It felt like a tennis ball hit me in the calf!

[Say Chi Sin Lo]

Hey Charliefederer, thanks man. But I still want a few questions answered:

1) Once the inflammation subsides, is the elliptical and stationary bike low impact enough so it won't hinder the healing?

2) Over the past few months where I've been managing this minor injury, I observed no loss in stamina and strength in the tendon. Also, it's asymptomatic while I'm playing. However, once I shut it down, it's like a raging storm on the back of my heel. Why is that?

 

[charliefedererer]

Thanks charliefederer for your reply. It's very helpful.

I couldn't walk during Day 1-3 due to severe pain; but now I can walk for like 45 mins with calf sleeve and walking stick. It's a very humbling experience.

I only had mild swelling but still can't stretch my calf (even in normal walking stand). I'm also using heat lotion (will try Voltaren once heat rub runs out) & warm clothe 4 times a day. It seems to help just a tiny bit.

It's embarrassing to use a walking stick at my age, but I'm gonna stick to it till I can walk w/o pain in my calf. The only side effect right now is twitches on my upper calf (every 10 mins or so) when I walk .

Question: What's my next step? Stretching? When can I start stretching ? When I feel no pain when I walk?

Thx for your reply in advance

Well there is stretching and STRECHING!!!

Gentle stretching should be fine when there is no pain when you walk.

At first, you are just slowly trying to get closer and closer to a full range of motion.

The amount of stretching can increase slowly over time.


[I know answers like this can be less than satisfying, but how vigorous one is stretching is hard to quantify.]

 

[charliefedererer]

Hey Charliefederer, thanks man. But I still want a few questions answered:

1) Once the inflammation subsides, is the elliptical and stationary bike low impact enough so it won't hinder the healing?

2) Over the past few months where I've been managing this minor injury, I observed no loss in stamina and strength in the tendon. Also, it's asymptomatic while I'm playing. However, once I shut it down, it's like a raging storm on the back of my heel. Why is that?

1. Eventually the elliptical bike are great ways to get back in shape without the pounding in running.
I can tell for you the hard part will be holding back and not going full tilt too soon.
Slow and steady wins the race - to full health.


2. It is amazing that after a warm up, even areas that are quite sore often feel much better.
I don't know exactly what is happening, but I suspect it could be a combination of factors.
Warmed up muscles are more elastic and supple. More force can be absorbed by the long muscle body, rather than being transferred to the tendon ending, especially if some degree of "spasm" is present in the muscle.
Exercise leads to increased blood flow and greater exchange of the [interstitial] fluid that bathes our tissues. The chemicals [cytokines] that are regulating the inflammation (and irritating the sensitive nerve fibers) are being "washed away" faster than new cytokines are being generated at the site.

 

[TimeToPlaySets]

I love charliefedererer's posts. They are on another level. Are you a doctor?
I agree with charliefedererer's questioning the efficacy of ice.

I do not believe in icing or heating any injury.
Not so sound like a new-age idiot, but the healing body inflames, swells, or heats the injured area for a reason.
Why would you want to interfere with that?

What is "ASTYM treatment" ???

 

[TimeToPlaySets]

I was at the baseline when the other side hit a drop shot.
I took a sudden step forward, and felt a snap/pop in my calf.
It wasn't a terrible pain, but was uncomfortable enough to not be able to play anymore. I knew I had pulled it.

Next morning, the calf has tightened up significantly and I have a pronounced limp. It is not as bad as others who needed crutches or a boot. But, it looks like I will be watching movies all weekend.

There is no visible sign of any injury.
No swelling. No discoloration.
I assume this is only a mild tear.

It looks like I will not be doing tennis for a while.
Maybe I will wait until Spring, to play it safe.
In the meantime, I will resume my fitness routine after about a week of rest (Plyo/bodyweight/bootcamp, weights, yoga, Pilates, etc)
My job also involves a lot of walking, so that should avoid total stagnancy.

 

[Mick3391]

I was pushing off at the baseline for an easy shot & I stopped immediately & said "Did I just get hit with a tennis ball?" I was in such shock when my friend said "No". Our coach helped me off the court & immediately started ice.

