This document summarizes a presentation on common health concerns for tennis players, including musculoskeletal issues, skin care, and hydration. It discusses back pain, shoulder pain, elbow pain, knee pain, foot pain, and skin health. For each issue, it provides statistics, risk factors, prevention strategies like proper technique and cross-training, and guidelines for self-treatment versus seeing a doctor. The overall message is that most minor pains can be self-treated, but serious or persistent issues warrant medical evaluation.

1. A presentation to the New
England USPTA Winter
Conference 01/15/2011
Stephan Esser MD
www.esserhealth.com

2. Skin and Bones
Staying Healthy on the Court
Stephan Esser USPTA, MD
Harvard/Spaulding

3. Intro

4. Topics
• Common Health Concerns
–Musculoskeletal
–Skin Care
–Hydration on Court

6. Learning Points
• Get to know your body
– Basic Anatomy
– What can go wrong
• Know what yo u can do
– Preventing problems
– Basic Treatment
• When to see a doctor

7. Why it Matters?

8. Back
Pain

9. Back Pain Stats
• > 80 % of Americans in a lifetime
• ≈ 30 % at any given time
• 2nd leading reason to see a doctor
• Spending in 2005 = $85.9 billion
• Among Athletes highest rates:
– Football, gymnastics, wrestling etc.

11. 80%
10%

15. Preventing Back Pain
• Maintain healthy Posture
– Awareness
• “Ergonomics”
– Core Strength
– Flexibility & Balance
– Ideal Body Weight
• Muscle Balance
– Weight training
– Cross-Training

17. Ergonomics

18. Core Strength
• Defined
– Abdominals: Rectus, Obliques
– Back Musculature: Extensors
• Function
– Provide spinal stability
– Improve spinal circulation
– Look Good
– Ball defense

19. Flexibility
• Maintain
– Hamstrings
– Quadriceps
– Lower Back
– Upper Back and Shoulders
– Abs

20. Preventing Back Pain
• Cross-Training:
– Challenge “Tissue” in different ways
– Develops complementary muscles
– Engages the nerves and brain
• Maintain Muscle Balance

21. Preventing Back Pain

22. Back Pain
• You can handle it:
– Mid-Low Back pain that improves with rest, ice
NSAID’s and core work
– Pain with a clear cause: eg: Inc. serving, played a
tournament now with some mild LBP
• Self Treating
– 1-5 days of ’d activity: Soft-Brace, Ice, NSAID’s,
maintain light activity (stationary bike)
– 1-3 weeks of intensive core strengthening,
stretching

23. More Stats.
• Back Pain Free
– 50% of people in 1 week
– 75 % of people in 1 month
– 95% of people in 3 months
Regardless of Treatment or no
Treatment

24. Back Pain
• See your Doc’:
– Extreme Pain
– Pain that fails to improve with “conservative”
management in 3-7 days
– Pain with associated symptoms:
• weight loss, fevers, chills, skin rash, night sweats
– Pain with numbness, tingling or weakness
down the legs
– Change in bowel or bladder habits
– Numbness in the groin area

25. Back Pain Wrap-Up
• Back Arthritis and degeneration is a normal
part of aging, but how we experience it varies
• 90% of back pain is “safe pain”
• You CAN do a lot to reduce the intensity,
frequency and duration of back pain
• You CAN manage most back pain on your own
• There are times when you NEED to be
evaluated by a Doc

26. Shoulder Pain

27. Shoulder Pain

28. Shoulder Pain
• Common Causes:
– Muscle Strain
– Bursitis
– “Rotator Cuff” tendinopathy or tear
– Arthritis
– Neck problems

29. Risks
• Age
• Family History
• Overuse/Mis-Use
• Trauma
• Other:
– Diabetes, Liver Problems, Nerve dysfunction

30. Why

31. Preventing Shoulder pain
• Muscle Balance
– Maintain “cuff balance”
– Avoid excess overhead weight-lifting (military
press, delt raises etc)
• Technique
– Serve, Forehand
• Graduated training
• Diet?
• Smoking?

