TENNIS LEG(BPT 4th year – Sports physiotherapy topic)

PRESENTED BY:

Dr. LAKSHMI PAVANI P. (PT)

OBJECTIVES

TO KNOW:

1. Epidemiology2. Clinical presentation3. Causes4. Radiographic features5. Treatment according to the grade of injury6. Rehabilitation

Tennis legCaused by the rupture of the medial head of

the gastrocnemius muscleOccasionally the plantaris is involvedSeen generally in sports persons and is an

important cause of painful calf.

EPIDEMIOLOGY

Classically seen in people who play tennis (elite)Can be seen in squash, skiing and athletics alsoMore frequently occurs in middle age (40-60 yrs.)Extension of the knee along with forced

dorsiflexion of the ankle seem to be the most frequent biomechanical causes of tennis leg.

Example: Lunging shot

LUNGING/ LUNGE SHOT

CLINICAL PRESENTATION

Audible pop when the injury occurred is usually reported.

Sensation of something “snapping” within the calf.

Sudden onset of severe calf pain with significant disability.

Tenderness and swelling presentMay be associated with extensive bruising

A focal ‘gap’ can be felt sometimes on early palpation, prior to the onset of swelling at the site of tear

Moderate to severe pain is present – passive ankle dorsiflexion( due to stretching of the torn muscle fibers)

Active resistance to plantar flexion is painful ( due to the activity in torn muscle fibers)

CAUSES

Deconditioned / un-stretched muscles of recreational athletes - “weekend warriors”

Previous injuries/ recurrent calf strainsDD: DVT, ruptured baker’s cyst

GRADES OF MUSCLE TEAR

Grade 1 (Mild) – tear of only a few muscle fibers (micro tear) with minor swelling and discomfort. Minimal to no strength loss nor motion restriction

Grade 2 (Moderate)– Larger number of micro tears leading to a greater damage with clear loss of the ability of the muscle to contract

Grade 3 (Severe) –tear extends across the entire cross section of the muscle resulting in near complete loss of function.

RADIOGRAPHIC FEATURES

Ultrasound : A tear in the deep surface of gastrocnemius may be seen as a disruption in contour and echogenicity of muscle fibres. 

MRI : focal area of disruption of muscle continuity noted along the deep aspect of the medial head of the gastrocnemius, with associated edema of the muscle

Plantaris tendon may be identified either torn or intact.

TREATMENT ACCORDING TO THE GRADE OF MUSCLE TEAR

GRADE 1PARTIAL WEIGHT BEARING

PASSIVE

MOVEMENTS

ACTIVE

EXERCISES

GRADE 2I

MMOBILIZATION FOR 3-6 WEEKS

ADEQUATE REST

REHABILITATION

GRADE 3SIGNIFICANT TEAR OF THE MUSCLE

SEPARATION

OF THE TWO

ENDS

SURGICAL EXPLORATION & REPAIR

TREATMENT IMMEDIATE: PRICE : Protection, rest, ice,compression and elevation

1) PROTECTION: most important part of the recovery process to prevent further damage and to minimise the hematoma (eg: not to perform dorsiflexion with eversion, using crutches to unload the calf during locomotion)

2) REST: Immobilization

3) ICE: for 10-15 min and repeat this several times a day

4) COMPRESSION BANDAGE to prevent and minimize the intra muscular hematoma

5) ELEVATION: Above the heart level and foot held in slight plantarflexion.

Anti-inflammatory medicationsContinue these for the initial 3-7 days

is advised.

AFTER INITIAL 48-72 HOURS

INITIATE CONTROLLED MOVEMENT

According to researches, early movement limits the size of the scar, facilitates the alignment of the regenerating muscle

fibers and helps in regaining the strength of the injured muscle.

STRETCHING

INITIATE 10 DAYS AFTER INJURY

START IN LONG SITTING POSITION

PROGRESS TO STANDING

STRETCHING

STRENGTHENING EXERCISESINTRINSIC FOOT MUSCLES: Eg: GRASPING A TOWEL WITH TOES etc.,

SWIMMING & CYCLING- ENHANCES BLOOD FLOW & HELPS IN RECOVERY

GRADUATED RETURN TO WEIGHT BEARING

WALKING

• BRISK WALKING• EASY JOGS

STRENGTHENING

RUNNING

PRE REQUISITES TO RUNNINGSymmetrical flexibility of the calf muscle in comparison to the non-involved side.

No residual signs of swelling/inflammation

Patient Should tolerate ADL’s Without hindrances/issues.

ADVANCED REHAB

ENDURANCE TRAINING SPRINTING AGILITY DRILLS

IN RETROSPECT Calf muscle is regarded as the peripheral heart in the

human body and plays a major role in locomotion as well.

Calf muscle strains/ tennis leg can be a debilitating condition.

Failure in proper evaluation and rehabilitation can not only prolong the patient’s recovery but may also pre maturely end a person’s career as an athlete.

So it is important to prevent worsening of the condition as well as prevent recurrence of injury.

REFERENCES Clinical sports medicine, Peter Brukner and Karim Khan; Third edition, Tata Mc Graw

Hill. http://radsource.us/tennis-leg-plantaris-tendon-rupture/ http

://webcache.googleusercontent.com/search?q=cache:3AW3e16wtr0J:www.chsm.net/tennisleg.html+&cd=12&hl=en&ct=clnk&gl=in

http://www.sportsmedicineofatlanta.com/reference/tennis_leg_common_sports_injury.html