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Physio Energy

Muscles

Plantaris

Symptom Area: Leg, Ankle and Foot

Small muscle behind the knee with a long tendon; trigger points cause pain at the back of the knee and upper calf.

Overview

Plantaris arises above the lateral femoral condyle and sends a long slender tendon down the calf to the heel. It contributes little power but is richly supplied with proprioceptors, and it is a frequently overlooked source of posterior knee pain.

Trigger point locations

A point in the small belly at the back of the knee, just above and lateral to the lateral head of gastrocnemius.

Referred pain pattern

Pain behind the knee spreading into the upper half of the calf.

Palpation & testing

With the patient prone and the knee slightly flexed, palpate deep in the upper lateral popliteal region; pressure over the taut band reproduces the posterior knee pain.

Common causes

Sprint starts and sudden push-off, hill running, jumping sports, a sudden lunge with the knee extended and ankle dorsiflexed.

Self-care & clinical treatment

Calf stretching with the knee straight and bent, gradual return to sprinting and jumping, self-massage of the upper calf. Clinically: needling of plantaris with gastrocnemius and soleus; exclude DVT, Baker cyst and meniscal pathology in posterior knee pain.

Treatment protocol

Evidence-based options, dosage and safety limits for this muscle. Educational content — not a substitute for individual clinical assessment.

Manual trigger point release

Position Plantaris in a shortened, fully supported position, locate the taut band across the fibres and hold the most tender nodule between finger and thumb (pincer grip) or against the underlying bone (flat palpation).

Apply sustained pressure release at an intensity the person rates 4-6/10, holding 30-60 seconds until the discomfort fades by roughly half, then release slowly. Repeat 2-3 times per point, once or twice a day. Follow each release with slow active movement through the full available range rather than stopping at the pressure itself.

Manual release, ischaemic compression and soft tissue technique reduce trigger point pain and pressure-pain threshold in systematic reviews, with effect sizes comparable to needling in the short term; combining manual work with movement retraining is what maintains the gain.

Charles 2019 · Simons & Travell · Shah 2015

Stretch, heat and movement dosage

Warm the area for 10-15 minutes (shower, hot pack) before stretching Plantaris: warm tissue tolerates the lengthening better and the post-release window is when range is easiest to gain.

Hold each stretch 30 seconds, 3 repetitions, 5-7 days a week, to the first firm resistance and never into referred pain. Add low-load isometrics or slow controlled repetitions in the newly gained range on the same day, then progress load once the daily pain pattern has settled.

Reassess after 2 weeks. If the trigger point keeps returning to the same spot, the driver is usually postural load, sustained shortening or an unaddressed perpetuating factor rather than the point itself.

Simons & Travell · Fernández-de-las-Peñas 2019

Dry needling and injection (clinician only)

Clinician only

Trigger point dry needling of Plantaris is performed only by a clinician licensed for it, with clean-needle technique and informed consent. The taut band is fixed between the fingers and the needle advanced into the nodule; eliciting local twitch responses is associated with the largest immediate drop in pain and in spontaneous electrical activity.

Typical dosage in the trials is 1-2 sessions per week for 3-6 sessions, reassessing function each time, rather than open-ended treatment. Meta-analyses in upper-quarter and multi-region myofascial pain show reduced pain and improved pressure-pain threshold in the short and medium term compared with sham or no treatment.

Injection with local anaesthetic gives comparable pain relief to dry needling with less post-needling soreness; corticosteroid is not required for myofascial trigger points. Expect 24-72 hours of local soreness after needling and tell the person so in advance.

Kietrys 2013 · Gattie 2017 · Boyles 2015 · Cagnie 2013 · Hong 1994

Precautions and contraindications

In the calf, ankle and foot the tibial nerve and posterior tibial vessels in the deep posterior compartment, the common peroneal nerve at the fibular neck and the plantar neurovascular bundle guide needle placement. Post-treatment soreness in the calf must be distinguished from vascular or compartment symptoms.

Do not press or needle over broken or infected skin, an acute haematoma, a suspected fracture, a joint replacement approach, a tumour site, lymphoedema or an area with lost sensation. Anticoagulation, bleeding disorders, needle phobia, pregnancy, uncontrolled diabetes and immunosuppression all require the technique to be modified or avoided.

Documented adverse events after dry needling are mostly mild (bleeding, bruising, post-needling soreness, brief autonomic symptoms); serious events are rare and almost always relate to depth and direction in a thoracic or vascular field. Stop and seek urgent assessment for new breathlessness or chest pain, spreading numbness or weakness, fever, or a rapidly expanding swelling.

This page is educational and does not replace an individual clinical assessment. Progressive night pain, unexplained weight loss, cancer history, recent trauma or bladder and bowel change need medical evaluation before any trigger point treatment.

Halle 2016 · Boyce 2020

Sources for this protocol

  1. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysisJ Orthop Sports Phys Ther 2013;43(9):620-34
  2. The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysisJ Orthop Sports Phys Ther 2017;47(3):133-49
  3. Effectiveness of trigger point dry needling for multiple body regions: a systematic reviewJ Man Manip Ther 2015;23(5):276-93
  4. A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger pointsJ Bodyw Mov Ther 2019;23(3):539-46
  5. Physiologic effects of dry needlingCurr Pain Headache Rep 2013;17(8):348
  6. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigmJ Pain Res 2019;12:1899-911
  7. Myofascial trigger points then and now: a historical and scientific perspectivePM R 2015;7(7):746-61
  8. Pertinent dry needling considerations for minimizing adverse effectsInt J Sports Phys Ther 2016;11(5):651-62
  9. Adverse events associated with therapeutic dry needlingInt J Sports Phys Ther 2020;15(1):103-13
  10. Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch responseAm J Phys Med Rehabil 1994;73(4):256-63
  11. Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.)Williams & Wilkins, Baltimore

Primary Symptoms

Secondary Symptoms

Related muscles in this region

References

  • triggerpoints.net — reference

Medically reviewed by: Physio Energy clinical team — physiotherapists specialised in myofascial pain · Last reviewed:

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