Rupture of the medial head of the gastrocnemius muscle in late-career and former elite jūdōka: a case report

Introduction. In 1883 Powell in The Lancet for the first time described a clinical condition incurred during lawn tennis, and which involved a calf injury that most commonly resulted from sprinting acceleration or a sudden change in running direction, and which hence became known under the name “tennis leg”. In the present case report we describe for the first time how, a similar injury arises from a very different way of moving that may occur during the practice of jūdō. Case presentation. A 52-year-old male former elite jūdō athlete of African-American ethnicity, during the entry for performing a jūdō shoulder throw, upon pushing off with the front part of his right foot while making an inward turning motion and simultaneously stretching his right knee, heard a snapping sound in the mid-portion of his right calf accompanied by a sudden sharp pain and immediate loss of functionality. Ultrasonography and clinical findings were consistent with a partial rupture of the distal part of the medial head of the right gastrocnemius muscle. Differential diagnosis. Achilles tendon rupture, arterial aneurysm, Baker’s cyst, deep venous thrombosis, ischemic necrosis, tendon strain or rupture of the plantaris or soleus muscles, tendon strain or rupture. Treatment. Proper acute care (P.R.I.C.E.-principle [Protection-Rest-Ice-Compression-Elevation]) and rehabilitation were adhered to, which contributes to excellent prognosis of partial gastrocnemius ruptures. Uniqueness of the study. “Tennis leg” as previously described has not been associated with practicing jūdō. Conclusion. Simultaneous active plantar flexion or dorsiflexion of the foot and extension of the knee, as may occur during entry for some standing jūdō throws, puts the gastrocnemius muscle at risk for rupture. Predisposing factors are its high density in type-2 fast-twitch muscle fibers, reduced neoangiogenesis, increased nonimmuno-hematopoietic cell content, muscle fatigue, adipositas athletica, metabolic syndrome, male gender, and age-related sarcopenia