Common Tennis injuries: Lower body

The 2019 Wimbledon tournament saw Simona Halep overcoming her tennis injury set back in the first round to go on to win her first Wimbledon title against Serena Williams. An incredible achievement!

Talking of tennis injuries, James Ticehurst is back again to follow up from his blog on upper body tennis injuries, to discuss common tennis injuries found in the trunk and lower body.

The trunk/spine

Research shows that the trunk/spinal areas have the highest injury prevalence out of all the areas of the body tennis can injure. This can double, and sometimes triple the incidence rate over a 5-year summary in comparison to other areas.

Paraspinal, rib and abdominal muscle strains

The paraspinal, rib and abdominal muscles are there to predominantly stabilise the trunk/spine. The rib muscles sit between the rib bones and attach the ribs to each other. The abdominal muscles are the stabilising muscles of the stomach and trunk.

During the high levels of forces that occur in tennis, especially twisting, they can overload these muscles, over stretching them and causing a muscle strain. If the forces are great enough it can possibly even cause a tear where the fibres have been stretched so much they break apart. This occurs usually as a result of overuse/overload, improper use of the muscle or fatigue.

Symptoms include:

Paraspinal

• Reduced range of motion and pain on twisting and bending
• Back pain
• Soreness on touch
• Possible muscle spasms

Rib

• Sharp pain at the time of injury (it may come on more gradually)
• The pain will get worse when you twist, stretch, breathe in deeply, cough, or sneeze
• Tenderness, Difficulty breathing, swelling, muscle tightness

Abdominal

• Sudden sharp pain
• Swelling
• Bruising
• Weakness
• Stiffness
• Pain or difficulty stretching or flexing the muscle
• Spasms or cramping

Tips to avoid this injury:

• Warm up and stretch before engaging in any physical activity.
• Do a cooldown after your workout.
• Take time off each week to rest your muscles.
• Start slowly and gradually work your way up in terms of intensity and duration any time you begin a new exercise program

Equally, you must focus on your flexibility, static stretching and strengthening.

Flexibility

Keeping the muscles of the back flexible is one way to prevent a back strain. Static stretching performed over time will gradually elongate muscles allowing them to be stretched farther before an injury to the muscle occurs.

Static stretching

The individual gradually stretches the muscle to a point of discomfort and then backs off slightly. This position is then held for 30 seconds and repeated. The individual should not move into a position of pain as pain is an indicator of injury to the body.

Strengthening

Strengthening the muscles in and around the spine will also reduce the risk of injury. Exercises that strengthen the core muscles of the trunk should be the focus. This can be achieved through a variety of exercises that focus on sustaining either an isometric or concentric contraction for the muscles most involved in flexion, extension, and rotation of the spine.

Hip/Groin

Groin muscle strain: a groin muscle strain occurs in athletes that require a quick change in direction and explosive movements. The groin muscle is a muscle the sits in the inner thigh and can be either the primary hip flexor muscles and/or the hip adductor muscle group (group of five muscles that contract to bring the leg in and across the body).

A strain to a muscle is caused when the muscles are overstretched or overloaded. In this case, it can happen in several ways including a strong kick of a ball without warming up, a quick stretch during a lateral movement, or a fall in sports.

Symptoms include:

• Pain on loading
• Reduced range of motion
• Bruising or swelling

Tips to avoid this injury:

• Warm up
• Hip adductor stretching and improving flexibility
• Strengthening or the groin and hip flexors and ensuring they get the same attention

Thigh muscle strain

The thigh muscle is made up of three sets of strong muscles: the hamstring at the back, the quadriceps at the front, and the groin/adductor muscles on the inside. The quads and hamstrings work together to straighten (extend) and bend (flex) the leg. The adductor muscles pull the legs together. These groups are particularly at risk for muscle strains because they cross both the hip and knee joints.

Symptoms include:

• A popping or snapping sensation as the muscle tears
• Sudden pain
• The area around the injury may be tender to the touch
• Bruising

Tips to avoid this injury:

• Condition your muscles with a regular program of exercises
• Warm up before any exercise session or sports activity
• Take time to cool down after exercise. Stretch slowly and gradually, holding each stretch to give the muscle time to respond and lengthen

Knee ligament sprain/rupture

The knee is stabilised by fibrous tissue called ligaments. There are four cruciate ligaments that hold the knee together, all having different jobs: lateral (LCL), medial (MCL), anterior (ACL) and posterior (PCL).

• LCL and MCL which sit on either side of the knee to prevent any excessive side bending.
• The notorious ACL which prevents your shin bone moving too far forward.
• Your PCL which does the opposite of the ACL, preventing the shin going too far backwards.

In tennis with all the bounding and changing direction and at high loads, these ligaments become very stressed. If there is excessive force it will cause a strain or tear of the ligament. If the force is great enough it will cause a full tear or rupture of the ligament.

Symptoms include:

• ACL: Signs of giving way, loss of stability, pain, a loud “pop”, rapid swelling
• PCL: Pain, swelling and instability
• MCL: Pain, which can range from mild to severe, stiffness, swelling, tenderness along the inside of the knee, a feeling that the injured knee may give way under stress or may lock or catch.
• LCL: swelling of the knee (especially the outer aspect), stiffness of the knee joint that can cause locking of the knee, pain or soreness on the outside of the knee, instability of the knee joint (feeling like it’s going to give out)

Tips to avoid this injury:

• Strengthen your lower limb muscles
• Taping

Meniscus tear

The meniscus is two C shaped rings of cartilage that sit inside your knee. The main function is to act as shock absorbers and reduce the load going through the knee. They are typically injured when the knee is in a slightly bent and twisted as maximum compression is occurring.

Symptoms include:

• Pain
• Stiffness
• Clicking or catching
• Locking of the knee
• Swelling
• Hard to fully straighten the leg

Tips to avoid this injury:

• Similar to the ligaments, have a well-conditioned and balanced lower body

Ankle sprain

The ankle is supported by two sets of ligaments either side of the foot. Sprained ankles are relatively common in tennis players. Roger Federer, Andy Roddick and Andrew Murray have all suffered sprained ankles. The sudden sideways movements that are required during tennis can cause the ankle to twist, particularly if the surface is slippery or the player is fatigued.

A twisted ankle causes damage to ligaments and other soft tissues around the ankle.

Symptoms include:

• Pain
• Swelling
• Inability to weight bear
• Bruising
• Reduced range of motion

Tips to avoid this injury:

• Strengthen your ankle stabilizers on the outside of the leg
• Improve balance and proprioception of the ankle
• Have your ankle-strapped or taped or use a brace for that extra bit of support