March 15th, 2013

Health N' Sports: Tennis Calf Strains

Staff Report

Health N' Sports: Tennis Calf Strains
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Louisville Orthopaedic Clinic shares strain information

As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation.

On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to

Upper to mid-calf injuries below the knee (typically medial vs. lateral gastrocnemius muscle belly) are typically referred to as “Tennis Leg” due to their prevalence in this sport. Lunging forward puts maximum tension on the back leg, when the knee is extended and the ankle/foot dorsi-flexed (pulled upward). Maximal contraction in this lengthened position results in strains and tearing of the muscle. The injury is common in those 40-60 years of age, and more common in men than women.

The calf muscle complex (CMC) is a superficial muscle group on the posterior aspect of the lower leg. It consists of the Gastrocnemius, Soleus, and Plantaris muscles. The Gastrocnemius muscle belly (more medial than lateral) is the most frequently involved. Strains and tears present themselves rather acutely as an audible pop with subsequent disability.

The athlete may feel as though he was struck in the back of the leg & frequently must be helped off the court secondary to the inability to put weight down or push off with the foot. The injury is classified as follows: Grad I (mild), Grade II (moderate), and Grade III (severe), ranging from a few fibers torn to a complete disruption of the muscle fibers, with varying degrees of disability associated with each grade.

Treatments consist of early intervention, including ice, compression and controlled motion. Once serious conditions have been ruled out (such as DVT, and compartment syndrome), steps to early recovery are as follows:

Protection: Protecting the healing tissue is the most important part of the recovery process; preventing further tearing to the healing tissue, minimizing the size of the hematoma and connective scar tissue. Crutches may be necessary the first 2-3 days, ice, compression and elevation. Sometimes, in the more severe cases, a walking boot may be required for the first week.

“We have been fortunate enough not to experience many issues with calf strains, DeSales tennis head coach Mike Ayersman said. “But they can be caused by cramps due to dehydration and quick movements that over extend the muscle causing the strain.”

Early Controlled Motion: Early active motion limits the size of the scar, facilitating alignment of the regenerated muscle fibers and helps regain strength of the impaired muscle. Early motion consists of active dorsiflexion/plantar flexion, pulling the foot upward to its max, and then pointing the toes/ankle downward as far as tolerated.

“Stretching is very important,” Ayersman said. “I require our players to do various stretches that target legs, arms, back and core before they play. I try to mix in some basic Yoga poses also to get a good stretch. We also do various plyometric exercises before we play that help to warm up the muscles and get them ready to go.”

Static Stretching: Static stretching with a rigid strap can begin after day 10, pulling the foot/ankle upwards, holding for 30 sec/4 sets 3-4x daily (with the knee straight and bent), progressing to static weight bearing stretches (the more familiar standing calf stretch with the knee straight and bent).

“Tennis elbow of course is always a concern,” Ayersman said. “It is more of a nagging injury though. Knee strains, Hamstring pulls, and back strains seem to be issues for us.”

Strengthening and return to play: Strengthening with elastic bands, double-single leg heel raises, followed by sports specific drills are added in as tolerated. Before return to play, daily activities should be pain free (such as ascending/descending stairs, heel raises). The athlete should be able to perform an independent heel raise on the involved side, hop and run without pain.

“Of course your legs are very important,” Ayersman said. “Leg strength and lateral quickness is a key for any tennis player. Core strength is the key to being a great tennis player. Your core is from your knees to your chest. Those muscles groups control the strength of your body because that is what holds your posture. If you have a strong core you have put yourself in position to be a good athlete. This will allow you to fine tune your skills to become a great tennis player.”

Calf strains/tears can be debilitating, but with proper early intervention, being out of the lineup will be short. With a proper early diagnosis, along with effective treatment measures, the athlete can expect to return back to full health.


-Tom Mooney, PT-

Louisville Orthopaedic Clinic & Sports Rehab Center

Main Office: 502-897-1794

Physical Therapy: 502-897-1790


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