James Gladstone, MD, an orthopedic sports medicine surgeon at The Mount Sinai Hospital in New York and the Medical Advisor to the U.S. Davis Cup team
After a long and punishing summer hardcourt season, the world’s best tennis players are preparing to descend on Flushing Meadows in New York for a chance to win the US Open. To ensure that players are well cared for throughout the two-week tournament, a team of Mount Sinai doctors and sports medicine experts will be there, using the latest medical advances and technology to provide world-class care for the athletes.
In this Q&A, James Gladstone, MD, Chief of Sports Medicine at the Icahn School of Medicine at Mount Sinai in New York and the Medical Advisor to the U.S. Davis Cup team, explains what it’s like to treat elite athletes during a major championship and what tennis enthusiasts can learn from their favorite player’s preparations for a big tournament.
What kind of medical care does Mount Sinai provide for athletes during the tournament?
We have a really good, comprehensive setup for athletes in which a team of sports medicine specialists are present at any given time. We also have portable X-ray and ultrasound machines for on-the-spot diagnosis.
In addition, within the Mount Sinai Health System, we have every specialty on call at a moment’s notice. If a player has a problem with her eye, we can bring in an ophthalmologist; if someone is having trouble with his throat, we will get an ENT specialist.
What type of injuries are you usually treating?
Mainly we treat acute injuries—something that has just happened on the court, like a twisted ankle or heat exhaustion. For soft tissue injuries, like sprains or strains of the muscle or tendon, the ultrasound can be a great tool. You get a good sense of what is going on quickly.
Unfortunately, players do not have a lot of recovery time. They typically have only a day off between matches. As quickly as possible, you have to figure out how serious the injury is and whether you can get the player back to the tennis court. Is this something for which the player can take pain relievers, apply some heat or ice, do some stretching, and be okay? Or is it more serious? There are definitely cases in which we have to send players for an MRI to get a diagnosis immediately.
Often we see players who have had nagging injuries over the course of a few months. Either they want to be reassured that they are okay and can keep pushing through, or they just played a match or had a practice and the injury is causing more pain than usual.
What additional staff supports the Mount Sinai sports medicine team?
Trainers and physiotherapists are onsite and many of them travel with the men’s and women’s tour. This is a huge asset because, from a medical point of view, the trainers really know the players. For example, if I am treating a player’s injury, the trainer will be able to tell me, “Well, the player was in Germany a few weeks before and had a similar issue and this is how it was treated and it helped a lot.” There is a lot of backup. On top of that, massage therapists are onsite to maintain the player’s muscles and flexibility. Many players will have massage treatments after every match.
What is your experience of being at the US Open? How different is it to treat athletes at the tournament as opposed to in your office?
At the Open, the atmosphere is electric. Early on in the tournament it can be very busy; there is a constant stream of players with minor ailments. This is usually when we will send people to get MRIs if we need immediate answers, as they have the whole tournament ahead of them. The athlete’s physician or the tour physiotherapists can always access those scans and discuss the results with us.
One big difference is that in my office at The Mount Sinai Hospital, I have some additional tools. For example, I use an in-office arthroscope. This device is approximately a fifth as large as the arthroscope used in the operating room. It has a digital camera that is inserted into a joint in the same way an injection is given and provides much of the information that you get in the operating room. In many cases it can take the place of an MRI, and it can be done on the spot in the office. X-rays, MRIs, and ultrasounds have a lot of value, but sometimes it is best to actually see a problem.
I do not bring this device to the US Open. While it is minimally invasive, players have such little time between play. I would not want to take a chance that using the device would cause soreness that would interfere with play.
Finally, as players head to New York from tune-up events throughout North America, what are they doing to prepare for the final Grand Slam event of the season? What can a weekend warrior do to emulate how the pros get ready for a new tournament?
Leading up to the tournament, players will want to maintain their hydration, nutrition, and sleep. They also will work with their trainers to maintain conditioning on three different levels: flexibility, strength, and agility.
For amateur athletes, I stress the importance of this kind of preparation and maintenance. One big difference: Amateur athletes are not travelling or battling jet lag, which adds a whole other component of complexity to their preparation and disruption to their biorhythms.
Alexis Colvin, MD, an orthopedic sports medicine surgeon at The Mount Sinai Hospital
As tennis players, we tend to focus on training and physical maintenance, but often forget an important part of the physical fitness process: the recovery period. Over-training without proper recovery time can lead to poor performance.
Alexis Colvin, MD, Associate Professor of Orthopaedics at the Icahn School of Medicine at Mount Sinai, discusses the proper way to recover from a match. Mount Sinai Health System is the official medical services provider of the United States Tennis Association (USTA) Eastern Section and the US Open.
