Written by Mr Ali Noorani, Consultant Orthopaedic Surgeon
As I write this piece the French Open tennis final is being played out. Two great players are flashing around a hard clay court, hitting the ball at great speeds and exhibiting such extraordinary athleticism that it leaves me feeling quite breathless. And in just over a week’s time the pro circuit will be at it again, this time on the manicured grass courts of London SW19.
Of course, not all of us are sufficiently gifted to play at such an exalted level; for us, three sets in the local park may define our talents. However, we do share at least one thing in common with those at the top of this game – the prospect of a tennis-related injury. As an NHS consultant trauma and orthopaedic surgeon at the Royal London Hospital, with a private practice in the City and West End, I see many patients with a variety of trauma caused while playing.
Unfortunately, tennis related injury is all too common; it’s a demanding, fastpaced, sometimes explosive game; and one that puts high loads on joints, including the shoulder and elbow. These are particularly impacted as many shots are played overhead, including the service – the most strenuous stroke most of us will play.
The shoulder can suffer various problems including internal impingement (when one or both tendons become trapped between the humeral head and the posterior glenoid) and injuries to the cartilage of the shoulder, both likely to be caused by repetitive overhead motions. Repairing painful labral tears of the shoulder are also a regular part of my practice – especially so-called SLAP tears on the top of the labrum (a thick ligament on the socket (or glenoid) side of the shoulder joint) where the biceps tendon attaches. The bicep tendon is also vulnerable to tears (full or partial) caused by excessive force or overuse – the latter of which may require surgery.
If the possible shoulder injuries weren’t bad enough, the elbow can suffer from lateral elbow tendinopathy – inflammation most likely to be caused by backhand stokes with the wrist flexed. It can also suffer from medial elbow tendinopathy – most likely caused by ‘wrist snaps’ on serve or forehand shots, open-stance hitting or ‘short-arm’ strokes.
Tennis elbow? Tennis elbow is probably the most well known injury to affect tennis players. It’s a pain around the outside of the elbow that will usually get better by itself without treatment, but requires rest. It can persist for weeks or months, occasionally longer, because tendons mend slowly. Treatment with an ice pack can ease the pain, as can using an elbow brace and over-the-counter pain relief medication. Fortunately, the need for surgery is rare, although some people benefit from platelet-rich plasma (PRP) injections to accelerate recovery.
Prevention is the key since “stop playing tennis” is probably not the answer you want to hear. It’s important to carry out exercise to strengthen the muscles that stabilise the upper arm in the shoulder socket and enable its range of movement. And, although I can’t advise you about your playing technique or your choice of racquet (although I think a more flexible one with a wider grip can help), warming up is essential and carrying out wrist and elbow exercises can also help to prevent injuries.
So what should you do if you suffer a sports injury? If you feel pain, stop. Carrying on may cause further unnecessary damage, meaning your recovery takes even longer. You should also seek medical advice; a clear diagnosis of the cause of the pain can help set your mind at ease and point you in the direction of a full recovery.