Tabassum Ali, DC, CCSP, CCCN
Pain found deep in the calf area can be a symptom of a soleus strain. Anatomically the soleus is found in the posterior calf, starting just below the knee and traveling down behind the gastrocnemius muscle and the Achilles tendon and then crossing over at the ankle. Due to the deep location of the soleus muscle, it can often be misdiagnosed with a gastrocnemius strain.
The main function of the soleus is dorsiflexion of the ankle. Those who have difficulty running can possibly have a restricted joint in the lower extremity, but a majority is due to poor biomechanics from a previous overuse injury of the soft tissue. Although the gastrocnemius is the first muscle susceptible to a strain within the calf muscles, a soleus strain is also common. Calf strains are usually caused by sudden, quick movements applying too much pressure to the muscle. Runners are known to have this injury sometimes because of running uphill frequently, or from a lack of stretching pre and post workout. Other repetitive stress injuries of the soleus can be from wearing high heels for extended periods of time, keeping the calf muscles in a shortened state, or a sudden increase in the intensity or number of training sessions. Symptoms of soleus tear:
Pain anging from slight to severe
Burning sensation from severe pain
Swelling of the calf
Bruising of the muscle
When observing the ankle for motion, the patient may experience pain through the ranges of motion, which is a good indicator that there is some sort of restriction in the soft tissue or in the joint. To fully diagnose a tear and the degree, imaging is necessary. The first source of imaging is X-ray, however it will not be able to show any soft tissue damage but it will help rule out other conditions. An x-ray will tell you if there is any joint degeneration, impingement from an osseous structure, or arthritis in the joint. If a tear is concluded, scar tissue will be built up in the muscle, and prevent full range of motion in addition to pain upon exertion. Possible treatments for a soleus strain:
RICE (rest, ice, compress, elevate)
Surgery based on the severity of the tear to reattach the muscle tendon
Non-Steroidal Anti-Inflammatory medications
Addressing the scar tissue formation
Rehabilitative strengthening exercises
Addressing the scar tissue and rehabilitation of the calf is very important. Skipping out on stretching can lead to further advanced conditions. A misconception that many runners have is, a tight muscle indicates a strong muscle- this is incorrect! Although a tight muscle can be strong, it is more common that the muscle is weak and spasming in hopes of remaining stable, but probably on the verge of an injury. Warm up of the calf muscles is important before beginning any strengthening protocol and can be done with stretching. A great calf stretch is downward facing dog yoga pose. Exercises to strengthen the muscles associated with soleus strain:
Eccentric exercises- calf raises
Proprioceptive one legged stance
Approximately 6-8 weeks of treatment will be needed, depending on the severity of the injury, to decrease the pain and strengthen the muscles.
At Lone Star Sport & Spine, we approach injuries in a conservative manner that will give the patient the most weighted benefits. Our providers are board certified chiropractors and certified in full body Active Release Technique. We examine the patient and determine the most efficient and quickest treatment plan for them. Our goal is not only to get the athlete back out on the field doing what they love to do, but to also enhance their athletic performance. We address the scar tissue that is built up from micro tears in the tissue due to overuse or previous injuries and develop a program to strengthen and train the muscles to be used functionally. Most all of our patients find results within a few treatments with decreased pain, and increased range of motion, strength, and balance. We then move into the second phase of treatment with strength and conditioning which is the most important aspect of the treatment, to prevent future injuries.
In summary, to address soleus strain:
Address the scar tissue in primary involved muscle, and any associated muscle
Warm up and stretch the calf muscles
Strengthen and condition the calf to prevent future injury (sport specific functional training)
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