MOUNT SINAI HEALTH TIP: Avoiding Back Injuries
March 22, 2017
Welcome to the Mount Sinai Health Beat, a feature with the official medical provider of USTA Eastern, USTA, and the US Open. This month, Evan O. Baird, MD, Assistant Professor of Orthopaedic Spine Surgery at the Icahn School of Medicine at Mount Sinai, talks about how players can avoid potentially painful and debilitating back injuries.
Back problems can sideline younger and older athletes alike, especially with the extreme twists of the back on the serve and the excessive rotation of the hips now part of the modern tennis game. The best remedy can be taking some simple steps to avoid problems in the first place, and my approach is to work with patients with the long-term goal of minimizing periods of back pain that keep them from playing their best.
For younger players, problems often stem from simply playing too much, what may be termed an ‘overuse’ syndrome, while older players often don’t do enough of a warm-up, or don’t realize that perhaps they are not able to do quite as much as they did the previous year. Occasionally, younger players can develop a stress fracture of the lumbar spine, and persistent pain in a younger player is certainly a reason to see a physician. ADVERTISEMENT Fortunately, for about 90 percent of players who see a specialist, rest, physical therapy, and anti-inflammatory medications are enough, and there is rarely an indication for surgery.
When I see these athletes in the examination room, I often give them the same speech and run down the same list of options. We have a discussion about their back, but I also encourage them to control the amount of stress they put on their body, because it adds up.
First the obvious: You need to watch your weight and your overall health. Stretch before playing, and focus on strengthening your core, which includes your abdominal muscles, back muscles, and the muscles around the pelvis. Here are some excellent basic tips.
Perhaps not so obvious: Be sure to focus on your hamstrings, the muscles that run along the back of your thighs. Some of my patients give me a quizzical look at this point. I ask them to think about their back and leg muscles as one unit, so that when your hamstrings are tight, that in turn can influence the tension on the back muscles as well. If you can’t touch your toes, I’m talking about you.
I also suggest keeping a mental note of your day-to-day routines. If you have an office job, be aware that sitting all day is tough on the back. Take breaks and walk around the room, change positions, try a standing desk if possible. Pay attention to your posture, because poor posture also puts added stress on your back.
A lot goes into maintaining the health of your spine, and one (unavoidable) factor is genetics. Clinical studies have proven that some people are simply more at risk for arthritic changes of the spine due to their genetic makeup. The things you can control however are significant. To give you an idea of how many different factors can affect spine health, consider that one of the most damaging behaviors is smoking: Nicotine impairs your ability to maintain proper bone density and may contribute to premature wear of the discs as well. There’s no question that stopping smoking can be good for your aching back.
Some patients prefer just to live with back pain, and that’s their choice. But there are certain red flags that you must be on the lookout for. If you experience pain that radiates down your arms or legs, or if you encounter problems with balance or weakness in your extremities, that could indicate a neurological problem and you should consult with a doctor.
One of the best things you can do for chronic back pain is to find an experienced physical therapist. I suggest you take the time to find the right one, in the same way you might pick a financial advisor. Mount Sinai doctors can make some good suggestions, or you can ask your friends and family. In some ways, a qualified physical therapist can do much more for you than a physician in a single office visit.
Several years ago, Roger Federer acknowledged he was worried by back pains that would not go away, and many tennis stars have struggled with back problems, including Andre Agassi, who cited chronic back pain as one of the reasons for his retirement from competition, and Pete Sampras, who once had to withdraw from the U.S. Open. Rafael Nadal might have won the 2013 Australian Open final if not for a back injury that prevented him from playing his hardest.
Back problems are common for the rest of us as well. In fact, the American College of Physicians recently noted that lower back pain is one of the most common reasons for all physician visits in the United States. But sound medical advice, coupled with a commitment to watch out for your back, can make a big difference.