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Getting Back into Tennis After an Injury

Q. “Has anybody out there come back to tennis after surgery for a ruptured Achilles tendon and, if so, what type of shoes and/or supports have you used for preventative measures?”

From Kit, Charleston, SC:

I ruptured my Achilles in January 2006. Once I was released to play again, I started back in the K-Swiss Ultrascendor Mid. I felt very confident wearing this shoe while easing back into tennis. It is very supportive of the Achilles (and ankle), while still very comfortable. I played in it for a few months and have now moved back to my regular shoe (K-Swiss Ascendor). Good luck with your comeback!

From Ron, West Hartford, CT:

Your best bet is to first go through a physical therapy treatment and continue some kind of follow-up treatment afterwards and also, early on, place small heel wedges in both of your shoes to eliminate some tendon strain. However, you must remember, there is no guarantee that it will not happen again. So, a long-term ankle and leg-strengthening program is a “must.”

From Bill:

I ruptured both Achilles tendons while playing tennis, one in 1992, one in 1997. Both happened late in matches.

Each recovery period was about 4 or 5 months. I played in the National 50s and Father/Son after the second one in 2000 and in 2001. I did not win any matches, but I can’t blame that on the ruptures. However, my back now bothers me, so I have not played tournaments in about 4 years. I believe that the shortened tendon may affect my hamstrings and, thus, my back. I cannot get even close to touching my toes but never could do that well even as a kid.

My back problems also may have been caused by playing on hard surfaces since I was 10. No one else in my family has ever ruptured an Achilles tendon.

I was fortunate that the ruptures were not very painful, as the tendon broke completely each time.

I don’t wear any special support, as the tendon area in back of each ankle is very think – over an inch – and my doctor told me I would probably pull something else before I ruptured either Achilles again. The only problem I have in that area is that the skin is thin, and I sometimes rub it raw if I wear the wrong shoes.

From Laura:

I have played for the last 13 years after Achilles tendon surgery with K-Swiss tennis shoes. I like very sturdy shoes. Last summer, I tore the plantar fascia in the same foot. It was better after 10 days. I am not sure why I tore the fascia. I think that I may have had a problem with the length of one leg being slightly shorter than another. I will see someone this Wednesday to check that out. Since I tore the fascia, my heel is bothering me. Otherwise, I would have ignored the situation.

I didn’t have any problems for 13 years. I just started slowly, after 9 months healing. I think my fascia problem may be related to the original reason that my Achilles tore while playing tennis. I play singles at the 4.0 level.

From Lee, Borehamwood:

I think that the Nike tennis court edition shoes really help. They’re comfortable shoes, and they’re easy to move in. Just what you need on the court. About the support, I can’t give you an answer. Sorry.

From John, Oakland, CA:

Yes, I have returned to tennis after my ruptured Achilles tendon. It took me 14 to 16 months before I was back on the court. I now where Nike MAX AIR basketball shoes with Dr. Scholl’s Double Air-Pillow insoles.

From Glenn, Wilmette, IL:

I ruptured my left Achilles while playing doubles on Memorial Day weekend, 2001 (I was 47 years old at the time). I had surgery to repair the injury on June 1. By the end of September 2001, I was playing tennis again – not moving particularly well but without the “boot.” I think that by the anniversary date of my injury, I had recovered full movement (which never was my greatest strength, but it is what it is). I have not chosen to wear any type of special shoes or supports for tennis.

From my perspective, the key to recovery from this injury is to do the rehab work diligently. Rebuilding strength and flexibility is critical. Find a good, experienced physical therapist and follow his/her instructions. The approach was almost “cookie-cutter” in nature – “Week 1, you’ll do Activity X, Week 2, you’ll do Activity Y, etc.” I still pay extra attention to exercising and stretching that area.

As a footnote (pun intended), approximately one year after my injury, I developed some discomfort in my right Achilles. I did get prescription orthotics then and went back for another round of physical therapy. I since have discarded the orthotics and (knock on wood) have experienced no discomfort since then. Best of luck.

From Abby, Richmond, VA:

Hi. Sorry to say that I have ruptured both my Achilles tendons at different times, and my doctor didn’t recommend any special equipment once I had been cleared to play again. I have been doing yoga and that seems to help with general flexibility. Good luck.

From Bill W., Spokane, WA:

I had a complete rupture of my right Achilles tendon playing singles in a tournament four years ago. It happened in the second set after I was thoroughly warmed up.

After surgery, I was in a non-weight bearing cast for around three months and then in a walking boot (with heel lifts) for another three months. Following physical therapy in which we worked on stretching and strengthening, I was able to return to tennis and now play on a 4.5 team, a senior team and a mixed doubles team. In addition, I play four to five tournaments a year. I also coach high school tennis (30 years).

I have been pretty faithful about doing toe rises from a 2 x 4 board or something similar. I have worked up to the point of doing three sets of 25 on each leg. I do these three times per week. I also make a point of warming up and stretching before I go onto the court. Since my surgery, I have not had any problem, although my right calf is somewhat atrophied and, therefore, weaker than my left

Good luck with your recovery and your tennis.

Q. Can anyone recommend some good shoes to wear while playing tennis after recovering from an ankle sprain?

From Karl K. of Greene, NY

A sprained ankle in May of this year kept me sidelined for nearly six weeks. I tried several ankle braces available at local pharmacies, as well as Reebok "high top" basketball shoes. Although these did provide some ankle support, I was not really satisfied with any of these solutions. Eventually I tried ASO ankle braces, which Andy Roddick and Sania Mirza wear and, quite frankly, they're the best. My ankle sprain was quite severe, but with the ASO braces I play fearlessly. The braces are available at AchillesMed.com. The plastic inserts that can be ordered with the braces add some additional support, but I find that they slide out of their pockets and that the brace provides excellent support without them. Tweaking these braces takes a little practice since they use a combination of laces and straps, but once you get them right you can wear them for hours without any discomfort. They can also squeak a bit when rubbing against the lining of some tennis shoes.

From Jim C. of Towson, MD

The New Balance 802 is designed for players with foot problems. My right foot is flatter than a pancake. One afternoon while officiating HS tennis, a coach observed me limping around and he told me about the New Balance shoe. On the way home I stopped at Holabird Sporting Goods and asked the manager if there was a shoe that could help me. He immediately recommended the NB 802 shoe. When I tried a pair, it was like putting on a new foot. The pain magically disappeared. I have worn nothing since.

From Kathleen Bright of Hingham, MA

I have had problems with my ankles for years. I’ve had physical therapy, worn splints and had acupuncture. In the meantime, I found a men’s shoe, K-Swiss Preventor 7.0. This shoe has a higher throat that supports the ankle and a Velcro strap around that throat, which fastens over the laces. The shoe does not restrict the ability to move easily and quickly around the court, but it does supply just enough additional support that you are less apt to roll over the outside or inside of your heel. The K-Swiss Preventor 7.0 only comes in men's sizes and is a little hard to find in stores, but it is available online at K-Swiss.com. Best of luck.

From Noel B.

I went to my general practitioner for an ankle sprain and was told I could play on it, but to wear an ankle brace. After many weeks with an ankle that continued to swell, I decided to go see my Orthopedist. He suggested taking three weeks off, so I took four. He did not recommend that I continue to use an ankle brace and told me that it would weaken my ankle over time. I was wearing New Balance shoes when I sprained my ankle and knew that the shoe was just too wide in the heel. I did try a pair of Prince mids and found them to be uncomfortable. I have since ordered the Adidas Barricade II and I am doing really well. I would recommend you purchase a well constructed shoe that fits your foot. Perhaps the shoe you were previously wearing was too wide like mine and allows your foot to slide around. My Orthopedist also provided ankle strengthening exercises such as writing the alphabet with the foot and using an elastic band. I have found running in the pool also helps to keep my ankle in shape, though it does get sore from the workout. According to my Orthopedist, strengthening the ankle is key to reducing the number of sprains in the long run.

From Pam of Durango, CO

If Adidas makes a men's version of the Barricade, I would definitely try that one.

From Dean of Ann Arbor, MI

I highly recommend Andy Roddick's old shoe, the Reebok Match Day Pump. This shoe is slightly higher topped than normal, very stable and well cushioned. The heaviness gives the shoe all the more stability and cushion and comes in six colors. Follow the link to Tennis Warehouse.

From Dr. Mary Rutkowski, Chiropractic Orthopedist, Center Valley, PA

I recommend New Balance shoes -- they seem wider and have more foot coverage. I also recommend orthotics inside that have an out raised edge to eliminate rolling the foot to the outside. This worked for me after I sprained my ankle last year and kept rolling the ankle afterwards.

