Soleus muscle pain

Introduction

Many leg muscles work together to help us go on with our day. The coordinated relaxation of the quadriceps muscles and calf muscle contraction enables us to walk, run, skip, and jog. The posterior muscle group in the leg has a set of muscles that can easily be damaged if there is a lot of strain. One such muscle is the soleus, and injury to this muscle can cause the inability to walk and discomfort.

There are a lot of sports injuries that result in soleus muscle strain. This can be painful and often result in athletes taking a break from their activities unless the injury has healed completely. The Soleus muscle is a muscle in the leg, and it helps with running and walking and, therefore, can make it very hard to walk comfortably when injured.

Anatomy of the Calf muscles

Three calf muscles are present in the posterior part of the leg. They are listed below;

1. Gastrocnemius muscle
2. Soleus muscle
3. Plantaris

The calf muscles are the ones that lie at the posterior part of the leg. The biggest muscle in the outer calf comprises the gastrocnemius muscles, which split into two parts- the medial and lateral head and finally converge to mesh with the soleus muscle fibers, combining to make the Achilles tendon.

One of the deeper muscles of the calf is the soleus, whose head originates from the distal end of the femur (thigh bone) and has medial and lateral aponeurosis, which then gets attached to the Achilles tendon at the lower leg.

The plantaris muscle is a thin sheet of fiber that originates from the lateral side of the femur and then takes a little turn running behind the knee joint and finally getting merged with the Achilles tendon.

Achilles tendon

The gastrocnemius, plantaris, and soleus muscle tendons converge at the end to form the Achilles tendon. This tendon is the tendon of the heel and is a very sensitive spot as it is the most common tendon that gets ruptured. It is also the thickest and the strongest tendon in the body. This tendon helps with all the locomotor functions, as the contraction of the muscles helps raise the heel, enabling us to walk, jog or run.

Soleus muscle injury

The Soleus muscle is also known as the ‘flat fish muscle’ because of how its fibers are arranged. These fibers are slow-twitch muscle fibers. The gastrocnemius is another muscle of the posterior leg and is composed of fast-twitch muscle fibers.

The degree of discomfort and pain depends on the more overworked that muscle in the calf area. Injuries of the soleus muscle are easily misdiagnosed even though they are one of the frequent muscle strains seen in distance runners. The main reason many sports medicine professionals do not recognize it is related to its complicated anatomy. It lies deep initially and then becomes slightly superficial towards the end. It has three intramuscular tendons, making diagnosing its pathology complicated.

Injury to the soleus can be acute or chronic and usually takes less time to heal completely. However, once the muscle fibers are damaged, there is a high chance of re-injury.

Movements affected due to soleus strain.

If the soleus muscle undergoes an injury, it is hard to predict how long the recovery will take. Many factors influence the healing process, including the individual’s health status, the care provided after the incident, and, even more so, the damage caused to the fibers. Sports professionals often need to sit out of competitions or take a break from their training to let the muscle heal completely.

Calf strains are a common injury and can lead to significant pain, increasing the recovery period. Soleus muscle strain results in difficulty in plantar flexion. Pain and localized tenderness are also felt at the lateral aspect of the musculotendinous junction when the area is touched. However, the gastrocnemius strains typically present with pain in the medial border of the musculotendinous junction for the other calf muscle injuries.

Lower leg muscle injuries

The symptoms of calf strains and soleus strains are different, which is why the recovery period can differ depending on the injury’s nature and the muscle affected the most. This has more to do with the type of fibers in the soleus muscle than the gastrocnemius muscle. The pain and recovery period differ since the gastrocnemius contains fast twitch fibers, and the soleus muscle contains slow twitch fibers.

Sports med have seen that long-distance runners get affected by soleus injuries as it is due to overuse of the muscle.

It usually happens when the knees are flexed for long, exerting the muscle.

Other calf strain, including gastrocnemius injury, is seen in athletes who are fast runners and sprint. Therefore, it is more commonly seen in tennis players.

Diagnosis

The common clinical presentation seen in sports medicine with those suffering from lower leg injuries requires a set of examinations to help evaluate the degree of injury.

The physician asks for tenderness during the following activities;

• Bending of the knees
• Pressure applied to the Achilles tendon
• Placing the thighs parallel and lifting the foot with the toes pointed straight.
• Stretching the foot

After a clinical examination, an Ultrasound is performed to check for muscle damage. Often an MRI can also be used to check for tears.

