Sports Massage for Achilles Tendinopathy

Stuart Hinds demonstrates the assessment and treatment of Achilles Tendinopathy

From a dynamic postural viewpoint, the soleus prevents the body falling forward at the ankle joint during standing.

In gait, the muscle eccentrically decelerates subtalar joint pronation and internal rotation of the lower leg at heel-strike. It also decelerates dorsiflexion of the foot. Spasm or myofascial trigger points in the soleus can be the origin of Achilles pain, tight hamstrings, lower back pain, night cramp and even headaches.

The soleus typically refers pain to the posterior aspect and plantar surface of the heel and to the distal end of the Achilles tendon. A rare myofascial trigger point spreads pain to the ipsilateral sacroiliac joint, and can also refer pain to the jaw in extreme cases.

Anatomy

Part of the triceps surae. The soleus is so called because its shape resembles a fish. The calcaneal tendon of the soleus and gastrocnemius is the thickest and strongest tendon in the body.

Origin

Posterior surfaces of head of bula and upper third of body of bula. Soleal line and middle third of medial border of tibia. Tendinous arch between tibia and bula.

Insertion

With tendon of gastrocnemius into posterior surface of calcaneus.

Soleus - Common Trigger Point Sites

Action

Plantar flexes ankle joint. Frequently in contraction during standing, to prevent body falling forward at the ankle joint, that is, to offset line of pull through body’s centre of gravity, thus helping to maintain an upright posture. Antagonist: tibialis anterior.

Nerve

Tibial nerve, L5, S1, 2. BASIC FUNCTIONAL

Movement

Example: standing on tiptoes.

Soleus Trigger Points - Common Referred Pain Patterns

Trigger point referred pain patterns

Pain in distal Achilles tendon and heel to the posterior half of foot. Calf pain from knee to just above Achilles tendon origin. 4–5 cm zone of pain in ipsilateral sacroiliac region (rare).

Indications

Calf/heel/posterior knee pain, chronic/long-term use of high-heeled shoes, plantar fasciitis, chronic calf shortening, calf pain walking stairs, low back pain, leg cramps.

Causes

Post-fracture splinting, poor orthotics, prolonged driving, sports (e.g. running, soccer, cycling, climbing, skiing, rowing machine), footwear (high heels), PSLE, occupational standing, direct blow/trauma, pressure on calf.

Differential Diagnosis

Achilles tendonitis. Compartment syndrome. Vascular disease. Heel spur. Fasciitis. Subtalar joint problems. Venous pump mechanisms. Tendon rupture. Baker’s cyst. Shin splints. Stress fracture. Leg length discrepancy.

Connections

Popliteus, gastrocnemius, tibialis posterior, quadratus plantae (of foot), abductor hallucis (of foot), piriformis, occasionally to jaw.

Soleus Trigger Points can be self-treated but the muscle is deep and pressure tools should not be used without instruction from a professional. 

Stretching can be useful and there are many simple stretching exercises for the soleus that anyone can perform at home without special equipment.

Self Help

Self-massage techniques can be helpful; you can even use the opposite knee. Balls and pressure tools may be used but not by the novice, as the muscle is deep and there are many superficial and deep veins in the area.

Stretching is excellent for disabling trigger points in the calf muscles. Use of foam rollers can be effective.