May 2012

Spring Into Sports - Injury Prevention for Golf and Tennis

Author: Dr. John Batson

It is that time of year in the Lowcountry. The oak leaves are falling, azaleas are blooming and marsh grass is green. As a sport and spine physician, I see a large number of golf and tennis injuries this time of year in patients who have been less active during the winter. In this article we will discuss some of the more common injuries, ways to prevent them and when to seek medical attention.

Golf and tennis elbow. Golfer’s elbow affects the inside (medial aspect) of the elbow, and tennis elbow affects the outside (lateral aspect). In golfer’s elbow the problem usually is a result of poor swing mechanics. It affects the back arm of your swing and is usually a result of excessive hooking the ball or rolling the wrist in the follow through of the swing. Tennis elbow most commonly affects players with a slice backhand and results from excessive wrist extension. An injury may precede the symptoms, but more commonly these conditions are the result of overuse and not trauma. The pain with either condition will be fairly easy to pinpoint on the outside or inside of the elbow. These conditions can be chronic, so it is important to diagnose them early. Treatment usually involves stretching, strengthening and massaging the affected area. These modalities can encourage blood flow to the injured area. Icing after activity may help keep symptoms manageable and allow you to continue to play during rehabilitation. Swing mechanics in golf and equipment modifications in tennis (grip size, string tension, racquet stiffness) are also key to the treatment process. If symptoms persist past two-three weeks, if you notice weakness, or if there is associated numbness/tingling, it is important to seek medical attention.

Shoulder pain. Tennis players, in particular, often struggle with shoulder problems. In most cases, these problems are overuse related and involve the rotator cuff muscles in some capacity. Younger players often have tendonitis. Players over the age of 50 often have varying degrees of small rotator cuff tears. These four muscles help to hold the ball part of the shoulder in the socket. If they are not working properly, the ball can ride up in the socket and bursitis or impingement can occur. The pain from these problems usually occurs when reaching above your head or behind your body. Sleep can be difficult. The pain is usually on the outside of the shoulder and radiates toward the elbow. Treatment involves rest, ice, and sometimes medications such as Advil or Aleve can help. There are excellent physical therapy exercises to help treat these conditions. I encourage patients to continue these exercises after the condition is treated as a means of injury prevention. You should seek medical attention if there was an injury or fall that preceded the pain or if there is any obvious weakness.

Low back pain. One of the most common complaints with tennis players or golfers is low back pain. Both sports place a tremendous stress on the low back due to the repetitive twisting, bending and torque during the swing. In younger patients, the problem is typically a result of an injured disc or the joints in the spine. Older patients often have a combination of degenerative disc disease, spinal stenosis and arthritis of the spine. Treatment involves improving swing mechanics, therapeutic back/core exercises and flexibility exercises. Warming up prior to play can prime the spine for activity. Icing the area after play can help as an anti-inflammatory. If you are having pain during the activity it is important to rest and seek treatment rather that work through the pain. Tennis players may tolerate mini tennis and golfers can often chip and putt during the rehab process. This helps maintain sport-specific muscle use and hand/eye coordination, but does not stress the area. As your symptoms improve, you can gradually play more full-court tennis or move up golf club lengths and take more full swings. Golfers and tennis players should devote some time every week to core strengthening, general fitness and flexibility. Seek medical attention if your back pain persists past two-three weeks. See a spine specialist if you have difficulty with strength, balance, coordination or if you notice sciatica type leg pain, numbness or tingling.

Knee pain. Knee injuries such as sprains or cartilage tears are common in tennis. In golf what I see often is a problem such as underlying arthritis cause symptoms during or after the activity. If there is simply mild pain after the activity, you may be able to rest for a short period, ice the area and perform some basic exercises to help with the problem. If the condition is a simple sprain, tendonitis or mild arthritis your doctor may recommend physical therapy, a knee sleeve and medications to help with the inflammation and pain. As with other conditions, mini tennis or in golf putting and chipping can often be continued during the treatment phase. If the problem is more significant arthritis, various injection therapies and stabilizing braces can help control symptoms. Exercises you learn in therapy to strengthen the quadriceps muscle should be continued as a means of injury prevention. Flexibility in the hip and leg muscles also can assist with injury prevention. Supportive shoes can assist by maintaining proper alignment. If there are symptoms such as clicking, catching or locking, you should seek medical attention. Also, if there is obvious swelling or instability (giving way), you should see a sports medicine physician.

General injury prevention. Whether you are a professional athlete or weekend warrior there are some general concepts that can help with injury prevention. First of all you should be fit before you try to be an athlete. All too often, I see individuals simply skip over the fitness and try to play a sport. This is putting the cart before the horse and asking for an injury. Fitness involves maintaining some aerobic conditioning for the heart and large muscle groups. A reasonable goal is 30 minutes a day of some activity such as walking, biking or swimming. Strength training helps maintain muscle mass so less stress will be placed on the underlying joints and spine. Flexibility protects the muscles from injuries and aides in joint motion. More and more we are seeing athletes incorporate sport specific training and balance training into workouts to help with performance and injury prevention. Certified personal trainers can assist with this type of training. Nutrition is also a key component of injury prevention. Healthy protein (lean meats, fish, nuts, low fat dairy) can aide in muscle development and repair. Healthy carbohydrates (fruits, vegetables, whole grains) give you energy to fuel muscles and keep your brain alert during sports. Fruits and veggies are also high in antioxidants, which help your body repair and recover after exercise. Healthy sources of fat (certain nuts, avocados, cold-water fish) provide energy during more endurance oriented activities. Hydration is critical as we move into warmer months. If you are dehydrated, even a small amount, your performance is impaired and you are more prone to injury. Avoid caffeine or alcohol around the time of sports participation. Proper fitness, healthy nutrition and hydration will also help you maintain a healthy weight. This is very important for back and knee injury prevention.

Golf and tennis can be great lifelong activities. Hopefully the above suggestions will help you not only avoid an injury, but also improve your game.

Dr. John Batson specializes in interventional spine care, adult and pediatric sports medicine and pain medicine. For more information, call (843) 208-2420 or visit Lowcountry Spine and Sport online at

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