Muscles
Soleus Trigger Points
Symptom Area: Leg, Ankle and Foot
Soleus Trigger Points are explored here through their location and referred pain pattern. Muscle knots is an everyday term used for tender muscular spots; myofascial pain describes pain involving muscle and its surrounding connective tissue. A frequent hidden cause of heel pain, and sometimes of pain referred up to the sacroiliac area.
Where you feel it
When the Soleus holds active trigger points, you usually notice it as buttock pain, heel pain, posterior ankle pain, posterior leg (calf) pain and restless leg syndrome. Where the pain spreads: Heel, Achilles area and sacroiliac region — a classic 'low back' referral. What often sets it off: Running mileage spikes, prolonged standing, calf disuse.
Overview
The soleus lies deep to the gastrocnemius and points the foot down regardless of knee position; it is the key muscle for running endurance. Its trigger points are common in everyday and athletic populations and are a frequent hidden cause of heel pain, nocturnal calf cramps and pain referred up to the sacroiliac area — the patterns described below.
Trigger point locations
Deep to gastrocnemius along the lower calf.
Referred pain pattern
Heel, Achilles area and sacroiliac region — a classic 'low back' referral.
Palpation & testing
Palpate the muscle belly along its accessible course. Reproduction of the patient's familiar pain on palpation supports involvement.
Common causes
Running mileage spikes, prolonged standing, calf disuse.
Self-care & clinical treatment
Bent-knee calf stretch, heel raises with bent knee. Clinically: needling.
Treatment protocol
For Soleus, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and palpation: Palpate the muscle belly along its accessible course.
Regional precaution for clinicians: 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.
Primary Symptoms
Secondary Symptoms
Often confused with
These muscles cause the same primary symptoms, so they are checked together:
Related muscles in this region
Related articles
- Referred pain: why the spot that hurts is rarely the spot that needs treatment
- Calf cramps at night: a step-by-step plan for the gastrocnemius and soleus trigger points behind them
- Heel pain on the first steps of the morning: the calf and foot trigger points behind it
- Posterior Knee Pain: which trigger points cause it and how to treat them
References
- • Travell & Simons — Myofascial Pain and Dysfunction
- • Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2013;43(9):620-34
- • The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2017;47(3):133-49
- • Effectiveness of trigger point dry needling for multiple body regions: a systematic review — J Man Manip Ther 2015;23(5):276-93
- • A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points — J Bodyw Mov Ther 2019;23(3):539-46
- • Physiologic effects of dry needling — Curr Pain Headache Rep 2013;17(8):348
- • Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm — J Pain Res 2019;12:1899-911
- • Myofascial trigger points then and now: a historical and scientific perspective — PM R 2015;7(7):746-61
- • Pertinent dry needling considerations for minimizing adverse effects — Int J Sports Phys Ther 2016;11(5):651-62
- • Adverse events associated with therapeutic dry needling — Int J Sports Phys Ther 2020;15(1):103-13
- • Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response — Am J Phys Med Rehabil 1994;73(4):256-63
- • Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.) — Williams & Wilkins, Baltimore
Medically reviewed by: Marco Aruffo — physiotherapist since 2006, specialised in myofascial pain · Last reviewed:
