Low back Pain, Tennis and Physiotherapy
This article is by Alex Conty the physiotherapist in London at Islington's Angel Wellbeing Clinic
Back pain is probably the most common problem that I see at the clinic in Islington as a physiotherapist. In the UK it is estimated that up to 80% of us will suffer from low back pain in our lifetime. As a physiotherapist in London I see back injuries from patients participating in sports and I see patients with low back pain from poor ergonomics at work. Despite the fact that 80% of the population will get low back pain, thepopulation is not well educated about how physiotherapy can help their back!
The spine is a complicated structure comprising of joints, vertebrae, discs, ligaments, capsules, nerves and muscles which protect the spinal cord and support trunk and allow mobility. As such there are many structures that are susceptible to injury if the muscular stability is not up to scratch.
The other side of the coin is when there is poor spinal stability form the muscles , long hours sitting at a desk and commuting which is a low intensity activity can lead to overloading spinal structures such as the disc and result in low back pain. As a physiotherapist in London low back pain is a condition that I commonly see and sitting at a desk is often a major factor in the cause.
Andy Murray needs to see our physiotherapist!
Andy Murray retired from the Madrid Maters tennis competition a few years ago due to his ongoing intermittent low back pain. Last year he took off a few months for spinal surgery and he has taken a while to get back to full fitness. Tennis players are susceptible to low back pain as large forces put through the lumbar spine during a game. There is plenty of stopping and starting and changing of direction as well as twisting and explosively rotating the torso to get as much power as possible into the ball.
Why do players on the professional tennis circuit suffer with a high volume of spinal injuries and intermittent low back pain when they have access to physiotherapy?
To answer you first need a small understanding of the biomechanics of tennis. When contemplating spinal loads in the different shots in a game of tennis, the serve is understood to place more stress and higher load on the spinal structures than any other stroke.
When the racket moves over head and behind the body the spine flexes laterally and hyperextends. To smash the ball, acceleration of the racket before ball impact is produced by huge muscular forces bringing the trunk into rapid flexion accompanied by a very high velocity rotation (from right rotation to left rotation for a right-hander, vice versa for the left hander). This corkscrewing motion transfers the force of its torque to all the spinal segments. The repetitive trunk hyperextension we see in the tennis serve is understood to be a predisposing mechanism of lumbar arthritis.
Tennis players may also be at an increased risk of lumbar disc injuries due to the shearing effects of the forces from high velocity rotation from a position of lumbar hyperextension to lumbar flexion. This is as true for a professional at the French Open or at Wimbledon as it is for the average club player at the Islington Tennis Centre in London or at London’s Regent’s Park Tennis Centre. Interesting fact, poor posture at work and a loss of the lumbar lordosis when sitting also creates shearing forces for the disc to deal with and this can eventually lead to disc failure and the legendary ‘slipped disc’.
You can now see why Andy Murray isn’t the only pro tennis player to suffer with low back pain. If muscular control and dynamic stabilization around the spine is not up to scratch, injuries will result. Additionally, an individual could potentially have brilliant core dynamic stability, but other factors such as fatigue or poor endurance of the muscles, general poor health, overload of schedule with long hours spent training and the simple fact there are massive repetitions of the same movement or activity can all lead to spinal dysfunction.
Causes of low back pain in tennis players
In my experience of being a physiotherapist with experience of treating tennis related injuries, Low back pain is common. Frequent issues involved with tennis players suffering from low back pain need to be diagnosed with a thorough history and examination to rule out the following:
• Lumbar disc abnormalities
• Muscular strains secondary to under trained or over loaded muscles
• Facet joint pain
• Pars injuries in adolescents including Pars fractures / Pars interarticularis
My experience as a physiotherapist makes me very aware of the importance of the involvement of lower trunk muscles in tennis and indeed many sports. This reinforces the importance on abdominal and lower back exercises in strength and rehabilitation programmes. The strengthening of the lower trunk muscles will not only improve performance in athletes, but weekend warriors and desk workers will benefit from preventing low back injury and pain by improving trunk muscle strength and stability.
If you want to get better you can!
Strength and rehabilitation programs are not exclusively limited to professional athletes such as Andy Murray, who has his own personal physiotherapist – anyone in London suffering an episode of low back pain can come to see me for physiotherapy at Islington’s Angel Wellbeing Clinic. I will work with you to address the cause of your back pain. Most likely cause of the low back pain will be muscular imbalances / deficiency and poor posture. I will then provide a programme to get you back to full fitness as soon as possible and at the same time try and reduce the chance of recurrence.
It is important to keep active, lying on your back for extended periods when you have back pain can cause more stiffness and increase the length that you have low back pain for. Most individuals respond quickly to treatment comprising of manual therapy from a physiotherapist followed by a tailored rehabilitation exercise programme. The long-term outlook is positive if you have low back pain. You do not have to suffer with constant low back pain however physiotherapy treatment for low back pain isn’t a magic wand as I will want you to put in some effort!
So whether or not you are a tennis player and have a bad back or if you are a keen sports person and have episodes of low back pain, it may be time for you to visit our physiotherapist in London and invest your efforts into building core strength and dynamic stability so you can have a happy spine. If you want an appointment with our physiotherapist in London at Islington’s Angel Wellbeing Clinic click below.