First, do no harm!!!
 
These are the first words in the Hippocratic oath that doctors take. As I begin this month's column. It is clear that all who are reading this should keep these words in mind.
 
I must begin with a disclaimer. Neither this publication, The Tennis Server, nor I make any medical claims. We are not health practitioners, and we are not affiliated with any health related organizations.
 
This month's column is not meant to replace any medical examination, diagnoses or treatments that health professionals may recommend. Rather, this is just one person's reflection on the nature of injuries in this great sport of ours.
 
If you suspect that you have any injury, you should seek to consult with a health care professional!!!
 
At the time of this writing, I have been unable to play tennis for two months. This is particularly disturbing to me, in that, these two months are the outdoor season for tennis played north of the Equator. I may be looking at an additional three to six months of being unable to play tennis.
 
Very simply (without getting into too much unnecessary detail), I am suffering from "floaters" and flashes in my right eye. Fortunately, there are no retina tears or detachments at this juncture. But, my retina surgeon does not want to see me dislodge my retina through tennis, running, etc. This is not an easy situation for me, but it speaks to the realities that each of us face sooner or later with respect to this great game.
 
Invariably, every tennis player experiences some injury during his/her tennis "life."
 
In the last year, I have received approximately six e-mails from readers who are unable to play tennis for some medical reason. The most common is "tennis elbow," but some of the situations these readers describe are a bit more drastic in nature. For example, one senior player is out due to a torn Achilles tendon. This is a serious injury that has required surgery, and will have a long rehabilitation time associated with healing.
 
So this month, I want to address several aspects of injuries. First, what can you do to avoid injuries? Second, how do you know if an injury is serious in nature? How do you "survive" the process of healing and return to this wonderful game?
 
Before I begin, I must recognize Serena Williams as an individual who has exhibited exemplary patience, faith and fortitude. Until her return at this year's Wimbledon, Serena was literally incapacitated for many months. In a recent "Tennis Magazine" article, she describes the emotional ordeal of surgery, wearing a boot, and the fear of never being able to return to her game. She admits deep depression during these dark hours. Still, she made a remarkably good showing at Wimbledon, and I hope her career continues to blossom as we finish the "tennis year."
 
One thing that each of us must realize is that tennis takes a tremendous toll on our bodies. Those who have not played this sport serious may doubt that tennis is at all grueling. They are dead wrong in this assumption!
 
Think about the pounding that every joint in our bodies receives when we play tennis on a consistent basis. Reflect upon the physical fatigue and mental fortitude needed to compete in a long, three set match. Consider the fact that tennis is mentally challenging, and as such, places incredible stress upon our already physically challenged bodies.
 
Yes, tennis is a game for a lifetime, but it is a serious, demanding and rigorous sport!!! Fortunately, this wonderful game is so inviting, and dare I say addictive, that tennisphiles abound around the world!
 
In preventing injuries from occurring, there are several things that must be kept in mind.
 
1. Every player needs to stretch before and after each practice session and each match. Usually, it is best to do some light aerobic activity to "loosen up" the muscles before beginning to stretch. At the end of a practice session or match, the muscles have "seen action." Here, the problem may be a build up of lactic acid within the muscles. Some time back, I wrote a column where I illustrated the stretches that I advocate. You can access this column at Turbo Training: Stretching it to the limit, but not beyond!.
 
One should always stretch before and after each practice session or match. Of these two, most trainers will tell you that the after practice or match stretching regimen is the more important.
 
2. During off peak seasons, each player should engage in a reasonable strength-training regimen that will build muscles necessary to protect joints. For example, doing weight training that strengthens the quadriceps is likely to help minimize the likelihood of a knee injury.
 
3. When taking a break from active on-court training or competition, be reasonable and incremental as you resume this type of practice and play. Too frequently, players will delve back into practice/play with no moderation. Doing this is a formula for injury.
 
