The Peripheral Heart
In this episode, I dive into the world of this 'peripheral heart', the soleus muscle. I discuss the anatomy of the soleus and how it relates to movement and general health, as well as how a weak soleus can create a ripple effect, leading to increased tone and trigger points, cognitive decline, and fluid imbalance.
Listen to some unexpected revelations about this muscle and how strengthening it can be a game-changer for your mobility, balance, and for me, even in alleviating symptoms of exertional compartment syndrome.
I share about the role the soleus plays in common pathology like achilles tendinopathy and ACL injuries looking at both of its roles in postural control as well as elastic recoil.
Resources mentioned in this episode:
Dr. Michaud and the Toe Pro- https://www.humanlocomotion.com/
Social media educational posts on the soleus-
Key Spots- https://www.instagram.com/reel/Cv0lDFDJ515/
Self-massage- https://www.instagram.com/reel/Cv-J7kYMRXh/
The Peripheral Heart- https://www.instagram.com/p/Cu5LyI-vYCq/
Soleus force production- https://www.instagram.com/p/CwP-vCcL9hW/
Unlocking the Fibula- https://www.movementrev.com/podcast/season-1-episode-8-unlocking-the-fibula
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: 0:38
Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like. I'm glad you're here. Let's dive in. Hello, hello, welcome to the Unreal Results podcast. Today we're talking about the soleus. So I recently have been talking about it a little bit on social media and I sent an email to my email list about it, but I just wanted to highlight it here on the podcast too, in case you didn't see it in those mediums, but also just because I feel like it needs to be talked about as much as possible. So the reason I've been looking into this is one of my athletes recently strained his soleus and anytime I have an injury in my own body or an athlete has an injury, even though I might have dealt with it before, my brain just starts turning, like the wheels of my brain start turning, and I just get curious and I like to review everything about it. So I like to review the anatomy, the origin, the insertion, how it relates to the viscera, how it relates to movements. You know what is a study show on injuries and and you know, like the common strengthenings, like ways that I strengthen it, maybe things that I have missed, that kind of thing. So I always allow injuries to be an opportunity to dive back in, to review and to make sure that, from a rehab standpoint, we're not missing anything going forward. Part of this is like my general silver lining thought process of like, instead of being like upset about an injury or a pain or whatever we're going through, I see it as an opportunity of it was meant to happen and what is it supposed to be? Tgs, and so that's really sort of where this information came from. And it has been a while since I had dealt with someone with a soleus strain or medial gastroc strain even, and so you know I just was like let's, let's review, and and part of it is to like a searching of like what did we like miss going into it? If at all, maybe it's nothing like, unfortunately, like getting hurt. Some tissue injuries can sometimes just be the nature of the beast with being athletic and you know, with the forces, especially that my athletes put on their body, and so it's always like I'm always thinking like onward, like this is happening for a reason. What is the lesson? What can we learn from it? Like, continue on. So that's sort of why I dove deeper into it, and, and the other thing that was highlighting this for me is I was thinking of, like, what rehab tools I wanted to use, and I remembered that Dr Tom Michaud I'm not sure if I say his last name right, but he sent me his product, the tow pro years ago, probably in 2017. He sent it to me and I thought it was cool. He sent it to me as, like, maybe I think he learned about me through Mike Boyle and because I'm like a big like, I'm kind of like a nerd when it comes to the foot and like foot mechanics so he sent it to me to check out and I had gotten it and I was like, oh, this, this is cool. I like the way it's designed. It makes sense. I'm all about creating an environment that puts somebody in the movement experience you're trying to get, as opposed to queuing them, and that's what his Toe Pro product really is all about. It's designed to put the foot in a specific position. So it's like, no matter how you do the exercise, you tend to do it correctly and but, for whatever reason, when I got it, I just didn't really do anything with it. It sort of put in the cupboard at my house and and there it sat, and so, for whatever reason, when we're going through this rehab process, I remembered that I had the Toe Pro and I was like you know what I want to? I want to play around with. This is a great opportunity to play around with it, learn more. And so I, of course, went to his website and read some of his blog posts and he has a book out to. I have not read, but I've heard it's good, and I watched his YouTube videos and it was in watching all that I was like, oh, this is such great review and also like man, I can't believe I've had this great tool and I haven't been using it. So, like I said, I just wanted to share with you sort of my thoughts, what I pulled from that and then putting it in this different lens of view. Right, like what are we also missing from a visceral piece and when it comes to dealing with the soleus, or even Achilles tendonitis at that from that standpoint to so. So let's dive in the soleus in general when we look at its anatomy, so we know it's part of the superficial posterior compartment of the lower tromady and it is the largest of the three muscles that make up the triceps array, which