Tennis Leg

This calf injury usually presents together with injuries to other muscles and soft tissues at the back of the lower leg. It is a sub type of the general category of injuries called calf strains.

Typical symptoms of tennis leg are an audible popping sound in the calf area and persistent pain and soreness there. There may also be pain associated with the act of trying to flex the ankle.

Tennis leg is typically treatable using the P.R.I.C.E. (Protection, Rest, Ice, Compression, Elevation) conservative protocol. Calf sleeves can help to apply compression to the calf muscles and promote healing. Surgery is required only in cases involving compartment syndrome.

Tennis Leg Causes

The calf consists of two muscles – the gastrocnemius (which has 2 heads) and the soleus. The gastrocnemius is the larger of the two muscles and is a superficial muscle that lies closer to the skin. The soleus, on the other hand, is smaller and deeper under the skin.

Both muscles connect to the Achilles tendon at the bottom of the lower leg.

The gastrocnemius is an example of a biarthrodial muscle that crosses two joints – the knee and the ankle. This means that it can be subject to higher forces than other muscles that cross only one joint. As a result, it is particularly vulnerable to calf strain injuries like tennis leg as well as other soft tissue injuries.

Tennis leg tends to result from a sudden contraction of the calf muscles. Typically, this happens when someone is sprinting or changing direction. It can also occur when “pushing off” the ground such as to execute a tennis serve, for example.

These movements are very common among tennis players, which is how the injury acquired its name. Many recreational tennis players tend to neglect proper warm ups and, if middle aged, may not be as physically fit as more serious players. As a result, tennis leg injuries are frequently seen among these individuals.

The gastrocnemius muscle plays a key role in “pushing off” to jump, sprint or change direction.

As a result, most cases of tennis leg involve injury to the gastrocnemius and specifically to its medial or inner head (the one closer to the centre of the body). A minority of cases may alternatively involve injury to the soleus muscle.

Tennis leg can also happen to athletes in many other sports such as basketball, soccer and rugby. These are all sports that require frequent “pushing off” to jump, sprint or make a sudden change of direction. The resulting demands on the gastrocnemius will tend to cause this injury.

Symptoms

Athletes (or other individuals) who suffer a tennis leg injury will likely experience some or all of the following:

• An audible “popping” sound or sensation from the calf area;
• A burning and sudden sharp pain from the same area that continues after the “popping” sound or sensation;
• Difficulty walking or even placing weight) on the injured leg, which usually requires them to stop playing.

Individuals experiencing some or all of these symptoms should see a healthcare professional for medical advice. They should preferably choose one with a sports medicine background.

Up to 10% of individuals presenting with tennis leg may also be suffering from deep vein thrombosis. Deep vein thrombosis  is actually a potentially life threatening condition. It is a further reason to seek medical help if you think you have tennis leg.

Tennis Leg Treatment

As mentioned earlier, almost all cases of tennis leg are treated conservatively using the P.R.I.C.E. protocol:

• Protect the calf muscles from further damage by avoiding strenuous activity. In cases of severe injury, the patient should consider temporarily keeping his or her weight off the injured calf. This can be done using crutches, for example, or by sitting down as much as possible instead of standing;
• Allow the calf muscle to Rest and recover naturally. This too can be achieved by avoiding strenuous activities, using crutches or by sitting whenever possible instead of standing;
• Apply Ice or a cold compress to the injured area for a few days until the pain has significantly decreased. Do this for periods of 20 minutes and at intervals of 2-3 hours. Avoid direct contact between the ice or compress and the naked skin, as this can cause skin injury;
• For further pain relief, the injured individual may use an over the counter medication such as Tylenol;
• Apply Compression to the calf using a tensor bandage or calf compression sleeve. This will increase blood flow through the calf and accelerate healing;
• Elevate the calf above heart level as much as possible, e.g. when lying or sitting down. This will help the removal of stale blood from the injured muscles and its return to the heart. It will then be replaced by fresh oxygen and nutrient rich blood that will promote the healing process.

Once healing is underway, the patient should start to work with a physical therapist as part of his or her return to normal activities. The physical therapy program will include exercises to stretch and/or strengthen the calf muscles. This will reduce the risk of re-injury after the normal activity level has been resumed.

Surgery

Almost all cases of tennis leg can be resolved without resorting to surgery. The exceptions are cases involving compartment syndrome. This is a condition that involves a rise in pressure in a compartmented area and consequent blood flow restriction.

Recovery Time

As with most types of sports injuries, recovery from a tennis leg injury will depend on several factors including:

• The severity of the injury;
• The fitness level of the patient; and
• How closely the patient adheres to the treatment recommendations.

Having said this, most individuals should be able to resume normal activities within 4-6 weeks of the injury.

Tennis Leg Prevention

If you are a middle aged tennis player or other “weekend warrior”, it is only natural to wonder how this unpleasant injury can be prevented. We have put together some suggestions:

• Ensure you warm up properly before commencing your activity. Your warm up should include stretching and flexibility exercises as well as some light jogging. Allow 5-7 minutes before your scheduled start for this activity;
• Cool down properly after your game or work out. This will involve some additional stretching and flexibility exercises. Foam rolling may be particularly beneficial as part of your cool down routine.
• If you are playing or working out in cool weather, wear compression sleeves or tights to keep your calf muscles warm and supple. Cold muscles are less supple and more likely to tear when faced with a sudden push off or jump, for example.