You’re out on the court and something hurts. Maybe it’s your elbow, maybe your knee, maybe your heel.
Pain is a part of life, especially when it comes to athletics. It is a signal, your body’s way of communicating with you about what it can and can’t handle. Pain is how your body protects itself.
This guide will transform your understanding of pain and injury, and it will dispel the common disposition towards pain of anxiety and brokenness, replacing it with one of confidence and control.
We’ll be specifically addressing the most common kind of pain felt by athletes – pain from minor soft tissue injury. Nearly all common tennis injuries are soft tissue injuries – knee pain, wrist pain, forearm pain, low back pain, tennis elbow, plantar fasciitis – all of these ailments are, at their core, a soft tissue system that has been over-stressed.
From a 5000 foot view, rehabbing a soft tissue injury is very simple. You must do two things:
- Figure out what’s causing the injury, and stop doing that.
- Take the injured body part through it’s natural range of motion under a light load
The rest of this guide will explain this seemingly simple process in greater detail.
Prevent Further Injury
The first step of rehabbing an injury isn’t trying to get the injured body part to repair itself, but rather to prevent further injury to that same body part.
This is mostly trivial for acute injuries: injuries where the body part went from totally uninjured to injured all at once. You can occasionally take steps to avoid these – wear lower heeled shoes if you’re an ankle roller, for example – but for the most part, acute injuries are simply random.
For chronic injuries, on the other hand, prevention is squarely within your control. Many, many, many people forget that prevention is the first step towards rehab. You must discover the root cause of the chronic injury, and then fix it, so that you are not constantly re-injuring that same body part while you’re trying to rehab it.
Many players, instead of investigating the cause of their chronic injury, immediately start medicating with things like
- non-steroidal anti inflammatory drugs
- various braces and taping schemes
If you do this, your injury is not going to heal.
Until you implement some sort of technical or conditioning fix, you are re-injuring whatever body part is hurting every time you step out on the court. The reason your particular soft-tissue system got over stressed in the first place is that there is some part of your tennis game that is too stressful for that system to recover from.
Until that changes, the injury won’t heal.
The Nature of Injury
During everyday existence, and especially during sports, all tendons, muscles, and ligaments are constantly undergoing a stress-recovery-adaptation cycle. During a tennis session, more stress is put on these systems than during everyday life, but not so much so that the body can’t recover. When played with proper technique, tennis constitutes a very healthy level of stress. The body will recover from that stress before your next session, and that recovery will drive further adaptation of the stressed systems, making you into a fitter tennis player the next time you step out on the court.
Insofar as the body can fully recover from your daily activities, the body is considered uninjured.
Injuries occur when too much stress is placed on the body, and the body can no longer recover from that stress. Therefore, the first step in diagnosing and treating any injury is to discover why too much stress was placed on your body, so that you can prevent that excess stress in the future.
The manner by which you were injured greatly influences the manner by which you will heal.
Let’s imagine you’ve accidentally banged your elbow on the door. The day after the accident, you step out on the tennis court, and as you hit your first few balls, you notice your elbow hurts.
The injury you’re feeling here is an acute injury, caused by the acute stress of banging your elbow on the door. In this situation, your tennis game itself is not responsible for creating the excess stress that led to injury. Tennis is certainly more stressful than everyday life, which is why you’re feeling pain during tennis that you don’t feel walking around, but there’s a good chance tennis is non-stressful enough that your elbow can recover, even while you continue to play.
Since your elbow never hurt before you banged it, we know it’s plenty strong enough to handle the typical stress of tennis. This means that, even when slightly compromised by injury, your elbow can likely still recover from tennis and also have enough recovery resources left to slowly heal its injury.
Occasionally, that won’t be the case, and you’ll have to rest an acute injury. This occurs when an injury is severe enough that, for example, even though your elbow was able to recover from the stress of tennis completely in its uninjured state, in its injured state, that stress has become too much – your body doesn’t have enough resources to both recover from that stress and make progress towards healing the injury. In this case, intensity has to be dialed down (even to the point of complete rest). The proper level of activity is such that:
- The injured body part can fully recover from any stress each day.
- It is then capable of healing itself a little bit, on top of that.
Imagine that you’ve been playing tennis consistently for the past few weeks. Each session, your elbow has hurt more and more, and now it’s finally to the point where it hurts every time you hit the ball.
This is a chronic injury. There is something about your tennis game itself which is too stressful for your elbow to recover from. Medicating with rest, ice, and NSAIDs alone will not work, because they do not fix the underlying issue: your tennis is too stressful for your elbow.
In this situation, you are injuring your elbow while playing tennis. There exists no medical fix here: no pill, no therapy, no rest or rehab routine. You will never be able to play pain free tennis until you correct whatever is causing the excess stress on your elbow. In your current state, tennis itself is the injurious stimulus.
The hardest part of injury management is discovering, and subsequently fixing, whatever technical flaw is causing the excess stress on your injured body part.
Don’t be discouraged by this process, which can be quite frustrating – it is possible to play tennis pain free. The human body can move around the court and produce all the shots necessary for the game without putting so much stress on itself that it breaks down.
