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Soleus Muscle Pain in Runners – Soleus muscle pain is one of the calf muscle’s most common sources of muscular pain. They can be challenging to diagnose as it’s not common to have a sudden large tear when running; therefore, the symptoms can feel more similar to calf tightness.

It is expected that the onset of the sensation of calf tightness occurs quicker when running if you do not rest on it and can eventually turn into pain. These injuries usually are prolonged to heal due to a poor blood supply. It is hard to clinically diagnose as the Soleus muscle sits deep within the calf complex so it is difficult to palpate, and an MRI scan best identifies it.

Treatment involves a reduction in running and soleus strengthening exercises.

What does a strained soleus feel like?

Soleus strains – Strains of the soleus vary in reported occurrence from rare to common, Soleus muscle injury may be underreported due to misdiagnosis as thrombophlebitis or lumping of soleus strains with strains of the gastrocnemius, Unlike the gastrocnemius the soleus is considered low risk for injury.

It crosses only the ankle and is largely comprised of type one slow twitch muscle fibers. Soleus strains also tend to be less dramatic in clinical presentation and more subacute when compared to injuries of the gastrocnemius. The classic presentation is of calf tightness, stiffness, and pain that worsen over days to weeks.

Walking or jogging tends to provoke symptoms, Swelling and disability are generally mild,

What causes soleus muscle pain?

Mechanism of injury – The potential underlying causes of soleus strain include (but are not limited to):

• Training error – overtraining, rate of increase of training loads too high, introduction of too much hill work over too short a time, poorly designed training program – eg a hard running session after a long run
• Kinetic chain dysfunctions – poor hip extension flexibility and associated poor gluteus maximus recruitment. This is a common problem in triathletes or runners that sit for long periods for work.
• Past injury – to the ankle plantar flexors, the ankle joint or the Achilles or plantar fascia.
• Poor strength-endurance of ankle plantar flexors.
• Footwear – a change leading up to the injury (e.g., change in heel counter, pronation control).
• Running technique – conscious change in running technique to mid-forefoot running or running technique modified by footwear type.

How long does a soleus strain take to heal?

What is a calf strain and how can it happen? A strain refers to an injured muscle or tendon that has partially or completely torn. A calf injury is most often caused during sports where you need to push off with your foot quickly for a sudden burst of speed.

The sudden movement can stretch the muscle beyond its normal limits. This can happen suddenly or over time. Various sports such as rugby, football, tennis, baseball, soccer, dancing and even simple running are impacted by calf muscle strain injuries. Calf strains are common muscle injuries that if not managed appropriately can result in re-injury and prolonged recovery.

The calf muscles: The “calf” refers to the muscles on the posterior aspect of the lower leg. It is composed of three muscles: the gastrocnemius, the soleus and the plantaris. • Gastrocnemius muscle : Main function is plantar flexion of the ankle joint in conjunction with the soleus and the plantaris which provides the propelling force seen when walking.

• It also helps provide flexion at the knee joint.
• The gastrocnemius muscle is more susceptible to injury as it is a extends over both the knee and the ankle.
• Soleus muscle : Main function is stabilizing the tibia on the calcaneus limiting forward sway while helping the gastrocnemius with plantar flexion.

• Plantaris muscle : Acts with the gastrocnemius and the soleus as both a flexor of the knee and a plantar-flexor of the ankle. These muscles come together to form the achilles tendon and all three muscles insert into the calcaneus. How can a calf strain present? Patients may feel pain depending on which muscle has being strained:

Gastrocnemius strain: Can present as a sudden sharp pain or tearing sensation at the back of the lower leg. Patients often report an audible or palpable “pop” in the medial aspect of the posterior calf and tenderness to touch at the point of injury. Swelling and bruising may appear within hours or days of the injury. During examination stretching of the muscle and resisted plantarflexion will reproduce pain. Soleus strain: Tend to be less dramatic in clinical presentation and more subacute when compared to injuries of the gastrocnemius. This injury causes pain when activating the calf muscle. On examination stretching the Achilles tendon, walking on tip-toe or applying pressure at the calf muscle aggravates pain. Plantaris strain: Injury to the plantaris muscle can present with similar clinical features as those of the gastrocnemius and soleus muscle. Depending on the extent of the injury, the individual may be able to continue exercising although they will have some discomfort and/or tightness during or after activity.

Typical symptoms for all strains are stiffness, discoloration and bruising around the strained muscle. Grading of strains: Muscle strains are graded from I to III, with grade III being the most severe.

