What is Tennis Leg
Tennis leg is a common sudden mid-calf injury that is usually caused by an incomplete rupture of the medial (inside) head of the calf muscle. It can also be caused by rupture of the lateral (outside) head of the calf muscle.
What causes Tennis Leg?
Tennis leg often occurs during a sudden contraction of the calf muscles while the knee is extended and the ankle is flexed, as happens during sprinting or with sudden changes of direction. Jumping or pushing off with the leg can also cause tennis leg.
Who is Affected by Tennis Leg?
Tennis leg is most commonly seen in tennis players, runners, soccer players, and other athletes who participate in sports that include sprinting, cutting, or jumping. Tennis leg occurs twice as often in males as in females.
What are the Signs and Symptoms of Tennis Leg?
The most common symptom of tennis leg is a sudden, sharp or burning pain in the calf. Sometimes a snapping sound is heard. The pain is usually severe enough that activity cannot be continued. The calf muscle is usually tender to touch after the injury and there may be bruising and mild swelling. There is often an increase in pain and weakness when standing or walking on tip toes. In more severe injuries a visible lump or defect can sometimes be seen on the calf.
How is Tennis Leg Diagnosed?
The diagnosis of tennis leg is made based on a history of the injury, symptoms, and a physical exam. Musculoskeletal ultrasound or MRI of the affected calf are commonly used to image damage to the calf muscles or tendons and ensure the Achilles tendon is intact.
How is Tennis Leg Treated?
Initial treatment is important for reducing healing time and should begin with POLICE: protection, optimal loading, ice, compression, and elevation. Immediately after injury, activity should be discontinued. Ice or a cold pack should be applied for 20 minutes every two hours. Wrapping the injured area with a compression bandage and elevating the lower leg will reduce bleeding within the muscle and swelling.
How Can Tennis Leg be Prevented?
There are several methods for reducing risk of re-injury. A strength program that address weaknesses or imbalances in the quadriceps, hamstrings, hip flexors, or hip abductors may be beneficial. Warming-up and cool down for 10 to 15 minutes before and after training sessions is also helpful. Wearing proper shoes and wearing orthotics, if needed, may also prevent re-injury.
When Can I Return to Sport?
Recovery time depends on the severity of the rupture. Most tennis leg heals without surgery in 3 to 16 weeks. Return to full activity should be determined by functional assessment rather than by time.
Once you can walk without limping and do 15 single leg calf raises with minimal pain a slow return to sports activity may be started. At this stage activity should be stopped when pain starts. Pushing through the pain will increase recovery time. Wearing compression sleeves that reach 20 to 30 mm Hg may reduce swelling, promote healing, and increase speed of returning to activity. Wearing heel lifts may also decrease pain and can be used for 6 to 12 weeks after injury. Eccentric calf raises from a step can strengthen calf muscles and facilitate rehabilitation. During rehabilitation, excessive stretching exercises should be avoided as they can exacerbate the injury and do not aid in healing. Initially downhill walking and running should be avoided.
Once you can run slowly for 30 minutes without limping and do 3 sets of 15 single leg heel raises with knees bent and knees straight without pain, you can begin to build to full training. Build up should be gradual with adequate rest.
References:
Harwin, J. R., & Richardson, M. L. (2017). “Tennis leg”: gastrocnemius injury is a far more common cause than plantaris rupture. Radiology Case Reports, 12(1), 120–123. http://doi.org/10.1016/j.radcr.2016.10.012
Fields, K. B. & Rigby, M. D. (2016). Muscular calf injuries in runners. Current Sports Medicine Reports, 15, 320-324.
Rainbow, C.R. & Fields, K.B. (2016). Calf injuries not involving the Achilles tendon. Uptodate. Retrieved from https://www.uptodate.com/contents/calf-injuries-not-involving-the-achilles-tendon
By Leslie Streeter and Alee Vladyka
