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"Tennis Leg"
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This condition is not nearly as well known as Tennis Elbow, but nonetheless it is a worthwhile topic to discuss in some detail. Quite often we are rushed to get to the club on time to play a game of tennis and we forget about the warm-up stretches. Stretching does not make oneself immune from any sort of injury, but it is my personal belief that it can help reduce one's risk of suffering a strain to the soft tissues. When you arrange a time to play , make it your policy to arrive at the club fifteen minutes earlier than is necessary to provide you with a relaxed time period to do your stretches.
There are many muscles that we rely on to play the sport of tennis. One group is known as the calf muscles. The name of the major calf muscle is the Gastrocnemius. I know it sounds a bit like a mythological Greek figure, but it is really quite an important muscle and bears worth mentioning. As you can see from the diagram, the muscle is divided halfway up into two heads which then attaches to both sides of the Femur (the thigh bone) at the back just above the knee joint.
From this point it travels downwards to blend with some other tendons in forming the popularly known Achilles Tendon. The large Achilles Tendon then inserts into the back of the Calcaneus (the hell bone). Most muscles will only cross one joint from the point where it arises to the point that it ends, but this particular muscle (Gastrocnemius) crosses two joints throughout it's whole length and this will be an important feature to remember for later on. There is another important muscle in the calf called the Soleus which lies beneath the Gastrocnemius muscle. The Soleus muscle is different in that it arises from the upper portion of the Tibia and Fibula bones and attaches through the Achilles Tendon into the backside of the Calcaneus (the heel bone). This muscle only crosses one joint at the back of the heel. This anatomical difference between the two muscles will be an important point to remember when planning your stretches. As you will see later it is important to have an understanding of the anatomy before one can have an appreciation of the logistics behind stretching.
The two muscles mentioned above have similar yet slightly different functions
The main function of both these muscles is to plantarflex (pointing the foot downward) the foot. From a practical point of view, these muscles allow you to push off your foot. These muscles allow you to maintain your stability and balance when returning to the ground after jumping in the air. Another way to picture the function of the calf muscles is to remember the sprinter in the starting blocks. When the runner initially pushes out of the blocks, it is the strength of their calf muscles through their Achilles Tendon that allows them to do so. As well it is their calf muscles which allows a player to be on their toes during the serve. It is important to have a good understanding of the movements a muscle allows before you can appreciate how it becomes injured.
The mechanism of injury is always a very important piece of the sports medical history. In the case of Tennis Leg, the injury usually occurs when the knee is suddenly straightened while the foot is dorsiflexed (bent position). As well, the same result occurs when the foot is dorsiflexed and the leg is suddenly straightened. This imposes an acute increase in tension on the muscle at it's junction with the tendinous part and causes it to tear. A sudden sharp pain is usually felt on the inside aspect of the calf approximately halfway up. The sensation of the tear is compared to being ''shot in the leg''. Sometimes the tear is audible to even the players opponent. Swelling and bruising usually occur rather rapidly, but will depend on the degree of the tear. The player is usually in a fair bit of pain and is unable to fully weight bear. A potentially early sign of pending partial rupture/tear is calf pain which occurs after playing tennis. The player is also unable to stand on their toes because of the pain and weakness arising from the injury. Just like Tennis Elbow, Tennis Leg can also occur outside the sport of tennis. Needless to say, it is important to stop playing immediately and to start treatment with some icing while seeking medical treatment.
The best way that 1 have found of treating this injury initially is to apply a cold, wet elastic bandage around the affected area of the calf to show for some compression. The next step is to apply some crushed ice in a plastic bag on top of a few layers of this bandage. The foot should be elevated above the heart and the foot held in a position of slight plantar flexion (foot pointed downward). The player should then be non-weight bearing with the use of crutches. The use of anti-inflammatory medication would be quite useful at this point provided there is no underlying contraindication for the patient.
Follow-Up
Depending on the degree of the strain, the treatment may be quite different. Once the health care practitioner has assessed the injury, it is then important to decide what would be the best form of treatment for that particular individual. The musculotendinous strains are graded one, two, and three. A first degree strain is due to a microtear of the muscle. A second degree strain is due to a larger number of microtears that coalesce to form a bigger tear. A third degree strain will involve a complete tear/rupture of the muscle. For a fist degree strain one can get by with the same initial treatment and progressing to partial weight bearing with the crutches and then passive moving towards active treatment with a physical therapist. The use of a quarter to a half inch heel lift in both tennis shoes may also offer some relief by reducing some of the tension and strain on the calf muscle.
For a second degree strain it may be quite necessary to immobilize the calf with the foot slightly pointed downwards for anywhere between three to six weeks to allow for an adequate period of healing time. A program of rehabilitation exercises would be essential once out of the cast/brace before returning to activity.
For a third degree strain when their is significant tearing of the Gastrocnemius muscle to the point of separation of the two ends, a surgical exploration and repair would be considered the optimal form of treatment, but is still quite controversial among sports medicine specialists.
Long Term
There is a whole series of stretches and strengthening exercises that a player should be following as part of their rehabilitation program after their initial treatment. The numbers of which are too great to list here, but it is important to make the point of two particular stretches that should be done both before and after any athletic activity to reduce ones risk of injury to the calf. The first one is to stand facing a wall with one foot about two and a half feet from the wall and with the other about half the distance of the first. The idea is to have both hands resting on the wall while the leg which is furthest from the wall is kept straight and the leg closest is maintained in a bent knee position.
It is important to keep both feet flat on the floor during these stretches with the heels touching the ground throughout. Hold the stretches for a minimum of fifteen seconds and then repeat on the opposite leg. Do these stretches five or six times before and after playing. The bent knee stretch will prepare the Soleus muscle for battle and the straight leg stretch prepares the Gastrocnemius and Soleus muscles. It is important to do both stretches as you can see, because the Gastrocnemius muscle would be left out if you didn't do the straight leg stretch. As you already know an ounce of prevention is worth a pound of cure. Spend the time to do your stretches and minimize the risk for injury. Try and plan to get to the club fifteen minutes before your playing time so you can get these and your other stretches completed without rushing.
Respectfully submitted,
Howard A. Winston
MD, CCFP, FCFP
Dip. Sport Med. (CASM)
Medical Director, The Centre for Health & Sports Medicine
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