Boyd W. Haynes III, MD
While not as popular as football, soccer or basketball, the sport of tennis has a huge following in the United States and around the world. Tennis is synonymous with warm, sunny weather, ritzy country clubs and pro players who are also jet-setting celebrities. Many of us love to watch Wimbledon on TV or hit the courts for a set with friends. As a busy Sports Medicine Physician, I often see tennis players who are complaining of pain which keeps them from playing well or playing at all. In this article, I will discuss the most commonly seen tennis injuries and how they are treated. I will also outline prevention measures for each.
Tennis Elbow – Lateral Epicondylitis
This tendon inflammation occurs on the outside of the elbow and is typically caused by overuse or improper form while gripping and swinging the tennis racquet. Conservative treatment includes the use of a compression elbow brace, relative rest, steroid injections, and Physical Therapy. More difficult cases can be treated with PRP (platelet rich plasma) Therapy or surgery.
Prevention of this injury involves the strengthening the wrist, hand and forearm with light weights. A Tennis Pro should be consulted about the proper form and grip to use while holding and swinging the tennis racket.
Shoulder – Rotator Cuff Tears & Bursitis
This shoulder injury is usually caused by a lack of strength in and conditioning of the shoulder musculature. Tendons and bursa can become inflamed, swollen and painful. Conservative treatment includes the use of a rest, avoidance of the impingement position, steroid injections, anti-inflammatory medication and Physical Therapy. Bursa can rarely become infected and require antibiotics. More extensive rotator cuff tears will require surgery to repair.
Prevention of this injury entails strengthening the shoulder muscles and proper stretching and warm up before play. A Tennis Pro should be consulted about the proper form and technique for overhead swings used in serving the ball and other plays which require overhead movement.
Jumper’s Knee – Patellar Tendonitis
This injury is caused by repetitive stress to the patellar tendon or quadriceps tendon, common to athletes. It typically occurs when playing often on hard surfaces, but there are many contributing factors. It causes achy pain on the front of the knee. Conservative treatment includes the use of rest, ice, activity modifications, bracing, steroid injections, anti-inflammatory medication and Physical Therapy. More difficult cases can be treated with surgery. Return to play will depend on rehabilitation efforts and whether pain during activity can be resolved.
Prevention of this injury necessitates stretching and strengthening the leg, although certain anatomic issues may predispose players to the injury. Movement assessments may help the player understand areas of improvement based on body and leg anatomy.
An ankle sprain occurs when one or more of the ligaments of the ankle is stretched or torn. Ankle sprains are graded in severity, based on the number of ligaments involved. Conservative treatment includes rest, icing, the use of a compression bandage and/or air boot, elevation of the ankle above the heart and the use of NSAIDs for pain and inflammation. Players with less severe sprains should ambulate on the foot. More difficult sprains may be treated with steroid injections. Grade III sprains rarely require surgery and temporary crutches will be needed during the healing process. Physical Therapy for ankle rehabilitation is necessary for more severe sprains.
Prevention of this injury requires regaining full motion and strengthening the muscles of the leg, foot, knee and ankle. Agility and balance training are also helpful. Proper, supportive footwear is crucial.
These tiny fractures or cracks occur when training is increased too rapidly. When the player is not well conditioned, muscles and tendons tire quickly, transferring more stress to the bones. The stress causes microscopic fractures to occur, typically in the lower leg bones or bones of the foot. Conservative treatment includes rest, icing, modified activities, the use of a brace, boot or crutches, anti-inflammatory medication or NSAIDS. Most stress fractures take six-eight weeks to heal. Rarely, surgery will be required to repair the fracture.
Prevention of this injury is predicated on not doing too much too soon and not playing beyond ones’ strength and conditioning. Supportive, cushioned tennis shoes are absolutely necessary to reduce stress on the bones.