Back injuries in junior Tennis players
A study performed on all high performance junior tennis players in England revealed that 85% of the players had changes on MRI scan of their backs. This confirms the high incidence of backache in tennis players and also the strain put on the back of even junior players. Basically all tennis players are at risk.
The causes for backache in growing athletes are different than in skeletally mature athletes and therefore backache in junior players must be approached differently. Young players are especially at risk during their growth spurts when the vertebrae and relative weakness in the core muscles lead to several different injuries to the lumbar spine. All young players should be monitored according to the long term athlete development programs, to prevent these potentially debilitating injuries.
The most common injuries in backs in growing players:
a). Stress fractures of the vertebral rings (pars interarticularis) are very common injuries in tennis players and young cricket fast bowlers. These injuries can be debilitating and, if it is ignored, lead to a permanent weak area in the vertebrae.
b). Scheuerman’s disease affect the vertebral body growth plates and lead to abnormally formed vertebrae. This disease will be asymptomatic when the vertebral growth has stopped.
c). Junior tennis players are also at risk for injury to the discs between the vertebrae (intervertebral disc rupture) which can lead to nerve impingement and debilitating pain.
d). Some unlucky players can develop breaks in vertebral arches due to incomplete bony growth (Spondylolysis and Spondolysthesis).
e). Scoliosis is usually not symptomatic, but should be monitored.
Diagnosis
It is therefore clear that any acute of even chronic backache in young players should be taken seriously. All growing players should stop playing or training immediately and the cause for the backache should be found with X-rays and MRI scans.
Treatment
Prevention
Prevention is always better than cure. Therefore all players, coaches and parents should be aware of basic biomechanics of stroke making and especially the service action in tennis. A well synchronised service action with using "leg drive" and "hip over hip" will protect the back from injuries. Excessive rotation and hyperextension of the lumbar spine during the service action, can also place the back at risk.
Adequate recovery and periodization during the fast growth spurt is essential in preventing these serious injuries. Special care to detail in a core stability program should be part and parcel of all young tennis players training programs.
Pars interarticularis stress fractures
This very common injury in growing tennis players, cricket fast bowlers, high jumpers, pole vaulters and sprinters need to be treated with utmost care. Full recovery take 4-8 months. These young athletes need to be monitored carefully and a too early start can lead recurrence and longer time off from their sport. During the recovery phase a core stability program, careful monitoring by biokineticist supported by proteien and and calcium rich diet with Vit D supplementation is essential to prevend recurrence.
The key to successful return to competitive sport is a gradual built up to match fitness and restriction of strenuous activities where ever possible (like restricting amount of overs that young bowlers are allowed to bowl per week.
Spondylolysis and Spondolysthesis
In the growing athlete spondylolysis can be asymptomatic, but any backaches in growing athletes need to be investigated. Core stability exercises and a change to a less demanding sport is sometimes the only option in these injuries. In severe instability a fusion between lumbar vertebras can allow for a return to sport.