Overuse injuries in tennis: What you need to know

Tennis is known for its complexity: One minute, you might feel the joy of victory; the next, you might feel the agony of an overuse injury.

 

Overuse injuries occur when a person repeatedly uses the same part of the body—such as during drills or while playing—which can result in strains and pain. They are one of the most common ailments a person can pick up while playing tennis, says Dr. Morgan Busko, a sports medicine physician with NewYork-Presbyterian/Columbia.

 

Below, Dr. Busko shares insights on why overuse injuries form, how they can be treated and what preventative measures players can take to reduce their risk prior to hitting the court.

 

Overuse injuries result when you don’t give the body enough time to recover.

 

“In the first 24-36 hours after activity, the tendons in your body lose collagen,” Dr. Busko explains. “That makes those tendons weaker and less flexible. It then takes about 2-4 days to [regain] that collagen.”

 

If someone plays tennis again within those 2-4 days, the tendons may not yet be back to full strength to accept the stress a person’s body incurs when chasing down a drop shot or serving repeatedly at a high MPH.

 

“Let’s say you play an hour a day, six days a week,” she says. “If you do too much, too soon, your body might not be ready. And if you play too many times [without proper recovery], tendons start to undergo changes at a cellular level. Tendon fibers could stop aligning perfectly and healing in between each bout of exercise.”

 

Changing surfaces too quickly can also lead to overuse injuries.

 

Prevailing wisdom suggests that playing on softer ground can somewhat alleviate the strain on the body. And in the long run, that might be true. The short term, however, is a different story, according to Dr. Busko.

 

“When someone who always plays on hard courts suddenly starts playing on grass or clay, the little bit of extra give in the surface might put more stress on their tendons,” she explains. “A new surface changes the way the tendons respond to the impact and creates a little extra work for them. So that can definitely lead to an issue.”

 

Overuse injuries can affect many different areas of the body.

 

Tennis elbow—or as it is more formally known, lateral epicondylitis—is somewhat synonymous with the sport, thanks to its moniker. But tennis players can develop many different overuse injuries because the game involves so much multidirectional and explosive movement. Patients with a penchant for tennis most frequently visit Dr. Busko with elbow, shoulder (rotator cuff tendonitis) or Achilles tendon pain, she says. She also notes that it’s not uncommon for those who frequently pick up a racquet to stop by her office with groin, quad or thigh strains.

 

Interestingly, tennis players are often diagnosed with golfer’s elbow, Dr. Busko says. While that may seem slightly paradoxical, medial epicondylitis—as it is known in medicine—affects the tendons that connect forearm muscles to the inside of the elbow. Golfers use that part of the body whenever they swing a golf club—hence the colloquial term.

 

“But every time tennis players hit a forehand, they’re also activating that muscle group,” Dr. Busko explains.

 

Beginner players are at more risk.

 

Muscles and tendons will adjust over time. They will accept more stress on the body as you gradually build a routine tennis regimen.

 

The key word there is gradually.

 

“Somebody who is a beginner or has taken a long period off needs to allow their body time to adapt,” Dr. Busko says. “Often with [overuse injuries] what we see is that people don’t want to allow that process [to play out].”

 

Rehab exercises are an effective treatment.

 

A common misconception is that rest alone can alleviate the issue.

 

“I'll frequently see someone come in and they’ll say, ‘Well, I took a month off tennis, I've done nothing and my pain's actually worse or no better,’” Dr. Busko says. “And that doesn't surprise me because the tendon wants to be exercised. It wants to be loaded, just in a very gradual fashion. And stressors from rehab exercises are actually what will produce the stimulus for healing. Tendons don't get very good blood flow, so they need exercise to start to promote blood flow to the area.”

 

Similarly, strength training is a fantastic preventative measure players can take to reduce the risk of an overuse injury diagnosis in the first place. Dr. Busko says that core exercises, along with something as simple as working with exercise bands for 20-30 minutes on both the upper and lower parts of the body, can help muscle groups adjust and prepare for more frequent tennis outings.

 

Women are potentially more susceptible to overuse injuries.

 

Research on the ACL—a ligament in the knee—has shown that women have what doctors call “a greater laxity” in their tendons and ligaments compared to men.

 

“If you had a male and female ACL in front of you and you pulled on them both, the female one would feel stretchier,” Dr. Busko explains.

 

As a result, women are 4-6 times more likely to develop a non-contact ACL tear than men. (A non-contact ACL tear is when the tear occurs without physical contact with another athlete, and can be associated with overuse.)

 

Women are also more likely to develop patellofemoral pain—or, as it is perhaps more commonly known, knee pain. The reason, again, is anatomical.

 

“The angle from the hips down to the knee is called the Q angle,” Dr. Busko explains. “Obviously it varies in the individual, but in general, women are going to have wider hips than men, which results in a larger Q angle. That means more pressure is placed on the front of the knee [when women jump or engage in strenuous activity], making us more predisposed to that type of pain.”

 

Still, tennis remains one of the best sports for the body.

 

“Tennis involves multidirectional movement, and that's really important when we're talking about loading the skeletal system,” Dr. Busko says. “Running is great for bone density, but it's only loading the body in one direction. The great thing about tennis is that you're loading in multiple directions. Tennis also involves a lot of start-and-stop movements, it uses both upper and lower body strength and it can improve your hand-eye coordination. And then there are lots of other things it can help you strengthen, like agility, flexibility, balance, footwork.”

 

The advantages for women are particularly striking.

 

“Women’s peak years for building bone density are between the ages of 19 and 25, so it’s really important to promote a healthy lifestyle in developing girls,” Dr. Busko says. “Tennis is a great way to achieve that goal. Then, when we think about aging populations or those who are postmenopausal, tennis can be a great way to halt the loss of bone density because it is so multidirectional and there is a strength aspect associated with it. I think tennis really can provide great benefits to women of all ages.”

 

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