February 12, 2025
What is a Tennis Leg?
A tennis leg is commonly observed between the medial gastrocnemius and soleus muscle. The connective tissue between these muscles is called aponeurosis which is the tissue that is affected, and tears are observed. Aponeurosis is an extension of the Achilles tendon which attaches to the calf muscle complex. As a result, aponeurosis tears are treated like tendon tears which often take longer to heal and rehabilitate than myofascial strains.
Differentiating between Achilles tendinopathy and a Tennis Leg is often based on the location. Tennis leg is usually higher up the calf belly and an Achilles tendinopathy is closer to the heel on the Achilles tendon.
Mechanism of injury?
A tennis leg is commonly observed by a sudden high force to the calf such as a quick change of direction, sprint or jump commonly when the knee is rapidly extended with the highest incident within people who play sports and middle-aged men.
Achilles tendon pain is usually a gradual onset and rarely due to a traumatic mechanism.
Common symptoms?
-Immediate pain after sudden movement
-Popping sensation in the calf
-Increased calf muscle tenderness
-Generalized tenderness around the medial calf complex
-Pain when walking or trying a calf raise
How are Tennis leg injuries diagnosed?
Expert Physiotherapists at OHL will use a range of clinical tests to help determine the diagnosis. It is often the compilation of the mechanism of injury, location of pain, and previous calf injuries.
Physical assessment will often involve close observation of the calf complex for any obvious bruising, swelling or muscle belly disfiguration followed by calf range and strength testing.
If a calf strain or a tear to the connective tissue is suspected, your physiotherapist may refer you for a diagnostic ultrasound to determine the grade of your injury. An ultrasound will also determine if there is a hematoma/fluid collection in the calf. Often, if large enough, the fluid may need to be aspirated to help facilitate better healing of the tear.
A common complication with calf-related injuries is deep vein thrombosis (DVT). An ultrasound will help determine if further investigation is necessary to manage the presence of a DVT.
How can you treat a tennis leg?
Most complex calf tears involving the connective tissue is treated with a comprehensive rehabilitation program guided by a physiotherapist. Rehabilitation usually takes 6-12 weeks depending on the degree of tear and history of calf or low back injuries with associated nerve compression.
1. A short period of rest and modification of aggravating activities
2. Crutches may be used to offload the calf completely for a short period
3. POLICE: Protection, optimal loading, ice, compression and elevation acutely
4. Progressive strengthening program: Calf strengthening, achilles loading, hip strengthening
5. Plyometric retraining
6. Balance and stability exercise
7. Gait and running retraining
8. Return to play testing
9. Ongoing calf strengthening to maintain the resilience around the muscles of the affected aponeurotic tear
In summary, Calf strains can occur in both the gastrocnemius and soleus. Less common strains are aponeurotic tears, but they do happen. The rehabilitation principles for all calf strains remain the same, however, due to a poor blood supply of aponeurosis, they can take longer to return back to performance. The goal of rehabilitation is to complete a comprehensive calf program 2-3 times a week. Isolating the knee in a straight and bent knee position and progressing to plyometric and power exercises. This will give you the best chance of returning to your sport. Our expert team of physiotherapist at the Optimal Health Lab are trained to rehabilitate complex calf injuries. Book today if you have recently injured your calf muscle.
