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Ask The Lab: Hip Pain & Cramping

PLEASE NOTE: The medical opinions in USTA.com's Ask the High Performance Lab are responses intended for the average player. Please consult with your primary physician before beginning any new exercise program.

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    From William Brannon of Columbia, SC:

    1. What is the mechanism of heat related muscle cramps?

    2. What are important precipitating factors?

    3. What preventive measures may be taken?

    4. What treatment measures short of IV fluids may be helpful in preventing progression of cramping once the process begins.

    Dr. Riewald: William, thank you for your questions regarding cramping.  Let me try to answer your questions in the order you asked them.

    1. Cramping generally results from muscular fatigue – overworking the muscles until they become tired.  However, tennis players also can suffer from heat cramps and these typically are thought to arise as the result of dehydration and electrolyte loss that can come with sweating.  There are also likely other factors (e.g. anxiety, psychological stresses) that contribute to heat cramps as well.  The end results is there is a change in the way the nerves communicate with the muscles - the nerves send inappropriate electrical signals to the muscles that cause them to contract or spasm.

    2. Muscular cramps are most often due to fatigue and can be relieved by rest, stretching and massage.  Heat cramps are thought to arise from electrolyte loss, most commonly sodium.

    3. As far as preventative measures, fitness plays a huge role and every player should strive to develop a strong base of fitness.  Maintaining proper hydration, and drinking fluids before, during and after play can help with this.  Players who suffer from heat cramps should add extra salt to their diets and/or drink a sports beverage that contains electrolytes while playing. 

    It is also beneficial to adjust to a hot climate gradually – do not expect to just be able to go out and play long matches in the heat if you have not given your body time to acclimate.  Most experts say it takes 2 weeks for the body to adjust to a hot and humid environment when coming from a different climate.  You should gradually increase your playing time and intensity each day and this can help avoid cramping.

    4. Once a heat cramp begins (and these are the ones typically treated with IVs) it is very difficult to stop the progression. If you stop play immediately and drink fluids containing sodium, that may help.  However, there is no guarantee that you will be able to stop the cramping process once it starts.

    From Fred Metrick of Toronto Canada (and a tennis nut):

    I play every day, sometimes 1 1/2 hours on ball machine.

    The right hip sometimes develops a pain.

    Could it be from hitting forehands with open stance, after 500 hits on the machine? 

    I am 81 and in good health and love this game. Is there an exercise, or medicine or prayer, as I would go nuts to give it up?

    Dr. Riewald: Fred, first off, congratulations on your health and your love for the game of tennis.  You serve as an inspiration and an example that tennis truly is a lifetime sport. 

    To answer your question, I think it is definitely possible that the pain you are experiencing in your hip is the result of overuse.  You say you are hitting 500 open stance forehands every day.  That means you are loading that hip and putting essentially the same stresses on it each time you hit the ball.  That is a lot of repetitive stress, and you can probably see how that could damage the structures in your hip.  Overuse injuries occur over time. 

    Every time a stress is applied to a tendon, or ligament, or another structure in the body a small amount of damage occurs.  This is not enough to cause an injury, but over time, these small micro-tears build up and lead to pain and inflammation. 

    One suggestion would be to mix things up a bit – play with a partner or have the ball machine alternately feed to your forehand and backhand.  At least then you will be moving and hitting different shots – some likely will still be open stance forehands but you also will likely hit some with semi-open or square stances.  As for strengthening, there are some exercises you can do to build strength in your legs. 

    Some examples of exercises you can use are found on the Player Development website – there is an article on Strength and Conditioning for Injury Prevention under the Sport Science – Strength and Conditioning heading on the left side of the page.

    I also recommend you get an exam by a physician and/or orthopedist as your doctor will be able to tell you more accurately what is going on in your hip.

    About the Author:

    The answers to this week's column come from Scott Riewald, PhD.  Dr. Riewald was the USTA Administrator of Sport Science, reporting to Paul Lubbers, Director of Coaching Education.  Dr. Riewald worked with Sport Science and Coaching Education to provide information to the coaches of top American players through seminars, workshops and newsletters.

    Past Riewald Columns:
    Knee Problems & Tennis Elbow
    Strength & Flexibility Exercises
    Playing in the Sun & Jumping Rope
    Banned Substances & Youth Strength Training
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