Most often we hear of a tennis elbow, or sprained ankles as common tennis injuries. However recently during my work with an avid recreational tennis player, we stumbled upon another common, but overlooked tennis injury; it is Spondylolisthesis.
Spondylolisthesis is a spine condition where one vertebra begins slipping forward over another. The slippage is the result of a stress fracture in the bony extensions that interlock the consecutive vertebrae together. Normally the vertebral blocks of the spine are tightly interlocked with bony extensions and ligaments. With spondylolisthesis that structural chain is disrupted and the spine, as a result, can be destabilized.
The degree of slippage varies. It can be minor and may not cause obvious symptoms. But it can progress and lead to severe pain, and compromise to the function of the lower extremities. One problem is that sometimes it is misdiagnosed as a disc or arthritic low back pain. Spine imaging is ultimately needed to confirm the diagnosis of spondylolisthesis. The symptoms associated with this condition are low back pain, which often radiates to the buttock or leg. Although these symptoms sound similar to those associated with a bulging disc, they have unique characteristics that help us distinguish them clinically. Unlike pain with a bulging disc which is made worse by bending or sitting, those associated with spondylolisthesis are exacerbated with extending (arching) of the back, or full rotation of the torso. It is very useful to track which activities tend to flare up or relieve symptoms and relay that information to your doctor.
Why Is It Common With Tennis?
Playing tennis involves big swings with a lot of momentum and torsion, and overhead serves which also require arching and extension near the end of available range of motion. Those large torsion motions can be strenuous to the spine, especially if the form during play is not correct. A lot of coordination between the torso, pelvis and extremities is needed to execute the movement correctly, and if fatigue sets in, then risk of injury is even greater.
What Training Would Help With Injury Prevention?
The neuromuscular control is extremely important in maintaining good movement and minimizing stress on the spine with tennis. Core stability exercises targeted to work in the frontal and transverse planes would be helpful in creating a sport specific program that would help prevent injuries. We want to focus on rotation and lateral motion, or the muscles that control those torso motions. Below are suggested moderate level exercises that would be helpful to include in your core stability training to improve game performance and save your back.
In conclusion, diversify your training, pay very close attention to your form, gage fatigue during play and include core stability exercises that target lateral and torsional stability in your training. And if you suspect an injury, don’t wait, visit your doctor promptly.