Leg Injuries. Soleus Muscle Strain or Tear Anatomy The soleus is located in the superficial posterior compartment of the leg.
Mechanism of Injury Repeated overuse of the muscle, eg. Symptoms Pain is felt deep the calf and recurs on repeated loading. Pain is triggered when the foot is plantar flexed against resistance eg. Although there is little consistency by authors in the semantics of grading strains, there is consensus on the use of a three-part classification system.
This system includes clinical, pathologic, and radiology correlation as noted in the following table [ 1 , 7 , 13 , 14 ]. Accurate diagnosis and early appropriate treatment can significantly affect duration and amount of disability [ 1 ]. Complete recovery of strength and flexibility should be achieved prior to return to pre-injury activity.
Premature return may result in a prolonged recovery or incomplete return to pre-injury baseline. Acute treatment is aimed at limiting hemorrhage and pain, as well as preventing complications.
Over the first 3—5 days, muscle rest by limiting stretch and contraction, cryotherapy, compressive wrap or tape, and elevation of the leg are generally recommended [ 1 , 2 , 7 , 13 , 14 ]. Simple application of an ACE wrap, heel wedge, and crutch-assisted walking would accomplish these goals. Use of NSAIDs should be restricted in the first 24—72 h due to increased bleeding from antiplatelet effects. Celebrex and possibly other COX-2 inhibitors are an option during this period due to their lack of antiplatelet effect [ 15 ].
Acetaminophen or narcotic pain medication could also be used. Moist heat and massage early in the healing process are thought to increase the chance of hemorrhage and are generally contra-indicated [ 13 ]. Although rare, myositis ossifcans and compartment syndrome can complicate acute strains. If symptoms have not improved as expected with acute treatment, reexamination and consideration for imaging studies should be considered to evaluate for complications or surgical indications.
Following successful acute treatment more active rehabilitation strategies can be started. Rehabilitative exercises should isolate the soleus and gastrocnemius by varying knee flexion as described above.
Passive stretching of the injured muscle at this stage helps elongate the maturing intermuscular scar and prepares the muscle for strengthening. As range of motion returns, strengthening should begin with unloaded isometric contraction. Ten days after the injury, the developing scar has the same tensile strength as the adjacent muscle and further progression of rehabilitative exercises can begin.
Isometric, isotonic, and then dynamic training exercises can be added in a consecutive manner as each type of exercise is completed without pain [ 3 , 14 ].
Application of other physical therapy modalities, including massage, ultrasound and electrical stimulation, could also be considered at this stage. Contractures suggest the presence of painful and restrictive adhesions that may be amenable to surgical intervention. The presence of large intramuscular hematoma may impair clinical progress and is also an indication for surgical referral [ 14 ]. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited.
National Center for Biotechnology Information , U. Curr Rev Musculoskelet Med. Published online May Bryan Dixon. Author information Article notes Copyright and License information Disclaimer. Bryan Dixon, Email: gro. Corresponding author. Received Sep 18; Accepted Feb 9. This article has been cited by other articles in PMC.
Abstract Calf strains are common injuries seen in primary care and sports medicine clinics. Keywords: Muscle strain, Calf, Gastrocnemius, Soleus. Introduction Calf strains are a common injury. Gastrocnemius strains Calf strains are most commonly found in the medial head of the gastrocnemius [ 3 ]. Plantaris strains The plantaris also crosses the knee and ankle joints prior to its common Achilles tendon insertion on the calcaneus.
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Enertor advises anyone with an injury to seek their own medical advice — and do not make any health or medical related decisions based solely on information found on this site. Your cart. Close Cart. It joins the calcaneal, or Achilles, tendon along with gastrocnemius muscles to insert into the posterior aspect of the calcaneus. Its plantar flexion action over the ankle is accentuated when the knee is bent and the gastrocnemius muscles are shortened.
Important distinctions between the soleus and gastrocnemius muscles are that the soleus is mono-articular and the gastrocnemius muscle is bi-articular. The soleus has a high proportion of slow twitch muscle fibers and gastrocnemius muscle a high proportion of fast twitch 1.
For moderate-force contractions like distance running, the soleus is preferentially recruited due to its higher proportion of slow twitch muscle fibers. The gastrocnemius muscle is more preferentially recruited for high-force contractions — eg sprinting and jumping 2.
During the early stages of the stance phase, the soleus contracts eccentrically to decelerate ankle dorsiflexion. At mid-phase, the soleus contracts concentrically to plantarflex the ankle and propel the runner. This stretch-shortening cycle results in higher forces produced across the plantar flexors during running — even higher than in jumping 3. Acute muscle strains are most commonly seen in bi-articular muscles that have a high proportion of fast twitch muscles fibers, usually with internally driven high levels of force like sprinting, or stretching movements like kicking.
These instances produce high levels of force across the muscle. The most common muscles affected include rectus femoris, hamstrings, and gastrocnemius. However, muscle strains can less commonly occur in muscles with different anatomy and physiology, like the soleus. The reported frequency of soleus strains varies from rare to common.
A soleus muscle injury may be underreported due to misdiagnosis as thrombophlebitis or the lumping together of soleus strains with strains of the gastrocnemius 4.
Historically, muscle strains have been graded as one, two or three, referring to mild, moderate or complete 5. There is, however, some ambiguity around this grading system. This also includes low-grade muscle injuries that do not have positive radiological findings but have clinical presentations, which can often be the case with soleus injuries. Grade-one muscle strains, such as those experienced in the soleus, can be classified as mild pain with activity, localized tenderness on palpation, mild spasm and swelling.
On MRI investigation, there is the presence of an edematous pattern only, without substantial disruption of muscle fibers or muscle architecture 6. Also considered here are muscle injuries of a chronic nature where there is no sign of muscle fiber disruption but — due to the buildup of micro-trauma — inflammation can be present within the muscle.
This explains the difficulty in diagnosis. The nagging symptoms persist without clear objective findings.
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