As I sat there in shock, I knew this was more than just a simple calf strain. I reviewed the last 45 minutes - knowing I was completely warmed up (had just played a set of singles in 75* weather) How did this happen?!

I am 41 years old & very active. I grew up playing soccer & only started tennis a year & 1/2 ago. I fell in love with this sport and have been hooked ever since. Ironically, I am the person that encourages others to stretch before tennis and actually incorporated a yoga DVD into my regiment a few weeks ago.

After seeing an orthopedic doc the next day, he diagnosed me with a calf tear/strain. I cannot walk or put weight of any kind on my leg & am in a boot and on crutches. The strange thing is he pushed on my calf forcefully in many areas & to my surprise - No Pain! But, pressure from trying to walk is a different story.

If you have had an injury similar to this, I am interested to hear about your recovery. I have been faithful with Rest, Ice & elevation and am taking an anti-inflammatory. Doc also prescribed physical therapy 3 days a week for 4 weeks.

One lesson that I've already learned is one of compassion. This injury has touched my soul in the fact that I will reach out to those I know that become disabled with more than an "I'm so sorry". Although this injury can't begin to compare with the devastation of a permanent disability; the love, meals & visits from friends are what make this more tolerable.

Check if it's a ruptured plantaris muscle, I had that in both calfs, every painful, can't walk down stairs. Took me months on and off for it to work itself out.

 

[Mike Hodge]

I had a moderate tear of the gastroc. Tough injury. I remember going to the PT who told me I'd be out a couple months? I was skeptical. Weeks? The PT glared: "Just be glad you'll play again."

It was 2,3 months. Depending on the tear, it can be a serious injury.

 

[TimeToPlaySets]

When is the ideal time to start stretching and working the calf so scar tissue does not build, yet not too soon to impede healing of torn fibers? It is now 2 weeks after my calf strain. It was mild, and I was walking perfectly within 7 days. I have rested for 2 weeks, and it's totally fine. I understand that it is only superficially healed, and I run the risk of re-injury. I will not be "active" on this calf for 2 months to be safe. However, I am worried about this scar tissue from underuse. Since it's a tear, you don't to stretch the calf b/c you are just damaging the partial heal. But, when is it safe to stretch/strengthen the calf, and not worry about impeding recovery and healing?

Cliff's Notes: When is the ideal time to start stretching and working the calf so scar tissue does not build, yet not too soon to impede healing of torn fibers?

 

[baoshuxiong]

Nasty Injury

I had a moderate tear of the gastroc. Tough injury. I remember going to the PT who told me I'd be out a couple months? I was skeptical. Weeks? The PT glared: "Just be glad you'll play again."

It was 2,3 months. Depending on the tear, it can be a serious injury.

I totally agree with your PT, it's been 4 weeks for me and I can only walk (still not in perfect form) 30-45mins and then my injured calf will be worn out & started twitching.

I'd just be happy to meet the healthy old me again by summer, even if it means staying off tennis for months.

It's the kind of injury that cannot be rushed or else the chance of long term / more serious injury is bound to occur.

Concerning when 1 should start exercise, I'd say when you can walk w/o pain. How much exercise? The muscle will tell you to stop, don't push it. And rest alot after you exercise. What can be done to improve the healing process? Do whatever you can to increase the blood flow to the calf area - massage, hot water, ... etc.

 

[40_Love]

Tennis leg-shoe connection?

Trying to sort out the shoe-gastroc tear connection...

I am a fit 40 yr-old woman with a midlife love affair with tennis. I have been playing 4-5x a week for about 18 months with the only injury being some (predictable) knee tendonitis related to a chronic IT band issue after years of running a lot and stretching very little. I fixed the tendonitis w/ PT. And recently, I changed shoes in an attempt to address pronation, also an issue in my knee.

I went from T22s to a Barricade (5.0) and immediately got crazy sore feet and a minorly sore lower calf. Added insoles and the foot soreness went away but sore calf continued. Saw PT and got the okay to play as long as warmed up, etc. Two days later, Grade 2 strain of the gastroc--the kind of bang! and you immediately can't walk injury. Am on the slow road to recovering from that, with plenty of good PT, etc.

