Though far less known than their counterparts in the main draw, another group of elite tennis players shared the spotlight at the 2018 US Open in New York: the top wheelchair tennis players in the world.
“You don’t have to be an elite player to reap the benefits,” said Dr. Huang, who has worked with a wide variety of patients who have taken up wheelchair tennis as part of their rehabilitation. “Wheelchair tennis is an amazing sport that enables those recovering from a serious injury to socialize and connect with their family and friends. It also helps them rebuild their life after their injury. They don’t allow their injury to define them.”
Another unique benefit of wheelchair tennis is that it allows someone who is in a wheelchair to play on the same court with able bodied friends and family. Plus it is one of the few sports where the world’s best athletes—both those in wheelchairs and able bodied players— gather for international competitions, including the US Open, where wheelchair players are “showcased alongside all of the great able bodied players of our day,” said Jason Harnett, USTA National Manager and Head Coach for Team USA Wheelchair.
In this Q&A, Dr. Huang explains how wheelchair tennis can offer a challenging and exciting outlet while playing an important role in the rehabilitation process, one that can help participants build and sustain a positive outlook on life.
What exactly is wheelchair tennis?
The sport is played by those who have been paralyzed in their legs or have amputations or congenital and degenerative conditions that prevent them from playing regular tennis. It’s pretty much the same as tennis, except the ball can bounce twice on your side before you hit it back. It’s played on all the same surfaces as regular tennis: hardcourt, clay, and even grass. Elite athletes like those competing at the US Open have special wheelchairs, but you don’t need one, and you can play on your neighborhood courts.
How do athletes compete?
Just like tennis. You can play singles or doubles, and there are separate tournaments for men and women. There’s also a new category called Quad. This is for players who have lost the use of their legs and have lost substantial function in at least one upper limb. Some players may tape racquets to their hands or may be allowed to use electric power wheelchairs. Wheelchair tennis is featured at the US Open and the three other Grand Slam events as well as the Paralympic Games, where wheelchair athletes compete in many other sports, including basketball and rugby.
What are some of the benefits of wheelchair tennis?
You have to use your hands to maneuver on the court, as well as your upper body to be able to hit the ball. This allows players to strengthen their arms, build their core strength, and rebuild their fine motor skills, which helps with everyday life functions. Wheelchair tennis challenges them to overcome something that may have initially seem impossible because of their disability. This helps build confidence and self-esteem. Wheelchair tennis also creates bond among persons with spinal cord injury and provides an environment for peer networks in the community. Most important, it’s a great way to have fun and enjoy yourself
How can it help with the recovery process?
When you are in the hospital after a traumatic injury, it can be a very difficult time. You need to learn lots of things about how to manage for the rest of your life. Wheelchair tennis is a vehicle to allow those who are recovering to open their eyes to other activities they can do as long as they set their minds to it.
What are some of the things beginners should know?
First-time wheelchair players should be aware of blisters or calluses due to the heavy use of their hands and the friction that occurs with using the wheelchair. They should also make sure their movements are aligned properly so that they don’t overtax their shoulder, their arms, or their back. And they should listen to their body and not push it too hard, especially in order to avoid more serious injuries.
How does Mount Sinai work with someone interested in wheelchair tennis?
Our Department of Rehabilitation Medicine and Human Performance has a program called Life Challenge which enables individuals with spinal cord injury opportunities to participate in activities that may seem impossible because of their disability. After an acute spinal cord injury, most of the time they come to an acute rehabilitation center like Mount Sinai. They stay for three to six weeks learning about their injury and how to manage it. There is so much to learn and their stay is so short that it makes it difficult for them think about recreational activities. We try to educate and expose these individuals with spinal cord injury as soon as possible about different activities, especially wheelchair tennis since it provides so much benefits. We make sure they are medically able to participate in wheelchair tennis. We will refer them to our spinal cord injury outreach coordinator and connect them with other players and support groups. We will go over the mechanics in order to prevent further injuries. We can also match them up with a mentor and with people with similar backgrounds and injuries.
How did you get involved in this work?
When I was a rehabilitation resident, it was challenging and inspiring to see these individuals with spinal cord injury during their most difficult time and being an integral part of their recovery. I was drawn to this and wanted to help them. It’s pretty amazing what they can overcome.
Michael Hausman, MD, Chief of Hand and Upper Extremity Surgery for the Mount Sinai Health System
The modern power game of tennis has caused more of the top players to be sidelined with wrist injuries in recent years, with Juan Martin del Potro and Kei Nishikori just the latest.
