trials Injured trial The investigators instructed the subject to start from the same
Running speed (m • s–1) 4.74 (0.18) 4.99 position determined from practice trials and look forward
Stance time (ms) 215 (10) 204 throughout the run. However, between-trial variation in acceler-
Fimp (BW) 1.61 (0.19) 2.31 ation and stride length is possible.
Fact (BW) 2.55 (0.05) 2.49
Gz (BW • s–1) 120.4 (30.6) 115.0
Stretch-loading
Fbrak (BW) 0.45 (0.06) 0.57
At touchdown of the injured trial, the gastrocnemius muscle-
Fprop (BW) 0.47 (0.03) 0.28
tendon complex was in a more lengthened position and then
Gy (BW • s–1) 24.5 (2.0) 50.8
Flat (BW) 0.07 (0.03) 0.12 shortened more quickly and to a greater extent than it did during
Fmed (BW) 0.13 (0.07) 0.15 a normal running cycle. The initial stretch during the injured tri-
Gx (BW • s–1) 11.4 (4.5) 28.5 al (9.7 %) is close to the lower threshold of muscle injury (12%)
reported in an animal study [22]. The higher contracting rate
Data are expressed as mean (SD). Fimp = peak vertical impact force, BW = body
weight, Fact = peak vertical active force, Gz = peak loading rate of the vertical force,
and greater shortening in length may be a compensation mech-
Fbrak = peak anteroposterior braking force, Fprop = peak anteroposterior propulsive anism to adjust the gastrocnemius muscle length (more
force, Gy = peak loading rate of the braking force, Fmed = peak medial force, Flat = peak stretched at touchdown) closer to that of a normal gait cycle.
lateral force, and Gx = peak loading rate of the lateral force This explains the sharp decrease in ankle dorsiflexion during
the first 10% of stance phase. Although the whole muscle-tendon
complex was shortening during the early stance phase, it is un-
previous studies on runners suggest that injury is not related to clear whether the gastrocnemius muscles were undergoing con-
running experience [24] or speed [15, 24], there is evidence link- centric contraction since the muscle fascicles and the tendon
ing running injuries to training error such as a sudden change of may not follow the same length-change pattern [4]. Others have
routine [14]. The subject in this study ran at self-selected speeds showed that the gastrocnemius muscles were shortening
of 4.74 ± 0.18 m • s–1 during the five noninjured trials. These throughout the stance phase of running [11]. This suggests that
speeds are considered faster than average for a non-runner since the gastrocnemius muscles may contract at an even faster rate
the self-selected speed for young, well-trained male distance than the whole muscle-tendon complex. It has been shown that
runners is reported to be 3.77 ± 0.13 m • s–1 [1]. During the injured muscle strain injury is the result of excessive stretch or stretch
trial, his running speed increased to 4.99 m • s–1, the highest value while the muscle is being activated [5]. The evidence presented
among all trials. Thus, the injury may be related to the relatively in the present study supports that the injury may be caused by
fast running speeds compared to the subject’s regular activity the more lengthened gastrocnemius muscles at touchdown and
level and also the faster speed during the injured trial compared the faster contraction rate compared to those during a normal
to the five previous trials. This increase in speed may be caused running cycle.
by the subject “targeting” the force platform. It is likely that the

Table 2 Sagittal plane joint angles (in degrees) at critical events

Joint qtd qmax qMmax qPabs q Pgen

Hip N 49.2 (3.5) 49.2 (3.5) – 5.3 (1.8) 46.0 (5.4) – 2.9 (1.3)
I 57.0 57.0 – 4.2 48.0 48.6
Knee N 17.4 (4.3) 47.0 (3.5) 46.9 (1.9) 41.8 (1.9) 40.3 (1.2)
I 6.0 36.5 36.5 32.7 13.9
Ankle N 22.4 (1.4) 37.9 (1.6) 37.3 (1.6) 32.5 (1.0) 17.9 (1.1)
I 20.7 31.5 31.5 23.9 21.8

Data are in degrees and are expressed as mean (SD). qtd = angle at touchdown, qmax = maximum angle, qMmax = angle at maximum moment, qPabs = angle at maximum power for
energy absorption, qPgen = angle at maximum power for energy generation, N = noninjured trials, I = injured trial

Table 3 Sagittal plane joint moment and joint power variables at critical events

Joint Mtd (Nm) Mmax (Nm) Pabs (W) tPabs (ms) Pgen (W) tPgen (ms)
Hip N 102 (36) 127 (8) – 425 (76) 31 (39) 705 (165) 169 (11)
I 28 227 – 751 17 283 50
Knee N – 51 (17) 186 (15) – 1215 (220) 56 (6) 485 (78) 127 (18)
I – 38 142 – 758 67 657 33
Ankle N – 2 (4) 264 (6) – 971 (69) 78 (10) 2374 (250) 173 (10)
I 8 177 – 788 83 1078 167

Data are expressed as mean (SD). Mtd = moment at touchdown, Mmax = maximum extension moment, Pabs = maximum power for energy absorption, tPabs = time from touchdown
to Pabs, Pgen = maximum power for energy generation, tPgen = time from touchdown to Pgen, N = noninjured trials, I = injured trial. Positive moment = hip extension, knee extension
and ankle plantarflexion moment