4. If you are a senior player, try to practice and play on softer clay court or grass surfaces. Let's be honest. As we age, we all develop stiffness and maybe some osteoarthritis in knees, hips, ankles, shoulders, etc. Hard courts are brutal on the body! Any player who is a senior and plays on hard courts will tell you that the experience can be injury producing. Indeed, I would make a case that professional tennis needs to reduce the number of hard court tournaments as, in my opinion, the number of these lead to many serious injuries.
 
5. Hydrate your body before, during and after you practice or compete. Even when you don't feel thirst, your body needs to have fluids when athletically engaged. This is an area where many of us are negligent. Remember, your body is mostly composed of water! Deprive your body of the water it needs and you are asking for trouble... often times taking the form of cramping.
 
6. Allied with hydrating, eating properly can make a world of difference in preventing injuries. How? Well, our bodies need protein for muscle maintenance and complex carbohydrates for energy. Unfortunately, that fast food burger is not going to provide either in any meaningful way. If your body doesn't have the proper "fuel" in the tank, you are more prone injury.
 
7. Go for regular physicals with your doctor or health care professional!!! Many of us do not like going to the doctor. This is somewhat understandable. But, we each need to get a complete physical at least once per year. Indeed, schools and colleges in the U.S. require such a physical before student athletes can compete. The old adage, an ounce of prevention is worth a pound of cure, is truly valid.
 
If you do suffer an injury, you need to make an immediate assessment of the severity of the injury. If at all possible, try to have a trainer examine and evaluate your situation. Injuries fall into several categories:
 
a. Temporary and not significant. We would all like to believe that any injury falls into this category. Unfortunately, many do not. An example of this type of injury may be one that has happened to us all at one time or another. We are serving, and we inadvertently hit ourselves in the leg or knee with the racquet when finishing our service motion. Usually, the pain is more embarrassment than physical in nature. Don't be too eager to assume that any injury falls into this category! Rather, monitor carefully what you feel and be honest with yourself about the severity of what may be occurring. If there is swelling associated with the injury, it is definitely significant!!!
 
b. Significant injuries. Sprains, falls, back strains, cramping, and persistent pain... these are all indications that the injury is potentially, and likely, significant. Playing on through these injuries may make sense if you are a pro looking for a paycheck and ATP or WTA points. But for most of us, the risk these injuries present is not worth the benefits of continuing to play through the injury. Granted, a professional trainer can work wonders and can enable a player to continue to compete through many of these injuries. However, the reality for many of us is that there is no trainer available when these injuries occur. In my mind, it is better to be safe than sorry. Best to stop the practice or match, lick your wounds and monitor the injury over the next 24 hours. Ice, anti-inflammatory medicines and rest can work wonders. Remember the old acronym, RICE... Rest, Ice, Compress (with an Ace bandage or similar item) and Elevate the injury (to reduce swelling and pain). If you notice no significant improvement within 24 hours you definitely should seek professional medical advice.
 
c. Chronic Injuries. Regrettably, some injuries are clearly serious. These probably require a hiatus from practice and play, often times need physical therapy, and in some instances, these may require surgery.
 
If you tear a meniscus in your knee, you will immediately know and there is probably little doubt that some serious intervention is needed.
 
Where players frequently deceive themselves is with respect to chronic elbow, ankle or shoulder pain. These players will frequently try straps, bandages and a host of devices that seemingly will allow them to play despite the injury. Here is a simple rule of thumb. If you need a brace, bandage or device to play tennis; you have a serious and chronic injury. The more you delay medical treatment, the more likely you are to cause more serious injury!
 
Believe me. I have run the gamut of injuries over the years. I tore ligaments in my ankle. I had to suspend all play for a full month while undergoing physical therapy. I then wore an air cast for the next six months as a preventative measure. But all of this was under the supervision of my physician and PT professionals.
 
I have a right knee that is inflicted with osteoarthritis. Fortunately, my rheumatologist is capable of giving me injections of a synthetic lubricant that enables me to run and play. Still, I am required to see him every four months, and he images my knee at least once per year. Although I can play tennis, my mobility has been limited to a point where competing on any serious level is not viable. To do serious competition would only increase the likelihood that I may need a knee replacement. Obviously, this is not situation I want to face. So, I limit my play and monitor my knee carefully.
 
