Holding Back – Lumbar Injuries in Tennis.
Overplaying is one of the main causes of lumbar stress injuries. ROB BRANDHAM explains.
Back injuries are common among tennis players – both at the elite and grassroots level. As the sport requires high exertion and repetition, this places a lot of pressure on the lumbar spine.
What is the lumbar spine?
The lumbar spine is a column of five bones stacked on top of each other, separated by a disc at the front and two joints at the rear. It forms the base of the spine protecting the spinal cord, bearing the majority of the weight and load of the trunk. Tennis is a sport that relies heavily on the lumbar spine moving into extension – the backward arching movement when hitting groundstrokes and during service motions. This can place a significant amount of repetitive strain on the bones of the lumbar spine, especially when poor technique allows excessive amounts of extension. The muscles that support the trunk absorb some of this strain, but as they fatigue this support reduces. Along with poor technique, muscle weakness and fatigue plays a large role in the development of injuries across the lumbar spine. Placing excessive strain on the bones of the lumbar spine during repeated extension and rotation movements can cause bruising within the bone, known as a lumbar stress injury. With time, the bone heals and strengthens. However, without rest a lumbar stress injury weakens the bone further leading to a crack or stress fracture. These injuries predominantly occur in younger tennis players, especially in the teenage years when bones are softer and still developing.
What are the warning signs?
Pain usually starts as a one-sided ache, aggravated by activity, frequently on the dominant hand side. This can start out as some pain and stiffness initially when starting play, before easing as the body warms up. After activity, pain and aches typically return and can linger for several days. This pain progressively worsens with continued activity over several weeks and can become more constant. Rest can provide relief – however, most people do not give their bones adequate time to heal and often return to court too quickly. If not treated properly, bone stress can become bilateral.
How are lumbar stress injuries treated?
Rest from impact activity is the best form of treatment. Depending on the severity of the injury, between four to six weeks of rest is usually required. During this rest period, the athlete needs to work on strengthening muscles around the area in the trunk pelvis and hip under the guidance of a health professional. They should also address any technique faults with their coach that could have led to the development of the injury. If a stress fracture has developed, it may take up to three months before they can return to playing. These injuries often do not appear on x-ray initially and require an MRI, bone scan or CT scan for diagnosis.
How to prevent lumbar stress injuries
- Adequate periods of rest allow the body to recover during both training and play. Allocate at least one to two days per week for complete rest from impact activities. For younger players under the age of 15, this could extend to three days. It is also advisable for athletes to have one to two weeks off every three to four months.
- Focus on adopting correct serving techniques, especially when learning new service actions or attempting to increase power. Implement these changes gradually over 2-3 months, allowing the body to recover and adapt.
- Be wary of training and playing too much. These injuries often develop when younger players are training in more than one squad and there is limited communication between the groups.