Weekend Warriors: Don’t Go Down Swinging

COVID-19 may have recently put a damper on some team sports, but weekend warriors—athletes who practice a sport on weekends or otherwise infrequently—are making their way back out to golf courses and tennis courts. And, some are experiencing swing-related injuries.

In any sport, the act of swinging creates an eccentric contraction. Essentially, the muscle actively contracts, but the mechanics of the swing force it to stretch, even as it attempts to contract.

At some point, the muscle may become overloaded and tear—picture what would happen if you were playing a game of tug-of-war and the rope were to break. It’s that eccentric load that puts muscles and tendons at greatest risk.

Summertime swing injuries often seem to appear suddenly, but almost all of them result from a chain of events. Even when the player’s form is perfect, swinging a bat, racket or club places the body under repetitive stress, with long-range potential for injury. Injury is more likely when the swing-rate spikes—for example, after an intense period of training. Athletes are also at greater risk if they don’t warm up and stretch properly.

And once injury occurs, you’re significantly more likely to injure the same area again. That’s why prevention should be your number-one strategy. No matter what the sport, conditioning, strength training, warm-up and stretching, and a proper training regimen are critical to avoid injuries that might mean “game over” for you.

Stages of Injury

We grade orthopedic injuries across a spectrum:

• A grade 1 injury—a sprain or strain—results in very little structural damage but brings pain, swelling and inflammation
• In a grade 2 injury, we see moderate tissue damage, but everything is still attached and connected
• Grade 3 injuries are the worst—a complete tear to a muscle or tendon

Grade 1 and 2 injuries will generally heal with time, anti-inflammatory medications, and either complete rest or some form of active rest. Physical therapy with active rest can be essential to recovery. Muscles and tendons should be carefully worked to prevent atrophy and maintain strength of the uninjured tissue, but not worked so hard that the injury worsens or fails to heal.

Most grade 3 injuries require a period of rest and often involve surgery. Although we see grade 3 problems in all sports, fortunately they are not as common as lesser degrees of injury. However, mismanagement of a grade 1 or 2 problem can lead to a grade 3 injury down the road.

Batter Up

Rotation is what powers a baseball swing and the forces generated are tremendous. Arms, wrists and hands play a big role in the swing, but they’re not where we see the most serious injury. Mishaps that can sideline a player out of the game tend to affect the shoulder and abdominal oblique muscles.

Swinging a baseball bat can put a lot of strain on the rotator cuff and labrum (the cartilage ring surrounding the socket of the shoulder’s ball-and-socket joint). The repetitive nature of swinging a bat can lead to cumulative micro-trauma that results in what’s known as “batter’s shoulder.”

This condition generally affects the non-dominant, or inside, shoulder. It is thought to be the result of resistance to the large distraction forces that occur with hitting. The resulting damage and inflammation can be intensely painful and need time to heal, putting a player on the disabled list for weeks or possibly months.

Within the athlete’s core—where the power of the swing is generated—injuries to the abdominal obliques can likewise take a long time to heal. They attach along the rib cage and at the iliac crest, the top of the pelvis, where tears and separations are serious injuries.

Recovering from this damage involves active rest followed by a gradual resumption of swinging over a period of weeks. But, as in other sports, prevention is always the best medicine: strength training, conditioning, stretching and warming up.

Teeing Off Safely

Golf may be perceived as a low-risk sport, but the swing can cause problems.  Among the most common is “golfer’s elbow.” As in baseball, swinging a golf club generates a lot of force that can damage muscles and tendons connecting the elbow to the wrist. This is another example of an eccentric load causing muscle and tendon damage: the wrist and fingers attempt to rotate inward, in conflict with muscles stretched by the force of the swing. Again, issues can result from a chain of events—overuse, fatigue or micro-trauma over time.

The torque of the golf swing also puts the back at risk, especially disks between backbone vertebrae. Over years, repetitive micro-trauma can lead to disk degeneration, herniation and a constellation of associated mechanical and chemical changes that put pressure on nerves or cause arthritis. Fortunately, the most common back problem in golfers is a simple muscle or tendon strain or sprain of a ligament. These cause little structural damage and can resolve quickly with active rest.

Braces, sleeves and other devices golfers use to mitigate pain and strain are of little value. Generally speaking, if you feel the need to use a brace, you’re likely already injured and should seek medical attention to prevent the situation from getting worse.

As in other sports, a good warmup and stretch are very important. Don’t start swinging cold at full power. Also, when you’re not on the links, strength training and overall conditioning will keep your body strong and the whole system in balance, reducing your risk of getting hurt.

Keep the Advantage on the Court

Tennis can place enormous stress on many areas of the body, including the shoulders, wrists, elbows, knees, ankles, and back. Although “tennis elbow” gets a lot of attention, injuries to the ankle and back are more common. Repetitive back-and-forth motion, sudden stops, turns and other directional changes demand a lot from your joints.

An inversion ankle sprain is very common in tennis—when the foot rotates to a point that exceeds the structural capability of the ankle. Similar to swinging a baseball bat, swinging the racket is powered by rotation in the trunk, which can cause injuries and inflammation in the vertebrae and strains to the trunk muscles.

Footwear is very important in tennis. It has evolved and adapted over decades to help prevent the most common injuries. Also key is the right grip size for your racket. So is adapting your training for different court surfaces.

As in other sports, keeping your entire body conditioned and warming up before play will help you avoid injury on the court.

How We Can Help

Because the body is an integrated system, no sports injury is assessed without a look at the bigger picture. When the elbow hurts, for example, we observe the whole chain and mechanics that affect how that elbow moves. Problems in one area frequently manifest somewhere else. Sports performance often requires joints and muscles to move in ways that exceed their natural capability. Our job is to treat the whole athlete, no matter the age or experience level.

We understand the importance of sports and working out to those who participate. One thing we try to avoid is telling an athlete to stop playing.

Athletes in our area are fortunate to have access to MedStar Washington Hospital Center’s full-service clinic, where we perform motion analysis to assess joint function at each segment of the throw or swing. That kind of assessment is especially important as the athlete progresses through stages of experience, training, aging and adapting to new conditions.

Our team works with athletes of all ages and levels of proficiency—from children to professionals. In fact, we are the official medical team of the Baltimore Ravens, the Washington Capitals, the Baltimore Orioles, the Washington Wizards, and the Washington Mystics. That experience benefits all of our patients, as working with professionals lets us hone our skills at the highest level.

Whether weekend warrior or professional athlete, each of our patients has unique requirements. We work very carefully and collaboratively with athletes, trainers and coaches to develop safe, effective training protocols. A good program for most patients includes cross-training for flexibility, strength and conditioning; practice management to prevent overuse trauma; and developing exercises that mimic game conditions in a controlled environment.

In sports medicine, what seems like a minor issue could warn of bigger problems, so it’s always in your best interest to seek professional guidance. Don’t hesitate to find out what’s really going on.

Reach out to us. We’re committed to keeping you in the game.