Common Tennis Injuries – Questions & Answers
Q. Can different playing surfaces affect a person’s tennis game?
A. Absolutely! Tennis can be played on a wide range of surfaces including clay, grass, asphalt, concrete and synthetic grills. When you play on clay tennis courts, the ball is often slower, while the rallies are typically longer. Because of the longer rallies on clay courts, your physical endurance may be more of an issue. Harder court surfaces tend to be associated with a greater risk of injury to your knees, legs, ankles and feet.
Q: Is surgery ever necessary to relieve tennis elbow?
A. Typically surgery is a last resort as a treatment for tennis elbow. Surgery for tennis elbow is sometimes recommended if you have had elbow pain for more than 12 months, following non-surgical tennis elbow treatment, and if you have experienced short-term pain relief from corticosteroid injections. Surgery for tennis elbow may be most important if you are having difficulty performing daily activities due to the pain.
Q: My teenage daughter plays varsity tennis. Lately she has been complaining about lower back pain that gets worse when she bends backwards. What could this be?
A. It is possible that your daughter is suffering from a stress fracture in her lumbar spine. This injury is more common for younger tennis players who are going through growth spurts. Serving in tennis can put a lot of stress on the lumbar spine. Sometimes this can lead to a stress fracture.
Q: Sometimes I experience sharp pain in my calf while playing tennis. What is it and is there anything I can do about it?
A: Calf strains are quite common for tennis players, especially when you push off the ground quickly to return your opponent’s ball. Sometimes your calf muscles can become torn if they are stretched too far. It is important that you eat enough carbohydrates before you play since that gives you the energy you need when your muscles contract. If you do suffer from a strained calf, you should immediately rest your leg, and use elevation, ice and compression.
Q: I just tore my ACL and my doctor said I need surgery. When can I start playing again?
A: An ACL tear is a serious knee injury. It will take a person 5 to 6 months to fully recover from the surgery. At the 5 to 6 month mark, most athletes should be able to return to twisting, turning and jumping sports.
Q: My daughter is a junior tennis player. She plays in tennis tournaments year round and she just added a personal trainer to her workout schedule. Her right foot is now hurting? What do you think is going on?
A: My first concern is that your daughter may have sustained a stress fracture of her foot. Stress fractures occur more commonly in women vs. men. The most common location for stress fractures is in the foot. I would be concerned that the full-time tennis schedule, with the addition of the increased activity with the personal trainer, may have been too much, causing the bone to fracture. There are two types of stress fractures. The first type occurs in patients with normal bone but abnormal activity. Such as the situation discussed above, versus the person that has abnormal bone and sustains a stress fracture with normal activity. That condition would be seen in someone with osteoporosis.
Q: What are the side effects of a cortisone injection into the common extensor tendon for tennis elbow?
A. Cortisone injections to the elbow can have no side effects. In a small percentage of patients, they can cause fat atrophy. Fat atrophy is a condition where the adipose tissue around the elbow joint disappears or undergoes atrophy. This may be present for up to a year and the body will re-deposit fatty tissue to the area. It is purely cosmetic and does not affect function. Another potential, but rare, side effect is vitiligo. Vitiligo is a condition where the skin around the injection site turns pure white in color. This may be present for up to 12 months and typically resolves on its own. This is also a cosmetic condition and does not change the function of the the elbow.
Q: My doctor told me I have knee osteoarthritis. What are some non surgical treatment options for me so that I can keep playing?
A: Non surgical treatment for osteoarthritis in the knee includes teh following: 1) an oral NSAID if not medically contraindicated. You must check with your doctor prior to taking any medication. 2) Viscosupplementation such as Synvisc or Gel one can help reduce symptoms of knee arthritis. 3) A cortisone injection can also help pain and swelling associated with knee arthritis. 4) A custom unloader knee brace can significantly help to reduce knee pain while playing. 5) Cross training to build up the muscles around the knee joint to help reduce the force on the knee can also significantly help to reduce symptoms.
Q: Is it important to cross train as a recreational tennis player?
A: It is very important to cross train with any competitive sport, including tennis. Cross training improves the strength and function of the muscles not being used.