As I recover, want to address the shoe question. I'm curious if anyone has else experienced added strain with the added traction of a tournament grade hard court shoe. The traction from the Barricade is amazing--I'm a squeaky animal out there, but could it be overkill for me?

Thoughts and reactions welcome...as are thoughts on footwear that combines pronation, high arch issues and reasonable traction?

See this note from the Atlanta Sports MEd Ctr:
"due to the superior foot traction a tennis player obtains utilizing good tennis shoes and playing on a specifically-designed surface, it is not uncommon for sudden and abrupt changes of direction to bring about a tear in the calf muscle."

 

[Chas Tennis]

General Description & Considerations before Elevating the Heel

This is my view and I don't have any medical training-

I don't understand the pronation issue.

General Description Related to Calf Stress - Basically the plantar fascia, on the bottom of the foot, connects to the heel bone. The Achilles Tendon attaches to the back side of the heel bone. Both the Gastrocnemius and the Soleus come together at the Achilles Tendon. The Gastrocnemius originates above the knee so that the angle of the knee joint has a large effect on its length and degree of stretch. The Soleus originates below the knee so the the angle of the knee joint does not affect the length and stretch of the Soleus. When you stretch your 'calves' you have to stretch both muscles using separate stretches - a straight-knee stretch for both the Gastrocnemius and perhaps the Soleus and a bent-knee stretch to make sure that the Soleus is stretched. I've posted before on TW with the details on both stretches.

Which calf muscle is stressed by tennis, the Gastrocnemius or the Soleus? I don't know, but I read somewhere that usually the Gastrocnemius is injured in tennis calf injuries. This is an important point to research. See also 'Tennis Leg'. Ask your Dr which muscle is injured. Also, the Achilles is a long tendon so make sure that the upper part of the Achilles is not what is injured.

Tight/short calves are usually considered a possible cause of injuries to the linked chain consisting of the plantar fascia + Achilles Tendon + Gastroc. and/or Soleus.

My opinion on elevating the heel - One obvious way to compensate for shortened tight calves and thereby lessen the stress on this chain is to elevate the heel, say, with heel pads or shoe design. This increases the angle between the foot and shin and allows the calves to be at a shortened length. High heel shoes are an extreme heel elevation. they probably also contribute to shortened calves. Putting pads in shoes or selecting shoes that have elevated heels seems to me very questionable, a compensation for calves that are too short.

It seems a better approach to examine your lifestyle for why your calves might be tight ( how do you sit? etc.) and also to stretch the calves once you are over the injury. You may also have had past running injuries that have affected your calf muscles. ?

Of course, these are very complex issues involving overall posture and require a Dr specializing in the foot and related issues.

 

[Greg G]

Sigh. 2 weeks before a singles tournament, I got this playing doubles. Always happens playing doubles...

Very mild, feels like a grade 1 on the medial part of the right leg gastroc. Hope this heals quick.

 

[TimeToPlaySets]

Sigh. 2 weeks before a singles tournament, I got this playing doubles. Always happens playing doubles...

Very mild, feels like a grade 1 on the medial part of the right leg gastroc. Hope this heals quick.

If it's mild, you might be "fine" in a week.
Please post an update on recovery time.

 

[Greg G]

Was able to work out today on a treadmill with minimal issues. I just can't push off explosively with the right leg, but it's not too bad. Hopefully it improves in the next few days. Will probably wear some sort of compression band on it for the upcoming match.

 

[RogueFLIP]

Which calf muscle is stressed by tennis, the Gastrocnemius or the Soleus?

Both muscles are working during tennis.

The gastroc tends to be the primary plantarflexor of the ankle while the soleus is considered secondary. However the body will recruit every muscle possible during athletic movement in order to do what the mind wants to do.

 

[Chas Tennis]

Both muscles are working during tennis.

The gastroc tends to be the primary plantarflexor of the ankle while the soleus is considered secondary. However the body will recruit every muscle possible during athletic movement in order to do what the mind wants to do.

"The gastroc tends to be the primary plantarflexor of the ankle" - that depends largely on the angle of the knee joint.