Both players are back to top form, but it did take some time, which underscores how difficult it can be to recover from a serious wrist injury.
Fortunately, most amateur players can recovery more quickly from everyday wrist problems, according to Michael Hausman, MD, Chief of Hand and Upper Extremity Surgery for the Mount Sinai Health System, who has literally written the book on wrist injuries for young tennis players. Mount Sinai Health System is the official medical services provider of the United States Tennis Association (USTA) Eastern Section and the US Open.
In this Q&A, Dr. Hausman explains why wrist injuries are more common and what you can do if your wrist is giving you trouble. In most cases, rest and anti-inflammatory medicines should be enough. Some players may want to consider minor adjustments to their technique and their equipment.
Why are we seeing more wrist injuries these days?
Dr. Hausman: The biggest reason why this is very common now is that players are hitting the ball with lots of topspin. That involves rotating your forearm violently as you come over the ball. You are not only rotating your forearm, but you are also turning your wrist so that your thumb begins by pointing to the right (for a right-hander) and ends up pointing to the left. Your wrist can get quite a workout, which puts pressure on the tendon. It’s the same for both forehand and backhand. But wrist troubles are not a necessary part of the game. For amateur players, wrist injuries are most often the result of overuse or poor technique. In some cases, I see wrist injuries from a fall.
What should I do if I am feeling pain in my wrist?
Dr. Hausman: The first thing you should do is take a break from playing. I also suggest taking anti-inflammatory medications, such as ibuprofen (Advil or Motrin), which are a class of medicines called NSAIDs (nonsteroidal anti-inflammatory drugs). In many cases, the pain will go away in about a week. For more than three-quarters of my patients, this is enough. However, if the pain persists, you can talk with your doctor. The doctor may order an MRI to assess the extent of the problem and determine whether the tendon is inflamed or whether there has been some damage. You should also make sure you’re not hurting your wrist by hitting the ball improperly. You may want to try hitting with less topspin or talk to a tennis pro for other suggestions about your technique. Some players like using wrist braces, though I have not seen much benefit.
Is surgery an option?
Dr. Hausman: In my experience, surgery is rarely required. If your tendon is inflamed, a cortisone shot is generally enough. Surgery might be required if there is significant damage to the tendon and the pain is bothering you. The operation has a very high rate of success. But it can take up to four months before you can return to playing, and even longer until you are back to normal.
What about changing my racquet or strings?
Dr. Hausman: In recent years, there have been significant changes in racquet design and strings. If you are having trouble with your wrist, you may want to try different racquets and experiment with your strings to see if that makes a difference. For example, some players are choosing “closed” string patterns (ones with more strings that form a tighter pattern with smaller openings). They tend to offer more control than more “open” string patterns (ones with fewer strings and larger openings between strings). However, a closed string pattern can be stiffer and can transmit more force to your arm and wrist. Some manufacturers are advertising strings that are easier on your arm, and the tension you use to string your racquets can also make a difference.
Michael Hausman, MD, is the Robert K. Lippmann Professor of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai, Vice-Chair of the Department of Orthopedics at Mount Sinai, and Chief of Hand and Upper Extremity Surgery for the Mount Sinai Health System. He is an internationally recognized surgeon who treats disorders of the hand, elbow, shoulder and peripheral nerves (the nerves that connect the brain to the rest of your body). He has devised new treatments for conditions of the wrist and reconstruction of injured peripheral nerves as well as common conditions, such as tennis elbow. He has published more than 100 articles about these treatments and his research.
Eliana Cardozo, DO, Medical Director of the Women’s Health Program at the Mount Sinai Rehabilitation Center
One of the biggest stories in tennis these days is not about the ongoing rivalries among top players, but about Serena Williams’s struggle to return to top form after delivering her first child last year.
Rule number one: Be sure to take your time and consult with your obstetrician-gynecologist and other medical specialists before returning to tennis or any strenuous exercise, Dr. Cardozo says. Beyond that, there are a number of steps you can take to ease your way back, and there are specialists available to help who understand that properly returning to a sporting life can boost your overall health and well-being.
Dr. Cardozo, an Assistant Professor of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, has a wealth of experience to drawn upon, including having just had her own first child.
“I have always been a very active person. Being able to feel first-hand how your body changes in the prenatal and postpartum period gave me more insight and an even greater appreciation for what my patients are going through,” she says.
Dr. Cardozo offers some other insights in this Q&A.
How soon can a woman return to playing tennis after childbirth?