From Bret H. of Allen, TX

I've suffered since juniors with ankle sprains. The best thing I know is to wear the Swede-O lace up brace that you can get for $10 at Wal-Mart, as well as K-Swiss mid- or high-top 7.0 system tennis shoes.

From Bruce F. of Wallingford, CT

Play in any shoes. Use a Kallassy Ankle Support. Problem solved medically with a cost-effective solution, and you’ll promote flexibility as you heal and thereafter.

From Judy of Scottsdale, AZ

I had a few ankle injuries. Now I ONLY wear high-top sneakers. The only ones I have found (and they are for a wider foot than mine, so I tie them very tightly) are the K-Swiss 7.0. There is a lower version of this shoe, and the higher one clearly covers your entire ankle. I have played with high sneakers the last three years (after a few sprained ankles and a fractured one), and it seems that I will NEVER be able to roll that ankle again. It’s easy to get used to them, as well. I buy four pairs at a time (because you never know when they will no longer exist).

Q. "I am a 4.0 league player and came up with a right hip flexor injury a few months ago. I had to stop all tennis for two months and then started walking with light stretching. I am now trying to play again, but I still cannot seem to eliminate the pain and the “clicking" in the groin and hip area, although I continue to stretch. My mobility is limited to the right, as I am not confident I won't hurt myself worse if I go all out. Does anyone have further tips on how to get over this injury? Thanks!"

From Coach Kenny S., Highland Park, IL:

Well, I have this problem also at the moment. Run in the pool, side to side, forward and backward. Ice it at night. Stretching is key; put your leg up on a bike rack, or something like this, from the front and from the back. Also ice some more, and run in the swimming pool. Losing weight will also help this problem, all of which I am doing at the moment, and it’s better, even after a loss in the opening round of the Midtown Tennis Club, Chicago, Men’s Open, on Friday. No pain, no gain!!

From Rick H., Licensed Massage Therapist:

Locate a sports massage therapist in your area. Check their training and length of time working with athletes. With proper assessment, work and stretching techniques for this type of injury, you should be able to "go all out" in a reasonable amount of time. Each person responds differently, but unless something more serious is going on, you should feel confident getting back onto the court.

From Carol W., Potomac, MD:

Hi Paul. The description of your hip pain sounds as if it could be a tear of the labrum of the hip. This could be why you haven’t gotten better. The labrum is cartilage in your hip joint. You need to see an orthopedic surgeon and have an MRI (insist). If there is a tear, there are surgeons who specialize in arthroscopic hip surgery who could repair it.

From Lou W.:

My best advice is going to a well-recommended chiropractor and acupuncturist in your area. I had a similar injury, and they did wonders for me.

From Laurence S.:

I had that injury last fall. I went for a few weeks of physical therapy. I learned the proper exercises to loosen the area, which includes the hip area and the “core” abdominal area. That, together with an occasional painkiller, had me back on the court within two weeks of the injury. Good luck.

From Bill K., Birmingham, AL:

Find a good physical therapist to work out this problem. I have had very good results with two separate injuries that wouldn’t go away until PT solved the problem. These professionals can get right to the source of the pain and put your body back into balance. I had my doubts initially, but the results convinced me that there are some injuries that you just can’t heal on your own.

From Mike B., Rhode Island:

You may have "Snapping Hip Syndrome." You may want to check that out first and seek a physical therapist at some point, regardless. I managed to get through it with just therapy and deep tissue work, but it will depend on how severe it is.

From Dave S., Saratoga, CA:

I am a 4.0 player, as well, and have the same issue. I'm 54 and developed this a couple of years ago. I am captain of several USTA league teams with 4.0 and 4.5 players, and many have had this injury at one time or another.

I would bet Paul is right-handed. My sore hip flexor is my right one, and I am right-handed, as well. I have the clicking, also, and it can be painful. I am pretty sure the injury is caused by loading the right hip for both a forehand and a serve, and then the sudden release of force where the right hip drives forward and rotates to create power. An open-stance forehand only makes this worse.

The first thing to do if it is really painful is to rest it. That means no tennis for awhile. My friend, a very good senior 4.5 player, kept ignoring his hip flexor injury and treating it with a lot of painkillers. Finally he had to take off for several months. He couldn't even bend down at that point. I gave him this advice, based upon my experience.

If Paul is in so much pain that he decides to take some time off from tennis, he needs to rehab the area. He should stretch the affected area and follow that with ice for about 15 minutes. Do this about three times a day for a couple of weeks. Massage also helps. I found that given the area, a self-massage was better.

