Tips to avoid injuries playing tennis and pickleball

NEW YORK – The first game of tennis after a long break can feel like a revelation. The birds sing, the air is crisp and your serve is not half bad after three months off.

The day after, however, is a different story.

If you took the winter off, you can expect some aches and pains when you get back on the court. But compared with contact sports such as soccer and basketball, recreational tennis poses a fairly low risk of acute injury, said Dr Tiana Woolridge, a sports medicine physician at the Hospital for Special Surgery in New York City who has worked with collegiate players.

Even so, games like tennis and pickleball are full of repetitive and high-impact movements – such as lunging for balls and swinging the racquet – and that can put a lot of stress on the body.

A five-year analysis of 449 Austrian recreational tennis players found that acute injuries spiked in summer, especially in June. The most common involved falls or twisted joints, especially ankle sprains, usually caused by missteps.

The spine and upper extremities are also particularly susceptible to chronic wear-and-tear injuries, said Dr David Dines, medical director of the Association of Tennis Professionals.

Here are some common tennis injuries, and how to treat and prevent them.

Lower-back injuries

During a serve, the back is hyperextended and every stroke requires rotation. The damage can be subtle.

Back pains and strains become more frequent after age 40, when the cushioning tissues between the vertebrae can start to deteriorate, Dr Dines said. If you feel lower-back pain, the first course of action should be rest, he said. If the pain returns, see a physical therapist or have a tennis professional assess your technique.

How to prevent injury: When you hit a tennis ball, most of the force is generated from the legs up. If the body’s powerhouse muscles – the core, glutes, hamstrings and quads – are weak, the lower back pays the price. Dr Dines recommended adopting a routine of core exercises, such as planks, and lower-body exercises, such as Romanian dead lifts and squats.

Upper-body injuries

The ball-and-socket joint of the shoulder is secured by the four muscles and tendons of the rotator cuff, which can become irritated, torn or overstretched, particularly when playing overhead sports like tennis.

As people age, tissue in the body naturally starts to break down, causing often painless microtears, said Dr Elizabeth Matzkin, an orthopaedic surgeon at Mass General Brigham in Boston. But if the rotator cuff muscles are weak, the tears can worsen as you forcibly extend your arm going for a shot, she added.

Rotator cuff injuries cause pain when rotating the arm or extending it overhead and a dull ache in the shoulder that worsens at night. Minor irritation usually disappears after one or two days of rest, Dr Woolridge said.

If it persists, see a physiotherapist. An MRI (magnetic resonance imaging) scan may be required to rule out a full tear, which can require surgery.

Tennis elbow is a repetitive-stress injury that affects up to 50 per cent of tennis players a year and feels like a persistent pain on the outside of the elbow. It occurs when the muscles and tendons along the forearm that help extend the wrist are taxed from actions such as overgripping the racquet or hitting backhand with poor technique, Dr Matzkin said.

How to prevent injury: Dr Woolridge said shoulder-strengthening exercises, like scapular rows and shoulder extensions with a resistance band, should be part of every tennis player’s routine. These exercises can also ward off tennis elbow, as can wrist-strengthening drills such as wrist curl flexion and extension exercises.

For both drills, work up to 30 repetitions and then add a dumbbell of no more than 2kg.

Lower-body injuries

Ankle sprains are a hazard of any sport with intense side-to-side movement and sudden stopping or pivoting, Dr Woolridge said.

Most ankle sprains do not require surgery. The standard advice has been rest, ice and compression, but many experts now prefer movement and heat. Research suggests that once you sustain an ankle sprain, you are at greater risk of sustaining another.

Calf muscle tears are common enough that many doctors call them “tennis leg”. “When players are quickly changing directions, they might feel a pop in the back of the midcalf,” Dr Matzkin said. The injury rarely requires surgery, but the calf will be sore and swollen and require rest.

Tight calf muscles can also contribute to Achilles tendinitis, an inflammation of the tendon that connects the calf to the heel.

“If the calf is too tight and unable to contract, the Achilles takes the force and can rupture,” Dr Matzkin said. “That is a rough injury with a very long recovery.”

The fast-paced cutting and pivoting motions in tennis also put knees, particularly ageing ones, at risk for injuries such as ACL (anterior cruciate ligament) and meniscus tears.

How to prevent injury: The muscles in the feet and legs play an important role in ankle stability. Strengthen them with exercises such as resistance-band foot drills and lunges forward, backward and sideways.

Balance drills – such as single-leg toe touches or lunges performed on an unstable surface, like a pillow – can improve proprioception, or body awareness.

Protect your knees with a regimen of squats and lunges, which strengthen the muscles that keep the knee stable and firm up the tendons and ligaments around the joint, Dr Matzkin said.

To stretch and strengthen the calves and Achilles tendon, she recommended calf raises with heels hovering off a step. NYTIMES