Tennis Leg

What is Tennis Leg?

“Tennis leg,” a term coined in 1883 by R.W. Powell after experiencing sudden calf pain while playing tennis, continues to be a significant concern among athletes engaging in sports involving sudden movements, particularly those requiring knee extension and ankle dorsiflexion flexing foot with toes pointing up to the roof). This condition refers to acute mid-calf pain commonly associated with activities like jumping or pushing off, frequently observed in tennis players.

Historically, the plantaris tendon rupture has been implicated as the primary cause of tennis leg pain. However, recent advancements in diagnostic imaging, including sonography and magnetic resonance imaging (MRI), have revealed that the majority of cases are actually attributed to injury or rupture of the medial head of the gastrocnemius and/or soleus muscles, collectively known as the calf muscles. Surprisingly, deep venous thrombosis accounts for up to 10% of tennis leg cases, often mimicking muscle injury symptoms. The involvement of the plantaris muscle and tendon in this injury is relatively rare compared to the more commonly affected calf muscles.

Tennis leg typically appears as a sudden onset of pain in the upper calf region, followed by difficulty walking on the toes due to impaired calf muscle function. This presentation underscores the importance of accurate diagnosis to guide appropriate clinical management and ensure optimal patient outcomes.

The condition predominantly affects middle-aged athletes, particularly those participating in sports requiring explosive movements and rapid changes in direction, such as tennis, basketball, or sprinting. The mechanism of injury often involves sudden knee extension, leading to excessive stretching or tearing of the musculotendinous junction of the medial head of the gastrocnemius muscle.

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Domeracki SJ. “Tennis Leg”: A State-of-the-Science Review. Workplace Health & Safety. 2021;69(4):182-186. doi:10.1177/2165079920961966

Harwin, J.R. and Richardson, M.L., 2017. “Tennis leg”: gastrocnemius injury is a far more common cause than plantaris rupture. Radiology case reports, 12(1), pp.120-123.

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