I have had a slightly torn rotator cuff in my left shoulder (I am right handed). It didn't require surgery, but it took me a full year of relatively painful physical therapy to rehabilitate this shoulder. Fortunately, I hit a two handed backhand, and the shoulder injury really only affected my ability to toss the ball when serving.
 
Now, I face a long absence from the game due to my eye situation. Believe me. I am envious every time I see players on a court. But, it is what it is.
 
Whenever I am injured, I quickly try to put myself in a positive frame of mind. Granted, this is not always an easy task. Instead of lamenting what I can't do, I work on what I can.
 
Although I cannot run, play tennis, strength train or even swim at the moment, I can use the recumbent bike. So, I am focusing on building my quads with this stationary bike in the hope of helping my knees when I can return to practice and play.
 
I do Tai Chi movements each day to improve my balance and my ability to control my muscle groups. These "slow motion" movements stretch muscles, build strength and do so without much risk.
 
I am a firm believer in having many avocations. So, I am playing my guitar more these days. Like tennis, it brings me joy and relieves stress.
 
Those of you who have read my book, Perfect Tennis, know that I play tennis in my mind as part of my total training regimen. Although I am unable to actually play tennis in a physical way, I assure you that I play three sets of tennis in my imagination every day!
 
Though I cannot be on the other side of the net while giving lessons, I am able to use a ball machine to feed to my students. (The last thing I need is a ball hitting my eye.) I wear protective "goggles" during lessons. My point? I have learned to adapt by focusing on what I can do... not on what I can't.
 
I still am able to photograph this great sport. So, I focus more on this aspect of my love of the sport as I wait for my eye to heal. It keeps me connected to the game.
 
Lastly, there is wonderful tennis to watch on American television. I watch and learn every time there is a tournament broadcast. Again, this is a way in which I can stay connected to this great game.
 
I have no doubt that I will be able to return to actively playing this wonderful game of ours. The question is not if... the question is when!
 
When I read the article where Serena Williams was interviewed about her surgery and rehab, I was inspired. Her faith in God, support from family and friends, and her tenacious nature have enabled her to recover and play incredible tennis. She is in my mind the "poster child" for tennis injury recovery. (I must put in a plug for Monica Seles who surmounted obstacles that we mortals cannot even imagine.)
 
I suspect that some of you reading this are suffering from some sort of injury. If you are not, I truly hope this article remains a moot issue for you.
 
If you love tennis, you owe it to yourself to assure that you can play this game for as many years as possible. Unfortunately, injuries are likely to occur. The goal is to do everything possible to prevent injuries. If you are injured, even slightly, you want to address the injury quickly and appropriately. This probably means medical consultation. Playing through the pain is really counterproductive. The risks greatly outweigh any benefits. I doubt that many of us will find ourselves competing at Roland Garros or the U.S. Open. I doubt many of us will be taking home large sums of prize money. I doubt many of us will be featured in tennis publications.
 
So, we need take deliberate and conscientious steps to prevent injuries from occurring in the first place.
 
We need to keep injuries and their consequences in proper perspective. We cannot live in denial of an injury. In fact, we are wiser to be erring in the direction of caution than risking taking a minor injury and turning it into a major problem.
 
If we must take a hiatus from play, we need to dwell on what we can do. We need to recognize that the goal is not to simply win. Rather, the goal is to thoroughly enjoy this great sport in every manner possible. It may seem strange, but injuries can actually bring out a whole new level of love and appreciation for tennis.
 
So, take heart. Be aware of your body, honest about injuries, and seek the best medical advice you can find. If you are injured, work to recover. Think in long... not short... terms. Step back; take a deep breath and work to discover a sensible game plan for recovery. Work with your medical professionals. Stay positive. Recovery isn't always quick, easy or without pain.
 
And the moment you are back on the court with the racquet in your hand, you will realize that you still are a tennis overdog!