Injury to the soleus, a muscle of the lower extremity, located in the calf area, which runs along the back of the knee to just above the muscles around the ankle. It is the muscle responsible for plantar flexion, i.e. the position of the foot when the toes point downwards, and is therefore essential for the performance of everyday activities such as running, walking, standing, dancing and balancing.
This muscle is very important in runners: it is the one that applies the push of momentum when running. To endure long distances running, it is important that the soleus is in good condition.
What is the soleus injury and who does it mainly affect?
The soleus injury is a relatively common injury in runners and tennis players, caused by overuse of the muscles in the area and is accentuated in endurance sports and long distances.
Injuries commonly occur as a result of fatigue or overtraining. They can also occur when the knee is flexed for a long time while running, such as during uphill running.
Soleus injury: Innervation and referred pain
Its innervation belongs to the tibial nerve, which is a main branch of the sciatic nerve that descends to the posterior compartment of the leg, communicating with the ankle and foot through the tarsal tunnel.
As for the referred pain pattern and the hypersensitivity to the referred pressure of the trigger points that this muscle can trigger, it usually appears mainly on the posterior aspect and plantar surface of the heel. The pain may also be projected remotely to an area over the sacroiliac joint on the same side.
Soleus arcuate syndrome
The soleus has a ligamentous complex from an anatomical point of view that makes the diagnosis of soleus injury must be evaluated in a comprehensive manner. Both the ligamentous arcade and the different trigger points, make the dysfunction of this muscle is of great importance and primary evaluation in multiple pathologies of the lower limb, such as sciatica, plantar fasciitis, heel pain, deep compartment syndrome, knee and foot surgery, among others.
Diagnosis of a soleus injury
The main cause of soleus injury is overuse or mileage. When the soleus and gastrocnemius (gastrocnemius) suffer a rupture, we must talk about the famous “pedrada”. In all muscle ruptures we can find varying degrees of severity depending on the size and muscles affected, thus finding injuries of grade I, II, III:
- Grade I. The one known as microrupture that affects the muscle fibers, where a hematoma could appear due to the ruptures of capillary fibers, is usually the most common.
- Grade II. The so-called partial rupture occurs due to a greater number of muscle fibers affected, but without reaching the total involvement of the muscle belly. Diagnosis by palpation and then ultrasound is the best way to assess the extent of the injury. It can be diagnosed due to a deformity or a small jump of the muscle area by palpation.
- Grade III. We find the total rupture of the muscle belly, the pain is very intense and the patient’s response usually goes from a stone to a strong axe. We can find a strong hematoma of several centimeters and is an important injury which must be assessed and taken into consideration with its corresponding ultrasound and rehabilitation guidelines.
Soleus injury, its treatment and prevention
The first thing to do is to assess and identify the stage of the injury.
It is always recommended to start with a conservative phase to prevent the pathology from being accentuated, then, depending on the area of the soleus that has been affected, puncture treatments (invasive technique applied in points to treat myofascial pain), diathermy (non-invasive technique of local heating in the tissues), stretching, massage therapy, EPTE, cryotherapy and others would be performed.
As a preventive resource, it is also important to carry out actions that affect eccentric exercises, elastification of the musculature and specific postural hygiene such as the way of walking or running.
Finally, it is recommended that the resumption of physical activity be progressive.
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Recommendations for runners: how to strengthen the soleus muscle
Fortunately, the soleus is a muscle that is easily strengthened if taken care of properly. The most common strengthening exercise is the wall squat based on a seated position with your feet flat on the floor. Knees should form a 90 degree angle and thighs should be parallel to the floor.
An even weight should be placed on the thigh or quadriceps muscles and the toes pulled back to the maximum range of motion. It is advisable to repeat this cycle of movements with stop and restart up to a total of 10 times. It is also advisable to perform the series of exercises with the fingers pointing outwards, another with the fingers pointing inwards and finally one with the fingers pointing outwards again.
It is recommended to start light and progressively increase your weight over time as your body allows.
The key is to always add some weight because when running, we adopt a one-legged position, multiplying the force is two, three and even four times our body weight. That’s why bodyweight exercises alone don’t help. Instead of lifting your calves as usual, you can lift only one calf with a dumbbell in one hand, do one-legged deadlifts with dumbbells, or balance on an unstable surface. This is the only way to work the deeper, slow twitch muscle fibres.
It is also not unreasonable to alternate with the treadmill because here there is no lateral movement from the knees down, so the muscle suffers less and the impact on that area is reduced even more as it is a soft surface.
The soleus may not be the largest calf muscle, but strengthening it will go a long way toward helping you cope better with long-distance running and sports.