He should look into taking yoga classes and tell his instructor what his issues are. I took 16 private yoga lessons to help with this and other back injuries I had. Now I have a routine that I perform AFTER I play. I find that the after-play stretching actually is better than a lot of stretching before playing. It speeds recovery and reduces chronic pain. If some area is particularly sore, I would ice it (although that is not the best area to stick an ice bag!).

He should work on strengthening his core. There are a lot of exercises he can do to help that. He should look into working with light ankle weights and doing some leg lifts to strengthen the hip flexors.

The last thing I found that really helps with pain are the chemical heating products made by Thermacare. Sometimes I wear a Thermacare belt designed for lower-back pain but shift it so that it covers the hip flexor. That helps, especially for evening matches.

If he has an open-stance forehand, he may consider changing that. If he runs around his backhand a lot to hit a forehand, he should make his backhand a better stroke. If he is trying to hit a hard first serve all the time, he may want to develop more spin and change of pace and use the hard serve only occasionally.

I downloaded a 12-page report from eMedicine that helped me diagnose and solve my problem. Right now, I am relatively pain free and have been for about a year. My winning percentage of league matches has actually gone up over that time period, as well. I think that is due to all the work I put in getting in better shape and changing some aspects of my game.

From Coach Poppie, Palm Bay, FL:

Hip pain, lower back pain and tooth aches are all similar. You feel like you are in a tree with a lynx, shoot amongst us – one of us needs relief. Seriously, I strongly advise you contact an orthopedic pain management team and a sports injury physical therapist. Many call themselves sports injury therapists, but here is the true test.

Ask the important questions: What have they done that makes them proficient with sports-related injury recovery? Remember you are interested in recovery, not just treatment. How many years have they excelled with this type of therapy? Now here is the Big Q: How many patients do they see at the same time during my initial recovery treatment? If it is more than one while you are doing your warm up, find another PT.

Of course, once you get beyond the initial treatment and are well on your way to recovery, things will change, and the PT will shift patterns. The really good PTs may cost more; however, if they are on your PPO, that’s perfect. Bottom line: It is recovery you are in need of. If a PT puts you on a machine and then gives you a list of stretches to do and walks away, find the nearest exit and use it. Good luck, and rapid recovery.

From Stephen:

I had a very similar instance not too long ago in which my knee kept giving out. I went to a doctor, and he said it was due to low cartilage, so I decided to do something about it.

My recovery from this injury was due mostly to lifting weights and limiting my court time to two days a week until I felt more comfortable out there. Along with tweaking my diet to cut out excess water weight and drop some body fat percentage, I also began a full-body weight resistance program, lifting moderate weights, focusing on the main compound lifts three times a week, playing tennis on the off days, and adding a supplement called MSM to my daily intake.

Your best bet would be to get a personal trainer for a couple of sessions. (S)he would know how to get you started, then the rest is up to you.

Q. "I am about to return from rotator cuff surgery, which must rank high on the list of tennis injury comeback problems. Do you have any specific thoughts on rehab on the court for my shoulder?"

From Kenny S., Los Angeles, CA:

When coming back from a shoulder injury, I would really stretch before playing and wear a layer of clothes over it. On your serves, take it easy. Don't go for the huge first serve or heavy spin. After you play, take care of it – no heavy lifting, use a speaker phone or a head set. Ice at home, and don't push it too hard.

From Phil, Briarcliff Manor, NY:

I tore my rotator cuff when I threw a runner out at third base with a soggy softball from deep right as a weekend warrior 30 years ago. I rested it and did a lot of stretching to loosen up the adhesions and scarring.

But the biggest lesson I learned was not to re-injure it again. That happens in the service motion, when the shoulder joint externally rotates to the max (as in stop motion photos of major league pitchers with their arm fully stretched backwards as far as it will go, their gloved hand tucked into their chest and the chest square with the plate).

That is NOT what we old-fart tennis players want our serving arm to look like. The best photos to look at are McEnroe and Federer. The shoulder is NOT externally rotated. However, the shoulder is EXTENDED, with the racquet parallel to the back and the elbow maximally flexed. The torso unwinds, the elbow comes past the ear (like a quarterback's bullet pass) and the forearm extends on the upper arm in one unified motion.

Lastly, the forearm pronates, and the wrist snaps. That way the ligaments of the rotator cuff are not stressed nearly as much. MLB pitchers need that external rotation, but amateur tennis players have the extra reach of the composite racquet and space-age strings to send the ball at 100 mph plus.