is the three muscles of the triceps array are the gastrocnemius, the soleus and the plantarus. Those all come together and basically become the Achilles tendon. Achilles tendon continues on around the corner of the heel into the plantar fascia of the foot. So the Achilles tendon and the triceps array muscles are really important muscles and propulsion of our body. So movement, walking, running, jumping, the tendon elastic. So the Achilles tendon is a long tendon that is built for elastic recoil. So it is a tendon that also sort of spirals and is the interesting thing with that. When it comes to elastic recoil specifically, the soleus is actually the main muscle part of the triceps array that really helps with that elastic recoil. The soleus is really great at storing energy and letting like in having that elastic recoil component of it. And so what happens then when it comes to Achilles tendonitis, which is our tendon? Apathy and inflammation of the tendon or a breakdown of the tendon. Oftentimes what you see is a weakness of the soleus, and so that makes sense, right? Because if the soleus is the main part of the muscles that are responsible for this energy storage and release, then it would make sense. Then the tendon takes the brunt of it when that has a weakness. And in itself we're already looking at the soleus and looking how it's probably under considered when we're looking at Achilles tendonopathy and just plyometric activity in general. Because I would say too that if you were to look in the right room and you would look at sort of like traditional training for Achilles tendonopathy, you would see people, a lot of people, doing eccentric loading of the Achilles. But most of the time when you see them doing it, they're doing it with a straight leg and that just doesn't bias the soleus quite as much as it does the gastrocnemius, and so there is a little bit of a disconnect with understanding that. But taking a step back, before we talk more movement and stuff like that, I want to also just go back to the sort of the anatomy of the soleus. So we already said it's part of the superficial compartment, it's actually the main. The majority of it attaches to the fibula, or let me say that in a different way. The soleus has a very large attachment on the fibula. In fact it spans quite a bit of the fibula and so it plays a significant role in fibular mechanics. And if you've been listening to the podcast already, you know I did a whole episode on how important the fibula was to our body, to our ankle mobility, to our movement in general, and how important it was to unlock the fibula because it often gets so stuck. The joints of the fibula, the proximal and distal to fib joints, need to move for normal, healthy movement, normal function of the ankle, the knee, the SI joint and the hip. And so I actually didn't talk about the soleus, and this has probably been. For me, the biggest eye-opening piece is how important the soleus is in getting the fibula to move. Because when you look at the fact that a lot of people athletes and clutists have weaker soleuses than they should, when a muscle, especially a postural control muscle, much like the soleus is, which we'll talk about in a second is weak, the body often creates increased tone in it to provide some form of stability or stiffness within the muscle, to control postural control, and so that increased hypertenicity often feels like a trigger point which, if you know trigger points, you know there is a very common trigger point on the back of your leg, right around the proximal fib joint, and that is the soleus. In fact, oftentimes the soleus we don't really realize that it comes very lateral on the leg and I think that trigger point often gets blamed as a peroneus-longus trigger point, when in fact it's actually the soleus. And I have found, since I've been looking at this this has probably been like two months at least since I started thinking more about the soleus. Since I have been strengthening the soleus more on my own body and having my athletes do it, I have noticed I've had less issues with their fib joint. That's huge because that's usually a joint that I am constantly trying to get moving and the strategies I had to get it moving worked but they didn't stick right and if you know me, you know that if something lasts sticking, that means I'm missing something and so clearly I was missing the piece of it being the soleus and some underlying inherent weakness of the soleus. So that's a really interesting part of the anatomy. The other part of the anatomy that I want to talk to is just taking a step back, from a more visceral and neural lens of view is what nerves innervate the soleus. The soleus is innervated by the tibial nerve. So the tibial nerve comes from the sciatic nerve or actually the lumbosacral trunk and of the sacral plexus. So the tibial nerve, the sciatic nerve in general, that is a nerve that we get visceral referrals on quite a bit. So we can have a visceral referral from the liver, from the intestines or from the urogenital organs, most likely, which then makes sense because we look at the foot and ankle or the tib fib joint. So if we look at the tib fib joint, we know that a common visceral referral to the tib fib joint is going to be urogenital organs. To the lateral side of the foot is intestines and to the medial side of the foot is urogenital. So that is a big piece. When it comes to the left side, especially if we've got soleus weakness and sciatic pain or just soleus weakness and neural tension, we could potentially look to the liver as being in that. Because the liver drives left sciatica quite a bit, it can also drive some right sciatica, but it's a little bit more common to be left-sided when it's coming from