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Adolescents in Tennis – A Few Common Injuries by Nick Wirth

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Working in a high performance tennis academy I see a lot of 12-18 year old aspiring players and as a physio a good deal of the ones I meet are injured. The first thing to think when presented with an adolescent in pain is that they are not just little adults. Teenagers have immature skeletons that make them prone to certain injuries and the demands of sports, such as tennis, present particular physical challenges that can result in specific injuries.


In adolescent tennis I see a lot overuse type injuries. These can occur as a result of rapidly increasing hours of practice/competition or changes in training conditions such as the transition between court surfaces at different times of year. Regardless, tennis is a highly repetitive sport that involves a lot of rapid movements of the entire body, high levels of skill and hand-eye co-ordination plus lots of change of direction and stop/start type activities. With incorrect technique or poor movement control, as is often seen in younger people, the repetitious nature can result in overuse injuries.


In the lower limb two of the typical injuries I see, are Osgood Schlatter’s Disease and Sever’s Disease. Firstly and probably most importantly they are not diseases. Both are grouped under a technical term called ‘traction apophysitis’. Due to differences between the adult and adolescent skeleton, pain and inflammation can occur, at the part of the tendon that attaches to the bone, the ‘apophysis’.


Osgood Schlatter’s Disease is when this occurs at the attachment of the patella tendon to the lower leg and Sever’s Disease occurs where the Achilles’ tendon meets the heel. There are other differential diagnoses so accurate assessment is essential. Often, but not always, imaging such as X-Ray, Ultrasound or MRI is used to fully understand the specific diagnosis and to aid in management of the injury.  If this is required I would arrange for the individual to see a Sports Medicine Consultant or Orthopaedic Consultant.


In the spine not to be missed, is the teenage tennis player complaining of pain in the lower back, at the extreme of twisting or after lots of serving. This can be the tell-tale sign of a stress fracture in the spine called a ‘Pars defect’. These should be confirmed with imaging and referral to a Consultant is often the first course of action by the physiotherapist.


Managing these injuries is firstly down to understanding the problem. Then it is a case of stopping or greatly reducing the offending movement or activity, identifying the movement problems that caused the injury in the first place, then working on a combination of strength, control, co-ordination and stability, followed by a gradual phased return to play. Often I use the down time from tennis to work on the person’s athletic development in other areas, this also helps to deal with the boredom and frustration of not being able to play their favourite sport.


The majority of these injuries recover very well and very few need anything more drastic than accurate assessment and diagnosis, imaging where appropriate, a good plan and plenty of hard work. Adolescence is a key development time both physically and emotionally and dealing with injuries properly and promptly can stop them becoming a problem later in life.


Injury prevention screening can be used to identify possible future injuries and nip them in the bud. Fit players of any age can carry minor problems or have movement faults and these can be identified with physical examination and functional movement testing. Preventative programmes can then be given to reduce the risk of picking up injuries during the long tennis season. I typically screen fit players twice a year or more depending on the level and demands of the individual.