The Sport Science Committee of the United States Tennis Association (USTA) has tackled the job of outlining the importance of recovery after exercise, sponsoring an extensive evidence-based review of all literature related to tennis-specific recovery in their Recovery in Tennis booklet.
“Recovery is often overlooked and under-valued but it is an essential piece of the puzzle,” says Dr. Colvin.
According to the USTA Sport Science Committee, more than 200 physical and psychological symptoms are connected with overtraining and ineffective recovery.
The major takeaways from the booklet focus on hydration, the psychology of the sport, stretching, and coaching tactics.
“Hydration is so important, not only during the match, but also during recovery,” says Dr. Colvin. Proper nutrition is critical, but especially before, during and after training and/or competition.
Mental aspects of recovery are just as important as the physical ones.
“Without proper recovery, athletes may experience burnout and feel staleness with their sport,” says Dr. Colvin. Symptoms such as increased irritability, anger, exhaustion, or reduced motivation may indicate a stressed mental state. “Take time to check in with yourself after play to make sure you’re still enjoying the activity and not overworking yourself,” says Dr. Colvin.
Stretching is also an invaluable part of the recovery period. Focus on properly stretching the upper back, hip abductors, and muscles of the core. Appropriate stretching reduces muscle stiffness and increases range of motion in the affected area, helping you perform better in your next match.
Coaches can also be helpful to athletes during the recovery period. Remind players to rest well and encourage them to take “rest days.”
“A good night’s sleep is usually between seven to nine hours and provides time to adjust the physical, neurological, immunological and emotional stressors of the day. Some athletes, especially during major growth spurts, may need ten hours or more of sleep,” says Dr. Colvin.
Athletes require one to two rest days per week. Stay moderately active throughout the day, but skip the tennis on your rest day.
Follow these suggestions, and not only will your body recover to help you enjoy your next match, but your spirit will too.
Melissa Leber, MD, FACEP, RDMS, an Assistant Professor of Orthopaedics and Emergency Medicine at the Icahn School of Medicine at Mount Sinai
You’ve probably noticed that many tennis pros are wearing a colorful tape directly on their skin, often in unusual ways and patterns all over their body. It’s not just a fashion statement. In fact, some early studies suggest this tape may provide real benefit to those who wear it correctly and, though we still need more research to say for sure, some amateur players and patients report less pain and more stability.
Melissa Leber, MD, FACEP, RDMS, an Assistant Professor of Orthopaedics and Emergency Medicine at the Icahn School of Medicine at Mount Sinai and Director of Emergency Department Sports Medicine at The Mount Sinai Hospital in New York, explains why you may want to try kinesiology tape. Mount Sinai Health System is the official medical services provider of the United States Tennis Association (USTA) Eastern Section and the US Open.
Kinesiology tape gets its name from kinesiology, which involves the study of physical activity and its impact on health, society, and quality of life. It’s often called kinesio tape or K-tape.
Many tennis players use K-tape to prevent wear and tear, or to relieve shoulder impingement, tennis elbow, or rotator cuff injuries. Serena Williams has used it on both legs to support her knees, while Novak Djokovic has sported it on his knees and elbows.
Kinesio tape is porous, with tiny holes to provide breathability. It has a really strong ability to stick to the skin, so you can leave it on for up to a week at a time. It won’t come off even in the shower. It also has a lot of stretch. Companies make various types of the tape with different stretching abilities.
Where you place the tape depends on your injury or problem. If you are planning to use K-tape, you should consult a physical therapist or trainer. They can show you what type of tape is best for you and how to position it. That depends on the orientation of the injured muscle or joint. Sometimes the tape should be placed in a straight line or on a diagonal in relation to the muscle; other times, it’s placed in a circular fashion around the joint.
K-Tape can help in several different ways. For those undergoing rehab, the tape actually helps to support, stabilize, and take strain off the affected muscle, joint, or bone. It’s a mild but real benefit.
Some of the ways K-tape appears to work are surprising. For instance, if you have a knee injury and wear K-tape, it can help with proprioception—your mind’s ability to tell where your joint is in space. Normally, when you have a knee or ankle injury, you actually lose proprioception to the affected joint. Simply wearing the tape on the affected area reminds your brain that you have an injury there.
K-Tape also can help correct the biomechanics of your movement. The tape directs muscles properly and takes strain off the joint. For knee complaints, you can tape the kneecap toward the center, taking pressure off the joint. Similarly, if you tape your ankle, you’re actually not taping it to restrict movement. You’re taping it to help support the ligaments and tendons.
Part of the appeal of kinesio tape is that it doesn’t have any major side effects or complications. Its only downside can be skin irritation, but that’s very rare. Also, kinesio tape doesn’t encourage you to push yourself beyond your limits. Even though it provides support, you can still feel pain, which is your body’s way of telling you to back off.
