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Tennis leg
 A tennis leg is a lesion in the gastrocnemius muscle belly. An acute lesion can be very invalidating, but reacts very fast on a combined treatment of infiltration of local anaesthetic, friction massage and active mobilization.
(Part I, p154-155 ; Part II, p35)
Tennis leg - gastrocnemius lesion
Usually the lesion lies at the medial head, some 4-5 cm above the musculotendinous junction. Passive dorsiflexion is also painfully limited, particularly with the knee in extension.
The treatment consists of several phases :
If there is a haematoma, it should be aspirated as soon as possible. A local anaesthetic is then infiltrated and the patient performs some active contractions (non weight bearing) and uses a heel lift (approximately 3-4 cm).
From the next day onwards, DF is given, followed by active contractions (without weight-bearing) and a few minutes of electrical stimulation contractions. The raised heel is gradually lowered, after one week it is discarded. The deep friction lasts ten minutes the first time, then fifteen minutes afterwards (the patient receives daily treatment in the first week ; in the second week on alternate days) ; in chronic cases it can last up to twenty minutes.
There are however some differential diagnostic possibilities :
* Rupture of the plantaris tendon :
Resisted plantarflexion will be negative and neither there will not be an antalgic plantarflexion position of the foot.
* Rupture achilles tendon :
the resisted test will be weak, not painful, and there is no limitation of P dorsiflexion
* Deep venous thrombosis :
the pain appears after immobilisation or after sitting for some hours. There is no pain during contraction and no limitation of movement. The leg and foot are swollen and there is diffuse tenderness on palpation.
* Rupture of a Baker's cyste :
the patient has known rheumatoid arthritis and experiences sudden posterior knee pain with swelling of the leg and possibly the foot (rupture in the posterior capsula of the knee). Perhaps there was a trauma.
* Intermittent claudicatio :
We hear the typical story, as described earlier. Checking the pulsations in a. dorsalis pedis and a. tibialis posterior are useful.
* Posterior compartment syndrome :
a young male patient has pain and swelling in the calf, some hours after exertion. Walking is painful and causes more diffuse swelling. There is rubor and calor. P dorsiflexion is severely limited (the resisted version is negative).
Remark : in several cases accessory examination (medical imaging) is necessary.
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