A Tour around Tennis Injuries

(Date of publication 01 July 2005)

Tennis enthusiasts who have focused their attention on Wimbledon over the past two weeks, for the annual orgy of British national disappointment, must have noticed that a high proportion of top class players suffer significant injuries. Could tennis be that dangerous? It would appear that the answer is yes; this tour demonstrates that the brutal reality is far removed from the decorous image of the game as a gentle accompaniment to tea on the vicarage lawn, so beloved by romantic novelists of a sensitive disposition.

Everyone has heard of tennis elbow (lateral epicondylitis) and up to 50% of racket sports players develop the problem at some stage. It is a degenerative condition of the tendon fibres that attach the muscles of the forearm to the elbow, as shown in this diagram. Sufferers generally complain of a severe, burning pain on the outside of the elbow, which gradually worsens and is exacerbated by gripping or lifting things. The first phase of treatment aims to obtain relief from pain by rest, ice packs and analgesics, sometimes supplemented by orthotic aids such as a counterforce brace or wrist splint. Physical therapy is then used to strengthen the affected muscles and tendons, and is successful in 85% to 90% of cases. Where pain is incapacitating and does not resolve in six months, surgery may be required to remove the diseased tissue and re-attach normal tendon to bone. This site provides significantly more detail on rehabilitation, but at the bottom has a very useful section on choosing the correct racket to minimise the chances of developing tennis elbow, taking into account such factors as racket material, head size, string tension, stringing material and grip size.

Moving up the arm, biceps tendonitis is common in athletes who use an overhead action (as in serving) because of excessive abduction and external rotation of the arm. It causes pain at the front of the shoulder which is aggravated by overhead activity or lifting heavy objects. The cause is inflammation of the long head tendon of the biceps muscle, as a result of direct injury to the tendon or its impingement on other structures, and treatment is similar to that for tennis elbow.

The shoulder muscles which move the arm are known as the rotator cuff muscles, and their tendons, having a poor blood supply, are particularly vulnerable to degeneration with age. Rotator cuff injuries may arise as a consequence of this or of the application of excessive force. Victims experience a vague pain that can be difficult to pinpoint and concomitant weakness, even an inability to raise the arm. This site has some good advice on stretching and strengthening the shoulder joint, but a wider range of treatment is covered here, and the surgical procedures that may occasionally be necessary are described on this Rothman Institute page.

Constant deceleration during tennis can force the first or second toes against the front of the tennis shoe, particularly if the shoe is too small or the toenails long. The result can be 'tennis toe' or subungual haematoma, a collection of blood under the nail, as in this photograph. If the condition is painful, the blood can be drained by making a hole in the nail, which will often eventually fall off. Click here for more information on toenail injuries.

The longitudinal arches of the feet are supported by plantar fascia – the strong fibrous sheets of connective tissue shown in this photograph. Inflammation of this tissue (plantar fasciitis) is a common overuse injury in running and jumping sports, affecting some two million Americans each year. It produces severe pain in the region of the heel, which is generally aggravated by weight-bearing first thing in the morning, but gradually subsides with activity. People with high or low arches are particularly susceptible. Many different therapies are available, but identifying the most effective one can be challenging. However, the condition is essentially self-limiting and 90% of sufferers respond to conservative treatment.

Older players are more likely to experience 'tennis leg', an incomplete rupture of the inside of the calf muscle. The symptoms are a sudden sharp or burning pain which is sometimes accompanied by an audible sound. As with most muscle or tendon injuries, treatment follows the RICE principle – rest, ice, compression and elevation – succeeded by exercises of gradually increasing severity until normal function is regained. This regimen is also followed by victims of 'jumper's knee', another overuse injury, comprising inflammation of the patellar tendon where it attaches to the kneecap. Similar injuries that can affect the thigh include a 'pulled hamstring' and the unfortunately-named 'groin strain'.

So, we have already covered a broad range of injuries without even mentioning those resulting from falling over, being hit by the ball/racket, or colliding with your doubles partner. What can be done to maximise the chances of surviving a match unscathed? Tips suggested by the American Academy of Orthopaedic Surgeons and SportsInjuryClinic.net include thorough warming up and stretching, cooling down, massage, correct nutrition, avoiding courts with no 'give' in the surface, using heel inserts to absorb shock, and not landing on the ball of the foot. Enjoy your game!

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