In tennis especially, pain is a very good technique coach. For almost all hand, wrist, forearm, and elbow injuries, your body will give you real time feedback as to whether or not you’ve struck the ball properly.
Do not play tennis on pain killers.
Pain is a signal that you desperately need in order to stay healthy as a tennis player. You want your arm to hurt when you hit the ball wrong. That’s what allows your brain to self correct.
If you play on pain killers, understand that you’re putting a lot more stress on your body than you otherwise would, because you’re allowing yourself to ignore your body’s pain signals. Compete in that state very infrequently, and only when you’ve made a conscious decision that it’s worth it.
Pain as Your Guide During Healing
Pain will tell you whether or not any particular activity is too stressful, and is therefore detrimental to the healing process.
After any activity session with an injured body part, answer these questions:
- Did it hurt more and more as I used it?
- Did it hurt more the day after use than it did the day before?
If the answer to either question, specifically the second question, is “yes,” then said activity session constituted too much stress for your injured body part. You need to reduce the load on that body part until it’s further healed.
Notice that does it hurt while I’m playing? is not one of the questions. That’s because it isn’t super relevant. If you have, say, tennis elbow, then it’s probably going to hurt on most shots, even when they’re struck correctly. Your body is communicating to you that it’s injured, and you’ve gotten the message.
After that point, it is not the pain itself that matters, but the derivative of the pain. Pain that is getting better is just another way of saying “an injury that’s healing,” whereas pain that is getting worse is another way of saying “injury in progress.” Activities that make your pain worse and worse should be halted immediately.
Play Through Your Injuries
Rest is rarely a good option for injury rehab. Unless your pain is getting worse as you play, or has been static for at least a week, you should play through your injuries.
The body is self healing, and it heals far better when in motion than when at rest. Your body uses the electrical signals from the muscle contractions themselves in order to orient itself as it rebuilds your soft tissue.
In general, injured body parts taken through their range of motion under a light load heal better, faster, and are more functional after they heal, than injured body parts that are immobilized. This fact is well known among coaches and the better physical therapists out there, but I’ll still start you down the research rabbit hole here, in case you’d like to explore the science for yourself.
Many studies have been performed on rats looking at the beneficial effects of loading and motion on soft tissue recovery, typically utilizing the Achilles tendon. Immobilized and deloaded tendons healed worse, and scarred more, while mobile and loaded tendons routinely showed better outcomes.
In one study, for example, researchers found that loading is beneficial no matter when in the healing process it happens, debunking the common belief that injuries should be rested and immobilized initially, and only loaded after inflammation dies down.
The results showed that just four loading episodes increased the strength of the healing tendon. This was evident irrespective of the time point when loading was applied (early or late).
In another, functional tendon gene expression was higher in rats who had their torn tendons loaded, than in ones who had them immobilized:
In the late phase of healing, tendon-specific genes (scleraxis and tenomodulin) were upregulated with loading, and the healing tissue might to some extent represent a regenerate rather than a scar.
This is why it’s so common for tennis players to develop a chronic injury, take two weeks off, have the pain go away, and then resume playing only to find the pain immediately resumes. The tissue was never restored to its previous functional state, it merely scarred, and therefore still can’t handle the stress of the sport.
Other Forms of Rehab
Most injuries will resolve themselves if you fix your technique and then continue to play. For the ones that don’t, things like light exercises with resistance bands and massages have their place as well.
These techniques apply a very light stress to the area, in an attempt to stimulate recovery. For example, massage is a very good therapy for plantar fasciitis – injury of the plantar fascia, the fascia running along the heel and arch of the foot. The massage creates a light stress on the soft tissue, and the resulting recovery and adaptation response from the body to address that stress results in a net healing and strengthening effect on the entire area.
Band work for an elbow or wrist issue follows a similar pattern. You apply a light stress on the injured body part by taking it through its natural range of motion under a light resistance, and that light stress prompts a healing response which creates a net beneficial effect for the injury.
As I said before, pain is your guide. This kind of rehab work is subordinate to the same two pain questions listed above. The day after your rehab work, your injury should feel better, not worse.
Your body probably isn’t broken. Injuries are fixable, and you can fix them without putting your entire life on hold. Everything in your body is designed to heal while in motion. Prehistoric man couldn’t rest his sprained ankle for two weeks – he’d starve.
So don’t worry about a little pain, just make sure your injuries aren’t getting worse. If they are, you have to be an engineer. It’s up to you to diagnose the root cause and fix it, and after you do, the injury will start healing.
In the words of Lupe Fiasco in Battle Scars: “Never let a wound ruin me.”
The only truly difficult thing stopping you from rehabbing your injury is a lack biomechanical knowledge (and maybe eventually age). If you’ve got a remarkably sticky problem, research, research research. Even if it takes 3 months, and you end up with an entirely new understanding of the human foot and modern footwear, eventually you’ll figure it out.
Take control over your own body, and use it while it’s injured. If you do, you’ll discover the remarkably phenomenal powers of regeneration the human body naturally possesses, and if you’ve been listening to mainstream doctors your entire life, maybe for the first time.