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Health & Fitness Mailbag 02/11/2009 - 11:51 AM

Todd Ellenbecker, D.P.T., chairman of the USTA Sport Science Committee and co-author of Complete Conditioning for Tennis, answers your tennis health questions.

CrampsmallI have often experienced painful cramps in my legs, mostly the calf area, while playing. This normally happens during a tournament after three or so matches in the heat. I know that it could be caused by heat and excess sweating, but I drink plenty of Gatorade and water. Is there anything you know about this as far as supplements, stretches and training?—Hassan Rashid

Cramping as you describe it is likely due to an electrolyte imbalance and improper hydration practices. Even though you are drinking Gatorade and water, you may be starting matches dehydrated and not able to keep up with the fluid loss while you’re playing despite your efforts. Some players sweat excessively and really lose a lot of fluid and electrolytes while playing (especially sodium). A physiologist can evaluate you for this to determine if you need to take extra steps to combat this problem.

Some things I would recommend include weighing yourself before and after play in the heat. This will allow you to know how much fluid loss you have encountered while playing and also ensure that you drink enough to regain your pre-match weight ensuring that you replace the fluid you lost before you play the next day. Also, research has shown that many players are dehydrated before they even step out on the court. Monitoring the color of your urine can help as well. If it is yellow or dark colored, you are still dehydrated and need to keep drinking fluids (though if you take supplements, it may never be clear). Gatorade allows you to get extra electrolytes by adding the contents of electrolyte packages to your drink. Stretching is always a good idea but likely will not help if you are cramping due to a fluid imbalance.

What is the best way to build stamina for tennis?—Nicole Ross

By studying physiology in tennis, scientists have shown us that fitness in tennis requires bursts of activity known as anaerobic fitness, as well as aerobic fitness due to the long matches and the repetitive nature of the game. Given that, players need both explosive power and aerobic endurance to be successful. So, for the stamina aspect, you should try to supplement your training with some aerobic training. Research has shown that players with higher levels of aerobic fitness recover better between points. To build your aerobic fitness level, the American College of Sports Medicine recommends you perform steady exercise for periods of 20–30 minutes at least three to four times per week at an intensity of 60–80 percent of your maximum heart rate. To do this you could use a stationary bike, elliptical trainer or Stairmaster and use your heart rate as a guide to get optimal benefit out of our workout. Go here to learn to calculate your target heart rate.

Since you love tennis, you could also try enrolling in a cardio tennis program—any type of sustained exercise as mentioned above would be a great choice. If you have had any types of knee or leg issues, running would be my last choice since the pounding of tennis along with the pounding of running may be an overload in your training.

I partially tore my ACL in February 2008. I’ve seen a couple of ortho docs and some physical therapists and I’m really confused. My knee feels OK now, but it starts to hurt after an hour or so, especially when I serve. But I can still play and move. If I elect to have surgery, which is better for a tennis player? One doctor wants to do a hamstring autograft and the other doctor wants to do a cadaver/allograft. One P.T. I saw said I shouldn't get the surgery because it gives you arthritis in 10 years! He said just play with a brace. So, I’m really confused. Help!—Joe Polito

Injury to the ACL in a tennis player is a significant functional problem. With the weight-bearing, loading and twisting that occurs when you play tennis, not having the surgery in a knee that is unstable can lead to arthritis due to increased translation between the femur bone and tibia. You have done the right thing in consulting with numerous orthopedic surgeons and physical therapists as they can give you the specifics of the surgery and rehabilitation following the procedure.

Recent research following patients for as long as 10 years after surgery has not shown a superior graft choice. Patients using their own tissue (autograft) as well as a cadaver graft (allograft) both can return to function following reconstruction. Failure to have the ACL reconstructed can lead to continued meniscal (cartilage) tears which can lead to accelerated rates of arthritis in the knee.

Regardless of the graft and procedure chosen, a steady course of rehabilitation is required following surgery to retrain the muscles in the lower extremity and core to allow for an optimal result. Unfortunately, there is no best surgery, but by consulting the top sports-medicine physicians in your area and asking them the key questions you have outlined will likely guide you to the best procedure for your specific knee injury. Either way, making sure you regain the strength in your quads and hamstrings will help to stabilize the knee, no matter what you decide.

How can I avoid a bruise on the heel of my hand where the racquet rests? I use a [K] Three Wilson raquet.—Sharon Ortega

This problem is most likely not due to the racquet but rather how you grip it. Each racquet has an enlarged end (butt cap) to keep the hand from sliding downward on the racquet when playing. Having your grip and hand position checked by certified teaching professional is likely the best line of defense for this issue, as your hand might be too far down on the racquet. Additionally, if you have your hand positioned in a grip so increased loads are transmitted to certain parts of the hand, like the bones in your wrist, this may cause more discomfort. Sometimes an overgrip can give additional cushioning to your hand, but I would first consult the teaching professional to be sure your grip is proper and best suited for your game.

