MRI reveals injuries in young top tennis players

November 1, 2007

Healthy adolescent tennis players looking to turn professional may be unaware of the damage they're doing to their spines. Using MR scans, researchers at the Royal National Orthopedic Hospital in Middlesex, U.K., discovered a variety of spinal abnormalities in the lower backs of elite tennis players aged 16 to 23.

Healthy adolescent tennis players looking to turn professional may be unaware of the damage they're doing to their spines. Using MR scans, researchers at the Royal National Orthopedic Hospital in Middlesex, U.K., discovered a variety of spinal abnormalities in the lower backs of elite tennis players aged 16 to 23.

MRI revealed lumbar spinal problems in 28 of 33 (18 male, 15 female) athletes from the National Tennis Centre in London. None complained of back pain before imaging. Researchers were surprised to find serious use-related spinal deterioration, including some permanent injuries, in such young, highly athletic people.

Injuries included spinal disc degeneration, herniated discs, complete fractures, and stress fractures known as pars lesions, according to the study, published in the July 2007 issue of the British Journal of Sports Medicine. Three of the 10 pars lesions in nine players involved complete fractures.

In 23 subjects, MRI detected early signs of arthropathy in the facet joints, which help the spine to bend backwards. Nine of these players were experiencing moderate permanent degeneration. The rate of joint disease was four to five times higher than that experienced by the general public.

MR scans found 20 athletes with skin hardening, 24 with bone overgrowth, and 10 with cysts in the lubricating (synovial) joint fluid. Thirteen subjects exhibited excessive dryness of the spinal discs due to insufficient lubrication, while another 13 had discs that were bulging.

Dr. David Connell, a musculoskeletal radiologist, and colleagues at the Royal National Orthopedic Hospital were prompted to conduct the study after discovering what he characterized in an interview as "nasty changes" in the backs of a few of their teenage tennis-playing patients. They were concerned about what damage might be occurring in the skeletally immature tennis player who was hitting the ball up to five hours a day.

They found that aspiring tennis pros spend large amounts of time training to improve their junior career performance during their growth-spurt years. The regimen involves repeated rapid twists and hyperextension of the lower spine (often while practicing the serve).

"Our study showed that we need to be smarter about how we train young tennis players so that they can avoid damage to the spine and reach their full potential," Connell said. "The training regimen should be altered to prevent this from happening."

Although Connell noted that coaches and trainers are best qualified to determine any new training methods, he stressed that exercise routines should be revised to include more strength and fitness work and less actual tennis play.

To follow up on this initial investigation, Connell's team plans to scan these same players every two years for the next 10 years.

"We would like to compare this group with another group being trained in a different way-for example, hitting tennis balls two hours a day and doing a lot more core stability, fitness, and gym work," he said.