I believe for the most of the time during tennis play the knee is bent. Do we agree that the Soleus is then involved but that the Gastrocnemius is not? (Since the Gastrocnemius attaches above the knee it goes slack as the knee becomes bent.)

I can see that even if the Soleus is active much more of the time, the Gastrocnemius could receive excessive stress briefly. For example, if the player runs full to the side and, to stop, puts out a straight turned back leg that stretches the calf then that could stretch and stress the Gastrocnemius.

 

[RogueFLIP]

"The gastroc tends to be the primary plantarflexor of the ankle" - that depends largely on the angle of the knee joint.

I believe for the most of the time during tennis play the knee is bent. Do we agree that the Soleus is then involved but that the Gastrocnemius is not? (Since the Gastrocnemius attaches above the knee it goes slack as the knee becomes bent.)

Yes, as the angle of the knee enters more flexion, you'll get more soleus involvement, but it's not like the gastroc totally goes on vacation.

The gastroc is a secondary knee FLEXOR, so as the knee is bent, it's contracted, not on slack.

Playing tennis, the brain wants "all hands on deck" so to speak in terms of muscle recruitment; add the violent eccentric/concentric contractions of the muscles plus the amount of force impacted during running/stopping/split step and you can see how easily spasms/pain can occur.

 

[Chas Tennis]

Yes, as the angle of the knee enters more flexion, you'll get more soleus involvement, but it's not like the gastroc totally goes on vacation.

The gastroc is a secondary knee FLEXOR, so as the knee is bent, it's contracted, not on slack.

Playing tennis, the brain wants "all hands on deck" so to speak in terms of muscle recruitment; add the violent eccentric/concentric contractions of the muscles plus the amount of force impacted during running/stopping/split step and you can see how easily spasms/pain can occur.

I do not know the angle of knee flexion at which the Gastrocnemius can supply little force to the Achilles Tendon. I suspect that the angle of knee flexion does not have to be very large. ?

Do you have any information on that angle?

Maybe we should agree that we need to find some more information on the involvement of the Gastrocnemius vs knee flexion.

I did read somewhere that the majority of tennis calf injuries are to the Gastrocnemius but I only saw that information in one reference so far. This is an interesting issue since it would be useful to know what stresses lead to calf injuries - bent knee Soleus stresses, brief straight knee Gastroc stresses, or others?

For injury prevention, most players that I see only do straight knee stretches and its not clear what that type of stretch is doing for the Soleus, if anything. ?

 

[Say Chi Sin Lo]

Bone spur(s)?

1. Eventually the elliptical bike are great ways to get back in shape without the pounding in running.
I can tell for you the hard part will be holding back and not going full tilt too soon.
Slow and steady wins the race - to full health.


2. It is amazing that after a warm up, even areas that are quite sore often feel much better.
I don't know exactly what is happening, but I suspect it could be a combination of factors.
Warmed up muscles are more elastic and supple. More force can be absorbed by the long muscle body, rather than being transferred to the tendon ending, especially if some degree of "spasm" is present in the muscle.
Exercise leads to increased blood flow and greater exchange of the [interstitial] fluid that bathes our tissues. The chemicals [cytokines] that are regulating the inflammation (and irritating the sensitive nerve fibers) are being "washed away" faster than new cytokines are being generated at the site.

Just to give you and everyone else an update on my issues (I can't quite call them "problems", because whatever the issue(s), they're not affecting my performance/recovery).

Back in December/January, I decided to take ~ month off to rest this injury, and just to refresh my mind and get away from the game. I have since resumed tennis with the same intensity. Nothing's changed, there is still no pain while I'm playing. I am not experiencing any limitations as for as stamina/duration, nor am I experiencing any lost in explosiveness.

However, the aftermath/shut-down pain discomfort remains. I'm beginning to speculate that it's a bone spur causing me the aftermath/shut-down discomfort. I can recall one specific incident where I landed squarely on that heel, it was very painful at the time. I walked it off, but I am sure the discomfort began after that incident. I've had surgeries on my shoulder before, I know what soft tissue/tendon irritation should feel like, and this is not it at all.

