Kevin Sims is national physiotherapy manager for Tennis Australia, the Australian tennis federation. He has more than 30 years of experience with high-level athletes from various sports, such as cricket, rugby and football. His specialty is musculoskeletal problems. THE Sheet he spoke about the frequency of the type of injury suffered by João Fonseca and the need for a balanced training program.
After withdrawing from the Brisbane and Adelaide tournaments to recover from back pain, the 19-year-old Brazilian was eliminated this Tuesday (20) in the first round of the Australian Open. He lost 3 sets to 1 to the American Eliot Spizzirri.
“I would say I needed more time. […] I did my best. I think it’s bad that I didn’t play at 100%, but at the same time, this gives me the maturity to continue, to understand my body, to understand my limits”, said Fonseca after the match.
“It wasn’t the day. But I think I’m still confident, I’m still playing well. I’m having good training. I just need rhythm. I think this season will be great for me”, added the Rio native.
João Fonseca had a stress fracture when he was 13 or 14 years old. How often do tennis players, especially elite ones, suffer this type of injury?
It is common, particularly during the growing years. I don’t think there is very good global data on attendance, but I would say maybe a third, say 30% of young tennis players, would be a good estimate. During the growth phase, say, ages 13 to 16, it is more common to experience a stress fracture. If the fracture actually heals, that is, if the bone is completely repaired, there will be no problems later. But what usually happens is that people don’t have a complete and adequate healing of the fracture, and then it can progress, usually only on one side. [das costas]but it can progress to both, and then you may have ongoing problems even as an adult. The ideal way to treat a stress fracture in a young person is to take time to allow it to truly heal. This way you won’t have some of the problems that develop later in your career, such as bilateral fractures and fractures that don’t heal.
In an academic article, you describe a case in which you managed to speed up the recovery of an athlete. Could you describe it? Is it only recommended for exceptional situations like the one in the article, in which the athlete really wanted to participate in an important competition?
It largely depends on each individual case. In that specific situation, the MRI showed that there was no fracture. Showed early stages of bone stress. So we just had to wait for the bone stress to subside, and that takes a lot less time than a fracture, which will probably take about 16 weeks to heal. In bone stress, you can begin bearing weight again within four to six weeks. That’s what we did in the case you mentioned.
To what extent can the two problems, stress fracture and, as Fonseca mentioned, “rectified spine”, be related?
I’m not 100% sure what “rectified column” means. Evidence suggests that a stress fracture is more likely when there is an increase in lordosis, and “straightened spine” sounds more like a reduction in lordosis. An increase in lordosis puts more pressure on the bones at the back of the spine, which become overloaded, and this is how a stress fracture occurs.
Is it normal for an athlete, five years after a stress fracture, to start complaining again about pain in the lower back to the point of taking a break for a few months?
It’s very difficult to say. It could be something completely different. It may have nothing to do with the stress fracture he had as a teenager. He could easily have had a complete cure. But, if it was something that didn’t heal perfectly, then, yes, there is a possibility that these tissues are not as resistant and robust as if he hadn’t had the fracture. But that would be speculation.
What is your assessment of the compromise that young elite athletes have to make between the demands of high-level sports on the body and the risk of having to deal with chronic injuries throughout their career?
It’s a very good question. I think there is a very important balance that you need to find when coaching a teenage player. The only way for your body to be able to withstand the demands of elite sport is to train hard, to encourage your bones and muscles to adapt to the forces you try to exert on them. But there is an inherent risk that if you go too far, you could end up causing an injury. Balance is fundamental. The ideal time for this adaptation is during adolescence. It is at this stage that bones respond best to training and load. Thus, the bones become thicker and stronger, and the muscles also adapt. The important thing is to have a very well planned training program. Allow what I call “light and shadow” in your training so that you have days where you train hard but also have recovery days. And having days where you don’t even train is also important. And, when you’re on the court, really have quality, not quantity.
When you say adolescence, what do you mean? Fonseca is 19 years old. Is his body fully formed?
Girls reach the so-called “peak height velocity”, which is the maximum growth rate, on average, at age 12; boys, on average, at 14. Therefore, the period of adolescence, depending on whether you are a man or a woman, is somewhere between 10 and 16, 17 years old. Everyone is a little different, but that’s more or less it. Interestingly, bone strength does not reach full adult levels until around age 22, especially in the lumbar spine. Therefore, it is worth bearing in mind that a 19-year-old still has the potential for lumbar spine strengthening.
Fonseca said the injury impacts his serve, due to the movement it requires. What type of adaptation can tennis players make to minimize this impact?
O “kick serve” [saque em que a bola quica alto, para dificultar a devolução] it puts more pressure on the spine because it puts it in a more extended position, which puts more pressure on the bones at the back of the spine. Obviously, you need to work with your coach and ensure efficient and sustainable technique. Ensure that during training you allow time for your spine to adapt. Do not withdraw large volumes every day. Have high volume days, low volume days, and days without drawing anything, just to allow the spine to adapt. Train intelligently, so that the body adapts and recovers.
