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Bouncing ‘Back’


By Melissa Baudo Marchetti, PT, DPT, SCS, MTC

Research shows that about 80 percent of the population will have at least one episode of back pain in their lifetime. Tennis players are at greater risk of sustaining lumber (lower) spine injuries due to the repetitive nature of the sport, as well as the twisting, turning and hyperflexion and extension loads placed on the spine while on the court. Symptoms can range from a dull ache to severe muscle spasms where the back “locks up” to pain radiating down the leg.

Research has shown that up to 54 percent of the force production in tennis is driven from the trunk and lower extremities. So, if you have back pain or a back injury, you will be unable to transfer the ground reaction forces up the kinetic chain through the spine. Without the trunk available to help transfer those forces, you will “muscle” the ball to try to still hit that shot, which causes overuse in the shoulder, elbow and wrist and may lead to injury. In order to avoid developing other injuries, it is imperative to get your back checked out and treated sooner rather than later. In most cases, back pain and low back injuries can be managed conservatively with physical therapy intervention and education on injury prevention.

What Types of Back Injuries Can Tennis Players Have?
Most recreational tennis players will struggle with mechanical low back pain, which means stiffness and tightness in the joints and tissues in the low back, known as the lumbar spine. The primary symptoms include dull ache or sharp pain in the low back, stiffness and tightness in the back when waking in the morning or after prolonged sitting, weakness or instability in the low back and pain with lifting, bending and twisting.

Herniated discs and sciatica are also common in recreational tennis players. A herniated disc occurs when the gel-like center of a spinal disc bulges or ruptures through a weak area in the disc wall and compresses the spinal nerves causing radiating pain down the leg. The intervertebral discs are flat, round cushions that act as shock absorbers between each vertebra in your spine. Each disc has a strong outer ring of fibers called the annulus, and a soft, gel-like center called the nucleus pulposus, which serves as the main shock absorber. In the majority of cases, the disc herniation occurs at the L4-5 or L5-S1 discs in the lumbar spine. The rotation in the trunk that is required on the court for optimal stroke mechanics stresses the disc and can cause a disc injury.

Stress fractures and spondylolisthesis are more rare spinal injuries, but can happen due to the repetitive extension or hyperextension of the spine that occurs during a tennis serve. A stress fracture occurs when the vertebrae take on too much stress often due to overuse. The muscles in the back can become fatigued and can no longer absorb shock effectively and tiny cracks form in the bone. Sometimes, stress fractures can weaken the vertebra so much that it shifts out of its proper position. This condition is known as spondylolisthesis. The bones may press on the nerves, resulting in pain, tingling and numbness. Stress fractures and spondylolisthesis are often seen in youth and collegiate tennis players, but with age and chronic degeneration, we can see spondylolisthesis in the aging recreational tennis player.

What Influences Back Pain?
Poor Stroke Mechanics It is imperative to work with your coach to ensure that you are striking the ball with optimal stroke mechanics and using your legs and trunk properly.

The Core Connection Weakness and muscle imbalance in the core is a major contributor to back pain. The core encompasses the deep transversus abdominis muscle in the abdomen; the smaller, deep muscles along the spine (multifidus); the diaphragm; and your pelvic floor muscles. I also always include the gluteal muscles as part of the core as they are major stabilizers for your pelvis and spine. Hip and core strength is imperative to a healthy back. You can do various exercises to help strengthen your hips and core. If you work with a personal trainer or fitness trainer, they can also add drills that work on loading the legs and hips properly to help develop strength and agility. If you are a new mom or have had any abdominal surgery, including a C-section, restoring the core control is imperative to prevent back injuries. You can seek care from a physical therapist or one who specializes in pelvic health and women’s health.

Just Breathe Abnormal breathing mechanics can contribute to low back pain. Most people don’t realize that the diaphragm is a key component of the deep core. While on court, most recreational tennis players hold their breath as they strike the ball, which can cause abnormal intra-abdominal pressure. This causes you to overuse your neck muscles to help you breathe, which can lead to low back and neck pain. Abnormal breathing mechanics minimize your rib expansion, which can make you feel tight and stiff in your back, neck and chest. Off court, you may sit at a desk or drive carpool without good posture. This limits your rib expansion and diaphragm movement and places abnormal stress on the spine. Breathing takes conscious attention and effort. If you have back pain, you can guarantee that your deep core system and your breathing need some work. Physical therapists can assist you in retraining your breathing mechanics through simple exercises and manual therapy techniques.

Preparation and Recovery Poor warm-up and recovery strategies may contribute to injury risk. If you are a player who leaves the court and grabs your favorite glass of wine or beer after a match, you need to cool down before you throw back a few. If you sit at a desk all day and head to the court without stretching and warming up, your muscles are going to be stiff and tight. Good preparation and recovery doesn’t need to take long to be effective.

What Can We Do to Prevent Back Pain?
Most back pain and injuries can be rehabbed successfully with time, dedication and a physical therapist who understands the demands of tennis.

Dynamic Warm-Up Take at least 10 minutes to warm up before picking up the racquet. A dynamic warm-up may include hip swings, forward and lateral lunges, walking on your toes and heels, high knees and butt kicks. For more information on a proper tennis dynamic warm-up, ask your tennis coach or local physical therapist or visit onetherapy.com for videos.

Cool-down Stretching Stretch all the muscles you used on the court for about 30 seconds per muscle. This won’t take long, so take the extra few minutes after tennis to stretch. Your back will thank you!

Foam Rolling Foam rolling is a great way to stretch and massage your muscles and fascia after you play. I recommend combining this with your stretching. Roll each muscle for about 30 seconds.

Cross Training Cycling, running, Pilates, yoga and strength training are great ways to cross train for tennis, which build strength, maintain good core control and flexibility, and will help reduce your risk of injury.

Red Flags
Some conditions that are more rare can be severe and need to be treated quickly. If you experience any of the following “red flags,” seek care immediately:
• Extreme weakness in both legs
• Bowel or bladder dysfunction
• Numbness and tingling in the rectal and genital areas and the inner thighs

While it may be common for you to have back pain, it is not normal. If you feel pain in your back, I suggest you seek help immediately from a physical therapist.


Dr. Melissa Baudo Marchetti is board-certified sports clinical specialist at One on One Physical Therapy. She teaches a sports physical therapy course and assists in teaching orthopedics within the Division of Physical Therapy at Emory University. Learn more at onetherapy.com.

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