INJECTION THERAPY FOR CALF TEAR

What is Tennis leg?

The gastrocnemius and soleus muscles make up the calf (the muscles at the back of the lower leg). The connective tissue between these two major muscles is torn in a tennis leg. Tennis leg is most usually found between the medial gastrocnemius and the soleus on the inner (medial) side of the calf. A tennis leg is a frequent injury that occurs when the calf is subjected to abrupt high force trauma, such as during a quick sprint or jump in sports, or even after an unexpected, quick calf stretch, such as misjudging a stride. Tennis leg can affect anyone at any age, however the highest documented incidence rates are in the sports community and among middle-aged men.

What are the symptoms of tennis leg?

  • A acute discomfort in the calf muscle that appears out of nowhere. Frequently felt right after a quick movement.
  • At the time of the incident, you may have heard a popping sound in your calf.
  • When you touch the calf muscles, it hurts.
  • The calf muscle may change shape if there is extensive injury.
  • You limp because of pain while walking.

What other conditions present as Tennis leg?

  • Tendonitis in the Achilles tendon
  • Heel bursitis 

Tennis leg vs Achilles tendonopathy

The location of pain is a crucial diagnostic element in determining which of these illnesses you have. Tennis leg is felt in the muscular belly much higher up the calf, whereas Achilles tendinopathy is felt in the tendon on or just above the heel bone. Tennis players’ legs cause calf muscle soreness, but Achilles tendinopathy causes tenderness when the Achilles is squeezed. Achilles tendinopathy normally develops slowly and is not caused by a severe event. A tennis leg, on the other hand, arises as a result of a sudden, swift movement.

Calf’s Anatomy
Tennis leg is a calf muscle injury involving the medial gastrocnemius muscle and the aponeurosis (connective tissue junction) between the medial gastrocnemius and the calf’s deeper soleus muscle.

The gastrocnemius muscle originates immediately above the knee from the femoral condyles (large bony prominences at the end of the long bones of the thigh). It has two heads: lateral and medial. The soleus muscle, which sits in front of (deep to) the gastrocnemius, is the largest muscle in the calf complex.

The Achilles tendon is formed by the lateral and medial heads of the gastrocnemius muscle, as well as the soleus muscle, and is a common source of pain. The Achilles tendon connects the heel bone to the toes (calcaneus). The gastrocnemius is a powerful muscle that allows you to do dynamic and explosive activities like running and jumping. It participates in walking and standing activities as well, albeit to a lesser extent (Prakash et al., 2017).

Underneath the gastrocnemius is the soleus muscle, which is a large flat muscle. This is a strong muscle that controls posture and is the primary muscle used when walking (Prakash et al., 2017).

A calf muscle rupture, often known as tennis leg, is the third most frequent lower-limb muscle injury. Only injuries to the bicep femoris (outside section of the hamstring muscle) and rectus femoris (big powerful thigh muscle) are more common (Domeracki et al., 2018).
What causes a tennis leg?

Tennis leg is a calf ailment that occurs as a result of a high-force calf injury. According to Bright et al (2017), the connection between the medial head of the gastrocnemius and the underlying soleus muscle accounts for two-thirds of all tennis leg injuries. A partial or total rupture of the fascial attachment between these two muscles is referred to as a tennis leg. The other one-third of tennis leg injuries happen at the lateral head of the gastrocnemius muscle or within the gastrocnemius muscle’s belly.

A tennis leg can happen after tiny, harmless motions like stretching the calf or strolling, but it usually happens after a sudden, explosive movement like running or jumping, when the knee is rapidly extending (straightening) during the pushing off phase (Domeracki et al., 2018). The gastrocnemius muscle is subjected to tremendous forces during this action and can fail, resulting in a tennis leg injury.

Tennis leg is a common occurrence in the sporting population, but research has showed that it is most common in males over 40 who are in poor physical shape (Bright et al., 2018).

What is the best way to tell whether you have tennis leg?

Tennis leg symptoms appear suddenly and create excruciating discomfort.