Treatment

Musculoskeletal medicine management is done mostly by conventional methods rather than just painkillers. Therefore, performing certain exercises to treat and prevent the injury from happening again is very important.

There are four ways to treat a soleus injury,

1. Resting the injured muscle by abstaining from any physical activity.
2. Applying ice to the area helps decrease swelling, inflammation, and pain.
3. Applying pressure through compression bandages helps decrease swelling and pump blood through the affected area.
4. Elevating the area also helps decrease the chances of bruising and speeds up the recovery.
5. Analgesics are given to help relieve the pain.

Prolotherapy

In recent years, prolotherapy has built its reputation within the medical community due to its clinically proven ability to treat soleus muscle pain.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with small needles. This has been shown to reduce swelling, which helps with soleus muscle pain.

As prolotherapy is helping to treat the root cause of soleus muscle pain, it is deemed to be a permanent fix, preventing the symptoms from returning.

Prevention

Injury to the soleus is mostly overlooked and often misdiagnosed in sports medicine as the gastrocnemius is responsible for more active sports. However, both muscles are equally important to take care of, as damage to any of them can result in poor performance of an athlete. Therefore, it is important to incorporate exercises that help strengthen the lower leg so that athletes can perform their best.

Exercises that help prevent gastrocnemius and soleus injury

It has been seen that once the soleus is injured, the chances of re-injury are very high; hence it is important to strengthen them so that they are not easily tired. The ways to help strengthen the soleus is by following a few stretches and exercises as much as the body permits to prevent re-injury. Following is the list of bodyweight exercises recommended by sports physicians;

Calf wall stretch

The starting position of this exercise include the palms facing the wall at eye level, feet flat on the ground, with the affected leg a step behind the other leg. The back needs to be straight, and the back heel on the floor, then the knee should be bent forward, bringing the chest and hips towards the wall; this stretches the posterior surface of the leg.

Seated position heel raise

Light weights are placed on the back of the lap, gripped between both hands. Afterward, the knees are extended, and a tip-toe motion is used to exercise the calf muscles.

Single leg stance

It is a balance exercise and is performed standing with the feet apart. This is so that the body weight is evenly distributed. Hands should then be placed on the hips, lifting one leg off the floor and bending it back at the knee.

Wall sit variation

There are some of the wall sit variations to help exercise all body muscles. A basic sit-in position is achieved using the wall as support to exercise the soleus. After which, the heels are lifted off the floor, pushing the toes for a calf raise. After a few seconds, the heels should be brought back to the floor.

Single-leg deadlifts

It starts with standing, having feet hip-width apart, and holding a light weight in one or both hands. The weight evenly gets distributed in this position. After that, the weight is shifted to one leg by leaning forward with the hips as the other leg extends straight. Then slowly lower the body and extend the knees fully, with the body forward, forming a T shape, with the arms hanging straight downwards, holding the weight. Slowly bring the extended leg down and repeat the process with the other leg.

Frequently Asked Questions

1. How do you relieve soleus muscle pain?

Soleus muscle pain can be relieved through rest by applying compression over the injured muscle by wrapping it with a tight bandage. Moreover, applying ice helps decrease inflammation and prevent soreness.

2. What does a soleus strain feel like?

The pain is less severe than that experienced in gastrocnemius injury. However, there is stiffness and tight calves, which worsens with walking.

3. How long does soleus take to heal?

The period of recovery depends on the degree of injury. If there is a mild spasm, the mild pain can take up to 3 days to disappear. However, severe pain can take several weeks before complete recovery is established.

4. Is it good to stretch a strained soleus?

When the soleus muscle is strained, sports med has advised it to do strengthening exercises and passive stretching to help with the injury. This helps increase blood flow to the calf area, increasing recovery speed.

5. What is soleus syndrome?

Soleus strains result in calf tightness which increases the pressure in the posterior compartment of the leg. Due to this, the sural nerve that passes from this course gets compressed. This compression leads to soleus syndrome. It is characterized by; weakness in plantar flexion and tingling sensation in the lateral foot and distal part of the calf.

6. How do you test for tight soleus?

Tightness in the soleus muscles is tested by performing the Silfverskiöld test. It is a simple clinical testing method used to measure the dorsiflexion of the foot at the ankle joint, with the knee bent and then the knee straight at a right angle. When the angle of the ankle joint during dorsiflexion is greater with the knees bent than extended, the test is considered positive.