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Tennis Leg
Category: Knee Injuries and Tennis Elbow
Dec 6, 2006
Playing tennis two years ago, Douglas Mintz turned to reach a drop shot and heard a pop.
"I thought a ball had fallen out of my pocket," he recalls, "but then I felt the pain in my leg, and I thought, 'So that's what they talk about!' "
"They" are the middle-aged recreational tennis players who become patients of Mintz, a musculoskeletal radiologist at New York's Hospital for Special Surgery.
Mintz often is called upon to confirm a diagnosis of "tennis leg," an injury brought on by sudden, abrupt changes in direction.
The syndrome is distinct from the better-known "tennis elbow," a condition caused by overuse or repetitive stress.
"Tennis leg usually occurs from a tear in one of the calf muscles -- the gastrocnemius muscle -- but sometimes from a tear of the plantaris tendon," says Mintz.
"Tendons are where muscles attach to bones, and they're a weak part of the unit, so injuries occur often at the junction where they meet."
Ordinarily, tennis leg is best treated at home with ice, rest and compression, says Dr. Mark Bramwit of the Radiology Society of New Jersey.
If the injury is more severe or isn't healing well, further testing may be needed -- usually with resonance imaging (MRI), although the Hospital for Special Surgery also offers the less commonly used diagnostic ultrasound.
"The goal is to make sure there's nothing else causing the symptoms, like deep-vein thrombosis or a tumor," Mintz explains.
His tennis leg healed nicely, but he got back on the court a tad sooner than he should have and ended up reinjuring his leg.
"At some point, I got an MRI because my leg was more swollen than it should be," says Mintz. "It showed a really nice example of a gastrocnemius tear at the muscle-tendon junction."
To prevent tennis leg, doctors advise adequate stretching before physical activity.
"The more limber you are, the fewer injuries happen," says Raphael Longobardi, a Hackensack-based orthopedic surgeon, sports medicine specialist and former consultant to the U.S. Tennis Association. "How much stretching you have to do depends on how fit you are and how much you're asking of your muscles."
Hydration and carefully supervised mineral supplementation also are important, adds Keith Pyne, a Manhattan rehabilitation specialist who treats professional and Olympic athletes.
In older players, he says, hormonal changes cause some drying out between muscle and skin.
"Elasticity in muscles isn't what it used to be, so there can be tearing of tendons when doing explosive movements," he says. "You have to make sure magnesium levels are correct to prevent muscle cramping, but the biggest thing is hydration."
Pyne says it's not only tennis players who need to be aware of the potential injury. "We see this also in senior basketball or soccer leagues because of constant stopping and accelerating," he says.
If an injury does occur, Mintz has additional advice borne of personal experience: "Wait longer than you think you should before getting back into activity."
Because the gastrocnemius is a vital walking muscle, that can take up to six weeks, says Longobardi. While it's healing, he suggests using crutches or a cane to maintain normal gait and avoid aggravating adjacent joints.
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