the liver because of the relationship to the portal vein in the inferior mesenteric plexus from a vascular flow. And this vascular piece is really interesting to me too because the other part of the anatomy of the soleus is that it actually contains a venous plexus within it, within the muscle belly, and it's one of the only muscles that does that, I believe, does have that, I believe, and this is why the soleus is actually sometimes even referred to as a peripheral heart, because it is the main muscle pump driving our venous return to our heart. So that's huge. When we look too at that relationship to the liver and the congestion, so I'm kind of looking at like, oh interesting, when we have congestion in our venous system or our lymphatic system, which they go together, the lymph and the venous blood flow I'm already thinking about liver congestion and an imbalance kind of in the venous plexuses within the abdomen, some like entrapments maybe going on in the front of the hips, that kind of thing. And I in part of my swelling protocol actually is always to include deep tissue of the lower shemity and I'm a big believer that that actually is a huge, huge, helpful piece of the swelling protocol and I never really considered why, other than I knew it was at the distal end and that the muscle pump action has always been very important for returning blood flow to the heart, but I've never really considered even like a deeper reason why, and when I read that about the soleus it just made so much sense to me and so I think that is a big visceral piece that we might see with people who have soleus strains or have soleus weakness, or I've talked about it like exertional compartment syndrome is, I think, more prominent than we realize. I think a lot of people with general discomfort in their low legs, weakness in their low legs, achilles, tendon problems, shin splints, a lacking ankle mobility, despite like working on it, I think a lot of times it's actually a little bit of a congestion of fluid in the area and so this is a really interesting piece for me. How it also relates to some of the studies that I read in the Human Locomotion resources was that there's been studies showing that in the aging population there is a correlation between a weak soleus and cognitive decline, and that makes so much sense because of this peripheral heart rule of the soleus and so knowing that venous return to the heart is also venous return and blood flow to the brain and we know when we are not getting good blood flow to the brain or not giving good venous drainage from the brain, we're going to have a lot of brain fog and cognitive decline. And so this is a huge piece that just again highlights the importance of the soleus in fluid balance and general health as opposed to movement. So I already said to from an anatomy standpoint that the soleus is a postural muscle. So the soleus is this tends to be a little bit more slower twitch. It's a postural muscle, is actually the primary muscle that we use to prevent sway loss of balance. So our primary strategy of loss of balance is an ankle strategy, moving into ankle dorsiflexion. So with a fixed foot, the tibia moving forward on the on the foot, that is closed chain dorsiflexion and that is primarily checked by the soleus. And so this means that even when we think about how the soleus is strengthened, looking at it as that closed chain tibial tibia moving forward on the foot, is a huge piece, which then I hope that makes you think, you people in sports, sports medicine it should really put a light bulb off of how important soleus strength is for preventing ACL tears, because that is like another piece of it right and that's very exciting. And then, from a strengthening standpoint that means like doing something like a deep squat. And being down in a deep squat letting the knees go forward, controlling that knees over toe type squat, knees over toe type lunge is actually really good for soleus strength, maybe even just as much as a bent knee calf or bent knee, bent knee heel raise. So really exciting to think about that. So we talked about the soleus in terms of its anatomy, its connection to the fibula, so big piece of unlocking the fibula, huge piece of fluid balance, swelling reduction, general vascular health and wellness, which also means brain health and wellness, heart health and wellness. And we talked about the relationship to the sciatic nerve and the visceral piece to that, the relationship to the superficial compartment and the chelis tendon, the elastic recoil piece. So hopefully you're already seeing in this 20 minutes like wow, the soleus is really a big deal and are we really including it in our strength training and our rehab and what should be normal, right? So a great way to test it is to use a metronome and like a one second, so 60 seconds, like a beat on each second metronome and see how many calf raises you can do with a bent knee single leg and, depending on your age, might depend on what's normal for you, but in general, like if we're using a real general manual muscle tests like a melt, I'd say 25 repetitions. Staying on that pace is going to be good strength and you might be shocked at how difficult it is to actually maintain that pace. So give it a try, test your strength and see where you're at and then start working on it. And it can be as simple as doing bent knee calf raises, soleus only would be like seated calf raises, but then incorporating, like I said, a deep squat, some knees over toe lunge, and it doesn't have to be repetitions, it can just be holds. Because, again, it is a big postural muscle. But then, because it's just responsible for this elastic recoil piece too, we want to make sure that we're doing some biometrics, and biometrics are