Injury Watch: Outlast… with rest

Published by Rob Brandham

Roger Federer smiles during a training session; Getty Images
With players now competing longer into their careers, managing ‘wear and tear’ is increasingly becoming an important factor in scheduling and training routines.

Unfortunately body joints are not designed to last forever. Degenerative changes, known as osteoarthritis, often impact larger weight-bearing joints such as hips, knees, ankles, shoulders and spine.

What is osteoarthritis?

It is often thought of as the end stage of the degenerative process, but really osteoarthritis is a progressive disease of joints with a large spectrum of severity of changes over time. Once characterised as a disease solely of the cartilage, further research has revealed it also impacts joint structures such as ligaments, bones and muscles.

Many factors can contribute to its development, including stress on joints caused by weight, overuse and genetics. A major contributing factor is injuring the joint surface when younger, where there is risk the cells that nourish the cartilage, as well as bruising the bone that underlies it, can be damaged. This will progressively lead to the breakdown of the cartilage. As the cartilage layer does not have many sensory nerves within it, we often don’t feel a lot of pain when injury occurs. Conversely the bone underneath has lots of nerves and also provides the cartilage with its blood supply, therefore significant pain is often not associated with arthritis until the cartilage layer has been reduced to the point where the bone is then placed under stress. This is a reasonably slow process, explaining why it typically affects older athletes.

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Symptoms and prevention

Pain, swelling and tenderness are all symptoms, as is stiffness after inactivity and crepitus, the ‘crunchy’ sounds that joints can make. Arthritis cannot be completely prevented, however the progression can be slowed with the following measures:

  • Maintaining muscle strength.
  • Exploring options that help facilitate optimal joint alignment, such as wearing correct footwear and correcting playing techniques.
  • Keeping body weight within a healthy range.
  • Taking note of warning signs of wear and tear and allowing the joint time to settle down.

Reigning Australian Open and Wimbledon champion Roger Federer is an example of an older player who now carefully manages his schedule to allow time for his body to heal. Extended breaks have helped him produce outstanding results late in his career.

INJURY WATCH: Wrist and return

Regardless of your age or experience, there are lessons to learn from this. If you are consistently pulling up stiff and sore in a particular joint after playing, it is best to shorten sessions or allow more time to rest. Correcting some of the risk factors is also advised.

Once the damage has been done there is currently very little that modern medicine can do to reverse these changes. This does not necessarily mean you have to give up playing either – it just increases the need to be more sensible and conservative with expectations of what joints can endure.

Rob Brandham is a physiotherapist at the St Kilda Road Sports and Physiotherapy Centre in Melbourne. This article was originally published in Australian Tennis Magazine.

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