32. Treating Shoulder Pain
• You CAN handle it
– Mild to moderate discomfort in the shoulder after
an increase in training
– Pain that improves in 1-7 days with “conservative”
measures
– Mild chronic pain which you have previously had
diagnosed and is well controlled

33. Treating Shoulder Pain
• Call your “Doc”
– Pain that doesn’t improve with a 1-4 days of
conservative care
– Pain with weakness, numbness or tingling
– Pain with associated neck pain
– Pain with all the “red flags” from back pain section
– Dislocation, persistent clicking, popping, grinding,
swelling, instability

34. What to do?
• Relative Rest: Day: 1-7
• ICE 2-4 x’s/ day
• Maintain Range of Motion
– Pendulums, Wall Walks etc.
• If improving: Band workout: Day 4-14
• +/- 7-10 days of NSAID’s

35. 4 Simple Tests
• Neck ROM
– Pain reproduced, worsened, etc
• Shoulder ROM
• Strength Tests
• Empty Can Test

36. Shoulder Wrap Up
• Maintain Flexibility and Strength
– cuff, shoulder, biceps, triceps
• Avoid Excess Overhead Cross-Training
• Get it Checked out:
– New Pain
– Persistent Pain
– New clicking, popping, catching, grinding,
instability
– With Associated Neck pain, numbness, tingling,
weakness

37. Elbow Pain

38. Elbow Pain

39. Elbow Pain
• Causes:
– Tennis Elbow / Lateral Epicondylitis
– Golfers Elbow / Medial Epicondylitis
– Trauma
– Ligaments
– Nerve Injury/ Arthritis/Gout

40. Risks for Tennis Elbow
• Technique
• Muscle Strength and Balance
• Frequency of Play
• Change
• String Tension
• Racquet Stiffness
• Grip Size

41. Preventing Elbow Pain
• Technique
• Technique
• Technique
• Avoid Sudden Variation:
– Play Frequency / Racquet Width, Weight, Length /
String Type and Tension
• Conditioning
• Flexibility

42. Lateral Epicondylitis
• Treatment
– Modify Technique
– RICE
– NSAIDs
– Stretching and range of motion
– Strengthening
– Adjust Equipment
– Elbow band etc

43. Lateral Epicondylitis
• Non-Responsive:
– Acupuncture
– Cortisone Injections
– Platelet Rich Plasma
– Surgical Debridement

44. Elbow Wrap Up
• Adjust Technique
• Maintain Strength and Flexibility
• RICE etc.
• Modify Equipment
• Visit your Doc if failure to improve

45. Knee Pain

46. Knee Pain

47. Knee Pain
• Common Pre-disposing Factors:
– Genetics, Family History, Obesity, Trauma
– Muscular De-conditioning / Imbalance
• Causes:
– Arthritis
– Cartilage (Meniscal) Injury
– Ligament Injury: ACL, PCL etc
– Muscle Imbalance eg: Patello-femoral Syndrome

48. Knee Pain
• Things you can handle:
– Mild Intermittent Discomfort
– Previously Diagnosed low grade discomfort
• You need a Doc:
– Acute Trauma
– Moderate to Extreme Persistent Pain
– Swelling
– Catching, Popping, Clicking, Locking, Grinding,
Instability without a diagnosis

49. Knee Pain
• Prevention:
– Maximize Muscle Balance
– Maintain Hamstring and Quadricep Flexibility
– Exercise Form
– Balance Work
– Achieve “Ideal Body Weight”
– Diet?

50. Knee Pain
• Treatment:
– RICE
– Strengthening and Muscle Balance
– Guided or personal Physical Therapy Program
– NSAIDs
– Cortisone injections
– Cartilage Supplementation to the joint
– Platelet Rich Plasma
– Surgery

51. Knee Pain Wrap Up
• Maximize Muscle Balance
• Improve and Maintain flexibility
• Follow up with a “Doc” for evaluation of new
or persistent pain, popping, grinding, swelling
or instability
• Staying active does NOT worsen knee arthritis
but may cause pain if you have known arthritis
or other common proble

52. Foot Pain

53. Foot Pain

54. Foot Pain
• Common Causes:
– Trauma
–Ankle Sprains
– Plantar Fasciitis
– Stress Fractures
– Corns
– Bunions

55. Prevention
• Strength and Range of Motion
• Flexibility
• Proprioception / Balance
• Appropriate Equipment
• Diet: Consistent Caloric Consumption
– Vitamin D, Calcium
• Avoid excessive repetitive training