The typical presentation is described by Domeracki et al (2018) as follows:

A calf tear (tennis leg) can cause the following symptoms:

  • Calf discomfort that comes on suddenly
  • A popping sound might be heard coming from the calf.
  • When the medial gastrocnemius is palpated, it causes localised pain (touched)
  • If a complete rupture has occurred, the calf muscle bulk may change shape.
  • Significant pain impairing walking abilities, resulting in a limp

What are the symptoms of a calf rip (tennis leg)?
A diagnostic ultrasonography scan as well as a clinical examination are required for the diagnosis of tennis leg.

At Joint Injection, a clinical evaluation will involve the following:

1. Clinical interview

To help create a tennis leg hypothesis, the physician will ask a series of questions to learn more about how and why your pain began. A medical history will be taken to rule out other possible causes of pain, such as deep vein thrombosis (DVT). Differentially identifying a DVT is crucial since DVT necessitates immediate medical attention, including anticoagulant therapy.

2. Physical examination

Physical examination is done to determine the cause of your symptoms and the reasons for their occurrence. It contains the following items:

  • Increased heat, swelling, bruising, or a change in the form of the calf muscle should all be looked out for (indicative of rupture)
  • Range of motion in the ankle and calf
  • Can you stand on one leg or complete a heel rise during calf strength testing?
  • The calf complex is gently palpated (felt).
  • Walking evaluation

3. Ultrasound scan of the musculoskeletal system for diagnostic purposes

The optimum imaging modality for a calf muscle tear is diagnostic musculoskeletal ultrasound imaging. It offers information on whether or whether there is a big haematoma (fluid accumulation – see image below) in the calf, and it visualises the damage better than an MRI scan (a common occurrence in this injury). On your first visit to Complete, we will do a scan (at no additional cost) to assess whether the fluid should be aspirated (drained) to help with discomfort and tear healing (more later).

Diagnostic ultrasound, according to Bright et al (2018), is capable of detecting calf injury, estimating its severity, and assisting in its management by frequently monitoring the healing process during rehabilitation.

If considered necessary, a timely completion of a diagnostic ultrasound scan is critical in obtaining an early referral for more specialised DVT investigations (Bright et al., 2018).

How do we treat tennis leg?

 

Under the supervision of a physiotherapist, tennis leg is usually treated conservatively. Most patients react well to rehabilitation, with symptoms subsiding and exercise resumed after 6 to 12 weeks, depending on the severity of the rupture.

The following are common physiotherapy interventions:

  • Advice on activity adjustment – to minimise additional injury and allow the healing process to take place, a short period of rest on the muscle from activities that aggravate your symptoms is strongly recommended.
  • Rest, ice, compression, and elevation may be used to manage pain.
  • Advice on progressive weight-bearing — a crutch may be needed in the early stages to relieve strain on the healing tissue and allow for proper healing.
  • Gentle stretching exercises should be avoided at first, but your physiotherapist will introduce them as needed depending on the severity of your injury.
  • Calf muscle strengthening exercises that are progressive.
  • Exercising balance and stability
  • Soft tissue treatments can be utilised to help with pain relief and recovery.

Once you’ve had a diagnostic ultrasound scan to determine the full degree of your damage, the above choices will be discussed with you.

Ultrasound guided aspiration (draining the hematoma/swelling

Fluid collections can form between the gastrocnemius and soleus muscles, which can be treated by ultrasound guided aspiration (draining the haematoma/swelling). A haematoma is a clot formed by bleeding from damaged muscle fibres and surrounding connective tissue. The existence of a haematoma can have a substantial impact on recovery times as well as create a great deal of pain and discomfort.

We may recommend aspirating the fluid collection (hematoma) under ultrasound guidance in specific circumstances. This is a simple, quick, and somewhat painless operation that will significantly improve your discomfort and healing time.

Patients frequently report great pain relief right after the aspiration and are able to walk with minimal discomfort. Following the aspiration, a few days of compression and relaxation are required. Joint Injection recommends starting physiotherapy 5-7 days after aspiration to get the most out of it.

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all foot and ankle. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.