So it has been a long time since I last wrote a blog on here, partly due to the busy Christmas and New Year period. Tonight was the third of this seasons FA Medical Society meetings, and it was on the topic of the Soleus muscle. I have to say that it was an excellent evening with some really high quality speakers, who appeared to all have a very similar message about assessment and management of the soleus muscle.
A summary of key points from tonight’s speakers is given below;
(Soleus Anatomy and Function)
- The calf complex is a major problem in elite sport, being the fourth most common injury in football and the second most common injury in rugby.
- The soleus muscle has a medial & lateral aponeurosis as well as a central tendon.
- This structure is not uniform between subjects and the size and organisation of the aponeurosis and central tendon is completely different amongst all studied subjects.
- The soleus muscle contributes 50% of total vertical support force
- The calf will use 84% of its MVC in jogging, so we can understand the influence that a loss of strength may have
- Contributes to other movements such as knee flexion and tibial translation, not just plantarflexion
(Radiological Imaging of Soleus)
- There are two main issues with soleus injuries. Firstly obtaining a correct diagnosis, and secondly the high risk of reinjury.
- Ultrasound sensitivity of 27% vs MRI means that if suspecting a soleus injury then you must utilise MRI imaging.
- Initial study suggested that central tendon involvement provided a poorer prognosis, however subsequent work suggests this may not be the case.
- Better prognosis is the quantity of connective tissue damage, not the location of it.
(Case Study of Management of a Soleus Injury in Athletics)
- Muscle fibre make up means that this muscle has a strong endurance capacity, and therefore rehabilitation must train it appropriately.
- Utilise a “work backwards approach” to understand the demands of that athlete when returning to sport and provide exercise prescription to match it.
- Think about training the Tibialis Anterior muscle as a coupling muscle to assist in providing ankle stiffness
- Think about progressing from isometric, to eccentric, to concentric and finally to the stretch-shortening cycle
- Build the plantar flexor load in a variety of ways to gain the required tissue adaptations
(Management of a Soleus Injury in Football)
- A subjective assessment with discussion of gradual onset and no acute mechanism is potentially more likely for this injury.
- Advocates a “minimum dose” approach to rehabilitation, as any time on feet is going to load the injury site. Unlike with hamstring injuries where high volumes of low velocity work can be performed early on in the rehabilitation process.
- Utilise Alter G technology to gradually increase loading in a logical manner.
- Perform high volume of straight and bent knee calf raises in rehabilitation plan
This is just a very brief summary with some key points from each speakers talks, as there was a huge amount of information and advice provided which I cannot do justice to in this blog. Thanks very much to the organisers for putting on such a high quality evening of CPD. Please click on the speaker names for a link to their twitter pages for more of their content.