One potential drawback: the price. A roll that includes enough K-tape for 10 to 20 applications can cost between $7 and $20. So it can become expensive if you want to use it regularly.
Some health providers are still skeptical about the benefits of kinesio tape. One thing I’ve heard is that people are just using K-tape to look cool by mimicking professional athletes. And you can change the colors, so there is a fashion edge to it.
The bottom line: Early studies are finding that some people who use K-tape have less pain, and I’ve seen excellent results for many of my patients. But we won’t have a consensus in the medical community until we have results from larger studies.
Kelly Hogan, MS, RD, a Clinical Nutrition Coordinator
We all know exercise, stretching, and practice will enhance athletic performance, but proper nutrition is another important piece of the puzzle. Being mindful of your nutrition year-round is essential for good performance.
Kelly Hogan, MS, RD, offers tips on long-term nutrition habits that will enhance your tennis game. Ms. Hogan is a Clinical Nutrition Coordinator at the Dubin Breast Center in the Tisch Cancer Institute at The Mount Sinai Hospital in New York City. Mount Sinai Health System is the official medical services provider of the United States Tennis Association (USTA) Eastern Section and the US Open.
Long-term nutrition focuses largely on a healthy, varied diet, rich in the nutrients that will help fuel long practices, matches, and aide in recovery. Carbohydrates and proteins are two of the most important nutrients to incorporate into your diet.
Although they have a fluctuating reputation in the dietary world these days, carbohydrates are the body’s main source of energy, and thus, should be a tennis player’s best friend. Tennis may not be a typical endurance sport like distance running, but being on the court for several hours requires energy, which leads to the need for higher carbohydrate intake.
“Tennis players should focus on consuming adequate sources of complex carbohydrates both before and after play in order to provide the body with adequate energy and restock glycogen stores used during activity,” advises Ms. Hogan. Complex carbohydrates are commonly found in whole plant foods. Some good examples include sweet potatoes, whole grain bread, green vegetables, and beans. Easily digestible carbs, such as bananas, dried fruits, toast, or oatmeal are a reliable source of energy and great pre-match or practice choices.
As a general rule, players should aim to have a good protein source with every meal and snack. Animal sources of protein like lean chicken breast, fish, turkey, eggs, and low fat dairy are the most efficiently absorbed by the body, but plant-based sources like tofu, nuts, beans and whole grains also work.
But while protein is important, Ms. Hogan warns that the body can’t efficiently absorb large amounts of protein – more than 30g – when consumed at one time. “A common misconception I hear and see among athletes is the belief that they need to consume bars or shakes that are super high in protein in order to boost performance and aid recovery,” says Ms. Hogan. “This isn’t the case.”
Instead, it’s important to eat good protein sources with meals but in normal, appropriate portions. If athletes do that, chances are their bodies are getting enough. Plus, many protein bars, powders, and shakes are made with extremely large amounts of chemicals and sugar, which is reason enough to avoid them!
And don’t forget to eat your fruits and vegetables, obvious staples of a healthy diet.
“These foods are not only high in vitamins and minerals, important for so many of the body’s functions, but are great sources of antioxidants,” which can help reduce oxidative damage and cellular inflammation that occurs in muscles during athletic activity, she says. The benefits of fruits and veggies have far-reaching effects as well: research shows diets high in fruits and vegetables (and antioxidants!) can help lower the risk of chronic disease and some cancers.
Now that we know what to eat to maintain a healthy lifestyle year-round, Ms. Hogan does have some recommendations on things to avoid, the first being sugar-sweetened beverages.
“These usually have no place in one’s diet and can contribute to weight gain, dental caries, and lack any nutritional value,” says Ms. Hogan. Sports drinks usually aren’t necessary unless a player is involved in a long, hot match or practice. “Otherwise,” she says, “I think of sports drinks as I do soda – they can and should be avoided.”
She also suggests avoiding processed foods; basically anything that comes in a package. “Long term, a diet high in fast and/or processed foods can absolutely affect performance.”
If all else fails, think of food as fuel. Healthy eating is like putting gas in a car – you can’t run on empty for very long, and you can’t run well on junk. You only get out what you put in, so choose wisely. Happy (and healthy) eating!
Mary Ann McLaughlin, MD, Associate Professor of Cardiology at the Icahn School of Medicine at Mount Sinai
A recent study in the British Journal of Sports Medicine (BJSM) showed that those who play racquet sports, like tennis, had, as we doctors would say, a marked reduction in allcause mortality and a significant reduction in cardiovascular disease mortality. In other words, playing tennis is great exercise and excellent for your heart health.
The study of 80,306 British adults aged 30-98 used a novel approach to come to this conclusion. It looked at specific sports and their effects on health, controlling for other characteristics or risk factors for heart disease in participants. Among the other sports studied were football, running, swimming, and cycling.
