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Mount Sinai Health Beat: Mix Up Your Training

October 16, 2013 09:50 AM
Welcome to the Mount Sinai Health Beat, a feature with the official medical provider of USTA Eastern, USTA and the US Open. Each month, the Mount Sinai Medical Center will provide tips to prevent nagging injuries from cropping up, which prevent players from competing in tennis. One of the world’s leading medical institutions, Mount Sinai’s experts are uniquely positioned to help athletes from professionals to club players succeed in sport.

In addition to providing on-site clinical care for the professionals competing in the US Open, Mount Sinai’s team of medical experts aims to lead the development of policies around injury prevention and to conduct educational outreach to promote the health benefits of tennis.  

This month, the topic is how to minimize overuse injuries with the advice of Dr. James Gladstone, Associate Professor of Sports Medicine at the Icahn School of Medicine at Mount Sinai and Medical Advisor to the U.S. Davis Cup team.



Dr. Gladstone

Dr. James Gladstone

Tennis can be a lifelong sport, free of injuries — if only the dedicated would stop playing so much.

Dr. Gladstone, who is also the Co-Chief of Sports Medicine at The Mount Sinai Medical Center, says impassioned tennis players should partake in other physical pursuits, as well.

“That doesn’t mean stop playing. It means that to be the best you can be at tennis, it is best to mix it up. Do strength training, bike, swim, run, do yoga, pilates,” he says. “You can minimize overuse injuries in this way, and play for years to come.”

Maintain a Strong Core

Whole-body training ensures longevity in tennis. A common misconception among tennis players, says Dr. Gladstone, is that perfection comes through daily games and practice. Tennis players also believe that the most important parts of the body to exercise are shoulders and arms, even if that means hitting the ball against a wall on days when they cannot get out to the courts.

“But unless your core is strong enough—that’s your stomach and your back—unless your legs are resilient, unless you have the right footwork to put yourself in the correct position, you cannot hit the ball as effectively or to maximum advantage,” Dr. Gladstone says. “It’s something we call the kinetic chain, and if you want to look at it mechanically, it really starts from the foot and works its way up through the leg into your core and then into your shoulder and arm.”

That means a tennis player can exercise every day, but should not exercise the same part of the body every day.

“A body is constantly going through rejuvenation, so there’s always break down and build up, break down and build up, and overuse happens more at the microscopic level when the rebuilding can’t keep pace with the break down,” Dr. Gladstone says.

“It is common for tennis players to describe themselves as weekend warriors. They might be able to play once during the week, but they own the weekend, playing for hours each day. That is why they are sitting in my office,” he says.

“You can think of the muscles and tendons as a spring-like unit, and if you stress the spring too far it’s not going to recoil the way it’s supposed to, and that’s what leads to injury.”

Also important to prime tennis conditioning is stretching before and after play, hydration, and appropriate nutrition that offers the correct balance of protein, carbohydrates and fat the muscles need.

“Tennis should be viewed holistically because the sport involves the entire body,” he says. “It’s a simple concept but follow through takes dedication and a focus that can pay off beautifully.”

Rest, Ice, Compression and Elevation for Strains and Sprains

The good news is that most injuries from overuse— strains and sprains in the shoulders, knees, and ankles can be treated with conservative care, such as rest, ice, compression, and elevation (RICE), Dr. Gladstone says. 

“I commonly see strains in the calf muscles, which are really explosive muscles. If you haven’t stretched, you can easily tear the muscle fibers,” Dr. Gladstone says. “It is also critical that you start stretching three to five days after a sprain, because the tissue heals with scar tissue. If you don’t stretch to get the muscle to its normal resting length, you are setting it up to be re-injured.”

Tendonitis and bursitis are also very common and typically resolve with RICE and stretching, and perhaps a cortisone injection. Patellar tendonitis, a condition that can affect even the best of the best (Rafael Nadal), can be treated in the same way.

Back strains and spasms treated with medication (anti-inflammatories and muscle relaxants), physical therapy, and chiropractic care, can be over within a week. “These injuries often happen because a player makes the wrong move at the wrong time, perhaps twisting to get to a ball or really trying to put in a powerful serve.”

Tennis elbow “is one of the most common overuse injuries we see that rarely requires surgical intervention. It is often caused by overuse and incorrect racquet use that is not ergonomically correct, putting tension on the forearm tendons where they insert on the elbow,” Dr. Gladstone says. “Rest, stretching, and friction massage can be very helpful.”

Surgery may be in order for certain knee injuries, such as a meniscus tear, or a tear in the anterior cruciate ligament (ACL), as well as tears of the shoulder rotator cuff. Meniscus and rotator cuff tears can now be repaired with minimally invasive arthroscopic surgery and regional anesthesia, which reduce recovery time and pain.

Surgical repairs may require players to stay away from the court for months, and “accept the biologic healing process,” he says.

Meniscus tears that do not require a repair can also be treated arthroscopically to remove the torn tissue. Recovery time is a minimum of six weeks.

When Dr. Gladstone sees patients in their 70s, or older, who want to “maintain physical fitness essentially in perpetuity,” he suggests they be realistic and ratchet down their competitive urges to avoid injury and allow them to continue playing into their 80’s and even 90’s.

Remember, tennis can be, and should be, a lifelong sport!

For more information on "Orthopaedic Surgery" and "Sports Medicine," click here.

Upcoming health tips include: Preventing and healing foot and ankle injuries with Steven Weinfeld, Spine problems that may emerge for tennis players with Andrew Hecht, Shoulder injuries with James Gladstone and Preventing tennis injuries in youth with Alexis Colvin.



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