Knee Sports Injuries Tennis

Common Tennis Injuries And How To Avoid Them: Protect Against Jumpers Knee

Tennis is an extremely enjoyable yet physical sport that requires agility, speed, strength, endurance, and coordination to play. Due to the multitude of physical requirements to play tennis, it is no wonder that injuries occur regularly. The most commonly thought of injury is “tennis elbow”, however, tennis can cause injury to many parts of your body including the spine, legs (hip, knee, and ankle), and dominant arm (shoulder, elbow, wrist, and fingers). This is due to the high speed of racket swing, the torque placed on the spine, and the repetitive impact and cutting required for quick court movements. Proper form, conditioning, stretching, and body mechanics are key for injury prevention. With these precautions in place and having an understanding of your body’s limitations, tennis can be a “lifetime” sport played at any age. 

1. Tennis Elbow

examining tennis elbow in patient

How Does It Occur?

Lateral epicondylitis, known widely as tennis elbow occurs as a result of repetitive strain on the tendons joining the forearm muscles to the outside of the elbow. These tendons become inflamed and painful. Tennis elbow is typically caused by overuse and can present as elbow pain, burning on the outside of the elbow, and weak grip strength. The symptoms can worsen with the use of the forearm. 

How Can I Prevent It?

Warm-up and cool down before you practice or play. It is also important to cross-train and condition to prevent injuries. Also making sure to alternate to your nondominant hand and most importantly, honor your body and stop when it hurts. If you are unsure about your form or technique, work with a professional trainer. 

How Is It Treated?

Treatment includes rest, ice, compression, and elevation (RICE), anti-inflammatories (NSAIDs) such as ibuprofen and in some cases bracing. Alternating your grip can help alleviate pain as well.  It is advised that if you have tennis elbow you need to address it immediately to avoid it becoming chronic. 

2. Rotator Cuff Tendonitis/Tears 

How Does It Occur?

Damage to the rotator cuff (the group of muscles, tendons, and ligaments that supports the upper arm around the shoulder joint) often causes significant pain and disability. The rotator cuff is formed by four separate muscles and tendons that come together to support the shoulder and allow for mobility. The rotator cuff tendons can become inflamed, can tear gradually due to overuse, but can also tear due to an acute injury. Rotator cuff injuries often present with pain, tenderness, and weakness in the shoulder, difficulty lifting the arm, and snapping and crackling noises while moving the shoulder. Rotator cuff symptoms are often present in recreational players with improper serving or swing form. 

How Can I Prevent It?

To prevent rotator cuff irritations and injuries it is important to always warm-up and cool down after playing. Utilizing rotator cuff exercises is essential for further injury prevention and rehabilitation. One such exercise you can begin doing is putting your back flat against the wall, forming 90-degree angles with your arms and pressing slowly upward, bringing your thumbs together. This promotes the shuttling of synovial fluids, which lubricate the impinged (pinched) joint. Make sure your serving technique and grip techniques are correct and if you are unsure it is important to get training to improve your form.

How Is It Treated?

Treatment is RICE, activity modification, light exercising of the rotator cuff muscles, and anti-inflammatory drugs. Persistent symptoms or extreme acute symptoms require medical evaluation as tears often require surgery. 

3. Stress Fractures

How Does It Occur?

Stress fractures are small cracks in the bone that are a result of overuse and repetitive impact movements such as running and jumping during tennis. The courts are typically made from asphalt or concrete cured with an acrylic sealant; this material increased the impact on the body. The fractures cause pain, swelling, stiffness, that present slowly and the symptoms will worsen over time. These fractures can occur in several areas including the leg, foot, and lumbar spine (lower back). 

How Can I Prevent It?

Warming up and stretching is always key in injury prevention as well as taking breaks regularly. Listening to your body and not forcing yourself to play through the pain is also important and be sure not to play through pain. When you increase your activity levels, do so slowly and in small increments. Be sure to alternate between low-impact activities like swimming and biking when you plan to participate in high impact activities like tennis.  

How Is It Treated?

Treating a stress fracture is multifaceted but the most important aspect is rest. Avoid the motion/ impact that caused the fracture in the first place to allow the bone time to heal and prevent further injury. If rest and other conservative treatments do not help your pain evaluation by an orthopedic specialist is the next step as more advanced stress fractures may require bracing or immobilization. As fractures exit the acute healing stage, physical therapy can help patients regain strength and stamina.  

4. Ankle Sprain

How Does It Occur?

