A soleus muscle strain is a common but frequently unrecognised cause of calf pain in active individuals. Even though the soleus muscle covers a large area of the lower leg, soleus tears are often misdiagnosed as calf tightness or gastrocnemius tears. How can you tell if you’ve developed a soleus muscle tear, and what can you do about it?
What is the soleus muscle?
The soleus muscle is wide and thick and represents about 70% of the muscle bulk in your lower leg. It is found deep to the two heads of the gastrocnemius muscle. The muscle starts high up, close to the back of the knee, and ends by joining with the gastrocnemius to form the Achilles tendon in the lower calf.
The soleus muscle belly has a complex structure, comprising three intratendinous heads: central, medial, and lateral. It also has two coverings: the anterior and posterior aponeuroses. These are all potential injury sites.
What does a soleus tear feel like?
Unlike gastrocnemius tears, which occur during explosive movements such as sprinting or sudden change of direction, soleus muscle tears can be more subtle. Generally, sportspeople notice a gradual tightening or cramping of the calf. Often, the cramping is not severe enough to stop the activity. If the person stops the movement, the tightness or cramping lasts only a few days. However, if the action is started again relatively quickly, symptoms increase and may lead to a more significant tear. Sportspeople with undiagnosed soleus tears frequently experience recurrent episodes of calf pain from undiagnosed soleus tears.
Moreover, unlike gastrocnemius tears that occur at one position on the inside of the mid-calf, soleus muscle strains can often appear at different points of the calf depending on the structures torn. Sometimes, pain can move from the inside to the outside and vice versa.
How to diagnose a soleus muscle strain?
You should see a doctor with expertise in diagnosing and managing soleus tears. The history of the gradual onset of calf cramping or tightness should give you clues. Sometimes, recurrent calf pain during running or endurance sports is a cause for concern.
Your doctor will examine you to determine the exact location of tenderness. For soleus muscle strain, performing a calf raise with a slightly bent knee is often sore than with the knee straight. Also, jumping or hopping is provocative.
Your doctor must exclude other causes of calf pain, such as gastrocnemius tear, lower leg stress fractures, deep venous thrombosis, ruptured Baker’s cyst and referred pain from the spine.
Imaging of soleus tear: ultrasound or MRI scan
Generally, we use ultrasound or MRI to diagnose tears in the lower legs. However, due to the complexity of the soleus anatomy, we believe MRI is a better option than ultrasound for diagnosing soleus muscle strains. In a recent study, ultrasound detected only about 25% of tears visible on MRI.
Additionally, the soleus muscle tear’s location can influence the healing process’s duration. According to one study, tears involving the intra-tendinous connective tissue took twice as long (6 weeks) to return to sport as those involving the muscle covering or aponeurosis (4 weeks). The worst tear involved the central tendon, which could take up to 8 weeks to heal.
Soleus muscle strain treatment
Treatment should begin as soon as the tear is diagnosed.
You should apply anti-inflammatory measures for the first three days after the injury, including rest, ice, and compression. Generally, we advise against NSAIDS such as ibuprofen, as we don’t want to disturb the natural inflammatory healing process after a muscle is torn.
Once the acute pain has settled, active rehabilitation strategies are started. Gentle stretching of the calf muscle will improve mobility and reduce tightness. Graded strengthening will allow the scar tissue to mature and reduce the risk of a re-tear. Ususally we start with graded isometric strengthening (calf holds) and then progress to isotonic strengthening (calf raises). You must add weight to your body to achieve optimal calf strength and endurance before resuming dynamic activities like running. Standing and seated calf exercises should also target the soleus and gastrocnemius muscles. Your therapist will give you strength goals to achieve before you can progress into plyometric activities, such as jumping and hopping.
Other frequently asked questions about soleus muscle strain:
What is the soleus muscle tear recovery time?
Recent studies suggest that the location of the tear is the most critical factor in determining recovery time. Tears involving the intramuscular tendon take much longer to recover than tears restricted to the musculotendinous junction or the myofascial.
What conditions mimic a soleus tear?
Gastrocnemius tears, ruptured Baker’s cyst, stress fractures of the tibia or fibula, accessory soleus muscle and deep venous thrombosis can all present like soleus muscle strains. You should consult a doctor to receive an accurate diagnosis.
How can you tell the difference between a soleus vs gastrocnemius calf tear?
Generally, gastrocnemius tears, or “tennis leg,” occur in the mid-calf area secondary to ballistic movements, such as sprinting, jumping, or changing direction. In almost all cases, athletes with gastrocnemius tears cannot continue their activity. They are often stopped in their tracks and have difficulty weight bearing. Alternatively, soleus tears occur primarily in runners and typically present with a gradual onset of stiffness or pain.
How long does a soleus muscle strain take to heal?
We used to think that the size of the soleus muscle tear determined how long it took to heal. However, recent evidence suggests that the location of the tear is more critical. Generally, tears involving the intra-tendinous connective tissue take longer to recover than those involving the muscle covering. Additionally, if the intra-tendinous connective tissue is completely torn (a complete tear), the injury takes longer to heal.
Can PRP (platelet-rich plasma) injections help a soleus tear heal quicker?
We don’t know. However, we generally limit PRP injections to cases where healing is slow. We believe injecting PRP into soft scars may help transform them into mature scars. However, we don’t know whether this injeciton makes a difference in the long term.
Final word from Sportdoctorlondon regarding soleus muscle strains
Soelus tears are tricky to diagnose and manage. You should see a sports medicine doctor with expertise in diagnosing soleus muscle tears and other causes of calf pain.
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