I've ruled myself out of "Haglund's Deformity", I don't see a bulge on either side of my heel.

As an intern, I can't use my company insurance yet, so I'm doing some more home remedy, and it's actually working!

I'm icing more, and I'm stretching and strengthening my calves (lowering it on a step, then rising and hold for ~2seconds, 15reps).

If it is a bone spur, I would be hesitant on removing it. ESPECIALLY if it requires the detachment and re-attachment of the achilles tendon. (I'm sorry, but in my view, that's a bigger injury itself than some bone spurs).

 

[Bobby Jr]

...However, the aftermath/shut-down pain discomfort remains. I'm beginning to speculate that it's a bone spur causing me the aftermath/shut-down discomfort. I can recall one specific incident where I landed squarely on that heel, it was very painful at the time. I walked it off, but I am sure the discomfort began after that incident. I've had surgeries on my shoulder before, I know what soft tissue/tendon irritation should feel like, and this is not it at all.

....I'm icing more, and I'm stretching and strengthening my calves (lowering it on a step, then rising and hold for ~2seconds, 15reps).

Where exactly does this pain happen and how exact is the location (big or small)? Bone spurs are very uncommon compared to tendon damage so don't worry yourself that you have a bone spur until you're sure.

On treatment > Achilles tendon injuries typically don't react all that well to the sort of heel raises you mention assuming you do them down and up on each leg. Once past the most acute stage doing them as single leg downwards movement and then both legs upwards is the current thinking on Achilles tendon recovery and retraining (of the tendon fibres). Likewise - stretching or contracting out for 2 second etc does nothing for this sort of injury and can in fact slow recovery in some cases - basically because muscles are about contraction/relaxation, tendons are not.

(The routine you do would be more suitable for a muscle injury - gastroc, soleus or tibialus posterior)

Try adjusting your routine to something like this and see if it helps at all:

1/ Calf raises > 1 leg down, 2 legs up, no pause. Do a set of 15 for each leg twice a day.

2/ Ice afterwards - 20 minutes on and then an hour off two or three times. (the classic 20 mins on/20 mins off routine is slowly being regarded as more suitable for muscular treatment. Tendons act differently to icing because of their comparatively lower blood flow)

Lastly, Achilles tendon injuries are often accompanied by increased amount of/flow to blood vessels around the target area. These can prolong recovery by flooding the area more efficiently after stress. Massage and icing can be useful to reduce these back to a more natural level. In short: increased blood flow (through formation or new blood vessels) long-term is a good thing for muscles, but not similarly for tendons.

Many people have surmised that icing a non-inflamed (swollen or quite sensitive to touch) tendon is not all that productive but from my own experience with Achilles issues and having spoken to some very experienced sports specialists (who treat top triathletes, track & field athletes and other sportspeople who compete at Olympic level) are now increasingly thinking that post-massage or exercise icing as I described above is the way to go when tendon injury recovery is the aim.

By any chance do you spend a lot of time sitting at a desk and previously didn't? I.e. a had a major daily routine change in the last 2 years? The bent knee of sitting at a desk for long hours will generally decrease the length of the major calf muscles - meaning the tendons will reach stress point faster when you exercise. Similarly, the hip flexors play a big part in how much stress is on your lower leg. Sitting at a desk all day also reduces the flexibility here - adding to the potential issue lower down.

 

[Say Chi Sin Lo]

Where exactly? Here's a pretty accurate description of the discomfort, the "heel bone arrow" is spot on for me:

None of it bothers me during an activity, it's the shut down that gets me. The pain goes away after 1 or 2 rounds of icing and it does not linger to the next morning. Just that it flairs up after each time I play.

As for changes in routine, not much. All of the discomfort came about after I took a mis-step and landed squarely on that heel. I was wearing shoes and all, but it still hurt like a mother at the time.

 

[RogueFLIP]

I do not know the angle of knee flexion at which the Gastrocnemius can supply little force to the Achilles Tendon. I suspect that the angle of knee flexion does not have to be very large. ?

Do you have any information on that angle?

Let me see if I understand your question. You want to essentially know that at 10 degrees of knee flexion the gastroc is producing x% of force. And at 20 degrees, etc? Is that correct?