Happy rehab-ing.

From Eric R.:

Personally, I have found two areas that have helped my own shoulder pain in the rotator cuff.

One was a series of exercises that are in the same range of motion as the serving stroke. You asked for on-court suggestions, and the same gym exercise can be imitated by taking a racquet-head cover and putting a paperback book inside it near the strings. Then do a few minutes of gentle swinging in the same motion that a good serving stroke would make. The small, extra weight helps warm you up and stretch out the muscles, once you are cleared to start playing again.

Second, I found that hitting flat, over the highest point above my head, puts much more strain on my tender shoulder than putting the ball farther in front and a little more to the side with my wrist, applying a slice to the serve.

Hopefully you have a doc who is a tennis player and understands the specific stresses on the shoulder during play. If not, get one that has a track record of success in the rehab process, specifically with tennis players and their shoulders.

From Sandie S.:

Having gone through this, I can tell you that you have to work on getting the range of motion first. I thought that strength was most important. You do more damage if you try to build strength first.

I used a lot of stretching with light resistant bands and then tried to gradually raise my arm more. The physical therapist I found taught me this. I was able to build the strength, once I started to get the range. It took me about six weeks before I could get my arm up. Luck was that it was my ball-toss arm. I think it would have been longer if it had been my serving shoulder.

From Bob K., Minneapolis, MN:

Learn to hit with the other arm.

From Bob B:

I just went through this myself. Groundstrokes were much easier to re-learn than serves. Just playing made my forehand recover, but the serve was another matter. Throwing a football helped more than any other therapy. First, short throws with my wife; then longer and longer ones with my friends until my strength returned.

From Larry K., Poughkeepsie, NY:

Use a physical therapist who has no regard for your pain. Follow any exercises given by the doctor and therapist to do at home, as often as possible. You want to regain as much mobility as possible.

After the physical therapy, I was playing my normal tennis in two months. Since my rehab, I have no pain and complete use of my right arm/shoulder for tennis, and I play right-handed. It was only a painful process with no tennis limitations.

From George N.:

I had the surgery almost four years ago and have three screws in place there. Takes a good six to nine months to get back to almost normal with the help of therapy, and I am OLD... 70. I am now back to playing two leagues plus two senior softball leagues, also – not recreation, but competitive. Good luck.

From Tom A.:

I have had the surgery on both shoulders. Start with lots of stretching, and then stretch some more. Go easy on overheads for awhile. Stretch two to three times a day to keep the tendons from tightening up after you play. When warming up for a match or practice, do 360-degree rotations, like a ferris wheel! Do both directions. Good luck, and be careful.

From Judy, New York, NY:

I had the surgery five years ago, and I was back on court within five months. I had an excellent physical therapist, and I believe that this was the reason for my successful recovery. I even extended my sessions beyond the 12 weeks covered by insurance and did not return to full activity until the therapist felt I was ready. I attribute my recovery to my strict adherence to her advice.

I have also changed my service motion. Incorporating a technique that I was taught at the Vic Braden School in Utah, I lift my arm straight up in preparation. Sort of like Andy Roddick, although that is where the similarity ends! This seems to produce less wear and tear on the joint.

Good luck!

From Matt, Riverdale, NY:

My best advice is to maximize your physical therapy sessions and make sure that the therapist is a specialist in rotator-cuff injuries.

I had my rotator cuff operated on 15 years ago at the Hospital for Special Surgery in NYC and, though not most convenient, I did all of my rehab at the hospital's physical therapy center because of its expertise.

Also, I purchased extra "therapy bands" and attached them to the door knobs at home and did strengthening exercises (when approved by the therapist) every day for several years to avoid reinjuring the rotator cuff.

Good luck!

From Dave L., Reading, PA:

Sorry to give you bad news, but this surgery is not easy. I've had both my shoulders operated on for rotator cuff at different times. My right shoulder was the worst – a complete tear, and I am right-handed.

After surgery and 40 visits for physical therapy, I continued daily, prescribed exercises for more than a year and did not play tennis during that time. This may sound like a long time, but I have not had a problem with my shoulder since.

From David H., Lexington, KY:

My best advice to rehab a shoulder surgery is to use warm pool therapy. I find the pool therapy will strengthen the tendons by using the water resistance and keep the range of motion in the rotator cuff.

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