Tennis is one of the most popular racket sports in the world.  Not only is tennis a great way to stay in shape, it has health benefits such as: increased cardiovascular fitness, motor control, improving muscle tone, and more.  While tennis is an awesome form of exercise, the demand on the multiple joints and muscles can lead to injury.  Such injuries can happen whether you are a beginner or experienced tennis player.

How Do I Know I Have A Tennis Injury?

Tennis injuries can happen in multiple joints and muscle groups.  Symptoms of a tennis injury can include:

• Pain/tenderness in the area of complaint
• Swelling and visible bruising
• Pain that progressively gets worse over time
• Weakness in muscles and grip strength
• Decreased range of motion
• Snapping or crackling along a joint that causes pain

Rotator Cuff Injuries

The rotator cuff is one of the most common locations for tennis injuries.  The rotator cuff consists of 4 different muscles that provide stability to the shoulder.  They are located around the shoulder blade and attach to the upper arm bone (Humerus) at the front and side of the shoulder.  The muscles involved are:

• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis

As we put increased and repetitive strain through the shoulder girdle, the muscles and tendons start to become inflamed.  Increased activity (or possibly a fall on the shoulder) can lead to a tendonitis or tendinopathy of one of the rotator cuff muscles.  Even further strain can lead to tears of one of the rotator cuff muscles or a labral tear (tear of the cartilage surrounding the shoulder girdle).

In the case of Tennis, the overhand motion (serve/smash) is the action that will put the most strain through the rotator cuff. If any area of the shoulder is in pain, possibly damaged, or lacking range of motion, that will cause other muscles and areas of the body to compensate, leading to injury.  This is known as the ‘catch up’ phenomenon where other areas of injury may include the elbow, wrist, scapula (shoulder blade), and back.

Muscle Strains

Just like sprains, there are different degrees of muscle strains.  However, recovery times for strains are generally faster than sprains.  Listed below are the different Grades of strains and their general recovery time:

• Grade I: The muscle has been overstretched with some micro tears of the muscle fibers. These are mild strains and recovery time is usually 1-3 weeks

• Grade II: This is considered a moderate strain where there has been some muscle fiber tearing but the muscle is not completely torn. Bruising and swelling may occur but not always.  Recovery time is usually 4-12 weeks

• Grade III: This severe muscle strain involves a complete tear of the muscle. Pain, swelling, and bruising is present.  Use of the muscle will be extremely difficult and painful.  Recovery time is usually 3 months+

Muscle strains are more commonly known as a ‘pulled muscle’.  In the sport of Tennis, the most common muscle strains are:

• Groin
• Calves
• Back muscles
• Quad/Hamstring
• Rotator Cuff

Tennis Elbow

Lateral Epicondylitis, commonly known as tennis elbow, is an overuse injury located on the outside of the elbow.  Tennis Elbow occurs when the extensor muscles of the forearm become overworked due to repetitive gripping and forearm extension.  This is a common injury seen in all racket sports, not just tennis.  It is usually caused by over gripping a racket and/or repetitively hitting the ball with a quick motion of the wrist during a back hand swing.

Typically, tennis elbow begins slowly, then becomes worse with more activity.  The pain usually decreases with rest and becomes worse with increased activity.  Commonly, tennis elbow occurs a few days after starting a sport that the person is not used to playing or if there is a sudden increase in training.  If this is left untreated, or the person starts playing the sport too soon, it can lead to a more chronic lateral epicondylitis.

Stress Fractures

A stress fracture is when someone gets a small crack in the bone.  This is typically found in weight bearing bones, most commonly in the Tibia of the lower leg and the metatarsals of the foot.  It is caused by repetitive impact such as running, jumping, or stomping.  In the world of Tennis, stress fractures can occur in the back due to overarching the back when serving, and the bending plus rotation during play.

Stress fractures tend to worsen over time and pain symptoms will increase with greater weight bearing impact activities like jumping.  Although stress fractures are not complete fractures of the bone, continual stress and activity through the bone can lead to a complete fracture and lengthier recovery time.  Generally, stress fractures will heal on their own in approximately 4-6 weeks with ample rest away from high impact.  For many people, walking should be fine but activities such as jumping and running should be avoided.

Ankle injuries

Ankle injuries are one of the most common types of injury that affect everyone, not just tennis players.  The 2 most common types of injuries are: ankle sprains and Achilles tendinitis/rupture.  The repetitive start and stopping as well as the frequent, sudden sideway movements are large contributors to these injuries.

An ankle sprain can happen from the slightest misstep but the severity of it affects the recovery time.

• Grade I: The ankle will probably feel sore and be tender to touch. There typically isn’t much swelling or physical discolouration/bruising.  Recovery time is approximately 2 weeks.

• Grade II: The ankle will be painful and tender when bearing weight as well as through range of motion. Swelling and bruising is common.  The ligament affected has been overstretched, possibly creating a partial tear.  Recovery time is approximately 6-8 weeks.