I am 53 years old and starting to develop knee pain after playing for 30 minutes, is there a certain type of knee support that would offset the discomfort. I really don’t want to give up tennis, I use it as an encouragement to keep getting in better shape.—Jim Cielma

Without examining your knee is difficult to determine what is best for you as there are many options. Knee supports can consist of simple sleeves with a cut-out around the knee cap to support the kneecap when you play. These can be particularly effective if you don’t have really good quadriceps strength and need that support. If your knee pain is caused by an alignment issue (such as if you are bow-legged), then there are specific braces that can be used to unload your knee and relieve compressive type pain in the knee from early arthritis. The best advice for making sure you have the correct support and exercise program for you ailing knee is to see an orthopaedist to examine the knee and determine the source of the discomfort, then perhaps a physical therapist to get the right exercises. The combination of the right brace and exercise regimen will hopefully keep you out on the courts for a long time to come.

I’m trying to train my sister and get her as fit as possible. I want to do some stuff but I’m not sure if they’re a little bit too extreme for her since she’s only 9. Can you please give me some advice on what things she could do?—Erik Angamarca

At that age, working on basic athletic skills is very helpful. Lifting weights and other typical training methods are not as effective and could be dangerous without the supervision of a trained professional. However, doing general calisthenics and body-weight exercises like squat and lunges, sit-ups and push-ups can be used to tone the muscles and gain coordination. Often, exercises that promote body awareness and balance, such as agility drills and kicking (soccer) can be very helpful for general coordination. Many tennis drills can be used or altered for young players to keep it fun and promote overall athletic fitness at that early age, which can go a long way in a player’s development.

I’m 21 years old, and I haven’t played tennis for six or seven years. I started playing again, but now when I play I feel some pain in my wrist. What kinds of exercises can I do to prevent the pain and to strengthen my wrist?—José Dias

Great question. Since you have taken some time off from tennis, you may not have as much strength in your forearms and wrist as you once had when you were playing more regularly. I would recommend doing some wrist exercises to increase your strength to get you back in playing shape. These would involve using 3–5 pounds (I don’t know how large you are, how strong you are etc, so starting out with just a few pounds would likely be the best choice) and doing wrist curls both with your palm facing upward (flexion curls) as well as palm facing downward (extension curls).

In addition to the curls, you can squeeze a ball, holding for five seconds and repeating 10–15 times per session. The curls can be done moving the weight slowly in an upward and downward direction for 3 sets of 15–20 repetitions. These exercises should not be done right before playing or practicing as it will tire out your muscles before you play. Do these several times a week and in 4–6 weeks your wrists will be stronger.

I am 55 years old and play mostly men’s doubles at a 4.5 level. I have a ruptured disc in the lower lumbar spine area. The pain dictates when I can play and for how long. Should I stop doing what I love, consider surgery or try and live with the pain? I have had decent results with Z-pak steroids (a small dose for 6 days straight). Would this be OK to help me keep playing?—Ron Eddy

Injuries to the spine are common in tennis players of all ages and ability levels. Typically the best treatment for tennis players with back problems is to improve their core stability. The core consists of the muscles of the lower back, abdomen and hips. All players need to have a strong core to perform the rotational movements required in tennis. There are many ways to strengthen the core, and for tennis players, exercises with rotation are most specific to the movements you do in tennis. Using a physio ball adds a lot to the exercise by providing an unstable base, which works muscles of the core even more. Doing sit-ups with rotation, as well as exercises for the lower back such as the superman and pointer exercise can be especially helpful as research has shown that elite tennis players actually have fairly strong abdominal muscles, but have relatively weak low back muscles. Injections and surgery should be resorted to after physical therapy and exercise have not remedied the problem. Go here for a core workout from TENNIS. Adopting a comprehensive core training program would be a great step to playing with greater core strength.


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Posted by Blake 02/11/2009 at 07:53 PM

thanks for all the tips :)

Posted by John 02/12/2009 at 10:11 AM

Sarah, I need your help with cramping and finding a physiologist in my area. Last summer I had a match during a hot/humid day, both my quads started cramping, I'd try playing until both locked up. After that initial cramping, I've had recurring cramping problems, most of the time it's after 2 hours of play. I've done pretty much everything I know, load up on diluted G2 Gatorade and nuun electrolyte drink the day prior to my match. I always drink during the days and still my legs will start to cramp around the 2 hour mark. Do you have any recommendations??? tks

Posted by Joey Z 02/12/2009 at 11:02 AM

Hi Sarah,

I am so glad you are taking questions on the topic of tennis fitness. I have been searching for good content on this topic for the last few days (with little success).

I am 27 and in pretty good shape. I am fast around the court and recover fairly well after long points BUT my stamina needs a lot of work IF i am pushed really hard physically over the course of a long match.

My USTA season starts at the end of May and I really want to aggressively improve my fitness and stamina. Is there any serious training regimin you can point me to?

I want to have the confidence that my legs will be rock solid when the other guys legs feel like jello in the critical last games of a long close match.