Grade I: Partial stretch or tearing of a few muscle fibers. The muscle is mildly tender and painful, but maintains its normal strength. Leg use is not limited, and walking is normal. Average time to return to sports activities is 10 – 12 days. Grade II: Moderate stretch or tearing of muscle fibers. The muscle is tender with pain and loss of strength. Sometimes bruising will occur. Leg use is limited and limping when walking is common. Average time to return to sports activities is 16 – 21 days. Grade III: Severe tear of the muscle fibers. This can include a complete muscle tear. Bruising and swelling develops within hours of injury. Sometimes a “dent” is noticeable beneath the skin where the muscle is torn. Leg use is extremely difficult and putting weight on the leg is very painful. On examination a positive Thomson’s test may reveal an Achilles tendon rupture. Average time to return to sports activities is up to 6 months if the injury requires surgery.

At the physician’s office: A doctor can diagnose a pulled calf muscle by carrying out a physical examination, during which they will check for swelling, bruising, and redness. They may also ask the person to describe any recent changes to their regular physical activity routine.

Many doctors use Ultrasound imaging to determine the extent of damage and X-rays to asses for fractures or calcifications. They may also use imaging techniques such as MRIs to gather soft tissue detail and assess the severity of the injury. What is the treatment? Treatment depends on the severity of the muscle strain.

The following treatments may provide symptom relief:

Ice and heat therapy: People can use a cold compress to reduce inflammation and relieve muscle pain during the first 2 days. After 2 or 3 days, you can try alternating cold with heat. (Do not go to sleep with a heating pad on your skin.) Wraps and bandages: Wrapping the injured calf in an elastic bandage or compression sock can help prevent swelling and inflammation. Elevation of the injured leg: Try to keep it above the level of your heart. This will help reduce swelling. Over-the-counter (OTC) pain relievers: People can take a pain reliever, such as ibuprofen or naproxen to relieve pain and reduce inflammation. Physical Therapy/Exercise: Some patients respond well to certain exercises.The goals of physical therapy are to improve strength, function, and stability. Surgery: Most calf strains will not require surgery and tend to recover well with physical therapy.

Physical Therapy Exercises: Physical therapists treat people with calf strains by reducing pain, restoring muscle strength, restoring muscle flexibility, and increasing recovery speed. Some exercises that aim to strength these muscles are:

Chair stretches: Sitting in a stable chair, bend and straighten the knee of your affected leg. Wall stretches: Face a wall and put your arms out so your hands are firmly against the wall at shoulder level. Straighten your affected leg with your heel pressed firmly into the ground. Then step your other leg forward so it’s at a 90-degree angle. Repeat the process as often as you feel comfortable throughout the day. Floor stretches: Sit on the floor with your affected leg straight. Flex your foot and set your heel firmly into the floor. Gently press your toes towards you for 5 seconds in this position. Standing stretches. Grip the back of a sturdy chair and lift yourself on the balls of your feet for 5 seconds. Patient can repeat this exercise up to twice a day.

What is the recovery and prognosis? Recovery and prognosis will depend on the extent of the injury. In the less severe cases it usually takes up to three days for a pulled calf muscle to start feeling better. In the most severe cases that don’t require surgery a full recovery may take up to six weeks.

In the case that the injury requires surgery the recovery period may extend up to six months to a full year. Most people who have a pulled calf muscle will not need surgery. Promt treatment is important for your overall recovery. While it may be difficult to rest your affected leg for a few days, moving around too soon can make the muscle strain worse.

There’s also a risk for a recurring calf muscle strain within one to two weeks of the initial injury. Allowing yourself enough recovery time is critical to your calf muscle treatment. Once you’ve had a pulled calf muscle, you’re at much greater risk for getting another strain of this type in the future.

Warming up for at least five minutes before exercise Stretching your legs before exercising Cooling down for five minutes after you work out Stretching your muscles again for five minutes after you’ve cooled down

Endrina Mangual Valladares MS3 Third year Medical Student at University of Medicine and Health Sciences (UMHS)

How long does a sore soleus last?

Diagnosing Calf Strain – It is rather easy to notice a calf strain if you know what to look for. There are several symptoms, including:

Pain during activity or motion Bruising Swelling Tenderness Tearing sensation

A strain on the gastrocnemius might result in acute pain, a subtle discomfort, or something in between. The discomfort is usually felt at the back of the lower leg, although it can also affect the foot. Many people who have had a calf strain have difficulty walking because of discomfort or a loss of stability.

If you suspect a strain, you should consult a doctor right away. Injuries are more likely to heal incorrectly if they are not treated by a medical practitioner. Improper healing can lead to issues with the soft tissue later in life. The process of diagnosing a calf strain begins with a consultation. Doctors will inquire about your medical history, past injuries, amount of exercise, and the cause of your calf injury.