• Grade III: The affected ligament has completely torn. You shouldn’t be able to weight bear on the ankle and there should be severe pain, swelling, and bruising.  With proper immobilization of the ankle in the beginning as well as proper rehab, recovery time is approximately 3 months to 1 year+. Surgical repair is an option for treatment of this type of sprain

An Achilles tendinitis/rupture is an overuse injury of the Achilles tendon.  The Achilles tendon attaches the calf muscles to the heel of the foot.  Sudden increased activity of the calf muscles will cause inflammation of the tendon.  If ample rest and treatment is not taken, this can lead the Achilles tendon to ‘snap’ (rupture).  Commonly, an Achilles tendon rupture is reported as feeling like “being hit in the back of the ankle with a basketball”.  A decrease in voluntary range of motion and difficulties walking are signs of an Achilles rupture.  If a rupture occurs, surgical repair is the primary treatment.

What Can I Do To Help Prevent An Injury?

Although completely avoiding injury may be an unrealistic scenario when we are active with sports, there are a few ways to help prevent the (re)occurrence of them that you can easily incorporate into your daily life.

Proper Warm Up

I’m sure many people, including coaches and P.E. teachers, have told you the importance of warming up.  A warm up helps prepare the body for activity by increasing blood flow, lubricating the joints, and getting the muscles ready for play.  A proper warm up can help to increase performance and can help reduce muscle soreness afterwards.

I recommend focusing on dynamic stretches/exercise and mobility drills to get the body ready.  You should warm up for at least 10-20 minutes before playing to help prevent injuries.  In a future blog post, we will go over effective and sport-specific warm-up exercises in more detail.  A few warm-up exercises can include:

• Hip and shoulder circles
• Lunges – walking and lateral
• Lateral shuffles and/or Cariocas
• Hip Airplanes
• A Skips
• Rows, external/internal rotation exercises with resistance band

Sport Specific training

It’s important to incorporate training outside of the court that are specific to tennis.  Sport specific training allows us to translate skills and movement to the court to prevent injury and increase performance.

• Endurance training – it’s no surprise that aerobic training is important if you want to excel at tennis. Be aware that once fatigue sets in and you begin to breathe heavier, technique and form will start to decrease and body compensations will increase possibly leading to injury.

• Strength Training – the heavy use of trunk rotation and the lower body to generate power for the tennis athlete should be taken in consideration. Having a strong lower body with a strong, stable core will increase performance.

• Proprioception Training – proprioception is your body’s ability to sense changes in movement, location, and action. Proprioception includes: agility, balance, coordination.  Have you ever caught yourself from falling or rolling your ankle?  That’s proprioception.  Doing exercises or drills that focus on balance (ie. standing on one leg on an uneven surface) or ones that focus on coordination and agility (ie. alley hops) is part of proprioception training.

• Mobility – having ample mobility in joints such as the shoulder is key to playing competitively. Certain joints in our body are meant for mobility, and other joints are meant for stability. When the joints of mobility are not mobile enough, the body compensates and the areas meant for stability pitch in, which can lead to injury.

Working with your coach and/or personal trainer to get you sport ready is important depending on your competitive level.  Being aware of the areas that you are lacking, and focusing on improving in those areas will help you excel at tennis and prevent injury.

Proper Equipment

Just like in any other sport, ensuring that you have the proper equipment will help to decrease the chance of injury.

• You can consult with your coach or a tennis professional to

confirm that your racket is sized for your grip and the tension

of the strings are appropriate for your skill level.

• Making sure you are wearing proper footwear that is designed

for tennis is important.  Having firm support, especially on the

outside of the shoe can help to prevent ankle injuries.  An ankle

brace can also be worn for additional support while playing tennis.

Proper Treatment

As mentioned earlier, most tennis injuries are from overuse. If you begin feeling soreness or pain in a particular area of your body, try taking a break and resting for a few days or weeks.  The decreased stress through the area will usually calm down over time and you can get back to play.

If you have tried resting for a few days or weeks after you started feeling pain, and there has been no change in symptoms or the symptoms get worse, you should seek out a medical professional.  Chiropractic care can help restore range of motion, increase function, decrease pain, and get you back out on the court.  Massage and Physical therapy, as well, can be effective in loosening over worked muscles and rehabilitating certain injuries.

We hope that these recommendations were helpful to you and that you remain injury-free this tennis season.  By learning how to prevent these common injuries, you will be able to play tennis for years to come.  I hope the information provided helps you on your tennis journey.  Stay tuned – future tennis blogs will go over a warm up routine and some sport specific exercises you can do to get you ready for the tennis season.

If you are experiencing an injury and you are seeking Chiropractic, Massage, or Acupuncture treatment in south Edmonton, you can give us a call (780) 431-1201 or book an appointment with our Edmonton Chiropractor to start you on your recovery process.

Remember, when you enhance your health, you enhance yourself! 

Author: Dr. Justin Kwan MSc, DC