Q: I have knee osteoarthritis. What is the best tennis playing surface and tennis shoe to wear?
A: Clay is the most forgiving surface on which to play tennis. I recommend clay to all my players with hip, knee, or foot issues. Shoe wear is also very important. A tennis shoe with a well-cushioned sole and wide heel will help to reduce force to the lower extremities. A shoe with built in arch support can also provide additional stability and reduce force to the feet, knees, and hips.
Q: My shoulder keeps me up at night because of pain and I have a difficult time serving and hitting overheads. What do you think might be going on?
A: A rotator cuff tear will typically cause night pain. Rotator cuff tendinitis will cause pain that will wake you up when you roll over on the effected shoulder whereas a rotator cuff tear will typically prevent you from falling asleep. Shoulder impingement will cause a secondary rotator cuff tendinitis and can have very similar symptoms. All 3 conditions will cause pain with serving and overheads. The player may describe that their arm fells dead while playing.
Treatment typically consists of an oral NSAID, if not contraindicated. It is recommended to check with your doctor before taking any medication. A cortisone injection can cure the problem if is it a rotator cuff tendinitis. A cortisone injection plus physical therapy is recommended for impingement syndrome and surgery is needed to repair a torn rotator cuff.
Q: Is my tennis racquet contributing to my tennis elbow?
A: Maybe….Tennnis racquets that can cause or at least worsen tennis elbow tend to be a very stiff with a high power level. If you have tennis elbow look for a racquet that is relatively flexible. It can be difficult to differentiate stiffness types between the brands. The best resource is a certified racquet technician (CRT). They may be employed at the tennis club where you play. Additionally, the big internet tennis sale companies will many times have several CRT on staff that you can speak with over the phone.
There are many factors involved with a tennis racquet purchase: head size, neck length, flexibility, balance point, overall weight, string pattern and grip size. Higher level tennis players tend to play with a smaller racquet head compared to beginner players. However there are many factors involved which is why an expertise in the field should help you make the decision. The level of the player is an also important factor to consider when picking out a racquet type.
Q: What are some simple home treatments for tennis elbow?
A: Simple home treatments for tennis elbow include specific stretches of the common extensor tendon along with deep tissue massage. Please see my You Tube Channel video for instruction. The You Tube icon is located at the upper right hand corner of my website. The use of ice once or twice a day for 20 minutes can also help to reduce the inflammation of the tendon. Consult your doctor to ask if an oral NSAID, topical NSAID cream, NSAID patch, or cortisone injection may also be a treatment option for you.
Q: My knee hurts when I am playing tennis. What do you think might be causing me my symptoms?
A: If you are having knee pain that is sharp and stabbing, making lateral movement on the court difficult, you may have a meniscal tear. Other signs of a meniscal tear include an effusion (swelling in the knee joint), pain primarily associated with a plant and tist of the foot or knee, and a clicking or popping sound or feeling within your knee joint. An MRI scan can confirm the diagnosis.
Q: What is the best type of string for a tennis player with a history or current elbow and shoulder problems?
A: A blended string or natural gut is better for players with elbow or shoulder injuries such as tennis elbow, impingement syndrome, or rotator cuff injuries. The monofilament strings such as a Big Banger string adds more pop to your stroke but also adds significant force and strain to the elbow and the shoulder. Gut string is very expensive and breaks quickly. Gut string is also very sensitive to temperature changes. So if you leave your racquet in the car by mistake on a sunny day you may return and find that your strings have broken. The tennis racquet should be re-strung with 2 to 3 pounds less than what you normally play with if tennis elbow is present.
Q: Does it matter how tightly my strings are strung in reference to elbow and shoulder injuries?
A: Did you know that the tighter your strings are strung in your racquet the more control occurs when you hit the ball? If you are developing symptoms of tennis elbow, get your racquet restrung with 2 to 3 pounds of less tension. The loser the strings the less force is transmitted to your elbow. Increased force to the elbow can cause tendinitis or even a tear in your common extensor tendon (specifically your extensor carpi radialis brevis). Check out my YouTube channel for more info on tennis injuries.