by Todd H. Lanman, MD
If you think that tennis could be causing your low back pain, you are probably right, and you’re not alone. Studies show that 62% of tennis players have some degree of injury in their lower (lumbar) spine. Most of the time these injuries do not cause noticeable symptoms, but in 3 out of 10 cases there is disc herniation where a part of the disc between the spinal bones pokes out of its normal location. Remarkably, almost 40% of professional tennis players have had to miss a tennis tournament because of low back pain. Fortunately, there are ways to minimize the risk of spinal injuries that occur from playing tennis. And if surgery is needed to correct these issues, which it sometimes is, there may be a way to allow patients to keep playing the game they love.
How tennis affects the spine
Most of the potential injury to the spine that occurs during tennis can be traced back to a single feature of the game: the serve. You activate many muscles during a single serve, from your hands through to your feet. You may not think about your spine when you are in the middle of your power serve, but it is struggling to deal with the forces placed on it during the serve. The spine extends—hyperextends, really—during your backswing and rotates during your follow-through. Unfortunately, the spine is poorly equipped to hyperextend and rotate in this way. The most damaging stresses happen after you strike the ball, when the body is trying to stop the violent forces set in motion by the serve. Indeed the whole process of the serve takes a toll on the spine, which is why, over time, so many tennis players develop low back pain and spinal injuries.
How tennis players can prevent back injury
We know that tennis players who have weaker core muscles are more likely to develop spinal injury and low back pain. This makes sense since the core muscles must control the explosive rotational energies along the spine. If those muscles are weak, they cannot protect the spine. The fact that people with weaker core muscles are prone to spinal injury also suggests that strengthening the core muscles can protect against tennis spinal injuries.
Core muscles surround the core
When people discuss core muscles, they tend to focus on the abdominal muscles: the rectus abdominus, transverse abdominis, and the oblique muscles. Perhaps the abdominal muscles get all of the attention because they are generally easier to see, easier to target. With all of the attention that “abs” get, the other core muscles are neglected and forgotten: the back muscles. Core muscles in the back include the erector spinae (the muscles that run from the neck to the lower back) and multifidus muscles (the muscles that help stabilize the spinal column). I tell my patients to work their back muscles twice as hard as their abdominal muscles if they want to strengthen their core muscles. The back muscles are responsible for slowing down spinal rotation after a serve. Tennis players with weak back muscles are at great risk for lumbar spine injury.
What to do if surgery is the answer
When conservative treatments fail or low back pain is severe, patients may need spine surgery. There are two main types of spinal surgery in these cases: disc fusion or artificial disc replacement. Vertebral disc fusion is a surgical procedure in which individual vertebral bones are fused together. This adds stability and can reduce or eliminate pain, but it prevents the spine in that area from rotating. This may be a good solution for some patients (e.g. fractures in the spinal bones), but disc fusion may not deliver the desired results for serious tennis players.
The alternative is artificial disc replacement. In this spine surgery procedure, the injured disc is replaced by an artificial device. The vertebral bones are not fused together. This strengthens the spinal column and provides stability, but artificial discs allow rotation whereas a fusion procedure does not. Patients who wish to return to tennis after spinal surgery should strongly consider artificial disc replacement, since it allows the player to maintain good spinal motion and mobility. Artificial disk replacement surgery can be performed without any damage to the muscles surrounding the spine. Also, recovery times are shorter with disc replacement compared to disc fusion. Players can return to play faster and achieve full participation.
Alyas F, Turner M, Connell D. MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players. Br J Sports Med. Nov 2007;41(11):836-841; discussion 841. doi:10.1136/bjsm.2007.037747
Marks MR, Haas SS, Wiesel SW. Low back pain in the competitive tennis player. Clin Sports Med. Apr 1988;7(2):277-287.
As world-renowned Beverly Hills spinal neurosurgeon Dr. Todd H. Lanman of Lanman Spinal Neurosurgery (www.spine.md) believes, without a healthy spine, there is no healthy life. As he decrees, movement is life.
As a specialist in the advancement of spinal health, spine surgery, total disc replacement and motion preservation for more than 30 years, his attention to guaranteeing his patients the utmost in compassionate and skilled care under his watchful eye and steady hand has earned him top honors, his patients’ trust and respect, and recently in being named one of the Top Doctors in America. As one of L.A.’s Top Doctors by The Hollywood Reporter, Dr. Lanman is the go-to Spinal Neurosurgeon for many of the world’s top business leaders, professional athletes, and Hollywood’s biggest stars. He is also sought after by those from around the globe, with many of his patients traveling thousands of miles to see him and receive his sophisticated professional care.
A Diplomate of the American Board of Neurological Surgery and a Fellow of the American College of Surgeons, Dr. Lanman earned his M.D. at Chicago’s Northwestern University in 1983 with top honors and went on to complete his residency in Neurological Surgery at University of California at Los Angeles. Since then, Dr. Lanman has led his leading spinal neurosurgery practice in the heart of Beverly Hills, which is affiliated with Cedars-Sinai Medical Center, UCLA Medical Center and Saint John’s Medical Center.
As a leading innovator in medicine, as well as a media educator and contributor, Lanman has published more than 10 peer-reviewed articles, as well as book chapters on topics relating to neurological surgery, and has presented more than two dozen papers at national and regional medical society meetings. His expertise is often sought out as he is often tapped to be the principal medical investigator on a wide swath of clinical trials for motion preserving surgeries and artificial disc replacement devices, most recently the Prestige LP and M6, with the former recently receiving FDA pre-market approval on July 6, 2016, through his continuous support. He has also remained an assistant clinical professor at UCLA for the past 20 years.