They will pay attention to the symptoms and examine the region for pain, bruising, and swelling. They could watch the patient walk or do other activities to figure out where the injury came from. There are three major classifications of calf strain:

Grade 1: sometimes referred to as a “mild” injury, a grade 1 calf strain is a minor tear in the muscle. This is the most common form of a calf strain and many individuals who experience it can still walk or move around. It typically takes 1-3 weeks to fully heal, Grade 2: sometimes referred to as a “moderate” injury, grade 2 calf strains are also the result of a tear to the muscle. Though a grade 2 injury is more severe, it is not a complete tear. Individuals who have experienced this level of tear should expect to recover within 3-6 weeks, Grade 3: sometimes referred to as a “severe injury”, a grade 3 calf strain is a full tear of the muscle. Grade 3 calf strains should be immediately addressed by a doctor and often require surgery to correct. Due to the severity of the injury, it can take 6 months to a year to fully heal, Severe calf strains may cause a hematoma and should be examined by a medical professional immediately.

Many doctors use an imaging technique like an Ultrasound to determine the extent of damage, though they may also use MRI or CT Scans. These allow doctors to gather a picture of the soft tissue and assess the severity of the injury. Knowing exactly what is happening inside the body can inform surgical decisions and treatment.

Is it good to stretch a strained soleus?

Our assessment has shown that the soleus muscle in one or both of your lower legs is tight, and may be contributing to any foot, ankle or lower limb pain that you may be experiencing. It is important to reduce this tightness, and so we have asked you to perform regular stretching exercises to achieve this.

Do I have a soleus tear?

Strain/Rupture – A muscle strain occurs when muscle fibers are damaged by the loads placed on them by activity. A gradual onset of pain is commonly reported during soleus strain and often with no specific mechanism of injury (MOI). This may be due to the limited sensory innervation to the intramuscular aponeurosis.

• Pain with active or resisted plantar flexion
• Pain during walking, running, jumping or hopping
• Tenderness on palpation of the injury site

Investigations: Diagnostic ultrasound or MRI can be advantageous to confirm an injury diagnosis and ensure that injuries accurately assessed as full ruptures can be overlooked with clinical exam on occasion. Further information about soleus and calf strains is available here

Is walking good for calf strain?

After 3 days – As soon as you are able to put weight through the injured leg, start to get up and about more. Short walks are good for the healing muscle, but avoid long distances and standing for long periods. You may find it more comfortable in shoes with a thicker or higher heel to start with, as this will lessen the stretch on the calf.

Should I massage a pulled calf muscle?

Acute muscle strains – Massage should not be applied to recent muscle strains. During the first 24 to 72 hours following a calf strain applying massage will make your injury worse, increase bleeding and prevent healing. How long the acute stage lasts will depend on how bad your injury is,

Should I foam roll a calf strain?

Foam Roller For Calf Strains A foam roller is excellent for recovering from calf strains, especially if you do not have access to regular massage. Here we demonstrate how to use a foam roller for treating a torn calf muscle. You can use a foam roller for treating on your own, or with a partner.

Probably the best way is if you have a partner or your physio to help. This means you can relax and they can more accurately target how and where to apply pressure. Using a foam roller for muscle strains is excellent if you do not have access to regular massage therapy. Even if you are lucky enough to receive regular hands-on treatment, you can always use the foam roller in between massage sessions.

The applied resistance effectively massages the body. This releases muscle tension and tightness, reducing discomfort, adhesions, and muscle tension.

Lie on your front Your therapist or partner applies gentle pressure in small rolling movements Start at the bottom where your Achilles tendon is and work upwards Pressure should not be so great the pain causes you to tighten up You may feel mild discomfort but it should not be painful

Sit with your leg resting on top of the foam roller Move forwards using your body weight to apply downward pressure on the roller Use slow, small movements and try to feel areas of muscle tension

A calf strain is a tear to one or more of the muscles at the back of the lower leg. Here we explain the symptoms, Calf pain when running has a number of causes. These include calf strain, compartment syndromes, cramps, stress fractures and DVT (Deep vein thrombosis).

Chronic calf Our Calf strain treatment & rehabilitation program consists of four phases. It has been created by elite-level Sports Physiotherapist Phil Pask based on what he Here we explain and demonstrate simple sports massage techniques for the calf muscles and lower leg. Massage forms part of our full Calf strain rehabilitation How bad is my Calf strain? Injuries are categorised into grades 1, 2, or 3 depending on severity.

Grade 1 | Grade 2 | Grade Example of a rehabilitation program for a lower leg or calf muscle contusion. Below is an example of rehabilitation guidelines. We recommend seeking professional advice Calf pain refers to pain in the calf muscles at the back of the lower leg.

What is the stretch position for soleus muscle?

Stand facing a wall from about 2 to 3 feet away. Take 1 step toward the wall with your right foot. Place both palms on the wall. Slightly bend both knees and lean forward. Keep both heels on the floor. Hold for 30 to 60 seconds. Then relax both legs. Repeat the exercise 2 times. Switch legs and repeat. Repeat this exercise 3 times a day, or as instructed.

Tip: Don’t bounce while you’re stretching.