Tennis is a fast-paced game that requires a lot of multidirectional movement, especially lateral cutting. These abrupt sideways movements lead many tennis players to suffer from ankle sprains by stretching the ligaments too far. Twisting, overextension, changing direction quickly, and catching uneven ground can lead to a sprain. Clay courts provide a softer surface for impact but can pose a greater risk for an ankle sprain. the side of the foot can dig into the surface more easily, resulting in a turned ankle. These injuries lead to loss of range of motion, stiffness, swelling, pain, bruising, and sometimes instability. 

How Can I Prevent It?

When playing tennis it is important to wear supportive footwear with ankle supports that can help prevent sprains. Also, you should be aware of uneven areas of your playing surface that are a pitfall for ankle injuries. As always it is also important to warm up and cool down properly. 

How Is It Treated?

A sprained ankle responds well to rest, bracing, ice and NSAIDs (Nonsteroidal anti-inflammatory drug). An ankle sprain can range from mild to extremely severe and if you suffer an ankle injury  it is important to have it evaluated to make sure you receive proper treatment.

5. Jumper’s Knee

How Does It Occur?

Patellar tendonitis, also known as Jumper’s knee, is an inflammation of the tendon that attaches the patella (kneecap) to the tibia (shin bone). This tendon is responsible for supporting the body on impact and aids in the motion of the leg when walking, jumping, and other movements.  Tennis requires a lot of repetitive jumping which can increase the risk of small tears in the patellar tendon which will lead to tendonitis. This irritation can lead to pain, warmth, and swelling in the front of the knee. Increased activity levels including walking, kneeling, running, ascending and descending stairs. 

How Can I Prevent It?

Avoiding overexertion is the first step in preventing Jumper’s knee and cross-training with non-impact exercises like swimming and biking.  Some players benefit from the use of a brace called achopat strap. 

How Is It Treated?

Like most inflammatory conditions, Jumper’s knee responds well to RICE and NSAIDs. It is important to avoid aggravating activities while the tendon is healing. After the initial pain subsides there are some stretches and strengthening activities that can help prevent a recurrence that can be done at home or in formal physical therapy. If the pain does not respond to conservative treatments or reoccurs it is prudent to follow up with a medical professional. 

How Can I Prevent Tennis Injuries

Tennis is a high impact sport which means cross-training with non-impact activities is imperative in the prevention of injury. Swimming, cycling, and strength-training will all strengthen the muscles and tendons while alleviating some of the excess stress. It is also important to be aware of your body’s limitations and avoid overuse, especially when starting a new sport or progressing your practice. Proper form is integral for tennis players as well due to the high velocity of swings and the unilateral nature of the sport. 

Additionally here are a few more tips to help you avoid injury while playing tennis: 

  • Have The Right Equipment
    • Shoes should be sturdy, lightweight and have proper ankle support 
    • Socks should be well padded 
    • Additional ankle support may be beneficial 
    • Purchase a racquet with the help of a professional to assure weight and size is appropriate 
    • Make sure your grip fits well
    • Make sure your string tension suitable’
    • Ensure your clothing is non-restrictive and not a tripping hazard 
  • Focus on Improving Technique
    • Work with a coach who can make sure your serve, swing, and jumping techniques are safe and effective 
    • Once you have been trained, practice the kinematics of the proper movements 
  • Warm-Up/ Stretch/ Cool Down

Create a routine for yourself with pre and post-game stretches

Continue your cross-training  with non-impact activity and strengthening of the core, shoulder, and spine

Icing problem joints after a workout can help prevent pain and further injury 

  • Take Breaks
    • It is important to allow your body time to recover from impact sports like Tennis, so allow yourself time to reset 
    • If you develop pain, listen to your body and stop playing. Playing through pain can lead to more severe injuries

Knee Minimally Invasive Knee Surgery

What Is Minimally Invasive Knee Surgery

Minimally invasive knee replacement surgery refers to modifications of conventional knee replacement surgery designed to reduce tissue trauma and improve recovery time. Knee replacement surgery is one of the most successful procedures in modern orthopedics. The procedure involves resurfacing the knee joint with biomaterials that substitute for the worn-out bone and cartilage.  Many conditions can lead to the need for knee replacement surgery. The most common causes are:

dr martin examining a knee fracture from xray


  • Osteoarthritis
  • Rheumatoid arthritis
  • Injury
  • Avascular necrosis
  • Knee deformity
  • Gout 

Although modern techniques have allowed conventional knee replacements to last well and improve function, many patients still experience considerable pain and lengthy recovery following surgery. Uncomfortable physical therapy is a particular concern for patients looking to make a quick return to work and activity.  While adults of any age can be considered for knee replacement, most are performed on patients between the ages of 55 and 80. The best results tend to be seen in healthy active patients with few medical problems. 

