Friday, July 24, 2009

The Plantar Faciia, Achilles Tendon & Soleus Muscle

The calf muscles consist of the Gastrocnemius which is the big muscle at the back of the lower leg and the Soleus muscle which is a smaller muscle lower down in the leg and under the Gastrocnemius. The Gastrocnemius attaches above the knee joint and inserts into the heel bone via the achilles tendon. The Soleus attaches below the knee joint and then also to the heel via the achilles. Together the Gastrocnemius, Soleus and Plantaris are known as Triceps Surae.

Both muscles act to plantarflex the ankle (point the foot away from the body). As Gastrocnemius attaches above the knee it also helps with bending the knee. In this position, with the knee bent, soleus becomes the main plantarflexor. If the Soleus muscle is damaged you might get pain lower in the leg and also pain when you contract the muscle against resistance with the knee bent.

As I have recently experienced pain along the bottom of my heel up along the Achilles, as opposed to the Plantar Faciia area as I had previously, I believe that I may in fact have a strained Soleus. The Soleus often takes more of a beating than the larger muscle because it acts first when you use your calf muscles. Another indicator is that Acupuncture has revealed my most responsive or sensitive area is in fact the Soleus, as well as the bottom of my heel.

Alternatively, this could in fact be Achilles tendinitis, symptomatic of occasional pain in the lower calf along the cord connecting the heel to the calf muscle. This injury is an overuse injury, plain and simple, and one that may have been aggravated by too much hill work. I didn't think I was doing much hill work, but trail I run along the river is hilly in sections.

The injury is actually the swelling of the sheath within which the cord slides. When it becomes swollen, it creates too tight a fit for the tendon. Friction -- and pain -- are the results. To confirm that you have Achilles tendinitis, pinch the tendon starting close to the heel and working your way up toward the calf. If you feel some serious pain and maybe some swelling, you've got Achilles tendinitis.

To help the pain, it is recommended to ice the area immediately after running (either a cold pack or a frozen wet towel) for 10-15 minutes. To reduce inflammation, take an aspirin or ibuprofen at mealtime. At other times (before bed, for example), soak the sore tendon in hot water or put a heating pad (at a low setting) on the area in the evening and at bedtime.

When running, stretching is a crucial preventive prescription. Pay special attention to stretching your calves with wall pushups (do them religiously - several times a day and especially before and after running) and your hamstrings with the hamstring stretch. These stretches, incidentally, are key to avoiding Achilles tendinitis. Avoid running on soft surfaces which might let your heel sink in too much (e.g., sand) and hilly terrain.

As stated previously, Achilles tendinitis is aggravated by hills. The Circle the Bay is quite hilly - particularly the last half - so that could have caused the initial injury. However, that was in August and I have run only occasionally since so I don't know why I would be continually plagued with pain. Can the pain I experience truly be simply because of a weak Triceps Surae... because I don't do an adequate job stretching these muscles after running?

We'll have to wait and see. In addition to being more aggressive with stretching and strengthening exercises, I may also consider heel lifts in my shoes. I'm going to have another gait analysis done and buy a pair of supported flip flops.

Example strengthening exercises

Example stretches

OSN: 550m warm-up; 6 x 25m fly; 8 x 50m free; 8 x 50m back; 8 x 50m back/breast (10 sec RI between 50s, 1 min between sets) --> 1900m

1 comment:

  1. Hope you heal up soon

    A good tip to is to use a foam roller, stick, or trigger point roller to roll out the tension down the calves through the achilles


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