The delights of summer offer a good opportunity to take our sedentary winter bodies into exercise activities which may be too much and too fast. Swimming and tennis, for example both marvelous sport activities have the opportunity to sabotage the unwary.
In swimming, the shoulder is most often affected especially those involved in competitive summer leagues. Older recreational lap swimmers in addition to the shoulder, may find problems if underlying neck and back arthritis is present especially if distances are increased too rapidly. In the shoulder, the Rotator Cuff tendon is often the problem usually associated with looseness in the shoulder ligaments. Although rest for 3 days and an anti-inflammatory medication such as Ibuprofen might buy temporary comfort, gradual rehabilitation strengthening exercises especially to the muscles about the shoulder blade, and neck are key to proper return to summer swimming activities.
The return to lap swimming should be gradual and stroke variation is important. For competitive swimmers having a coach analyze stroke techniques such as breathing patterns, elbow elevation, and pull through angles is quite important. Also intensity and frequency of training must be monitored and teaching devices such as pull buoys which increase shoulder punishment should be avoided.
In tennis, the shoulder is affected in a somewhat similar manner to swimming. Tennis elbow is of course very common and often is associated with rotator cuff problems. To help prevent or control shoulder problems the tennis serve should have high elevation at ball impact. Also fairly common in the adult recreational tennis group are aggravation of neck and back arthritis. Poor ball toss on serve aggravates this situation.
In both recreational and competitive tennis players, knee and ankle injuries, muscle pulls, and foot problems are common. The underlying message in all these situations is to seek out weak and inflexible body parts. Once these deficits are diagnosed it is important to do strengthening and stretching exercises to improve or eliminate these deficiencies before the rigors of tennis cause injury. Again as with swimming injuries, temporary rest and medication are helpful but not corrective.
To prevent tennis elbow, good equipment properly fitted is a must. I currently recommend a mid flexible Graphite racquet in the 100 square inch hitting zone size with low or soft tension of 16 gauge strings. For proper grip size you may find the hand measurement technique I introduced into the medical literature helpful. Proper tennis strokes (using body weight transfer and trunk rotation supplies the power not the small elbow muscles) and the use of a double strap curved counter-force elbow brace are also quite helpful either to prevent problems or to aid in the treatment if tennis elbow occurs.
Overall with both swimming and tennis, easy does it. Let's enjoy the summer.
Dr. Nirschl is a practicing orthopedic surgeon and sports medicine physician at Columbia Virginia Hospital Center Arlington, Va. and is Associate Clinical Professor of Orthopedic Surgery at Georgetown University Medical School in Washington, DC.