The tennis leg is a strain of one of the calf muscles called the medial head of the gastrocnemius. A calf muscle tear occurs when the muscle is pushed to its limit, leading to tearing. So, how do we diagnose tennis leg, and what do we do about it?  

Anatomy of calf muscles

picture of calf muscle

The calf muscles consist of the medial and lateral heads of the gastrocnemius and the deeper soleus. They both form the large Achilles tendons at the midpoint of the calf. These muscles are used for walking and running, although the gastrocnemius muscles are more important for faster running, such as sprinting.  

Causes of tennis leg

Generally, tennis leg occurs during running or sports. For example, a sudden change of direction while running or a leg slip can lead to overstretching of the muscle, leading to a calf muscle tear. This tearing most commonly occurs when bending the ankle while the knee is straightened.

Although this injury is common in sports, we commonly see it in overweight, deconditioned men in their forties.

Symptoms of a medial gastrocnemius tear

Generally, people reported the following symptoms:

  • Sudden pain during running or sport
  • An inability to continue with the sport
  • Limping due to pain on the inside of the calf
  • A pop or crack in the calf

Overall, symptoms depend on the severity of the calf tear. For example, a minor tear might cause tightness with no swelling or limp. A more significant tear will cause more obvious symptoms such as calf pain, swelling, and a limp.

How to make a diagnosis of tennis leg

In general, diagnosis is based on the history of the tear. However, an examination is also essential. Often, we see swelling from the calf to the foot. Touching the inside of the calf is tender. Sometimes, we feel a defect where the tear is located. Next, we get the person to walk to see if they can use their calf correctly. Finally, it is essential to check other structures to make sure there are no causes that could mimic a calf tear. Examples include a DVT (or blood clot) or an Achilles tendon tear.

Usually, we use imaging to confirm a diagnosis and rule out other causes.

Ultrasound of the calf

ultrasound of tennis leg

 Overall, we think ultrasound is good at picking up tears in the tennis leg. In addition, ultrasound can help grade the tear and determine specific treatment.

A recent study published by Dr. Masci suggests that the location of the calf tear is more important than the size of the tear. The study grades tears from 1 to 4 depending on the site of the tear in the calf. If the tear occurs in the muscle only (grade 1), returning to sport is very fast, often in a few weeks. However, if the tear involves the connective tissue between the gastrocnemius and soleus muscles (grade 2a and B), recovery will take longer (4-6 weeks). Finally, if the tear extends into the large Achilles tendon (grades 3 and 4), this injury has the worst outlook, with up to 3 months. Overall, ultrasound is essential in helping doctors diagnose and manage gastrocnemius calf tears. 

Treatment of tennis leg

Recovery is quick for minor tears (grades one and 2a). Initially, we suggest heel raises in shoes, ice, and a calf bandage for three days. It would help if you avoided massage and heat in this early stage. Then, as the tear settles, we suggest starting calf-strengthening exercises to help heal the tear. Once strength is back to normal, your therapist will direct you into sports-specific training, depending on what sport you want to do. Also, balance and stability exercises are essential.

However, in larger calf tears (grades 2b, 3, and 4), you may need to wear a walking boot for a short period. We determine the need for a boot based on the size and location of the tear and whether the muscle moves correctly on an ultrasound scan. Only your doctor can decide if the calf muscle moves typically, using an ultrasound scan.

Draining the Swelling (Calf Haematoma)

A blood swelling, or calf haematoma, can develop between the muscles if the tear is extensive and involves connective tissue. Recovery is prolonged if you have a haematoma, as it takes months for the haematoma to dissolve and scar. Also, significant scar development can increase the risk of further calf tears. 

Generally, we recommend draining the haematoma to accelerate recovery. This draining is relatively easy with the help of ultrasound. After blood is drained, we recommend icing the calf and wearing a compression sock to prevent a recurrence. Also, you should have another scan in 1-2 weeks to see if the blood swelling has returned, as you may need it drained again.

Other Commonly Asked Questions in Tennis Leg:

How to prevent tennis leg?

We think tennis legs occur in older, deconditioned men. Therefore, keeping fit and strong will prevent you from tearing your calf.

How long does it take for a tennis leg to heal?

Generally, the severity of the injury will determine the return to sport. Grade 1 tears take a few weeks, while grades 3 and 4 take up to 3 months. We also know the tear’s site will affect healing, and we can assess the injury site by using an ultrasound.

Can I swim with a calf muscle tear?

We think swimming without kicking is an excellent way to keep active during the initial phase when walking, running, or cycling is challenging. You can swim with a pool buoy.

What are the other causes of calf pain during running or sports? 

Calf pain in runners or sportspeople is not always due to a medial head of gastrocnemius strain. It can also be due to problems in other structures, such as:

  • Blood clot or DVT: About 10% of calf injuries develop a blood clot. Ultrasound is a good modality for detecting a blood clot. If you have increasing calf pain or swelling, consider a clot. 

Final Word from Sportdoctorlondon About Tennis Leg 

Tennis leg is a common cause of acute calf pain caused by a gastrocnemius muscle tear. Ultrasound is a promising modality for defining the severity of the tear and determining treatment options. 

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