Preventing and Treating Tennis Injuries

By Stacie L. Grossfeld, M.D.

Because tennis is a sport that is often played for life, injuries from overuse sometimes occur. Most can be treated conservatively, but occasionally surgery is needed. As a fellow tennis player, I understand the need to recover quickly and resume play. Nothing is worse than time off the court. Injury prevention and early treatment are important.

ELBOW INJURIES

One of the most common tennis injuries is lateral epicondylitis, also known as tennis elbow. This injury can be prevented, but when it does occur treatment should be sought quickly.

Prevention starts with your racquet. Higher power level racquets have a higher incidence for tennis elbow. The stiffer the racquet, the more force is transmitted up to the elbow. An example of a racquet that transmits less force to the elbow is the Wilson Triad series.

If your elbow starts to hurt, first over-wrap your grip to make it slightly larger, decrease the tension of your strings, ice the elbow 20 minutes three to four times a day and wear a tennis elbow band. Then have a tennis pro observe your technique. Several technical points can lead to this problem: hitting the ball late, using your wrist to stroke the ball instead of focusing on the core muscles of your trunk and pelvis and a poor toss during your serve.

Seek medical attention if your symptoms do not resolve in a timely fashion. Occasionally tennis elbow will progress into a condition where the tendon tears off the bone. This becomes a surgical indication.

The most common shoulder injuries are rotator cuff tendonitis and cuff tears. The rotator cuff is a group of four tendons that coalesce into one large tendon that attaches to the top of the humerus (the long bone in the arm). The tendon can become inflamed or it can tear.

An inflamed tendon will hurt with overheads, serves and high volleys. Rotator cuff tendonitis can result from overuse or misuse. For example, common technical mistakes are made in the serve. The player will try to increase pace or power by using the shoulder when the majority of the power from a serve comes from your legs and core muscles. Schedule a lesson with a tennis pro to have your technique reviewed. Rotator cuff tendonitis can be treated with anti-inflammatory medications, physical therapy and technical modifications.

A rotator cuff tear will interfere with the ability to fall asleep. The pain will be located on the side of the shoulder over the deltoid region. The pain will worsen with overhead activities, and the arm will feel weak. Treatment for a rotator cuff tear is surgery because the tendon has been torn off the bone. Return to tennis is typically in three to four months after surgery.

KNEE INJURIES

Knee injuries range from chondromalacia of the patella and meniscal tears to ACL injuries. Chondromalacia of the patella is when the cartilage under the surface of the patella gets frayed or starts suffering from early wear. The pain, typically a toothache-type pain, is located in the front of the knee. The knee will feel stiff when going from a sitting to a standing position. Kneeling causes discomfort. Rushing the net with a quick stop to hit a volley will worsen the pain. Treatment is arch supports if you are pronated (flat-footed) and physical therapy to strengthen the quad muscles. A slip-on knee brace may help reduce symptoms.

There are two shock absorbers in the knee: the medial meniscus and lateral meniscus. They can get torn from playing. A torn meniscus will produce sharp pain, swelling and discomfort with twisting or deep flexion. A knee arthroscopy is typically needed to resolve symptoms.

An ACL tear is a major injury to the knee. At the time of the injury the player will typically hear a loud pop, have acute onset of swelling and be unable to finish the match. Surgery is the definitive treatment. Most players are able to return to competitive tennis in four months. Tennis-specific rehab is critical to keep the player on the court during the four months the player is recovering. Keeping the hand-eye coordination, strength and cardio fitness during the four-month recovery is key.

FOOT AND ANKLE INJURIES

The most common foot and ankle injuries are Achilles tendonitis and ankle sprains. The Achilles tendon is the large tendon that runs from the calf muscle down to the calcaneus (heel bone). It can get inflamed. The Achilles tendon will be sore to touch and painful to push off when running around the court. The tendon will feel stiff when rising from a sitting to a standing position between game changeovers. Ice to the tendon after playing will help. Anti-inflammatory medications such as Motrin can help reduce the inflammation. Physical therapy can help speed up the recovery process.

Ankle sprains can be of varying degrees. The more severe the sprain the more swelling and discoloration will be present. Physical therapy is critical. Diminishing swelling and regaining range of motion will result in a quick return to play. Simple treatments can help, such as immediately icing the ankle after the injury, placing a secure ace wrap on it and keeping the ankle elevated above the heart. Physical therapy is also important for regaining strength, balance and prevention of recurrent sprains.

Tennis is a sport that is played for years. Cross training will help prevent overuse injuries and help to maintain general fitness. Running, cycling and circuit training will help give you that extra edge on the court.

Dr. Stacie Grossfeld is an orthopaedic surgeon with a specialization in sports medicine. She has completed a year of specialty training in knee and shoulder reconstruction at Fowler-Kennedy Sports Center . She completed her orthopaedic residency at the University of Minnesota and joined Medical Center Orthopaedics, P.S.C. She is a competitive cyclist, cross-country skier and tennis player. Dr. Grossfeld is a member of Kentuckiana HealthFitness' Editorial Advisory Board.