I treat a lot of the top Seniors level (35+) tennis players in British Columbia, many of whom compete in the national and world championships every year.  These are not professional athletes, but very active adults with full time jobs that work hard and play harder.  The combination of work + age + sport inevitably results in aches, pains and unfortunately injuries.

The top five things that tend to bring tennis players into the physio for servicing are:1.  Tennis Elbow2.  Rotator Cuff Impingement3.  Knee Pain4.  Torn Calf/Achilles5.  Low Back Pain

Below I will briefly touch on some of the principles you should follow in dealing with these injuries as they relate to tennis, age and work.

‍Tennis Elbow

‍Lateral elbow pain does not necessarily follow the "if it hurts, ice it" rule.  Nine times out of ten the root cause of lateral elbow pain stems from your neck and the back of your shoulder.  It is usually an irritation of your C6 nerve root in your neck and the radial nerve in your arm...that being said, if your elbow is hot, red and swollen, go ahead and ice it, but don't expect just ice and rest to fix the problem.  Hands down the best way to fix tennis elbow is to go for IMS acupuncture to calm down the nerve irritation.  Once the arm feels better have a physio teach you how to move more efficiently so your swing doesn't create too much strain on your neck and shoulder.  You may also need a tennis pro to adjust your technique and/or your racquet.

Suggested articles:

‍Elbow Pain: why it can last so long & how to fix it properly

‍Why Elbows Hurt

‍Rotator Cuff Impingement

‍Most shoulder pains are some form of an impingement (which implies a pinching of one or more of the tendons of your rotator cuff).  The rotator cuff is not one structure, but four muscles that all work to help hold the ball in the socket (watch this video for Basic Anatomy).  You can manage to either acutely pinch your rotator cuff or gradually rub and wear it until it decides to scream at you.  Once you have annoyed these tendons, they will get inflamed and can create very sharp pains in your shoulder with reaching movements.  The pinching is most painful with your arm lifted to 90 degrees or completely above your head.  It can be from moderately annoying to excruciatingly painful.  This is one you want to start by icing!  If you can pinpoint the pain with your finger and are getting a sharp pinch every time you lift your arm, ICE IT for 15mins every hour you can for 3 days and take some Advil.  Once it calms down, know that you have treated the symptom and not the cause of your shoulder pain.  The root cause is typically tension in the muscles around your shoulder blade and immobility of some of your ribs.  You should see a physio for some IMS acupuncture and manipulation torestore the movement then work on shoulder control and flexibility exercises.

Suggested articles/videos:

‍Why Shoulders Hurt (explanatory video)

‍Reaching up 11(exercise video)

‍Air Bench Press (exercise video)

‍Counter top Push ups (exercise video)

‍Lat Stretch (exercise video)

‍Knee Pain

‍I have heard countless tennis players complain that knees were just designed poorly.  They are actually designed really well, they are just at the mercy of your hips and your ankles.  Your knee is a big hinge joint built to flex and extend while your hips and ankles are built to twist and roll.  When your feet get weak and your hips tighten up, your knees are left in a very vulnerable position.  Tennis requires a lot of court mobility with planting, pushing off and changing directions.  Acutely these plant and twist movements can result in a tear of the meniscus (See Basic Knee Anatomy) or more chronically can lead to patellofemoral syndrome or even osteoarthritis.  If you have torn your meniscus, you would benefit from seeing a physio, but in the long run will likely need surgery to fix it.  If your pain is more of a wear and tear problem, you likely need a physio to free up the deep muscles in your hips, check your alignment and help you strengthen your feet.  You would be amazed how much better you can move around the court after having IMS on your hips and legs (even with an arthritic knee).

Suggested videos/articles:

‍Why Knees Hurt (explanatory video)

‍What is IMS? (article

)WTH Step 1: a video progression of movement retraining

‍Torn Calf/Achilles

‍Back pedaling on the court is the best way to strain your calves.  A quick step back and change direction puts a lot of force on your calves and Achilles….which under normal circumstances they should be able to sustain.  However, if your low back and hips are quite tight, you likely have a moderate amount of annoyance happening to your sciatic nerve (it is the electrical wiring to most of the muscles down the back of your leg).  Ongoing irritation of your sciatic nerve will create subtle muscle knots and bands of tension in your hamstrings and calves that make the muscles less flexible and less tolerate of sudden stretching forces.  The combination of back and hip tension in an active aging tennis players makes calf strains a very common occurrence particularly in men.  It is the same mechanism of injury for a moderate muscle tear and a full blown Achilles tendon rupture.  The calf strain may lay you up for 2-6 weeks while the Achilles rupture can keep you out for a year.  It should be good motivation to keep your hips loose.  Again the best way to treat these strains is IMS acupuncture in the back, hips and calves.  Once the pain has calmed down, it is important to learn how to squat, move laterally and push off again (properly this time).

Suggested videos/articles:

‍Why Ankles Hurt (explanatory video)

‍Why Hips Hurt (explanatory video)

‍What is IMS? (article)

‍WTH Step 1: a video progression of movement retraining

‍Low Back Pain

‍Low back pain in tennis players is typically due to compression and torsion.  Your low back is built to flex and extend and just like your knees it hates twisting, rotational forces on it.  Your lumbar spine is sandwiched between your hips (built to rotate) and your thoracic spine (built to rotate).  The flexibility and control of your trunk and your hips will dictate how much or how little back pain you experience.  Court agility and power should come from how well you load your hips and how well you stabilize your trunk.  If you are either too stiff or too mobile in either area your back will get beat up on.  Going through a process of release, re-educate, rebuild, can help eliminate most back problems.  Release the tight structures that are causing the pain (IMS and manipulation), teach you how to move properly in your hips and trunk, then work on creating strength in your new movements.

Suggested videos/articles:

‍Why Low Backs Hurt

‍WTH Step 1: a video progression of movement retraining

‍What is IMS? (article)I hope this helps answer some questions.  I just touched on each topic in this post.  Please look at the suggested links for further detail in each area.  If you have any questions/comments, please leave them below.

If you are in Vancouver and would like to see me, please visit my clinic website EnvisionPhysio.com for contact details and location.