For an uncomplicated delivery, a woman can usually start light physical activity, such as walking, a few days after birth, beginning gradually with short walks and progressing to longer, more brisk walks. After that, we recommend starting a general core and pelvic strengthening program. Then, before getting back on the court, you will need specific clearance from your Ob-Gyn. The average time for patients I see returning to rigorous sports is about six to eight weeks after delivery, but it can take ten weeks or more, it really depends on each individual situation. Some women may even be able to return to playing in as little as four weeks after childbirth, it really depends. If you were very active and playing tennis before and during your pregnancy, you will probably have an easier time getting back on the court.
How do you know if you’re ready?
It is important to be patient and have respect for the recovery process. I tell everyone the same thing: Start slowly with physical activity and gradually increase. If there is any pain, or if something feels like too much, scale it down. You need to listen to your body.
What if I’ve had a caesarean birth?
A C-section is major abdominal surgery, therefore the recovery process is longer. We recommend starting with a light exercise program about six to eight weeks after delivery, although you can generally start a walking program prior to that. Depending on the individual, there may be other things to take into account, such as any issues with the incision healing or infections. Our general guidance is to start slowly and gradually, and build up your level of activity.
Why are strengthening exercises so important?
Both pregnancy and childbirth are huge events that produce many different changes to the body, including hormonal fluctuations and changes to your muscles and joints. This can increase “joint laxity,” which translates into looser joints, making us more susceptible to certain injuries. We recommend a series of progressive exercises, particularly for the core and pelvis. Depending on the situation, it may be ideal to start a program under the guidance of a rehabilitation physician and physical therapist. The exercises can be pretty basic. I normally give my patients simple, printed handouts to start. You can also get a number of helpful tips from the American College of Obstetricians and Gynecologists.
Why see a rehabilitation specialist?
There are many options available to women, including personal trainers and others with special certifications. We suggest you work with a rehabilitation doctor with experience in this area. They are able to provide you with a detailed plan for your condition and a tailored physical therapy prescription addressing your specific needs, after they conduct a thorough history and physical examination. Your physician can also direct you to a physical therapist with experience in treating postpartum patients. Typically a physical therapist will report back to your doctor regularly, and the patient will return to the physician after four to six weeks of therapy. One important point is that the physical therapist will be creating and teaching you a home exercise program, so that when you are done with your therapy you can continue the exercises on your own. We’ve had great results with our program. It’s no wonder that in many European countries, it’s much more common for new mothers to start a core and pelvic strengthening program after childbirth.
What are some of the biggest problems you see among your patients?
Many of my patients complain about pain in their upper back from carrying the baby, but most of what I see is low back pain. We can prescribe medication—usually anti-inflammatories—if the pain is intense. Or we may instead use topical medications, especially if the mother is breast-feeding. Some women have the misconception that it’s normal to experience pain for a long time postpartum and that they should “just deal with it”. But that’s not the case. There are many things we can do to help healing and expedite recovery.
What do you say to those who are pushing to get back out there as soon as possible?
Some women are eager to get back to vigorous exercise. We work with them because exercise can be a very important outlet, and studies show it can help boost your mood, which is very important during the postpartum period. But we need to be careful and avoid injuries, such as avoiding an overly aggressive abdominal exercise program that can put excessive pressure on the muscles in the abdomen and cause injury.
When will I be back to normal?
I get that question a lot. Your body is undergoing tremendous changes during the postpartum period, and some of that relates to whether you are breast-feeding. Around six weeks after delivery, there is normally a big shift when tissues have significantly healed. But you won’t be back to a “new” normal until eight to twelve weeks postpartum, assuming there were no complications during birth.
Calin Moucha, MD, Chief of Adult Reconstruction and Joint Replacement Surgery at The Mount Sinai Hospital
With all its running and twisting, tennis can sometimes place great strain on the hip joints of amateurs and professionals alike. Rafael Nadal and Andy Murray are just the latest top players who have had to deal with serious hip problems.
Many players believe they may need to play through the pain of a persistent hip problem. But doctors are often recommending they consider hip surgery earlier for better recovery. When arthritis is the cause of pain and disability, a successful hip replacement can allow many to get back on the court and play with exceptional results. New surgical techniques and implants are making this process quicker, easier, and safer.
The vast majority of hip replacements are done to treat arthritis, a degeneration of the cartilage that serves as a cushion between the bones that meet in the hip joint. Wear and tear is part of the problem, but so is genetics. Some people are predisposed to have a biochemical imbalance in the cartilage that accelerates its breakdown. Others are born with abnormal hip bony anatomy that may predispose them to arthritis. One thing to keep in mind: You probably will feel the pain associated with hip arthritis in your groin, thigh, and knee, rather than the side where many people think their hip is located.