If that is correct, then no I do not know those numbers. What you're also not considering is what the ankle is doing while the knee is being flexed.

But in the context of playing tennis, those numbers are irrelevant. Like I mentioned above, because you are requiring complex movement coupled with various degrees of explosive force, the brain's recruitment of muscles will require the whole system to be activated at some point. Even if the muscles are not actively contracting, the system will be in some state of "readiness" so to speak bc it knows that it will need to contract momentarily so it will not completely shut down.

Plus, everyone's recruitment pattern is different. Even if you knew that John's gastroc is at for example 50% activtated at 20degrees of knee flexion and 30% at 30degrees, while Phil's gastroc is 42% at 20 degrees and 25% at 30 degrees, all that goes out the window once you're on the court because John and Phil will not recruit their muscles in the same exact pattern and percentage even if you have them do the same stroke.


Bottom line, once you put a load on the system, everything changes.

 

[RogueFLIP]

I did read somewhere that the majority of tennis calf injuries are to the Gastrocnemius but I only saw that information in one reference so far. This is an interesting issue since it would be useful to know what stresses lead to calf injuries - bent knee Soleus stresses, brief straight knee Gastroc stresses, or others?

There's too many other factors, it's not about just the angle of the knee or ankle. Dehydration, faulty muscle firing pattern, the force of impact you hitting the ground has on your system, shoes...

I'm not sure if you could isolate one thing.

For injury prevention, most players that I see only do straight knee stretches and its not clear what that type of stretch is doing for the Soleus, if anything. ?

Because they both join to form the achilles tendon, you'll be stretching both with the straight knee stretch. Now if you want % of how much is getting the gastroc and how much is getting the soleus, I have no idea.

 

[Chas Tennis]

I'm sure someone has researched the force supplied by the Gastroc vs knee flexion angle considering the various factors. I've had that question on my list for some time and think it might be relevant for calf injuries and preventive conditioning.

For example, does a Gastroc calf injury occur only (or nearly always) when the knee is almost straight?

 

[Greg G]

Was able to play a set, right calf was about 95% once fully warmed up. I did have a strap on it though, which helped. Managed to tweak my left quadriceps though (face palm)

 

[RogueFLIP]

I'm sure someone has researched the force supplied by the Gastroc vs knee flexion angle considering the various factors. I've had that question on my list for some time and think it might be relevant for calf injuries and preventive conditioning.

For example, does a Gastroc calf injury occur only (or nearly always) when the knee is almost straight?

I'm curious to know even if you did find information on those numbers, and some possible correlation to knee/ankle angles and gastroc injury, how would you go about using that info for practical real world use?

I don't think it's possible to tell a tennis player, well you should avoid having your knee bent (or straight) at X angle along with your ankle bent (or straight) at Y angle bc there may be a Z% of injuring your gastroc. Like we don't have enough to worry about :?

 

[Chas Tennis]

I'm curious to know even if you did find information on those numbers, and some possible correlation to knee/ankle angles and gastroc injury, how would you go about using that info for practical real world use?

I don't think it's possible to tell a tennis player, well you should avoid having your knee bent (or straight) at X angle along with your ankle bent (or straight) at Y angle bc there may be a Z% of injuring your gastroc. Like we don't have enough to worry about :?

That's how I do research, keep collecting whatever is interesting or might be related to the subject. I don't have the answers but asking about forces and knee angles that are known to directly relate - in some way - to the stresses on injured muscles seems a pretty direct approach. It's also very possible that the answers are out there and asking a few hundred readers on a forum might turn up something.

 

[RogueFLIP]

You must have a ton of questions then :-|

Research and all is fine and dandy, I'm just not sure you can 100% prevent any injury.

If it's your time for your gastroc, knee, or anything to go, its gonna go.

But I'm always interested in learning about the body, so please post what you find.

 

[baoshuxiong]

After 1.5 years of calves problem, I encountered this video that fixed my problem within a month of daily exercise.

https://www.youtube.com/watch?v=1Vcebb9AaTE

Cut down on jogging helps as well. Hope it helped