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Healing the Hurt

Knowing the types of injuries your customers may encounter, and when to send them to a specialist, can keep them playing longer.

By Mary Helen Sprecher

Nobody wants to be laid up because of an injury. And as a tennis pro, you certainly want to keep your customers and students as healthy as possible. But tennis is not without its aches and pains.

Let’s face it: Any time a player is on the court longer than usual, or plays against someone who moves faster and hits harder, discomfort is going to follow.

But there has to be a way to draw the line between the out-too-long and hit-too-many-smashes kind of pain, and the kind that says, Uh-oh. See a doctor. Right?

Of course, says John Wilckens, M.D., chief of orthopedics at Johns Hopkins Bayview Medical Center in Baltimore. Wilckens sees his share of sports-related injuries every year, including those resulting from on-court incidents and accidents.

If a player comes to a pro to seek advice concerning an injury (or if that player is simply worried about a symptom and wondering whether or not to see a doctor), says Wilckens, “the important thing to do is to decide whether this is pain or whether this is simply discomfort.” Discomfort, he notes, can come from trying something new, or from playing more vigorously than normal. Also, in general, discomfort is something that will go away once a player has stopped doing (or overdoing) that new activity.

Pain, on the other hand, is different. “When you have sharp pain, or pain associated with swelling, you should see a sports medicine doctor,” says Wilckens.

A few of the more common tennis-related injuries and conditions Wilckens sees includes:

Tennis elbow (lateral epicondylitis)

Everyone has heard of it, but the problem is that the term has been misused to mean any forearm pain that crops up in tennis players. True tennis elbow involves pain in the outside (lateral area) of the elbow, just below the bend of the elbow itself. It is a gradual problem that grows more painful if left untreated. The patient eventually will feel pain not only during athletic activity, but when lifting or bending the arm even to grasp small or light objects.

Wilckens advises players who have been diagnosed with tennis elbow to meet with their pro. “Generally, [tennis elbow results from something] secondary to their game — usually the person’s backhand technique or the grip size on their racquet.” Pros should see firsthand both the racquet and the stroke before making a decision, he notes, since a combination of the two may be at fault. Statistically, players who have a two-handed backhand are less likely to suffer from tennis elbow, although that may not be the best technique for every player.

The good news is that the majority of tennis elbow cases can be treated with rest (perhaps the most important cure of all), ice and non-steroidal anti-inflammatory medications, such as ibuprofen or Aleve. Sometimes, players find relief by using special sports support bands that fasten around the arm, just below the elbow. A sports medicine specialist can prescribe some gentle stretching exercises to help limber and strengthen the joint area when play resumes. In the most severe cases, such as when an individual cannot do his or her day-to-day work without pain, cortisone injections or surgery might be recommended. For the most part, however, says Wilckens, the ice, rest and over-the-counter meds are effective.

Rotator cuff injuries

“A lot of club players develop shoulder pain,” says Wilckens. Many times, that pain can be traced to rotator cuff injuries. The rotator cuff is comprised of the tendons and muscles that cover the shoulder joint.

Sports that involve repetitive motion — such as tennis, swimming, baseball, and golf — can lend themselves to overuse injuries in varying degrees. These injuries range from impingement, which occurs when the shoulder blade rubs or “impinges” on the rotator cuff when the arm is lifted, to the most severe: a complete tear. A mild injury may only require rest and oral medication, sometimes combined with physical therapy. A tear can require surgery and a more protracted recovery period. A doctor can decide the severity of the injury and the treatment required.

Back injuries

According to Wilckens, there are two kinds of tennis players who suffer from back pain: quite young, and middle-aged and up.

“We see it in very young players — 12 or 13 years old — who commonly hyperextend their backs,” he says. “It can result in stress fractures in the lower back.” Pros and instructors should keep an eye out for exaggerated, arched posture, particularly when beginners and other young players are serving — it’s a dead give-away. Back pain in middle-aged and older players (ages 45 to 60), meanwhile, tends to be caused by degenerative disc problems that are worsened by the twisting or shifting of the body that tennis can naturally bring.

The good news? According to Wilckens, kids can be taught correct on-court posture to prevent injuries (and can sit out a season to heal anything that might be hurt). Even better, older players, including those who have had lower back injuries, “can continue their tennis careers for years,” provided they stretch properly, remain limber, rest when necessary and have a doctor’s approval.

Knee problems

Knee pain can by a symptom of a meniscus tear (also known as torn cartilage) as well as ACL (anterior cruciate ligament) or MCL (medial collateral ligament) injuries — along with a host of others. A sports medicine specialist can evaluate where and how badly the knee hurts and during which specific activities, and can decide how to proceed. Because treatment for various injuries can range from rest and over-the-counter medications all the way up to surgery, it’s important to get that advice from an expert.

Tennis Leg

Here’s a case where an injury looks and feels truly alarming, but doesn’t have terrible long-term ramifications, according to Wilckens. A player in mid-game will feel a “pop” followed by pain in the upper calf area that causes him or her to limp off the court. By the next day, the area is swollen and/or discolored, usually prompting the player to go to the nearest emergency room. The diagnosis? Tennis leg, a tear of the gastrocnemius muscle.

The name, notes Wilckens, is actually misleading, since the condition “really has nothing to do with the sport of tennis.” Unfortunately, it just happens to be one of those things that has cropped up in tennis players in the midst of a game. Theories abound on the reason for this, with one of the most popular being that the changes of direction a player makes during a game can stress the muscle. As distressing a condition as it is, claims Dr. Wilckens, tennis leg “usually resolves on its own. It can take about a week before a person is able to walk comfortably.”

Be aware, though: A non-medically trained person may confuse the symptoms of tennis leg with any number of other injuries, including sprains, strains, Achilles tendonitis, or even a ruptured Achilles tendon. And no, not all problems will fix themselves. Having any injury looked at promptly is always in the player’s best interest.

What the doctor orders

Wilckens particularly recommends that injured athletes seek out sports medicine specialists. These doctors, he believes, have an advantage over regular physicians, since they are familiar not only with athlete-related injuries and conditions but more importantly, with the mentality of the athlete who doesn’t want to stop working out for fear of losing his or her hard-won physical fitness.

“Sports medicine doctors will engage the athlete and will let them know when they can expect the injury to be better,” he says. “They’ll give the patient exercises and cross-training activities so that they don’t lose their conditioning. They’ll help the person outline their experience and goals and they can work with them.” Sports medicine specialists can also supply athletes with special stretches and techniques aimed at helping them avoid a recurrence of their problems.

Sure, there are always going to be those whom Wilckens refers to as “knuckleheads” — the hardcore athletes who want to play through pain. And pros can help keep an eye out for them. Just look for those players whose altered gait, posture or stroke can indicate that they are suffering from discomfort, or even from outright pain. A few tactful words of advice can help point an injured player in the right direction.

Preventive maintenance, particularly as athletes age, is imperative, says Wilckens. Core conditioning, stretching prior to play, paying attention to various aches and pains — and above all, resting and recuperating when necessary — can help keep players on the court right through their later years. Although he does not recommend a particular type of surface, he advises patients to know their limits and their comfort zone. With that in mind, he says, they can go back out on the court for years to come.

See all articles by Mary Helen Sprecher

About the Author

Mary Helen Sprecher  is the managing editor of Sports Destinations Management Magazine, a niche business-to-business publication for planners of sports travel events, in addition to being an RSI Contributing Editor. She is the technical writer for the American Sports Builders Association and works as a newspaper reporter in Baltimore City.

From the August 2008 issue
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