By Richard C. Lehman, M.D., Professional Athletics Orthopedics, LLC
The most frequent ankle injury seen in all levels of tennis players is the common ankle sprain. A sprained ankle involves over-stretching or tearing of one of the ligaments in the ankle and the severity can be minor or major, which also could lead to a fracture in the ankle. Generally, the ankle is inverted or supinated so your foot turns in and this occurs either from landing awkwardly or falling as your ankle rotates. Tennis is a multidirectional sport. The ankle is asked to do many rotational motions, and depending on the court surface, the ankle may not be able to support your body weight causing it to invert or sprain.
Court surfaces are important. Clay courts can pose a great risk because of the instability of the surface. If you sprain your ankle, the immediate treatment should be ice, elevation, and compression. Quite frequently, these injuries resolve in 10 to 12 days and need no further treatment. However, if the ankle sprain is severe — i.e., significant swelling, inability to bear weight, and severe pain — I would recommend seeking medical attention. This could be an emergency room visit, an urgent care visit, or seeing your primary care physician who may refer you to an orthopedic surgeon.
Severe ankle sprains require physical therapy, x-rays, possibly an MRI, and possibly immobilization for a short period of time. In general, the avoidance of ankle sprains is consistent with strengthening, stretching, and being quite aggressive as it relates to exercises prior to playing. This would include stretching exercises, some general strengthening exercises, and an appropriate warmup.
Another common problem we see mostly in older tennis players is Achilles tendinitis. This is much more severe than the common ankle sprain. Achilles tendinitis can be very painful. Generally, it is worse with push-off. Hitting your serve, coming to the net, and back pedaling for an overhead are on-court moves which can be significantly problematic. If injured, you may notice swelling in the Achilles area; you may notice a knot in the Achilles area. In the morning, the Achilles tendon appears to be very stiff, and although it does improve throughout the day, sitting for long periods of time creates further stiffness and more pain. As opposed to an ankle sprain, I would recommend seeking immediate attention if you suspect Achilles tendinitis, either through your primary care physician or orthopedic surgeon. Generally, they will evaluate your Achilles tendon, and an x-ray and potentially an MRI should be ordered.
The initial treatment for Achilles tendinitis is physical therapy and possibly a biologic injection. Biologic injections include platelet-rich plasma or stem cell injections which enhance healing significantly. Physical therapy is important and techniques such as dry needling and manual mobilization of the tendon allow increased blood flow and healing. If physical therapy and biologic injection do not resolve the Achilles issue, surgery may be warranted. With such an injury, the time frame to return to tennis is much longer, generally being two to three months.
Rehabilitation is important and exercises post-surgery should be a long-term approach. You can get more information on our website, uscenterforsportsmedicine.com, and we recommend you checking out our newly released book, “How to R.A.I.S.E. an Athlete: The Formula.”