Preventing Inner Calf Pain: Soleus Exercises for Long Distance Runners

This is for the runner whose ever struggled with nagging inner-calf pain. If you've done every stretch imaginable and committed to hundreds of calf raises, and that discomfort still that won't go away...

You're not crazy.

You might not be targeting the right muscle.

Here me out.

Years ago when I first started practicing, I had one patient who came in for a calf strain.

She did all her stretches.

All her exercises.

And she was making great progress...

But she had this deep, difficult-to-describe, ache along the inner part of her calf with occasional symptoms of tightness around the top, too.

I ran her through all the basics: checking ankle motion, gastroc length, calf raise strength etc.

Until I remembered: the gastroc (your big, main calf muscle) doesn't operate alone.

Underneath it lies your soleus.

So we changed her exercises and stretches.

And by the end of the visit, her pain was gone!

(Apparently her new exercises worked so well she never came back haha).

What this means for you as a runner:

If you have pain, tightness, or a deep dull ache along your inner calf OR higher up on the outside of your calf (where your fibular begins), you're not crazy if the "normal" stretches the internet gives you don't work.

The internet is obsessed with calf raises and gastroc strength.

But what you might need is soleus strength.

Let's dive in.

FAPID FIRE ANSWERS: to your soleus questions

How do I know what I'm dealing with is actually soleus pain? Where would I feel it? Is there a test I can do for it?

The bad news:

we don't have any fancy, super duper physical therapy tests (*yet) to 100% confirm a soleus strain

But the good news:

"The tendons within the soleus muscle are commonly used to define the site of injury in soleus strains.....The peroneal origin, which is superior to the tibia, originates from a thick band of tendon in the posterior sector of the head of the fibula and from aponeurotic fibers from the lateral border of the fibula and the posterior intermuscular septum, which separates the soleus from the peroneus longus. The tibial bundle originates from a bony prominence on the posterior surface of the tibia, called the soleus line, and from the medial border of the tibia."
I know, what a mouthful (and a brainful).

What you need to know as a runner:

just as I described in the first video above, often times pain from your soleus will present as a tightness that doesn't go away with regular calf stretches and can cause you pain specifically around the very top and outside edge of your calf and/or pain along the inner edge of your calf.

What do I do to fix it? Just keep stretching until the tightness goes away?

Not quite.

Now a days I use a gastroc vs soleus stretch as part of my differential diagnosis, a way to determine which muscle is it that's actually talking to you, your gastroc or soleus.

The problem with repeated stretching is that it often doesn't fix or resolve the issue.

Because here's what you need to know as a runner:

a tight muscle doesn't mean it's a weak muscle.
Often it means the muscle is an overachiever and too active. Think of it like the volume is turned up too high.
And since we're runners, we know that a stronger soleus which can work at the "right volume" not only feels better, but it helps us to run longer, further, more efficiently AND reduces the risk of shin splints.
So overall, building stronger solei muscles that know how to work at the "right volume" is a priority.

I know I need strength exercises. But what are some things I can fix NOW to keep running and prevent this pain from coming back?

I'm so glad you asked. You'll see a lot of cross over between the tips below and the exercises in the rest of the blog, but trust that it's part of the process

Prevent overstriding
Work on glute max strength to reduce pelvic anterior tilt
- (your pelvis tipping forward like a bowl giving you a Kim Kardashian booty)
Address glute med strength to eliminate pelvic drop culprit
- (if you film yourself from behind, you might see that one butt cheek actually drops down toward the ground versus staying level throughout your entire stride)
Work on intrinsic foot strength
- (itty bitty foot muscle strength)

Strength Exercises for Runners to Prevent Inner Calf Pain

Circuit:

2-3 sets each // LIGHT & medium weights

Short Foot Exercise + Pool Noodle

Flat surface: 2 sets x 8-12reps (depending on fatigue levels)
Pool Noodle: 2 sets x 8-12reps (depending on fatigue levels)