56. Treatment
• Sprains/Strains:
– RICE / Rehab / NSAIDs
• Plantar Fasciitis
– Stretching, Ice Rolling, Tennis Ball Work
– Splinting, Physical Therapy, Cortisone, Surgery

57. Foot Pain
• You can handle it:
– Ankle Sprain you can walk on right away
– Mild discomfort with a known diagnosis
• Time to see a Doc:
– Acute injury with immediate swelling, bruising,
extreme pain, inability to walk
– Persistent pain, swelling, clicking, popping,
grinding or instability
– Numbness, tingling, weakness in the foot

60. Foot Pain Wrap Up
• Maintain leg strength, balance and flexibility
• Appropriate equipment
• Any traumatic event with persistent
symptoms get it checked out
• Remember RICE

62. Skin

63. Skin
• Largest Organ in the body
• Function:
– Protect
– Maintain hydration
– Detoxify
– Thermoregulation
– Activate Vitamin D
– Sex Appeal or Repellent

64. Skin
• What Can go Wrong:
– Sunburn
– Skin Cancer:
• Squamous Cell
• Basal Cell
• Melanoma

65. Quick Stats
• Most common of all cancers
• 1:5 Americans in a lifetime
• Non-Melanoma: 2 million cases/yr
– Inc. of 300% since 1994
• Melanoma: 68, 000 cases /yr

66. Skin

67. Risks
• Unprotected and/or excessive exposure to
ultraviolet (UV) radiation
• Fair complexion/ Family History
• Occupational exposures to chemicals
• History of multiple or atypical moles
• Severe sunburns as a child
• Dietary intake
• Smoking exposure

68. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check

69. Sunscreen
• Broad Spectrum: UVA & UVB
• ≥ SPF 30
• Apply 15-30 minutes before exposure
• Re-apply every 2 hours if sweating/in water
• Don’t Forget:
– Hands, ears, neck, back of legs, lips

70. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check

71. Sun-Protective Clothing

72. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check

73. “Internal” Sunscreen

74. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Monthly Home Skin Check
– Yearly Doctor Skin Check

75. Know your ABCDE’s

76. Skin Wrap Up
• Wear Sunscreen daily
• Wear Sun-Protective Clothing
• Fill up on colorful foods
• Avoid known “cancer causers”
• Do regular skin checks
• Know your ABCDE’s
• Follow up with your Doc’

79. 10-12 cups of
Daily Reccs: water/ day
• Ideal: water, fitness waters, sport beverages,
club soda, mineral water, and flavored water
• Very good: 100% fruit juices, lemonade,
tomato and vegetable juices
• Good: raw fruits and vegetables
• So-so: soft drinks, decaffeinated coffee,
yogurt, skim milk
• Avoid: caffeine and alcoholic beverages
– act as diuretics

80. Hydration
• 80kg male ≈ 48 L of body water
• Lose 0.5-2.5 L H20 per hour of tennis
• 1-2% H20 loss before you feel “thirsty”

81. Sweat
• Constituents:
– H2O
– Sodium
– Chloride
– Potassium
– Magnesium

82. Risks
• HypOhydration
– Impaired heat control
– Altered Immunity
– Kidney dysfunction
•  endurance ≈ 30%

83. Pre-Match
• Water
• Carbohydrates
• Quick Sugars

84. On Court
• Drink 7 to 10 oz of fluid every 10 to 15
minutes and/or every changeover
• Carbohydrate Electrolyte Drink:
– Provides Glucose
– Replenishes Electrolyte Loss
– Enhances Water absorption

85. After Play
• Replenish
–H20
–Carbohydrate Meal
–Electrolytes
–Calories

86. Hydration Wrap-Up
• Prevent Hypo-hydration
– Stay ahead of needs
– Focus on H20 rich beverages and foods
– Avoid foods that dehydrate: Alcohol, Caffeine,
high protein, high fat foods
• Maximize hydration throughout the day/
match
• Re-hydrate post day / end of match

87. Conclusion
• “The first wealth is health” RWE
• There is a lot you can do to stay healthy
– Get to know the basics
– Make a plan
– Make changes when necessary
• Recognize when to seek help
• Some problems need a “team approach”