As a mental athletic sport, tennis stimulates both your mind and body. You could not play it well if your mental game is weak. You also to need develop your agility, speed, strength, and stamina. It gives you a good workout to improve your physical and mental health thus helps you to stay fit and maintain your general wellbeing.
You can start to play tennis at any age and the concept is really simple. It has two opposing players in singles and four players in doubles using a felt-covered rubber ball, a racket, and a net on a rectangular court. You can play it with friends and family to create a social network, so it is also good for your emotional health.
With all the benefits you can get from tennis, it can also cause physical injuries. Whether you’re a professional or an amateur, you can suffer from upper limb and lower limb injuries. You can get muscle strain on your wrists, elbows, arms, shoulders, thighs, knees, ankles and calves with practice and training using the same motions.
Upper Limb Injuries
1. Lateral Epicondylitis or Tennis Elbow
Lateral epicondylitis or commonly known as tennis elbow is the inflammation of the forearm or extensor tendons at the lateral epicondyle of the humerus. The forearm tendons attach the muscles to the lateral epicondyle where the bone also gives attachment to the ligament of the elbow joint.
When you hit the balls with your backhand stroke, you bend your wrist backward while your forearm tendons and muscles on the outside of the elbow absorb the force of the racket. The strain is great, especially if you’re using an improper backhand stroke, hitting the ball off-centre of the racket or you’re using a heavy, wet ball.
Excessive muscle strain results in moderate to severe pain when you move your arm in a certain way. As the repetitive motions continue, the pain may spread from the outside of your forearm and elbow to your wrist. It can become worse and you can feel a burning pain even if you raise your hand or place it on the table or grip a cup of coffee.
Tennis elbow can be prevented by proper technique and body positioning. If you’re using the one-handed backstroke, try to alternate it with the two-handed backstroke to relieve the pressure on the other arm. Chose the appropriate racket best suited to you in grip size, weight, length, and racket string tension (more info here).
The first step toward recovery from tennis elbow is rest. Your damaged tendons take time to heal that can last for several weeks or months. To hasten the process, you can apply ice, an elbow brace, and elevation. Non-steroidal anti-inflammatory medicines such as aspirin or ibuprofen can reduce pain and swelling.
Physical therapies like the wrist extensor or flexor stretch exercises can improve the condition faster so does wearing of braces or elbow straps to protect the injured tendon from further strain. If the pain doesn’t improve with rest and therapy for 6 to 12 months, it may require surgical treatment as recommended by your doctor.
2. Rotator Cuff Tendonitis or Shoulder Tendonitis
The rotator cuff, which connects your upper arm bone to your shoulder blade is the sheath of ligaments and tendons that surround the shoulder joint to give it mobility and stability. It keeps your shoulder in place while making possible for multi-directional movements as you raise and rotate your arms.
The inflammation of your rotator cuff is called rotator cuff tendonitis, commonly called shoulder tendonitis. It is caused by excessive overhead serving when you lift your arm upward to strike the ball. High-speed and repetitive movements of your arms cause a tear on your shoulder tendons and muscles which limits your functions and motions.
Symptoms of rotator cuff tendonitis include pain and inflammation in the front of your shoulder down the side of your arm. It is accompanied by stiffness, arm weakness, disturbed sleep when you lie down on the affected area, clicking sound when you raise your arm, and pain when you reach behind your back.
Dynamic tennis warm-up, as opposed to static warm-up, strengthens your rotator cuff by activating shoulder muscles and tendons and improving your range of motion. When you play, instead of hitting the balls directly above you, keep it at a slight distance and increase the angle between your arm and body to more than 90°.
Like tennis elbow, you need to rest your injury and apply ice to relieve the swelling. Cold-compress is good for the first few days because ice numbs the pain and causes blood vessels to constrict. You may benefit from hot-compress after 3 days to increase blood flow and help promote healing.
Chronic shoulder pain requires over-the-counter anti-inflammatories, such as ibuprofen or naproxen, physical therapy, and a sling to protect the injury from further damage. If these do not give relief, a steroid injection can be administered. The last option if all of the nonsurgical treatments failed is to undergo a surgical procedure.
3. Carpal Tunnel Syndrome (CTS)
On your volar wrist, the palm side of your hand, there is a passageway of bones and ligaments called carpal tunnel. The median nerve runs through this tunnel along with the nine tendons of the hand. It controls the movement and sensation in the thumb, index, middle and ring fingers.
Excessive pressure on the wrist caused the compression of the median nerve in the carpal tunnel. This leads to inflammation and damage with pain, weakness numbness, and tingling in the hand and arm. The condition is called carpal tunnel syndrome which can affect racket grip and movement of your hands.