Surgeons are constantly modifying their technique to improve the results of knee replacement surgery. “Minimally invasive” refers to those techniques that minimize the trauma to the soft tissues and bone around the knee.  Traditionally this meant simply making a smaller skin incision but more recently implant companies have developed specialized instruments that cause less trauma beneath the skin as well. Perhaps the most radical form of “minimally invasive” knee replacement involves modern robotic-assisted procedures where the soft tissues are protected during the cutting of bone by a robotic controlled saw blade.  These modifications to conventional knee replacement surgery are allowing greater numbers of patients to return home within hours of their surgery. 

What Does Conventional or “Traditional“ Knee Replacement Surgery Typically Involve?

  • Large incisions
  • Significant postoperative pain
  • Several day stay in a hospital
  • Postoperative rehabilitation
  • Extensive physical therapy

Patient satisfaction after traditional knee replacement has been described as ranging from 75% to 92%. This means that up to 25% of patients are dissatisfied with their results following surgery.  There are many reasons why patients are dissatisfied after knee replacement surgery but the most common are pain, stiffness, and deformity. The demand for knee replacement is increasing and the average age of patients receiving knee replacement is decreasing.  As people live longer and stay active later in life they put a greater demand on their joints. Modern medicine has responded with technological advances designed to improve the function and longevity of knee replacements.

Another major reason for dissatisfaction after knee replacement is the development of complications associated with the surgery.  Although knee replacement is one of the safest orthopedic procedures performed serious complications can still occur. These can range from skin reactions caused by medications to infection and blood clots.  A person’s overall health should be optimized prior to undergoing surgery to lessen the possibility of complications. Many times a patient’s primary care physician or specialist is consulted to help with this process.  Major advances have been made to our surgical protocols that decrease the risk of complications.  

Benefits Of Minimally Invasive Surgery

One example is outpatient joint replacement.  Healthy patients undergoing “minimally” invasive surgery are usually candidates for returning home the same day as surgery.  This promotes rapid recovery with early walking and decreases the chances of hospital-acquired infection. Many other advances will be discussed in upcoming articles.  

The overall concept of knee replacement surgery is the same for minimally invasive and traditional knee replacement. Biomaterials are used to resurface the worn-out cartilage on the ends of the knee joint.  The most commonly used materials are cobalt chrome, titanium, and polyethylene plastic. The design of the implants is fairly standardized with slight differences between manufacturers. The same implants can be used for either minimally invasive or traditional knee replacement.  It may be best to think of “minimally invasive” and “traditional” knee replacement as different techniques used to perform the same procedure.  

What Should I Expect During Minimally Invasive Knee Surgery?

Knee replacement surgery begins with an incision over the front of the knee. A second lengthwise incision is made beneath the skin going around the kneecap. This allows the surgeon access to the knee joint. In traditional knee replacement surgery, blocks of metal are aligned and fixed to the bone to guide the surgeon as he removes the ends of the bones with a special saw.  Metal implants are then fixed to the ends of the bones with a piece of plastic fixed in between. A plastic button is also sometimes fixed to the underside of the kneecap to complete the joint replacement. The soft tissue incisions are then repaired with suture material and a soft tissue dressing is applied. Patients are encouraged to start walking as soon as possible after surgery.  A physical therapist often helps the patient get out of bed and walk during their stay in the hospital.   dr martin looking at stryker diagram of knee

The major difference between minimally invasive and traditional knee replacement is in the handling of the soft tissues. The same implants still need to be attached to the ends of the bones in the joint but how the soft tissues are handled appears to make a big difference in patient recovery.  Smaller incisions and less soft tissue dissection results in less soft tissue damage which can lead to less inflammation which in turn can lead to less pain and stiffness. However, as with most things there is a trade-off. Sparing soft tissue can lead to better results but it makes the procedure significantly more technically demanding for the surgeon.  A surgeon is typically only as good as what he can see. Making smaller incisions decreases the surgeons ability to see and visualize the joint and increases the potential to make mistakes with implant positioning. Where the implants are fixed on the ends of the bones is probably even more critical to optimal results than minimizing soft tissue damage.

Decreased visualization and the technically demanding nature of minimally invasive surgery are the two biggest disadvantages. The next generation of knee replacement surgery utilizing robotic-assistance promises to minimize or eliminate these drawbacks.  This next generation of minimally invasive knee replacement utilizes software that allows the surgeon to visualize a patient’s joint without physically “seeing” it and helps the surgeon determine the optimal position for the implants. After this is done a robotically controlled sawblade protects the soft tissue surrounding the bones of the knee during cutting.  The precise cutting with the robotic arm ensures accurate placement of the implants. These advances improve results with many patients experiencing less pain and better range of motion following surgery than with traditional knee replacement.