Tennis-Related Back Pain: Risk Factors, Rehabilitation and Return to Play

Low back pain (LBP) and low back injuries among both recreational and professional tennis players are common and can interfere with training, practice and competition. Whilst in most cases, LBP induces minor disability and is resolved within a few days/weeks, some athletes develop persistent symptoms. Therefore, it is crucial to better understand how best to treat and rehabilitate LBP events in tennis practice. The purpose of this chapter is to review prevalence and risk factors of LBP in tennis players and discuss the optimal rehabilitation program (focusing on non-operated adolescent/adult tennis players). As for the general population, LBP appears multifactorial and both intrinsic (non-modifiable factors, conditioning and flexibility, sensori-motor control, physiological, psychological) and extrinsic risk factors (training-related and environment) might contribute to the development and/or recurrence of low back pain/injury in tennis players. Management and treatment of tennis players with low back pain/injury should be directed by a clinical reasoning process, which embraces a biopsychosocial approach. Rehabilitation should start at onset of the pain and needs to be directed towards the restoration of athletic function; it requires a close collaboration and coordinated efforts between the therapist and the player but also the coach and the athletic trainer. Regarding prevention, tennis players who have a previous history of LBP and/or presenting high risk factors should be targeted prior to the start of the tennis season. Preventive strategies should address modifiable risk factors. In case of recurrent LBP, players should be encouraged to further train their trunk strength, lumbopelvic sensori-motor control and flexibility after symptoms resolve.