"Where you think it is, it ain't."
As the great massage therapist Ida Rolf once said, "Where you think it is, it ain't."
This profound statement holds a lot of truth, especially when it comes to understanding and managing pain in the world of running.
Many runners have experienced Achilles tendon pain, and often, the source of this discomfort can be quite elusive.
Surprisingly, it may not always originate from the Achilles tendon itself.
In this blog post, we'll explore the concept of soleus trigger points and how they can refer pain to the Achilles.
We'll also discuss strategies to manage and prevent this type of discomfort.
The Soleus: A Hidden Culprit
The red area around the achilles and heel is known as ‘referred pain’ from the soleus muscle
The soleus muscle is a powerful calf muscle that plays a crucial role in running.
It is often overshadowed by its more prominent counterpart, the gastrocnemius, but the soleus is no less important.
When it comes to running, the soleus carries a substantial load, approximately 6-8 times your body weight with every step. Over weeks and months, this load can accumulate and cause various issues, one of which is trigger points.
Trigger points are hyperirritable knots or tight bands within a muscle that can cause pain locally or refer pain to other areas. They commonly are a result of excess waste products/metabolites (such as lactate) build up in the muscle when the muscle has worked harder than usual.
In the case of the soleus, these trigger points can lead to discomfort that radiates to the Achilles tendon, even when the tendon itself is healthy.
The New Runner's Dilemma
New runners are particularly susceptible to developing soleus trigger points.
The tightness in the soleus may have been building up gradually, and with a lack of experience, they may inadvertently make mistakes in managing their running-related discomfort.
Often, new runners tend to focus on stretching, but this can be counterproductive, especially when stretching with a straight knee, which primarily targets the more superficial muscle known as the gastrocnemius.
Understanding the Pain Pathway
The referral of pain from the soleus to the Achilles tendon occurs due to the shared neural pathways and the close proximity of these structures.
It's crucial to recognize that the Achilles pain can be a result of metabolic waste buildup in the soleus, not a direct issue with the tendon itself.
This insight can be transformative in managing and preventing such pain.
An assessment with an experienced running Physiotherapist who uses a load management approach (rather than a short sighted purely biomedical approach) early on can save you a lot of time and hassle down the track.
Albert Einstein is quoted as having said, “If I had an hour to solve a problem I'd spend 55 minutes thinking about the problem and five minutes thinking about solutions.” The point he makes is important: really listening and deeply understanding the context of the problem has great value in effectively solving the problem.
Tips for Managing Soleus Trigger Points and Achilles Pain
Dry Needling: Dry needling by a trained healthcare professional can be effective in releasing trigger points in the soleus muscle, reducing pain, and restoring normal muscle function.
Load Management Advice: Avoid overloading the calf muscles, especially if you're new to running. Implement the 80/20 rule, where 80% of your training is at a comfortable pace (Zone 2) to build your mitochondrial capacity while limiting high-intensity workouts.
Foam Rolling: Use a foam roller to massage your calf muscles after your runs. This can help release tension and prevent the buildup of trigger points.
Shoe Maintenance: Ensure your running shoes are well-maintained and provide the necessary support. Proper footwear can reduce excessive stress on your calf muscles and Achilles tendon.
Running Technique: Pay attention to your running form. Avoid overstriding with a heel strike, as this places a significant load on the Achilles. Aim for a midfoot strike (as opposed to forefoot strike) with a cadence of 170-180 steps per minute. When walking, avoid heel striking and aim for a cadence of 120-130 steps per minute.
Avoid Compression Loads: Be cautious about using hard massage tools, rolling balls, or aggressive stretching on your calf muscles and Achilles. Overdoing it can lead to further irritation, which would only present 24 hours later. Don’t win the battle but lose the war.
Conclusion
The Achilles' heel of running pain often resides in the soleus muscle, with trigger points causing discomfort that radiates to the Achilles tendon.
Understanding this relationship is crucial for effective management and prevention.
By incorporating the tips mentioned above, you can help alleviate pain, improve your running experience, and keep your Achilles tendon healthy.
Remember, sometimes where you think the pain is, it ain't – it might just be the soleus!