What if I think I’m too young for hip replacement?
Increasingly, reconstructive surgeons are finding that younger patients are electing to have hip replacement surgery so they can stay active. In my practice, I have seen a 15 percent increase of patients under the age of 60 who are having their hips or knees replaced.
Not that long ago, we would have told these patients to hold off on surgery until they were in much more pain and until their activity was much more limited. But our approach has shifted: waiting isn’t always the best thing. During that time, the arthritis progresses and muscles atrophy. As a result, patients start the rehabilitation process with a lower functional level, which makes recovery harder and longer. Together, all of those factors diminish the final outcome.
Our new attitude toward hip replacement is that if you’re an active tennis player in your mid-40s and you’re having arthritis-related symptoms, you might be better off having your hip replaced now instead of waiting until muscles atrophy and range of motion diminishes.
Why is minimally invasive surgery so important?
At this point, hip replacement can be done with minimally invasive surgery. The surgery entails removing the arthritic portion of the hip joint and replacing it with an implant. Most surgeons use cementless implants made of a combination of titanium, ceramic, and plastic. Evidence suggests that this combination is the safest, most long-lasting choice. Thanks to technological and surgical advances, there is very little muscle cutting involved in hip replacement, which is crucial to the recovery process.
How soon can I get back on the courts?
I tell my patients they can be back playing singles in three months. But that depends on whether they’ve reached targeted goals throughout the recovery process. Most patients stay one or two nights in the hospital and many are ready to go home the same day – every case is different and every patient is treated with a hands-on personalized approach. I expect my patients to be walking close to a mile a day within three weeks. Some people request regimented physical therapy, which can help, but the most important thing is really just walking.
Anything else I should know?
Hip replacement surgery is a highly successful procedure, truly one of the marvels of modern medicine. It can provide pain relief, improve functionality, and give you a long-lasting, working hip. But like any surgery, it’s not risk-free, and potential complications include infection, dislocation, fracture, leg-length discrepancy and neurovascular injury. So, while the overall complication rate is less than 1 percent, this is still a surgical procedure that shouldn’t be undertaken lightly. I create life-long relationships with my patients as I continue to follow their progress with check-ups every 2-3 years.
If arthritis is interfering with your quality of life and you’re considering hip replacement surgery, the most important thing is to talk with an experienced surgeon. The surgeon should know how to deal with any complications, and which surgical approach is best for you. Hip replacement is life-changing surgery. And especially for tennis players, it can allow you to continue following your passion and playing the sport you love.
Calin Moucha, MD, is a board certified, fellowship-trained hip and knee replacement surgeon and the Chief of Adult Reconstruction and Joint Replacement Surgery at The Mount Sinai Hospital. He is also an Associate Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai.
Sheldon Simon, MD, Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai
Injuries continue to be a big issue in tennis, as shown most recently by the surprising number of top players who were forced to withdraw from the year’s first major, the Australian Open. Some parents whose kids are just learning the game may be wondering about the chances an injury could sideline their child.
We’ve all seen those young superstars, the ones smashing the ball with a racquet that seems almost bigger than they are and who seem completely comfortable on the court. That’s by far the exception rather than the rule.
Most young tennis players have a lot to learn, and they are still growing and gaining strength, which means they are especially susceptible to injuries, in particular those caused by overuse. Also, more and more kids are specializing in one sport at an early age, which means far less cross-training and more stress on specific areas of the body.
One of the unique things about tennis is how much you repeatedly use some of the more vulnerable parts of your body, notably your wrist, elbow, and shoulder. It’s not hard to develop an irritation at these critical points, especially if you’re still learning a complex technique, and when being just slightly off can mean the difference between a clean stroke and an off-center hit that causes plenty of vibration and stress.
Those repetitive strains can lead to wrist sprains and a form of tendonitis better known as tennis elbow. In more severe cases, this can lead to stress fractures. Stress fractures are tiny cracks in the bone caused by repetitive motion or overuse. Stress fractures may cause a persistent pain that may seem like a sprain but that can persist for as much as eight to ten weeks. In cases like this, it’s best to see a doctor; your child may need a cast for the injury to heal properly.
In this regard, tennis is very different from other non-contact sports like basketball and baseball, which place very different demands on a young body. The racquet that allows young players to apply quite a force to the ball can also magnify the impact of that force on the weakest links in the body if the ball is not struck properly.