The median nerve moves up to 9 mm so you can flex your wrist that much. Prolong and repetitive flexion and extension can create pressure and inhibit nerve gliding. The normal pressure of the median tunnel ranges from 2 to 10 mm. With the wrist flexion, it becomes 8-fold and with the extension, it increases to 10-fold.
The style of your play, how you deliver your forehand and backhand contributes to having pain in your wrist. You are susceptible to the injury If you hit with excessive spins and use extreme grips such as Western forehand. Watch also your posture particularly the position of your shoulders as this affects your wrists and hands.
To prevent the injury, you can increase the flexibility of your muscles with wrist flexor and extensor stretches. Do your stretches before you play and during breaks to lessen tension at the wrist. Strengthen your muscles with isolation wrist flexion and extension exercises and forearm pronation exercises. Also, improve your posture and stroke mechanics.
Initial therapy includes rest and non-steroidal inflammatory drugs. For light to moderate injury, nonsurgical treatments also include physiotherapy, use of wrist braces and splints, and corticosteroid injections. If symptoms do not improve for 2 to 7 weeks, you may elect to proceed with the surgical release of the transverse carpal ligament.
4. Spondylolysis or Stress Fracture of the Spine
The lumbar spine is the area between the diaphragm and the sacrum, where it starts to curve inward toward the abdomen. The word lumbar came from the Latin “lumbus” which means “lion” for strength, power, and flexibility. It is an apt description to the part of the spinal column that bears the weight of the upper body when you bend, twist and lift.
Refers to as the lower back, the lumbar spine is made of the five spinal segments, from L1 to L5. The lowest two are prone to injury since they hold most of the weight of the whole torso. The joint where it meets the sacrum, the sacroiliac joint allows the pelvis and hips to rotate so they may swing when you walk and run.
When you serve, you do a lot of bending at the back and side, and rotations of the trunk. All these power movements put stress on the vertebra and as repetitive pressure continues on the lumbar region, it causes fracture on the pars interarticularis. This leads to a condition called Spondylolysis where the vertebrae slip bilaterally or unilaterally.
The symptoms of the stress fracture of the spine include spontaneous back pain on the beltline when you bend backward or stand on the leg of the affected side and feeling of tenderness when you touch the fractured area. The pain may radiate from the back to the thigh and aggravated by arching and walking.
If you’re right-handed, which means you hold the racket on the right hand or pick up the balls with your right hand, you may feel the pain on the lower left side of your back. Initially, you only suffer from lumbar spine pain and advanced to Spondylolisthesis as one vertebra shifts forward to the adjacent vertebra.
You must have a tennis coach when practicing your service so he can monitor your technique and ensure you don’t overuse your lower back. Also, weak muscular stability in the lumbar and pelvic regions results in injury. The core stability exercises can help by applying the concept that contracted muscles give better support and correct posture.
When you experience pain on your lower back, consult your doctor to discuss your symptoms and treatments. You will undergo an X-ray to determine the extent of the damage such as the single photon emission computed tomography (SPECT) bone scan. Computed tomography (CT) and magnetic resonance imaging (MRI) scans can also useful.
Your doctor will recommend you to stop playing until diagnosis and treatment prove otherwise. The main treatment involves wearing of back brace to support your lower spine for three to six months. To reduce pain and inflammation, your physiotherapist may use ice therapy, tens machine, acupuncture, and soft tissue massage.
Early injury repair may include hydrotherapy such as relaxed freestyle. The water buoyancy supports your weight which enables you to move without the pain. Next would be physical therapy exercises to normalize muscle flexibility, restore normal joint motion and posture, and restore muscle strength and coordination.
Lower Limb Injuries
1. Patellar Tendonitis or Jumper’s Knee
Patella, also known as the kneecap is a small, roughly triangular thick bone that lies between the femur or thigh bone and tibia or shin bone. It gives attachment to the patellar ligaments, covers and protects the knee joint, and provides knee extension. It allows the quadriceps tendons and muscles to contract as you extend and straighten your knee.
Patellar tendonitis, commonly known as jumper’s knee is an overuse injury. Repetitive jumping and quick changes of direction, which are the nature of tennis, can cause strain and tear to the patellar tendons leading to its inflammation. You feel a sense of warmth and a burning pain in the affected area and the pain increases when you walk.
Take a break, don’t continue playing through the pain and follow the RICE: rest, ice, compression, and elevation. Exercises and stretches involving muscle contractions of the quadriceps can be part of your physiotherapy. You can use a strap for your knee and suspension inlays for your shoes to reduce the risk.
If all efforts fail, high volume saline injection, autologous blood injection and platelet-rich plasma injection may be administered. Patients with debilitating pain for six months to one year may require surgery to repair damaged tendons. This generally occurs when patellar tendinitis is at stage 4 characterized by complete tendon tear.
