There are many runners who present to us with symptoms of sudden onset pain in their calf during training. There are many reasons why calf strain is common in running, but it’s very important for us to know which calf muscle is responsible for appropriate prognosis and rehab, and ultimately improving performance.
The calf complex is mostly made up of the two heads of gastrocnemius which cross the knee, and the soleus muscle, which attaches below the knee. These merge to form the Achilles tendon which crosses the ankle joint and inserts onto the heel. These attachment points mean that gastrocnemius and soleus have differing roles in forward propulsion.
The calf complex is the largest pump in the lower body, nearly as powerful as the heart.
Why are we paying attention to soleus?
The soleus muscle has a significant role in posture control and strains of this muscle are often under diagnosed.
In long distance running, soleus is hugely importantdue to its high percentage of slow twitch (endurance) muscle fibres, unlike the gastrocnemius, which has a high proportion of fast twitch (power) fibres. The soleus is responsible for stability, endurance and allowing pronation of the foot for adequate shock absorption.
As we see many runners with symptoms of calf strain, we must differentiate strains to be able to rehab you properly and get you back to performing optimally. On a small number of occasions it may be that both soleus andgastrocnemius are affected.
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What can lead to a soleus strain?
Uncharacteristic calf tightness that may increase with jogging rather than sprinting: Come and see us as soon as you suspect that something isn’t right as this is a big indicator of soleus being under stress.Sudden increased frequency, duration or intensity of your runs: Usually more than a 10% increase at a time can set you up for the above.Increased hill running: Soleus can be overloaded when you are running downhill as well as uphill.An ineffective warm up or cool down: Tissues need to be warm and ready for load before training and gradually returned to normal after training.History of strains:(especially poorly rehabilitated ones!) You may be prone to more strains due to weak, disorganised scar tissue at the sites of past injury. It is essential for good performance to understand how to strengthen, stabilise and prevent further injury.
How do we diagnose a soleus strain?
After hearing a full injury history, we use a combination of palpation, muscle strength testing and stretching in different positions to work out if soleus is involved. We then classify your strain based on its severity. Â It is also important for us to rule out any other bone or tendon involvement.
How do we treat a soleus strain?
Protection and offloading: We may use dry needling and soft tissue release to address any muscle spasm and tightness surrounding the strain as well as at the site of the lesion. We find this to be a very effective treatment in the initial stages. We may then offload the strained area with heel lifts to prevent too much stretch and tape for support and compression to allow you to walk more normally.Ice, compression, elevation: this can help with pain and swelling in the first few days.Optimal loading: as opposed to rest, we may advise you to modify activity for a certain timeframe. Stopping running and starting gentle swimming or cycling may be beneficial.Building up resistive exercise and range of motion: once the acute phase has passed and healing is underway we then commence exercise to progressively rehabilitate the injured site and enhance strength. Gentle stretching, isolated soleus strengthening, global calf strengthening as well as hip and pelvic complex strengthening will all be important.Return to running: Once you have achieved optimal strength and flexibility we will gradually increase your training load again. It is possible to recommence activity too prematurely and risk re injury, so following through with your rehab is essential!
What next?
If you have goals to improve your performance, whether you’ve had an injury or not, have a think about having your running assessed though our Physiotherapists at our Clinical Fitness Clinic. Here we analyse your running and produce a personalised strength and stability programme to improve performance, whether you are a casual runner or a serious marathoner.
Going to a running specific strengthening group at the Bayside Sports Medicine Group will certainly give you the edge on running performance and injury prevention.