Medial Head Gastrocnemius Tear (Tennis Leg)

with Rehab

ExitCare ImageMedial head gastrocnemius tear, also called tennis leg, is a tear (strain) in a muscle or tendon of the inner portion (medial head) of one of the calf muscles (gastrocnemius). The inner portion of the calf muscle attaches to the thigh bone (femur) and is responsible for bending the knee and straightening the foot (standing on "tippy toes"). Strains are classified into three categories. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament, due to the ligament being stretched or partially ruptured. With grade 2 strains there is still function, although function may be decreased. Grade 3 strains involve a complete tear of the tendon or muscle, and function is usually impaired.

SYMPTOMS

  • Sudden "pop" or tear felt at the time of injury.

  • Pain, tenderness, swelling, warmth, or redness over the middle inner calf.

  • Pain and weakness with ankle motion, especially flexing the ankle against resistance, as well as pain with lifting the foot up (extending the ankle).

  • Bruising (contusion) of the calf, heel and, sometimes, foot within 48 hours of injury.

  • Muscle spasm in the calf.

CAUSES

Muscle and ligament strains occur when a force is placed on the muscle or ligament that is greater than it can handle. Common causes of injury include:

  • Direct hit (trauma) to the calf.

  • Sudden forceful pushing off or landing on the foot (jumping, landing, serving a tennis ball, lunging).

RISK INCREASES WITH:

  • Sports that require sudden, explosive calf muscle contraction, such as those involving jumping (basketball), hill running, quick starts (running), or lunging (racquetball, tennis).

  • Contact sports (football, soccer, hockey).

  • Poor strength and flexibility.

  • Previous lower limb injury.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique.

  • Complete rehabilitation after lower limb injury, before returning to competition or practice.

PROGNOSIS

If treated properly, tennis leg usually heals within 6 weeks of non-surgical treatment.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given enough time to heal.

  • Recurring symptoms and injury, if activity is resumed too soon, with overuse, with a direct blow, or with poor technique.

  • If untreated, may progress to a complete tear (rare) or other injury, due to limping and favoring of the injured leg.

  • Persistent limping, due to scarring and shortening of the calf muscles, as a result of inadequate rehabilitation.

  • Prolonged disability.

TREATMENT

Treatment first involves the use of ice and medication to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. For severe injuries, referral to a therapist may be needed for further evaluation and treatment. Your caregiver may advise that you wear a brace to help healing. Sometimes, crutches are needed until you can walk without limping. Rarely, surgery is needed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • Numbness or tingling develops.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Medial Head Gastrocnemius Tear (Tennis Leg)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Gastrocsoleus

  • Sit with your right / left leg extended. Holding onto both ends of a belt or towel, loop it around the ball of your foot.

  • Keeping your right / left ankle and foot relaxed and your knee straight, pull your foot and ankle toward you using the belt.

  • You should feel a gentle stretch behind your calf or knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove your shoes and sit on a chair, preferably not on a carpeted surface.

  • Place your right / left foot directly under the knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair, until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Gastroc, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Soleus, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the other knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Gastrocsoleus, Standing

Note: This exercise can place a lot of stress on your foot and ankle. Please complete this exercise only if specifically instructed by your caregiver.

  • Place the ball of your right / left foot on a step, keeping your other foot firmly on the same step.

  • Hold on to the wall or a rail for balance.

  • Slowly lift your other foot, allowing your body weight to press your heel down over the edge of the step.

  • You should feel a stretch in your right / left calf.

  • Hold this position for __________ seconds.

  • Repeat this exercise with a slight bend in your right / left knee.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Medial Head Gastrocnemius Tear (Tennis Leg)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

ExitCare Image STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band or tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Plantar-flexors

  • Stand with your feet shoulder width apart. Steady yourself with a wall or table, using as little support as needed.

  • Keeping your weight evenly spread over the width of your feet, rise up on your toes.*

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If this is too easy, shift your weight toward your right / left leg until you feel challenged. Ultimately, you may be asked to do this exercise while standing on your right / left foot only.

ExitCare Image STRENGTH – Plantar-flexors, Eccentric

Note: This exercise can place a lot of stress on your foot and ankle. Please complete this exercise only if specifically instructed by your caregiver.

  • Place the balls of your feet on a step. With your hands, use only enough support from a wall or rail to keep your balance.

  • Keep your knees straight and rise up on your toes.

  • Slowly shift your weight entirely to your right / left toes and pick up your opposite foot. Gently and with controlled movement, lower your weight through your right / left foot so that your heel drops below the level of the step. You will feel a slight stretch in the back of your right / left calf.

  • Use the healthy leg to help rise up onto the balls of both feet, then lower weight only onto the right / left leg again. Build up to 15 repetitions. Then progress to 3 sets of 15 repetitions.*

  • After completing the above exercise, complete the same exercise with a slight knee bend (about 30 degrees). Again, build up to 15 repetitions. Then progress to 3 sets of 15 repetitions.*

Perform this exercise __________ times per day.

*When you easily complete 3 sets of 15, your physician, physical therapist or athletic trainer may advise you to add resistance, by wearing a backpack filled with additional weight.