not just for athletes. The elastic recoil is a very important quality to keep our fascia very healthy in our entire body. And in these areas like the Achilles tendon, where the fat in the lower leg especially, where there is a lot of fascial containers and fascial compartments, we should be loading it, and one to two times a week is plenty to do this, but starting to add it in. You know, less is more in this standpoint. So count how many contacts you have. I'd say, if you've never done it before, keep your contacts under 20 for each leg, but start adding that in and see how it works, because the soleus is a big piece of it. So working your way up to increase volume and bent leg exercises is great. You can eliminate gravity If gravity seems too difficult. You can do wall heel raises with a bent knee, especially to load the soleus. There's a lot of ways you can do it. Some people like to work on the soleus by being in a real common popular one right now is to do a split squat and the leg in the front, do a heel raise while you're in the split squat and that is very soleus but, I would argue, less functional. If that makes sense. I think the most functional way to do it is going to actually be with that anterior tibial translation as well as the elastic recoil piece. I don't discount that the, the split squat with the heel raise and the front is Challenging. I just don't think when it comes to actual strengthening the soleus it is like the best way to do it. It kind of actually reminds me of like People who use like a bo-soo ball to do a single leg squat or a squat or just even a fizzy ball. Stand on a physio ball and do shit like that, like You're not. You're not training any strength of anything, you're training your balance, and even then it's a really high risk for getting hurt. There's better ways to change, train your balance. There's better ways to train your proprioception, which proprioception and balance are actually different. They're related but they're different. So don't use the word proprioception If that you think that's what you're doing, when it's really just perturbing balance in a different way. Interesting thing about that. Remember, though, the primary way we control balance is with a tibia anterior translation, closed chain, dorsiflexion, and so it's like if you don't have that strength in that strategy and your soleus, then it doesn't matter how many things you you stand on and try to stay upright on, You're not going to actually get a lot out of even the balance work. So that's kind of how I view this split squat, heal raise thing. I mean, come at me if you want, if you love that exercise, great. But I just think, when it really comes to strengthening the soleus, there's a better way, especially when you start to understand the mechanics of it. So and what I see too, when we add in strengthening of this all the S, strengthening of the long flexors of the toes is Actually an improvement of ankle mobility because now the body knows it has Enough relative stiffness and dynamic control that doesn't have to Neurologically create that tone anymore and so the tissue actually feels better and Moves better. So I see that a lot with my people I too, like just from a Anecdotal piece for those I get. I actually get quite a few people messaging me on Instagram asking how my Journey with the realizing I had exertional compartment syndrome is going. And actually, since I've been adding in soleus strengthening, I feel so much better on my walks and I am excited for the next time I take a hike To see how I feel. And the interesting thing is what I've been doing. When I start to feel symptoms of my exertional Compartment syndrome on a walk, like numb toes or just that pressure feeling I stop and rest and I actually stop and on my rest period I do bent knee Heal raises. So solely as exercises but solely as activities and it relieves the symptoms Very quickly and then I'm able to continue my walk. So that's been really interesting. I'm, I'm basically using that peripheral heart, like pumping venus plexus, pump Peace, to help the fluid that is accumulated in my low leg during the walk to clear it a little bit more quick. So you know my, my kind of question. My head there is like what's happening? Why am I not really like using my soleus well with my gait? What's probably happening and I should probably play around with is I I tend to easily default into my old sway back positions when I'm walking and I don't anterior translate of my tibia very much over my foot While I'm moving, and so I'm assuming that that's why I have this part of this Fluid pump problem when I'm walking and and so I'm interested to try to change things to see if that helps. The simplest thing I can do to get out of that habit Ironically, as now is this walk faster. So I'll continue to play around with that and one of these days I'll report back with a formal exertional compartments and drum follow-up podcast. But for now, know that the soleus is an interesting missing piece here, I think. So, yeah, exertional compartment syndrome is feeling better and my knee the knee that is without an ACL is also feeling better. So probably because I'm controlling that anterior translation much better as well as I've. My fibula is moving better and so the Relationship of the fibula to the posterior corner of my knee joint, my meniscus, all the things is also Faring much better. So I hope that gave you some insight, practical insights. All Link some things in the show notes definitely to the tow pro and humanlocomotioncom. I'll link to some of the posts I've done on social media. And yeah, go, go right now and do a set of bent knee, he'll raises, see how you feel. Anyway, that's it for today. Thanks for being here. I'll see you next week.