2. Ankle Sprain, Twisted or Rolled Ankle
The inversion ankle sprain is a common injury on the lateral side of the foot when the anterior talofibular ligament is inverted and stretched too much. The other types, the eversion ankle sprain happens on the medial side of the foot and the high ankle sprain, an injury to the syndesmotic ligament that connects the tibia and fibula.
When the ankle joint is forced out of its normal position, you put too much strain on the ligaments. Explosive side-to-side motion, quick changes in directions, falling and awkward landing can result in an injury. Excess stress past the yield point damages the ligament and causes pain, stiffness, swelling and bruising.
An ankle sprain can be categorized depending on the degree of damage to the ligaments. Grade 1 is a mild tear, Grade 2 has a partial tear with loose ligament and Grade 3 has a complete tear with instability in the affected area. Returning to the game without full recovery will lead to a condition known as Chronic Ankle Instability (CAI).
To avoid ankle sprain, choose shoes with good support on the outer edge and socks with extra padding to help support your ankles, they should be specifically designed for tennis. If you’re playing professionally, you can benefit if you use ankle braces for additional support as you undergo intense training and join competitions.
It’s not all about the shoes or socks, develop your flexibility, strength, and balance so you can land on your feet in a good form with a stable stance. Avoiding to land on the balls of your feet when you jump prevents ankle injury. Diligent ankle stretches and exercises strengthen the muscles in and around your ankle and improve joint stability.
Initial treatment is RICE. It is recommended not to use ice directly but with a thin buffer or better use an ice pack to decrease pain and swelling. You can use a brace, an orthopaedic walking boot or crutches to keep your foot immobile and give a chance for your ankle to heal quickly and painlessly as possible. Further, rehabilitation exercises help the ankle regain its strength and flexibility.
3. Achilles Tendon Injury
Achilles or calcaneal tendon is the largest tendon in your body which made up of gastrocnemius and soleus muscles. It connects the calf or soleus muscles to the heel bone or calcaneus. Through Achilles tendon, you can flex your foot at the ankle to let you stand on your toes when you walk, run or jump.
There are three types of Achilles tendon injury. When this tough band of fibrous tissue becomes irritated, you’re suffering from Achilles tendonitis. As it degenerates with the presence of microscopic tears especially for those with calf tightness, the condition is called Achilles tendinosis. If the tendon breaks, it is known as Achilles tendon rupture.
Tennis requires high-velocity training in the lower extremity which puts your Achilles tendon into stress as it contracts and expands. It is more susceptible to damage due to the repetitive strain that causes abrupt tension and pressure on the tendon. A sudden increase in the intensity and duration of your game often leads to Achilles tendon injury.
Your physical makeup can be another cause. The flat arch in your foot and tight calf muscles can increase the strain on the Achilles tendon. As you age, your Achilles tendon weakens which makes you prone when you’re over 30. Your gender contributes too. Achilles tendon injury is more common among the male than female tennis players.
Signs that you may have the injury include pain along the back of your foot and runs around the heel. At first, you feel it when standing on your tiptoes or when you stretch your foot. Over time, you feel the pain when getting up in the morning and gets worse when you continue to play despite the condition.
If you won’t give it a rest, it may advance to Achilles tendon rupture. This accompanies with a snapping or popping sound and you find it nearly impossible to move your foot. You experience immediate and extreme pain with swelling, tenderness, and stiffness. So, don’t ignore when you feel the first sign of the injury.
For prevention, take it easy when you’re a beginner. Then, slowly increase your training to give time for your Achilles tendon and calf to gain strength and length. Balance your game with low impact activity such as swimming and cycling. Support it with warm-ups before the game and daily exercises to strengthen your calf muscles.
The onset of Achilles tendon injury is gradual. If you experience persistent pain, consult your doctor immediately. Part of the diagnosis includes X-ray to check for swelling or broken bone, ultrasound to identify a tear, and MRI to take pictures of the damage. First treatments include rest, ice and non-steroidal anti-inflammatory agents (NSAIDs).
Physical therapy such as eccentric strengthening exercises helps the tendon to heal. It aims to restore ankle range of motion and flexibility of the calf. When symptoms last for more than six months despite rehab programs, surgery is your best alternative. Also, a direct trauma of the Achilles tendon needs surgical repair and casting.
Whatever your reason for playing tennis, whether as a lifetime hobby or career, think safety first. Make sure you wear the right tennis gear, have the proper equipment, learn the best technique, be serious on your stretches and exercises, and take frequent breaks.
Changes in the weather affect your muscles and joints. Choose an indoor tennis court with a controlled heating system that ranges from 55° to 62°F during the winter. The air-conditioning temperature in the summer must range from 10° to 15°F below outside temperature, with 55% to 60% humidity.
Now, you’re ready to have fun on the court. Do your best!