A soleus muscle strain is a common but frequently unrecognised cause of calf pain in active people. Even though the soleus covers a large area of the lower leg, soleus tears are often misdiagnosed as calf tightness or gastrocnemius tears. So how can you tell if you’ve torn your soleus, and what can you do about it?
A soleus strain is one of two calf muscle tears — the other is tennis leg (gastrocnemius).
What is the soleus muscle?
The soleus is a wide, thick muscle that accounts for about 70% of the muscle mass in your lower leg. It lies deep to the two heads of the gastrocnemius. It starts high, close to the back of the knee, and joins the gastrocnemius to form the Achilles tendon in the lower calf.
The soleus has a complex structure — three internal tendon heads (central, medial, and lateral) and two coverings (the anterior and posterior aponeuroses). Each is a potential injury site, which is part of why these tears are tricky.
What does a soleus tear feel like?
Unlike gastrocnemius tears, which strike during explosive movements such as sprinting or a change of direction, soleus tears are more subtle. People usually notice a gradual tightening or cramping of the calf. Often, it isn’t bad enough to stop the activity. If you stop, the tightness lasts only a few days — but if you restart too soon, symptoms build and can lead to a bigger tear. People with undiagnosed soleus tears often get recurrent bouts of calf pain.
The location varies too. While a gastrocnemius tear sits at one spot on the inner mid-calf, soleus strains can appear at different points, and the pain can move from the inside to the outside and back.
How do we diagnose a soleus muscle strain?
See a doctor experienced in diagnosing and managing soleus tears. The history — gradual calf tightness or cramping, or recurrent calf pain in runners — gives the first clue. Your doctor examines you to pinpoint the tenderness: with a soleus strain, a calf raise with the knee slightly bent is often more painful than with the knee straight, and jumping or hopping is provocative.
It’s essential to exclude other causes of calf pain — a gastrocnemius tear, a lower-leg stress fracture, a DVT, a ruptured Baker’s cyst, and referred pain from the spine.
Imaging a soleus tear: ultrasound or MRI?
We use ultrasound or MRI for lower-leg tears, but because the soleus anatomy is complex, MRI is the better option for soleus strains. In one study, ultrasound detected only about 25% of tears visible on MRI.
The tear’s location also affects recovery. One study found that tears involving the intratendinous connective tissue took twice as long (6 weeks) to return to sport as those involving the muscle covering (aponeurosis), which took 4 weeks. The worst — a central tendon tear — could take up to 8 weeks.
Soleus muscle strain treatment
Treatment should start as soon as the tear is diagnosed.
Apply anti-inflammatory measures for the first three days — rest, ice, and compression. We generally advise against NSAIDs such as ibuprofen here, to avoid disturbing the natural inflammatory healing process after a muscle tears.
Once the acute pain settles, begin active rehab. Gentle calf stretching improves mobility and reduces tightness. Graded strengthening allows the scar tissue to mature and reduces the risk of re-tear: we usually start with isometric work (calf holds), then progress to isotonic work (calf raises). You then add bodyweight and external load to build calf strength and endurance before dynamic activity such as running. Target both the soleus and gastrocnemius with standing and seated calf exercises. Your therapist sets strength goals to reach before plyometric work, such as jumping and hopping.
Frequently asked questions about soleus muscle strain
What is the soleus muscle tear recovery time?
Recovery depends most on the tear’s location. Tears involving the internal tendon take much longer than those limited to the musculotendinous junction or the myofascial covering, typically 4-8 weeks.
What conditions mimic a soleus tear?
Gastrocnemius tears, a ruptured Baker’s cyst, a tibial or fibular stress fracture, an accessory soleus muscle, and a DVT can all mimic a soleus strain. See a doctor for an accurate diagnosis.
How do I tell a soleus from a gastrocnemius (tennis leg) tear?
Gastrocnemius tears (tennis leg) occur in the mid-calf during ballistic movements — sprinting, jumping, changing direction — and almost always stop you from continuing, with difficulty bearing weight. Soleus tears mainly affect runners and develop gradually, presenting as stiffness or pain.
How long does a soleus muscle strain take to heal?
The location matters more than the size. Tears involving the intratendinous connective tissue take longer than those involving the muscle covering, and a complete tear of that tissue takes longer still.
Do PRP injections help a soleus tear heal faster?
We don’t know. We generally reserve PRP for slow-healing cases, where injecting it into soft scar tissue may help it mature — but there’s no proof it makes a long-term difference.
Final word from Sport Doctor London about soleus muscle strain
Soleus tears are tricky to diagnose and manage. See a sports medicine doctor with expertise in soleus tears and other causes of calf pain for an accurate diagnosis and a structured recovery plan.
To book a one-stop calf assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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