Single Leg Hip Hinge + Paloff

2-3 sets of 12; rest as needed based on fatigue

Pool Noodle + Runner's Lunge

2-3 rounds to fatigue each side

Why Runners Need Stronger Solei: Prevent Future Running Injuries

Short Foot Exercise + Pool Noodle

This is a 2 part exercise, so be patient with yourself
Part 1: Learning how to do a "short foot exercise". This is part brain gains, part muscle gains, it's ok if this part takes some time. Start with your foot flat on the ground; sometimes it can help to stand vs sit. Formal cues are to try and "shorten the middle of your foot, bringing your toes closer to your heel." Ways you might be cheating: scrunching your toes or digging them into the ground. (don't worry, I made a video for you because I KNOW this can be confusing.)
Part 2: Adding the Pool noodle. This is for when the short foot exercises becomes too dang easy. Place the first third of your foot on top of the pool noodle. From there, step back into your long runner's lunge. Now perform the short foot exercise again, remembering to keep 90% of your body weight on the front leg.
WHAT'S WITH THE POOL NOODLE? By using a pool noodle, we're inviting your itty bitty foot muscles, or intrinsic foot muscles to the party. And by keeping 90% of your body weigh on your forward leg, your knee naturally bends, asking more of the work to be done by your soleus. So together, we're working smarter, not harder, getting 2 different muscles to work together in a position that replicates mid stance load bearing on your running stride.

Single Leg Hip Hinge + Paloff

Balance challenge ahead!
PRO TIP: get comfortable with this part first. Start out on one leg, and hinge forward about 50% of like you're going to do an RDL. With a free weight or a resistance band anchored to a door or weight rack, move the weight in and out (away from your body; back to your body).
To make it soleus specific and spicy: Place the first third of your foot on top of the Pool noodle and now perform the exercise. (you may need a light weight). By placing your foot on top of the pool noodle, we induce more knee flexion (knee bending) and this recruits greater soleus activation. Not to mention, we're working pretty hard on your single leg balance, which is CRUCIAL for runners!

Pool Noodle + Runner's Lunge

If this looks almost familiar, you're not wrong.
WHY? I wanted to update this super-running specific foot exercise from my Stronger Feet Workshop in a way that was more accessible to every runner and challenged your foot muscles even more.
THE SECRET: start again with the first third of your foot on the pool noodle and find your way into the elongated runner's stance. Remember to keep the front knee bent at all times, keeping 90% of your body weight on that forward leg. Next, bring the back foot to meet the front.
HOW THIS HELPS: looks a lot like the first exercise we did today, right? That's on purpose, but now in this position, the emphasis is on lower leg stability and balance as a unit, asking the soleus to stay strong while the intrinsic foot muscles fight for their lives, keeping a steady base. Not to mention, this exercise begins to replicate you traveling through running stride actively, giving your muscles a preview of when and how to use this new strength.

WRAPPING UP

If your head is spinning a little bit, that's ok.

Here's the 30,000 foot view of things you may need to work on and WHY:

Glute strength is important for happy solei.
Recent research places an emphasis on glute strength and hip stability along with a strong soleus muscles. The reason why is if 2 glute muscles in particular (your glute max and medius) aren't strong enough and able to work correctly for miles on end, it results in compensations as you fatigue. These specific signs of fatigue would be sloppy running form like that anterior pelvic tilt (aka Kim-K booty) and a notable pelvic drop, (where your hip is visibly dropping down towards the ground mid stride).
Weak glutes are choas creators.
Weak glute muscles can cause further chaos (read: compensations) such as resulting in greater hip flexion, then greater knee flexion, which further trickles down the kinetic chain into increased ankle dorsiflexion, placing greater stress on an eccentrically loaded soleus.
Translation: sloppy glutes can cause more bending at your hip, which causes more bending at your knee, which causes extra bending at your ankle which makes the soleus work really hard in an sub-optimal position, placing extra stress on it that could be causing you pain.

Strong Solei and Glutes make the perfect team...and a happy runner.
The above two points pain the picture for why you need to stay on top of glute strength. But we can't ignore the fact that a strong soleus and strong intrinsiic foot muscles play a huge part too. In fact, some of the itt-bitty foot muscles specifically called "short foot exercises" help reduce the risk of overuse of soleus muscles and notably decrease it's "over-activation" (think: volume turned up too high). This is particularly important for runners who struggle with repeat "inner calf pain", chronically tight calves, and shin splints.

If you want even more strength exercises made specifically for runners to keep you running strong, injury-free and help you run further and faster, check out my FREE strength guide for runners HERE.

and until next time...

Dare to Train Differently,

Marie Whitt, PT, DPT //@dr.whitt.fit

References:

*please note, running research on the soleus, differential diagnosis, and treatment are still in their infancy. There is a notable need for more research, greater sample sizes, and require greater diversity in testing.

Kinematic Characteristics of Male Runners With a History of Recurrent Calf Muscle Strain Injury: doi: 10.26603/001c.22971

Problems in Diagnosis and Treatment of Soleus Muscle Injuries—Narrative Review and Case Report: 5. https://doi.org/ 10.3390/jcm14061955

Acute effects of the short-foot exercise in runners with medial tibial stress syndrome: A quasi-experimental study: clinicalkey