Tennis leg is a general term used to describe pain in the leg typically caused by a tear of the medial gastrocnemius muscle (inner head of the big calf muscle). It is a somewhat common injury in middle-aged athletes that we at BTF would categorize as “weekend-warriors”. This athlete usually has a somewhat sedentary occupation, but when the weekend rolls around, they play hard! Sometimes they don’t have an adequate or even any warm-up strategy prior to their games. It is thought that because tennis is a game that involves quick accelerations, jumping and changes of direction, the calf muscles are under a high amount of stress and become prone to injury, especially in a weekend warrior that has less than adequate fitness. Of course this injury could happen to any athlete in any sport or activity.
Biomechanical causation for tennis leg (for healthcare geeks only!)
A biomechanical issue that we see as a possible cause of tennis leg is when unsupported calcaneal inversion occurs at heel strike (supination). The medial gastrocnemius is often strained (and eventually torn) when there is inefficient pronation preceding the use of medial forefoot push-off. If the medial longitudinal arch and tarsal bones of the foot are not sensed on the ground and used, the medial gastrocnemius will be gradually shortened and become prone to injury. This issue is seen more often on the right. When this occurs, the long peroneals on the side of excessive supination become hypersensitive.
Tennis leg symptoms
The typical complaint is the athlete feels a sudden pain in the calf and may feel that they have been struck by an object. The tennis player will feel that they have been hit by a tennis ball or racket in the calf area. That is the painful sensation of part of the calf muscle tearing. The athlete may experience pain and weakness when trying to stand on tip toes. Bruising and swelling at the back of the leg are common. The athlete might have difficulty moving the ankle and knee due to the calf pain and tightness.
Tennis leg treatment
At BTF, we have a unique protocol for the treatment of tennis leg. We DO NOT follow the typical RICE (Rest, Ice, Compression, Elevation) model, as this has proven to be less effective in the athletic setting. If you want to find out more information about why the RICE protocol isn’t the best approach for tennis leg, please see the following article Is the Use of Ice for Soft Tissue Injuries Actually a Bad Idea? So if not RICE, what to use?
CEM: Compression, Elevation, Movement
Compression – Use compression of the injured area in the form of bands, sleeves, compression clothing etc.. At BTF, we like to use the NormaTec as a passive form of compression that helps with lymphatic drainage. We also use compression bands (also called Voodoo bands because of their “magic” healing properties).
Elevation – This is a helpful way to assist with lymphatic drainage. Try to get the injured calf elevated as many times per day as possible with the addition of compression to speed your recovery.
Movement – If it is too painful to walk then crutches may be beneficial as partial weight bearing is recommended. Full weight bearing and walking normally should be done as soon as pain allows. Mobility exercises and gentle calf stretching should be started as soon as possible. As soon as normal walking is pain free then strengthening exercises should begin.
To diminish strain on the medial gastrocnemius, the calcaneus nees to be centered at heel strike. This means calcaneal eversion exercises, especially on the right side. If exercises do not sufficiently fix the calcaneal eversion limitation, changing shoes and/or custom orthotics can be helpful.
If you have an injury, please contact us at email@example.com or call 310-534-1900. Feel better and perform better today!
Postural Restoration Institute, Impingement & Instability Course Manual, May 14-15, 2016.
About Dr. Chad Moreau
Dr. Chad Moreau is the President of Back to Function, a sports chiropractic office dedicated to providing elite quality care for athletes and athletic-minded clients. He is also the Chiropractic Consultant for the University of Southern California Athletics. He was the team chiropractor for the Los Angeles Kings (NHL) from 2012-2020, Los Angeles Dodgers 2017-2019 and the Los Angeles Lakers 2020. He can be contacted at firstname.lastname@example.org.