Please let me know what you suggest. Thank you so much Sarah...have a great day!


Posted by Marco 02/12/2009 at 05:08 PM

Dear Sarah,

I am 21 years of age and playing with wilson K six tour. The problems i am having at the moment are 1)I always experience medium to strong pain around my left and right triceps and shoulder after most of my games. 2) my lower back seems to be hurting the next day as well. 3) my right ankle is also hurting (i broke my right leg last february but the doctors said it was fine to restart my tennis now)

I would like to receive some of your professional advises.

Many Thanks


Posted by poophead 02/12/2009 at 06:08 PM

these question and answer type things are really helpful, thanks! =)

Posted by Bernie Stang 02/12/2009 at 06:18 PM

Dear Sarah,

Can you explain the degree of difficulty Nadal had in winning against Federer in the Aussie Open Final after his 5 hour marathon match with Vedasco? Was that the equivalent of an Olympic effort? Is a 5 hour tennis match of the calibre played against Verdasco the emotional and physical feat or a marathon? And to repeat it a couple of days later!!! Or, instead of a marathon, is it the equivalent of 500 plus almost record breaking 30 yard sprints? Has anyone ever done pre and post match electolytes? Pre and post match glycogen stores? Are tennis players largely gifted in anaerobic metabolizing? Is that why women's tennis falls so drastically short of men's tennis? Are women less able to get rid of lactic acid? How many calories would Rafa and Verdasco burn in 5 hours? Surely those bananas aren't replacing the proper electolytes. Was Nadal's victory against Federer, after the Verdasco marathon, an Olympic calibre performance?

Cheers, Bernie

Posted by ALex 02/13/2009 at 01:28 PM

Hello Sarah:
I need your help due that I have had suffer of calf strain for three times each calf, since then I have done lots of stretching, but still I feel (sometimes) when im playing the feeling that I can have a new one, which is very frustrating because I have to slow a little bit and also stretch at the middle of the match....although I keep myself very hydrated (gatorate), perhaps Im missing some fluids as you mentioned (sodium), may be this is what I need... let me know how much and how can I have it...
you can email me...
thanks !!

Posted by RP 02/14/2009 at 08:12 PM

Dear Sarah:
I'm 17 but I developed tendonitis in my knees after a torn foot muscle. Whenever I begin to play, my knees begin to sting, expecially the left one, but I eventually just stop feeling it after some time. I'm wearing tendonitis bands and icing them after I play, but I don't know how to get this problem to stop continuing.

Posted by cg 02/15/2009 at 06:26 PM

if im going into the age 14 age group for competitive tennis, but I cant keep up with all the other kids, how do I-or how should I raise my fitness?

Posted by giovano fantin 02/16/2009 at 08:50 AM

Hi Sara,

I have a 13 year old boy, who has 2 to 3 hours a day tennis training.
What should he drink pre-during and after trainig?dosage?
I readed the article about fuel and energy.


Posted by kim 02/16/2009 at 11:36 PM

here is it

Posted by marie 02/17/2009 at 12:35 PM

few more suggestions to cramps etc.
Massotherapy : for those who play tennis on a regular basis no matter what age, a good massage (massage for athletes) every 2 weeks is recommended. 1 hour session. It will relaxes muscles, tendons, rotators,... lower back, neck, name it. I have started massage 2 yrs ago, twice a week the first 6 months and every 3 weeks since and it tremendously helped avoid injuries, cramps, ... it made a major difference on feeling better, sleeping better as well, faster recovery after matches...

Still of utmost importance in hydration : gatorade or... make your own : average proportion : 1 cup water, 1 cup coconut water (not coconut milk!), 1 lemon juice, 1/8 tea spoon salt. Coconut water is full of electrolytes, it is unrefined, unprocessed, 100% vegetal source. Have 1 or 2 Medjul dattes before match, they are delicious and full of energy.

A diet that is more alkaline helps too.

Enjoy Tennis

Posted by Calvin 02/17/2009 at 02:36 PM

I am wondering if the ATP is considering addressing the problems with injuries. Injuries seem to be a growing threat to professional tennis since so many top players are pulling out of tournaments. Couldn't this be avoided with balls that have more pop in them? Didn't they slow down tennis balls?

Posted by zolarafa 02/18/2009 at 11:51 PM

My question is, How does the surface affect the injuries? is this true that hard courts are harder on the body than the natural ones? and why?

Many thanks

Posted by Herpes Simplex 07/03/2009 at 12:24 AM

is this true that hard courts are harder on the body than the natural ones?

Posted by Barbara 07/03/2009 at 01:35 PM

Hi I am 35 and am over wiegth (225lbs) and have a bad back but want to start playing tennis. How do you recomend that I start to go about this in a healthy way.

Posted by daniel dzurnak 07/22/2009 at 04:21 AM

after a hard 2 - 3 hour match, I sometimes find my calves unusually swollen. I prefer Heineken for any post workout glycogen replacement. Is this unusual, or should I look for a liver problem?

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