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Tennis Injuries Are More Than Meets the Elbow: Ever Heard of Tennis Leg?

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With the French Open underway and Wimbledon right around the corner, June turns the spotlight on all things tennis, propelling many sideline lovers of the sport to dust off their own racquets and hit the court. What they may not know, however, is the potential injury that awaits them without the right preparation.

Notorious for their lack of proper warmup, tennis players set themselves up for a common affliction. You've probably already heard of tennis elbow, but few people are familiar with tennis leg, even though it also occurs in weekend warriors who neglect to properly warm up before play.

Although the need and efficacy of the warmup have been debated for decades, the discussion is more academic in nature. Elite and professional athletes who use their bodies for a living always warm up, and it's not for superstitious reasons. The warmup increases core temperature of the body. As the core temperature increases, muscles, tendons and ligaments become more elastic. The central and peripheral nervous system conducts (or fires) faster, and the lungs become more efficient in the exchange of oxygen and carbon dioxide. In simple terms, the body is better prepared to work.

The warmup can be divided into two parts: 1) the general warm-up, and 2) the specific warm-up. A general warmup is just an activity that uses the body to increase its internal temperature. Great examples of this could be a jog, stationary bike ride, elliptical "run" or calisthenics. You will know you are achieving the general warmup when you begin to perspire. Perspiration is a sign that your brain has recognized that your core temperature is elevating and it needs to cool the body by sweating. The specific warmup is typically similar to the activity/sport you want to perform.

Most recreational tennis players step onto the court and rally for a few minutes and then start playing a game that requires explosive starting and stopping motions, and direction change on an unforgiving surface (usually concrete). The warmup effort is usually inadequate to achieve its purpose. Once the rally stops and the games begin, tremendous demands are placed on the calf muscles, which can lead to calf tears.

Years ago, and for reasons unknown, tennis leg was believed to be a tear of a very small muscle in the lower leg known as the plantaris. The plantaris mystically seemed to be predisposed to tearing. Once we had the advent of MRI, health-care providers were able to visualize the tear. To everyone's surprise, tennis leg is a partial tear of the large calf muscle known as the gastrocnemius.

A tear of the gastrocnemius is quite painful. Those who sustain a tennis leg injury often describe the feeling of being hit by a ball (forehand or backhand) in the calf muscle. They look around the nearby court for the ball that hit them, only to learn there isn't a ball nearby. The feeling of being hit by the ball is the tearing of the muscle. They actually feel part of the muscle yield. As they try to "walk it off," they find the calf is too painful. They hobble off the court to rest for a minute to see if the calf pain is simply a muscle cramp, but quickly learn it's more than just a cramp.

Some people seek health-care advice and others hobble for a week or so until the muscle starts to heal. It is wise to not push the muscle for the first few days so the pain can be minimized and the tear is not made larger.

So, how can we reduce the risk of tennis leg? The first step is proper warmup. Most people go to a facility to play tennis. It is easy to start with a jog around the perimeter of the facility or park as a general warmup (elevate the core temperature). If you plan on stretching, it is far more effective once core temperature is higher because the connective tissue and muscles are more elastic when they are warm. If you stretch for more than a few minutes, jog for a short distance again. If you can't jog and you live fairly close to the tennis facility, you can ride a stationary bike just before you walk out the door to drive a few minutes. When you step onto the court to rally with your partners, you have already performed your general warmup and you can now perform your specific warmup -- tennis motions.

One more step to reduce the risk of tennis leg is to avoid dehydration. Dehydration can lead to muscle cramping, which can predispose a muscle to tearing (this is a topic for another day).

For more by Dr. Joseph Horrigan, click here.

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