Kong PW Gastrocnemius Injury during … Int J Sports Med 2009; 30: 46 – 52


During the injured trial, there was increased hip flexion and
higher hip extension moment. Previous research has demon-
strated that biarticular muscles act to transfer power from prox-
imal to distal joint during explosive leg extension [8]. With the
foot fixed on the ground, an increase in hip flexion could induce
knee extension movement which may explain the reduced knee
flexion observed during the injured trial. This, in turn, may lead
to the stretch of gastrocnemius muscle. The knee action trans-
ferred from hip flexion may also be influenced by the length of
the hamstrings, though the flexibility of the subject was un-
known.
Shock attenuation
Within the early stance phase before 35% of stance time, there
were higher peak forces and loading rates in the injured trial.
The increase in peak vertical impact force and peak braking force
was probably related to the faster running speed of the injured
trial [2,16,17]. The large twofold increase in the medial and brak-
ing force loading rates suggest that loading rate may be a more
sensitive measure of external load compared to peak force mag-
nitudes. Examination of the center of pressure pattern in relation
to the heel marker position did not reveal a clear difference in
the point of force application and thus the moment arm of the
resultant force. Assuming a similar moment arm, the higher ex-
ternal loads may have caused increased muscle contraction
since muscles activation patterns change in response to varying
impact load conditions [10]. It is thought that the increased de-
mand of muscular work to dissipate energy of the high impact
shock may possibly cause injury.
During the initial stance phase, hip flexion, knee flexion and an-
kle dorsiflexion actions all aid in absorbing energy and thus at-
tenuating impact shock, which can be indicated by negative joint
power. The abnormal touchdown body configuration during the
injured trial may have hindered the necessary knee flexion and
ankle dorsiflexion. The insufficient knee and ankle contributions
may be compensated by the hip action, as shown by increased
flexion, extension moment and absorption power. The lack of
knee support to absorb impact shock in the injured trial is also
reflected by the unusual increase in knee flexion moment in-
stead of extension moment following the touchdown. These ob-
servations suggest that the subject used altered muscle actions
Orthopedics & Biomechanics 51
Fig. 4 Gastrocnemius muscle-tendon complex
length and rate of change in length during the
stance phase of the injured trial (solid line) and five
noninjured trials (dotted lines). Length changes
were expressed as deviation from the reference
length when the knee and ankle were at 908 and
were normalized to percentage of the shank seg-
ment length.
to attenuate impact shock, which may have an influence on
causing the injury.
Timing of injury occurrence
The experimental data were in agreement with the subject’s de-
scription that the injury happened soon after he made contact on
the force platform because all distinct kinetic and kinematic
characteristics appeared to occur within the early 35% of the
stance phase. Once the subject realized the injury, he adjusted
his gait pattern which could be reflected by altered running me-
chanics towards the end of the stance phase. These adjustments
include a lower propulsive force during push-off, reduced knee
extension and reduced plantar-flexion, moment and power at
the ankle during the late stance phase.
In another case report which documented a torn gastrocnemius,
the injury was thought to occur during the push-off phase [18].
This raised the question whether the subject in the present study
was injured during the stride before making contact with the
force platform and the observations described were adaptations
to his injury. Full body kinematic data of previous strides were
not available because these strides occurred outside the capture
volume of the cameras originally set for movement occurring on
the force platform. Fortunately, some markers were captured by
the cameras which allowed a general view of the whole run. In
addition, a video camcorder used for qualitative purposes re-
corded (at 30 Hz) one foot contact before and after the stride on
the force platform. In the injury videos provided by Orchard and
colleagues (www.bjsportmed.com) [18], the cricket player who
injured his left gastrocnemius during the push-off phase made
whole body adjustments during the following right foot contact
and the flight phase. These adjustments were very obvious and
happened quickly within 0.2 s before the next touchdown of the
injured leg. In the present study, qualitative analysis of the video
and partial marker set reveals no distinct difference in move-
ment pattern before the subject made contact with the force
platform between the injured and noninjured trials. For the in-
jured trial, obvious adjustments occurred in the stride after the
subject made contact with the force platform. This confirmed
the injury did not happen during the push-off phase of the pre-
vious stride and strengthened the evidence that it occurred
while the foot was in contact with the force platform. The differ-
ence in timing of injury occurrence between the present study
Kong PW Gastrocnemius Injury during … Int J Sports Med 2009; 30: 46 – 52
52 Orthopedics & Biomechanics
and that by Orchard and colleagues [18] is likely due to the dif-
ferent touchdown conditions. In their study, the cricket player
accelerated forward from a stationary posture with close to zero
horizontal velocity. In contrast, the subject in the present study
made contact with the force platform at 4.99 m • s–1 which re-
quired muscular work to attenuate shock during the early im-
pact phase.
It is interesting to note that the injured cricket player in the case
report by Orchard and colleagues [18] felt “100 % certain” the
moment of injury after watching the video showing a sudden ap-
pearance of a deficit in the medial fibers of the lateral gastrocne-
mius muscle. In the present study, the experimental data also
support the subject’s description of when the injury happened.
Both case reports suggest that despite the neural delay in per-
ception, human subjects are able to determine the approximate
timing of injury occurrence.
Summary
! 285 – 294
In summary, the gastrocnemius muscle strain injury presented
in this case report is believed to have occurred during the early
stance phase. This injury may be related to a faster than usual
running speed and inappropriate body posture at touchdown,
which lead to altered muscle length and actions to attenuate ini-
tial impact shock.
Acknowledgements
! changes of the triceps surae muscle-tendon unit during passive exten-
The author would like to acknowledge Spira Footwear, Inc. for
providing financial support and shoes for use in this study. My
thank also goes to UTEP students (Miranda Bagdon, Norma Can-
delaria, Efren Herrera and Jason van Haselen) for their help in da-
ta collection and analysis.
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