Young people learning tennis may also be more likely to get injured because they don’t yet have the feel for the game, which can leave them lunging around the court, resulting in sideways movements that can lead to twisting of the ankle and ankle sprains.
What’s more, adults and experienced players generally know when to call it quits. Not so with some young kids. The most important thing for anyone to do if they are experiencing pain on the tennis court is to stop and listen to their body when it says they’ve had enough. Young people, though, can be pretty stubborn—especially if they are trying to keep up with other kids who may have had lots more instruction and practice—and they may end up straining themselves.
Parents need to be aware if their young star is having some pain or stiffness, and then reduce the amount of play until the problem begins to recede. At this early stage, I don’t suggest much in the way of medication; ice afterwards is best. Once they are ready to return to playing, try reducing the time of play and gradually increase it day by day. If the discomfort doesn’t go away in a few days, you may want to talk with your doctor.
Even if your child isn’t planning to play college tennis and turn pro, tennis is terrific exercise and a great lifetime sport. So make sure your young players don’t overdo it, and if they do once in a while, be sure to take a break and talk with your doctor if the problems don’t go away quickly.
Alexis Colvin, MD, an orthopedic sports medicine surgeon at The Mount Sinai Hospital
The tennis world was delighted by the appearance of Serena Williams at the French Open following her return from maternity leave in March. But the 23-time Grand Slam champion was forced to withdraw before her fourth-round singles match.
In announcing her withdrawal, Williams cited a right pectoral muscle injury that prevented her from blasting her trademark serves, among the fastest in the women’s game. Tennis fans wondered whether this injury could delay her return to the top of the game. Fortunately, the injury was not a season-ender, and it can be treated by taking time off to rest.
For many fans, this may have been the first time they heard about this type of injury. Indeed, Williams herself said she had never experienced this problem.
In this Q&A, Alexis Colvin, MD, an orthopedic sports medicine surgeon at The Mount Sinai Hospital in New York and the U.S. Fed Cup team physician, explains the injury and how you can guard against it. Dr. Colvin will be in her tenth year treating players at the US Open this year and leads a team of Mount Sinai doctors and sports medicine experts responsible for caring for players throughout the event.
What are common signs of a pectoral muscle injury?
The pectoral muscles are large, fan-shaped muscles that extend from each shoulder to your breastbone. You probably know them as your “pecs.” They are primarily used to control arm movement. Signs of injury to the area include arm or shoulder pain and weakness. Swelling and bruising may also occur if there is a muscle tear.
How does this injury happen?
When playing tennis, you are activating the “kinetic chain.” When you hit a ball, you transfer energy from your legs to your torso, through your shoulder, down the arm, and through to the racquet. Any disruption or weakness along this chain can overload another part of the chain and potentially lead to injury.
Is this an injury you can play through?
With any injury, it is never wise to play through pain. The pain may be severe enough that your body will force you to stop. Alternatively, sometimes you are still able to play through the pain, but other body parts will compensate for the injured part and you could cause further injury.
If you think you have an injury, when should you see a doctor?
You should see a doctor sooner rather than later if there was trauma or an injury, or if you experience swelling, weakness, loss of motion, and/or numbness or tingling.
Otherwise, whether you need to see a doctor depends on the progression of the pain. If the pain diminishes within a day or so, then you probably don’t need to see a doctor right away. Normally, Rest, Ice, Compression, Elevation (RICE) will be enough. If not, and the pain has not diminished within 24 to 48 hours, you should see a doctor.
What is the treatment for this type of injury and what steps should a player take during recovery?
RICE will be important initially. Afterward, physical therapy will help to gradually get pain-free motion back to the area and to strengthen the muscles around the injury. Then you can begin work on getting back to the sport.
With a muscle injury, you should be able to continue using the body part within a pain-free range. There is no need to shut down all activity; instead, work around the injury. For example, when recovering from a shoulder issue, you can work on lower body exercises and vice versa.
What can a player do to prevent the reoccurrence of this type of injury?
The best form of prevention is cross-training. This type of training works by exercising alternating muscle groups. It also ensures that your body is balanced and complementary muscles are strong. There are plenty of activities to choose from, including running, swimming, or exercises in the gym. You can find some additional information on our sports medicine web site.
Alexis Colvin, MD, is an Associate Professor of Sports Medicine at the Icahn School of Medicine at Mount Sinai in the Leni and Peter W. May Department of Orthopedic Surgery. Dr. Colvin specializes in the surgical treatment of knee, shoulder, and hip disorders. She is the Chief Medical Officer of the US Open and the team physician for the US Fed Cup team.
