Tennis is without doubt one of the most popular summer sports around- both social and an effective form of exercise (plus, if tennis means Wimbledon that also means strawberries and Pimms- can’t go wrong there!)
As a recreational activity, tennis players do subject their bodies to stresses through ballistic movements and repetitive motions. Whilst these often occur at specific parts of the body (tennis elbow, we’re thinking of you here) these can be the catalyst for more widespread challenges, because dysfunction in one joint can impact significantly on others.
The most common injury we tend to associate with tennis is, of course, tennis elbow (read about that here), but the ankle, hip, lower back and shoulder are also susceptible to injury, be it tendon injuries, plantar fasciitis or muscle tears. Stress fractures (caused by repetitive loading of the upper extremity) are also widely reported, and there are even rare vascular injuries reported, likely due to the compression of the large vessels in the armpit whilst serving.
Tennis is physically demanding with lots of sprinting, flexion, rotation, extension and lateral bending of the spine and related joints, and so a certain level of fitness is critical to help withstand the repetitive stop-start movements, bending, twisting and rotation. When we see a tennis player in clinic we also have to consider the dominant side of the person, as these repetitive motions can lead to one-sided disorders. In fact, when looking at a tennis player it is often easy to spot
whether they are left- or right-handed simply by looking at muscle tone and size!
Let’s talk technical tennis!
The ankle is often injured in tennis due to shearing forces that occur at the subtalar joints. The plant-pivot action often seen in tennis players causes translational distortions throughout the rest of the body, not to mention repetitive shock absorption, and in turn these lead to dysfunction both locally and in more widespread joints and tissues due to compensatory changes. For example- repetitive shear forces through the ankle can cause altered gait biomechanics, which in turn can compromise the stability of the pelvis and the lower back, leaving the player with not only an ankle injury, but also potentially other problems in his pelvis, hips or lower back.
We’ve all seen a tennis player serve- the racket moves over the head and behind the body whilst the spine flexes laterally and hyperextends- the trunk must then be brought into very rapid flexion to smash the ball, whilst very high velocity rotation causes a corkscrewing motion through the spine, transferring force and torque (twisting) into the spinal segments. The tennis serve places more load and stress on the spinal structures than any other stroke in tennis, and these shearing forces can lead the lower back susceptible to injury. Think of Andy Murray and his microdiscectomy surgery on his lower back in 2013- the large forces transmitted through the lumbar spine can cause intermittent lower back pain that can eventually lead to retiring from the game.
In addition to ankle and lower back problems, the shoulder also has to work hard during the serve to stabilise the glenohumeral joint when it is extended, preparing to serve. This relies almost completely on the rotator cuff muscles, who not only have to stabilise the shoulder but also cope with the added issue of the tennis racket- which further increases the distance from the shoulder to the moment of impact in the centre of the racket. When the rotator cuff muscles are weak, there is excessive “play” in the movement of the joint in the shoulder socket, causing irritation in the surrounding tissues.
[clickToTweet tweet=”Only ≈ 20% of #energy needed to serve a #tennis ball comes from shoulder- the rest is from hip, trunk & core strength” quote=”Only around 20% of the energy needed to serve a tennis ball comes from the shoulder- the rest is from hip, trunk and core strength.”]
So how do we avoid injuries?
Cold muscles are more prone to injury so always take time to warm up and stretch before any game.
Proper muscle strengthening and conditioning will help minimise the reduce of most injuries. Shoulder injuries are usually due to poor conditioning and poor strength of the rotator cuff muscles so these should be appropriately stabilised.
Pay particular attention to technical components such as grip size and proper technique can help reduce the likelihood of developing tennis elbow.
Appropriate footwear is critical to preventing stress fractures (which often occur in the leg or the foot) in addition to supporting the arches of the foot and ankle.
Focus on technique- the need to hyperextend through the lumbar spine when serving can be reduced by bending your knees and lifting your heels, which allows your upper body weight to be more evenly balanced.
Introducing specific core stability exercises will enable tennis players to achieve better balance and proprioceptive abilities (proprioception is the body’s ability to sense movement within joints and understand their position in space without having to look!) With this, players are better able to stabilise their body through the extreme ranges of motion it undergoes during tennis.
[clickToTweet tweet=”Remember that #tennis isn’t exercise. It’s a #sport. You have to exercise in order to play the sport!” quote=”Remember that tennis isn’t exercise. It’s a sport. You have to exercise in order to play the sport!”]
Pluim, B.M., Staal, J.B., Windler, G.E., Jayanathi, N. (2006) Tennis injuries: Occurrence, aetiology and prevention. British Journal of Sports Medicine. 40(5) 415-423
Pluim, B.M., Drew, M.K. (2016) It’s not the destination, it’s the ‘road to load’ that matters: a tennis injury prevention perspective. British Journal of Sports Medicine. 50. 641-642
Sell, K., Hainline, B., Yorio, M., Kovacs, M. (2014) Injury trend analysis from the US OPen Tennis Championships between 1994 and 2009. British Journal of Sports Medicine. 48. 546-551
As the old proverb said, ‘prevention is better than cure’. So what’s the simplest thing can we do every day to prevent musculoskeletal pain?
With every patient we find the root cause or underlying issue of the problem and treat it accordingly to patient preference and clinical evidence and research. The most common problem I see from children to adults…
The most effective way of getting you out of pain quickly is self management. We provide a personal back pain toolkits and show you how to do stretches to ease pain and prevent pain or injury in the future.
Prevent back pain with these three simple steps.
Include stretching into your daily routine, or go to a regular yoga class. Think of preventing back pain like preventing tooth decay – it’s as easy as brushing your teeth. We love using foam rollers in clinic- a great addition to your stretching routine.
Use ice immediately to reduce swelling and inflammation on a new injury. Use heat on a recurring injury to reduce pain. You can use paracetamol to help prevent swelling and pain as well.
Research shows a 20 minute walk everyday will reduce the risk of back pain by 10-50%. Similarly if you are sitting down all day, get up to move about or stretch every 20-30 minutes (this also has the helpful side-effect of improving your concentration).
If you would like more hints and tips about prevention of back pain or musculoskeletal injury please read our blog page that details particular injuries and more helpful tips.