A twitching calf muscle may seem like no big deal, and if it’s just a temporary annoyance that lasts a couple of days and then goes away, it may be. However, it can also be a warning sign of something bigger, especially if it continues. So, today, we’re going to explain a little about the calf and why it’s not a good idea to ignore calf muscle twitching.
What Is the Calf Muscle?
If there’s one muscle you’re likely familiar with, it’s the calf muscle. If you reach around and grab your calf and flex it, the muscle you are actually feeling just under the surface is called the gastrocnemius muscle in medical terminology.
The top of the muscle attaches behind the knee, and the bottom connects to the Achilles tendon, which stretches all the way down to the heel. If you’re a runner or even just exercise regularly, you probably spend time stretching the calf muscle—one, because it feels really good, and two, because it helps protect the muscle from damage. And who hasn’t woken up in the middle of the night at least once with the dreaded calf muscle cramp?
What Causes Calf Muscle Twitching?
The calf muscle, like every muscle, has an innervation. This means it has a nerve that supplies the muscle and tells it what to do. The nerve branch for the calf muscle starts all the way up in the lower spine.
If the nerve is injured or just becomes irritated, this can cause the calf muscle to involuntarily twitch (fasciculate is the medical terminology), a reflex response when the muscle isn’t being supplied with instructions from the nerve on what it’s supposed to do.
So what can injure the nerves in the calf muscle? Several nerves can.
For example, the S1 (sacrum level 1) nerve in the low back becomes the tibial nerve in the leg, which then innervates the calf muscle. If there is a bulging or herniated disc, for example, at the S1 level, this can put pressure on the nerve, and this nerve irritation can present as a twitching muscle in the calf. Likewise, an injured tibial nerve can also present as a twitching calf muscle.
Let’s Take a Look at an Actual Twitching Calf Muscle
Calf muscle twitching can be so subtle, you may not even realize it’s happening, or it can be dramatic and even create some pressure in the calf, or it can be anywhere in between. Watch Dr. Centeno’s very brief video of a patient’s calf muscle as it twitches dramatically as well as an ultrasound image as the twitching occurs compared to a muscle that isn’t twitching.
To Stop the Twitching Caused by Nerve Irritation, Treat the Nerve
The most common cause of a twitching calf muscle in S1 nerve irritation in the back. Typically, this nerve irritation occurs due to a disc issue or inflammation from arthritis putting pressure on the S1 nerve. So to stop the twitching caused by an irritated S1 nerve, the nerve must be treated. In interventional orthopedics, we can treat this issue with a platelet lysate epidural.
This involves using precise image guidance to inject growth factors from the patient’s blood platelets around the irritated or injured nerve. In addition, if there is a bigger disc bulge, if the disc degeneration isn’t too advanced, this can be treated with an injection of specially cultured stem cells.
While it might be OK to shrug off a calf muscle twitch that happens once or twice and doesn’t return, it’s never a good idea to ignore calf muscle twitching that continues. It’s a big red warning flag that the nerves aren’t functioning as they should. And, as always, it’s best to treat a problem when the warning signs occur rather than waiting it out and trying to treat it once a problem has advanced to something bigger and more difficult to manage.
More Conditions Associated with Twitching Calf
Annular Tear
To understand annular tears, let us first review the anatomy of the spine. The lumbar spine is comprised of 5 boney building blocks called vertebral bodies. Sandwiched between the vertebral bodies are the lumbar discs. Each disc is comprised of an outer fibrous ring, the annulus fibrosis that surrounds the inner gelatinous center, which is called the nucleus. The disc absorbs the forces of daily living. The annulus has multiple layers of collagen that provide important support. The annulus is similar to the sidewall of a tire which provides important stability for the tire. Through trauma or degeneration, the outer annular fibers can become injured and or weakened.
Read More About Annular TearDegenerative Scoliosis
Degenerative Scoliosis, also known as Adult-onset Scoliosis, is a medical condition that involves a side bending in the spine. The bending can be mild, moderate, or severe with side-bending to either the right or the left. The term degenerative means generalized wear and tear and is common as we get older. Degenerative scoliosis is the curvature of the spine that occurs as a result of degeneration of the discs, small joints, and building blocks. The Degenerative Scoliosis curve is often located in the low back and forms a ‘C” shape. There is a convex and a concave side. The convex side is the open side where it curves outward.
Read More About Degenerative ScoliosisFailed Back Surgery Syndrome
Failed Back Surgery Syndrome also called failed back is a clinical condition in which patients who have undergone low back surgery continue to have pain and dysfunction. Said another way the surgery that was intended to reduce pain and increase function FAILED. That is right, the surgery failed. You had the surgery, struggled with the pain postoperatively, diligently participated in physical therapy and yet the pain and limitation are still there. Unfortunately, this occurs frequently. Estimates range from 20-40% of patients who undergo low back surgery will develop Failed Back Surgery Syndrome. Pain is the most common symptom of Failed Back Surgery Syndrome…
Read More About Failed Back Surgery SyndromeHerniated Thoracic Disc
A herniated thoracic disc is especially difficult because there are not as many treatments available as there are for disc herniations in other areas of the spine. To understand Thoracic Disc Herniations, though, we first need to cover thoracic spine anatomy and function. With disc herniation, the annulus fibrosus get small tears throughout the annulus. An annulus is a bunch of concentric fibers, so, as the fibers get damaged and cut, the pressure that is built up within the nucleus pushes the now weakened annulus outward, creating a bulge or herniation. The disc begins to weaken via mild degeneration/tearing of the annular fibers…
Read More About Herniated Thoracic DiscPinched Nerves in the Back
We talk a lot about leg pain stemming from a pinched or irritated nerve in the lower back. And, indeed, that’s what our physicians are traditionally taught in medical school—a pinched nerve in the lumbar spine typically presents as a symptom in the leg. However, what if you have some butt pain but no pain or other symptoms in the leg? Does this mean it couldn’t be a pinched nerve? Not so fast. Turns out a pinched low back nerve doesn’t always have to be accompanied by leg symptoms. Let’s start by taking a look at how the back is structured.
Read More About Pinched Nerves in the BackSciatica
Disc herniation, disc protrusion, overgrowth of the facet joint, and thickening of the ligaments can result in nerve root compression or irritation, causing symptoms of sciatic compression. Some causes of sciatic compression can be interrelated with the following conditions: Degenerative disc disease, Spinal stenosis, damage or injuries to the discs, spondylolisthesis, piriformis syndrome, osteoarthritis. The symptoms of sciatica include pain in the lower back, buttock, and down your leg, numbness and weakness in low back, buttock, leg, and/or feet, pain increase with movement, “Pins and needles” feeling in your legs, toes, or feet., loss of bowel control, and incontinence. Sciatica can be treated…
Read More About SciaticaTorn Discs
The spinal discs are shock absorbers that live at each level between the vertebral bones (1). They have a tough outer annulus part and a soft inner gel part (nucleus pulposis). The outer covering can get damaged which can sometimes be seen on MRI and other times requires additional testing to identify. These tears are called: a torn disc, a disc tear, an annular tear, and when seen on MRI a “High-Intensity Zone” or HIZ. They can cause pain, mostly through ingrown nerves. There are torn disc findings that can be seen on MRI (HIZ) and these can be either asymptomatic (i.e. not painful) or…
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