Intense Pain at the Back of the Leg? You Might Have Tennis Leg!

Intense pain at the back of the leg

With the Australian Open in full swing, there’s no doubt that many of us will feel encouraged to get out our rackets and hit the court. Alongside the fun nature of tennis come the high-impact forces on the muscles and joints that can cause serious injury and pain. One of these injuries is commonly referred to as Tennis Leg – but what is it and what are the signs? The Podiatrist talks Tennis Leg!

What is Tennis Leg and how is it caused? Tennis leg describes the injury to one or more of the calf muscles, namely the gastrocnemius and the soleus muscles. Injury occurs when you strain or pull the muscle past a point that it can handle, after which it tears. It’s this tear to part of the gastroc muscles that typically causes the painful symptoms. It’s referred to as Tennis Leg because the movements in tennis make you more prone to calf injuries, although you can sustain this during various other sports too. 

What causes Tennis Leg? Any movements and activities that overload and strain the calves can result in a tear. Often this involves jumping or pushing off from the ground, and typically occurs when the knee is straight. In tennis, it’s the sudden stops, quick changes in direction, increased court grip and fast acceleration that strains the calves – and then suddenly it feels like you’ve been shot in the back of the leg! 

Those in or above middle age are also at a higher risk of developing tennis leg as the muscles are in the early stages of degeneration.

What are the symptoms? Symptoms are located in the middle of the calf at the back of the leg and can include:

  • A sharp, burning pain
  • Described as the feeling of being shot in the back of the leg
  • Bruising and inflammation
  • Inability to walk on the leg
  • Weakness around the ankle and/or difficulty moving it

How is it treated? The first thing you should do after sustaining the injury is follow the PRICE principles – Protection, Rest, Ice, Compression and Elevation. We don’t recommend you trying to walk, but if you need to, you’ll find that staying on your toes will feet a lot more comfortable and less painful as it place the least stress on your calves.

The next step is to come in and get the injury assessed and the diagnosis confirmed. There can be many issues that can cause a similar pain in legs, so it’s important to ensure that you have the right diagnosis for effective treatment. Deep Vein Thrombosis (DVT) is one such example.

Here at The Podiatrist, your initial treatment after assessing the extent of the damage will centre around reducing day to day strain on the calves. It’s important to reduce the risk of any further injury at this vulnerable time.

We may use customised orthotics made from a 3D scan of your feet to relieve some of the strain. We’ll also ensure your footwear is helping and not hindering your progress. As your calves will have weakened after disuse, we’ll gradually introduce strengthening and stretching as the muscles heal and are strong enough to handle it. Severe tears may require greater levels of immobilisation and off-loading, such as through crutches or moon boots. This will be discussed when we assess your injury and all of the suitable treatment options will be discussed with you. 

Will it happen again? Part of what we do here at The Podiatrist is not only treat your injury but do everything we can to reduce the likelihood of it happening again in the future. During your assessment, we’ll analyse exactly what happened to cause the injury. One such measure for strengthening and realignment is our reformer pilates in Toowoomba sessions, which can significantly aid in preventing recurrences.

Our team of expert Podiatrists and physiotherapists in Toowoomba specialise in all areas of Sports Medicine and are fully equipped world-class diagnostic equipment and treatment options. We combine advanced treatments options and our extensive podiatric expertise with your goals to deliver the best outcomes for you. This means you can recover as quickly as possible and reach your full potential!

  • For more information on this or any other sporting injuries, give our team a call on 07 4638 3022
physiotherapists in Toowoomba

Diagnosis: Patellofemoral Pain Syndrome (Runner’s Knee) Our clinical assessment revealed that Kelly was suffering from Patellofemoral Pain Syndrome – otherwise known as Runner’s Knee. This is when pain presents at the kneecap, especially behind it, as is often thought to be related to damage to and irritation of the cartilage where the kneecap meets the thigh bone.

The cause of her knee pain was an interesting one. It surprised Kelly, though it’s not uncommon if you have a good understanding of lower limb biomechanics. It was actually Kelly’s feet that played the major role in the development of her knee pain.

Her right foot was excessively pronated (flat), even more so than her left. We could see on the Zebris Gait Analysis that this was causing an internal rotation (twisting) force through the knee. This, combined with an imbalance in the thigh muscles that were constantly trying to counter the twisting, resulted in a malaligned patella (kneecap) which was rubbing on the surrounding bone and over time, resulting in the pain and aches.


Simple, Easy and Effective In order to eliminate Kelly’s pain and symptoms long-term, we needed to address the cause and the contributing factors. We did this through 3 primary ways:

  • Orthotics – We used orthotics to reduce the pronation through her feet, thereby reducing the twisting of the leg and malalignment of the knee. We used our in-house Orthema Orthotic Manufacturing System to create the orthotics from a 3D model of her foot and the results of her biomechanical analysis.
  • Footwear – We recommended that Kelly replace her worn, neutral joggers with supportive joggers that have some in-built anti-pronatory control
  • Strengthening and stretching – We went through a series of strengthening and stretching exercises with Kelly to help address the imbalance and strengthen her muscles to get them working with her body efficiently

The OutcomeKnee Pain from the Feet 2

After 5 weeks, we’re happy to announce that Kelly was increasing her running distances and completing them free of pain and discomfort. She still continues with the exercises to maintain her strength and performance. The freedom of being pain-free has also opened her up to being able to partake in many other activities, sports and gym classes.

Takeaway Point: If you’re experiencing anywhere pain in your knees, hips or even back, the cause of the pain may be starting from your feet. Working on the area will help settle your symptoms, but it won’t work to treat the cause and stop it from recurring. Only through addressing the cause will you be able to get long-term relief.

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