“Tennis leg” is a common acute mid-calf injury often seen in middle-aged tennis players and runners. The pain is usually caused by an incomplete rupture of the medial (inside) gastrocnemius (calf) muscle. This injury often occurs during a sudden contraction of the calf muscles while the knee is extended and the ankle is dorsiflexed, as happens during a sprint. The athlete will usually feel a sudden, sharp or burning pain in the calf and sometimes a snapping sound is heard. The pain is usually severe enough that activity cannot be continued. Diagnosing is made clinically can be done by Musculoskeletal Ultrasound and can aid in defining the extent of the tear. On rare instances and complicated tears, MRI is the imaging of choice.
Recovery can take from 3 to 16 weeks depending on the severity of the rupture. Initial treatment is important for reducing healing time and should begin with RICE: rest, ice, compression, and elevation. Immediately after injury, activity should be discontinued and bearing weight on the injured leg should be avoided. Ice or a cold pack should be applied for 15 to 20 minutes every two hours. Ice should never be applied to bare skin. The ice pack can be wrapped in a towel to prevent skin injury. Wrapping the injured area with a compression bandage and elevating the lower leg will reduce bleeding within the muscle and swelling. Adequate initial treatment will facilitate healing until the injury can be evaluated by a physician. Anti-inflammatories orally can be prescribed for pain and inflammation. Topical anti-inflammatory compounds may be used along with a menthol based cream. Kinesiotaping may give some comfort and distract the fascia and 'unload' the tear as well.
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, stretching exercises should be avoided as they can exacerbate the injury and do not aid in healing.
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. Initially downhill walking and running should be avoided.
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 training sessions is also helpful. Wearing proper shoes and wearing orthotics can prevent hyper-pronation of the foot if needed.
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.
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. (@016). Calf injuries not involving the Achilles tendon. Uptodate. Retrieved from https://www.uptodate.com/contents/calf-injuries-not-involving-the-achill...
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