For the pros, tennis has increasingly become a game of strength. But for everyone else, it’s still mostly an aerobic sport. In general, we know that aerobic sports help make the heart become more efficient over time. For example, tennis players condition themselves by doing repetitive short sprints. This trains the heart to be able to speed up and then return to normal quickly. Essentially, while you are practicing your footwork, you are also strengthening your heart rate recovery, which has been shown to reduce mortality.
Aerobic activity is known to improve the ability of the heart to supply oxygen to the rest of the body, decrease fat content in the body, and increase muscle mass—all very important aspects of heart health. We also know that exercise, aerobic exercise in particular, helps to lower and maintain blood pressure. In addition, exercise tends to raise your HDL, the good cholesterol—a previous BJSM study found that racquet sports do a particularly good job in this area.
And don’t underestimate the fun factor of a friendly match. Depression is an oftenignored risk factor for cardiovascular disease. Aerobic activity is good for endorphin release and promoting mental health.
Consider this: The major risk factors for a heart attack are high blood pressure, bad cholesterol, diabetes, obesity, depression, and smoking. When looking at the benefits of tennis, we can say that not only does it cause more efficient heart function; it can address each of these risk factors.
Another important point is that tennis is a virtually ageless sport that many can enjoy well into their 70s or 80s. All you need is one other person, a court, and minimal equipment.
Playing a sport is more important than ever. So many live a sedentary lifestyle, relegating their sporting activity to hours watching television rather than time spent on the court. Tennis presents a fun way to improve your health and, perhaps, improve our nation’s public health by encouraging others to pick up a racquet.
Alexis Colvin, MD, Orthopedic Sports Medicine Surgeon, Chief Medical Officer of the US Open, and Team Physician for the U.S. Fed Cup Team
Ever wonder how the world’s best tennis players make sure they stay fit and healthy? Sure, they have access to personal trainers, nutritionists, and massage therapists that the average player can only dream about. But they also follow some of the same basic rules that will work for you.
Alexis Colvin, MD, an Orthopedic Sports Medicine Surgeon at The Mount Sinai Hospital in New York, is in a unique position to know. She is also the Chief Medical Officer of the US Open and the Team Physician for the U.S. Fed Cup team. For the last five years, she has traveled with the U.S. Fed Cup team. This is also her tenth year treating players at the US Open, leading a team of Mount Sinai doctors and sports medicine experts responsible for caring for players throughout the event.
At Fed Cup matches, she sits courtside for all practices and matches, her medical bag at the ready, in order to attend to the best U.S. women’s players. So she has seen a lot, and she knows that the best players in the world are paying more attention to basic health and fitness as they continue to play at the top of their game well into their 30s.
This unique perspective is one she uses to help her patients, whether young or old, tournament player or novice.
“My philosophy is that you don’t need to be a professional athlete to see a sports doctor. I am going to treat someone no matter what their level because they have a goal. It’s just as important to want to be able to play doubles on the weekend or run the local 5K as it is to win the US Open.”
Here is her tennis fitness checklist:
Cross-Training
It may be more fun to hit forehands and backhands. But you should also work on your strength, your flexibility, and your endurance. There are plenty of complementary activities to choose from, including running, swimming, or exercises in the gym. This is more important than ever with the techniques of the modern game, and also critical for older and younger players alike. You can find some specific suggestions for avoiding injuries on our sports medicine web site.
Rest and Recovery
There are a number of activities that are helpful for recovery after a strenuous outing on the court: everything from massage to stretching to using foam rollers to taking an ice bath. Scientific research papers have been prepared on this topic for the pros. But it doesn’t need to be that complicated if you use common sense. You can find some helpful tips in this booklet from the USTA. One thing to keep in mind: The pros may take one or two days off after matches, but they may cross train on those days.
Diet and nutrition
Tennis can be vigorous exercise that requires plenty of running around, so you should have a plan for pre-match, during match, and post-match nutrition. Most importantly, make sure you drink enough fluids. Plain water is normally enough, but sports drinks can be of some help when you are sweating a lot especially with extended match play. You can learn more from this video on hydration from one of my Mount Sinai colleagues. One more reason to watch what you eat: many lower extremity sports injuries are aggravated if you are not at your ideal weight.
Equipment
You might be surprised how even the smallest things can make a big difference. Make sure that you have the right grip size and that your racquet is strung properly. When weekend players complain about a new injury, their equipment may be partly to blame.
Sunscreen
Make sure you use sunscreen every time you play outside. One of the things you don’t see on the Tennis Channel is that the pros always slather on plenty of sunscreen before walking on the court. You can find more details in this post.
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 Orthopaedic Surgery. Dr. Colvin specializes in the surgical treatment of knee, shoulder, and hip disorders. She has authored numerous scientific publications and has presented both at national and international meetings on sports medicine and orthopaedic surgery.
