When good exercise feels bad: common golf and tennis injuries and how to avoid them.

Many people looking for a recreational sport often turn to either golf or tennis. The game doesn't seem as rough or high-impact, and each requires individual focus, which can be challenging and relaxing at the same time. But players are still at risk for twisted wrists, sore shoulders, and torn tendons, especially if they don't learn correct form early on.

Even though golf and tennis are not contact sports, players are still vulnerable to injury. This is especially true if their club and racquet grips are off. Strained muscles can lead to surgery if not dealt with promptly and properly. Doctors and fitness experts agree that many injuries can be avoided with proper techniques, in addition to a comprehensive exercise routine. They say golf and tennis should not be the exclusive way one gets into shape; a complimentary exercise plan is necessary, too.

Golfer's and tennis elbow are the most common injuries Dr. Krishna Mallik, an orthopedic surgeon at the University of Ohio, sees. The medical term for this condition is epicondylitis, and it's characterized by pain on the outside of the elbow in tennis and on the inside of the elbow in golf. It often afflicts amateurs who jump into the game without having adequate muscle strength.

The amateur golfers Dr. Mallik sees usually aren't using their whole body in their swing, and the tennis players have usually been using the incorrect backhand stroke. "An important part of treating their injuries is trying to get them in a program where their golf swing or tennis stroke can be filmed and analyzed to see if they are moving improperly," Dr. Mallik says.

"Elbow" injuries are caused when tendon rubs against bone, which causes inflammation of the muscle. Rarely do these injuries lead to surgery. "We get better results if we see them sooner than later," Dr. Mallik says. That's not to say there's no pain to manage. Icing the area or wearing a padded strap on the arm can ease pain. Not playing for a while and resting the muscle may also be recommended. Surgery is a last resort.

Golf

Golf and tennis don't inflict the same wear and tear on the body as, say, soccer, skiing, or football, but they can still be physically taxing. And when players are of a mature age, sometimes the natural deterioration of the body exacerbates injuries. Dr. Vincent J. Roux Sr., a former surgeon, says players must consider their age and any past injuries when they decide to take up golf or tennis. If a golfer complains about an elbow injury, it could be in the "arm he hurt when he fell off a tree as a kid in Brooklyn," Roux quips.

For minor injuries, Roux suggests over-the-counter drugs such as ibuprofen. Roux, who has played golf since the age of three, has been the physician of black golf professionals Calvin Peete and Lee Elder. He says the most common problem he sees in players is an allergic reaction to grass and pollen on lush golf courses.

As the director of golf operations at the Doral Golf Resort in Miami, Michael Rushing watches players head for the greens and courts with no physical preparation at all, setting themselves up for injury. Rushing recommends that golfers stretch for at least five minutes, preferably 10: "When you're coming out to play golf, the proper thing to do is give yourself enough time to stretch, loosen up ... build up to your full swing." He adds that regular stretching before playing will produce a more athletic swing and give you more of an edge. "None of this is difficult or complicated," Rushing says. "It's quick. Within a few seconds, you'll get the blood flowing and be more flexible. It doesn't take that big an investment of time." These quick exercises will also help beginning golfers who are still working on their coordination. Golf can last for hours and put a great physical demand on the body. For players who experience constant soreness, Rushing recommends the spa for a massage.

Rushing recommends the following exercises:

* Flex the wrist back and forth

* Squeeze the hand gently so the fingers feel looser when gripping the club

* Press the forearm against the golf cart

* Place the golf club on the back of your neck and take each end in your hands. Spread your feet about two feet apart. Twist the torso back and forth to stretch the lower back. Breathe deeply during this exercise. Repeat about 20 times.

Tennis

Nascent tennis players tend to use too much wrist. Their timing in hitting the ball is off. There's a lot of repetition in tennis--a sport that hinges commonly on variations of the same stroke--and players have to learn how to use their whole body in the game.

Rich Gray, a tennis professional at Midtown Tennis Club in Chicago, observes many errors. He says, "People don't hit the ball out in front. They catch it behind, which puts force on the wrist and elbow or other parts of the body." Balance is key, says Gray. He explains that when moving around the court, the player wants to feel balance, otherwise control of the ball is lost: "You're moving in so many different directions. You don't want to feel like you're losing your balance."

Warm-up exercises can help players rectify the feeling of imbalance. Gray recommends the following warm-up before hitting the court:

* Stretch the groin area. Sit with your buttocks on the floor and legs apart. Stretch toward the center of the legs. Then lean to the left, keeping the right leg straight. Switch sides. Hold each stretch for 15 to 30 seconds.

It is important to stretch the groin area because it improves flexibility and allows the player to take longer strides and change body direction more easily. Gray says that because the entire body is used in tennis, doing other exercises on a regular basis can only improve your game. In short, if you want to improve your tennis game, you need to do more than just play tennis.

Other exercises to improve your game:

* Do crunches for core strength

* Jump rope for cardiovascular health

* Toss a medicine ball back and forth with another person for upper body strength and control

* Do push-ups for upper body strength

Gray says tendonitis in the ankle, knees, and wrists is common at the tennis club. Torn rotator cuffs (shoulder injuries) are also common. These injuries are often the result of bad technique and hitting the ball awkwardly. For minor injuries, Gray recommends putting ice on the area to reduce swelling. If pain persists, he'll recommend that you stop playing for a while and let the injury heal. It's best to resume activity with some light weight training. But injury is not solely a problem for amateurs. Gray notes that even professional tennis players--who can hit 1,000 to 2,000 balls a day, sometimes at 100 miles per hour--injure their bodies, noting Andre Agassi's hip and Patrick Rafter's shoulder injuries.

The United States Tennis Association, the largest tennis organization in the world, recommends strength and conditioning to perfect your game:

To avoid wrist injuries:

* Use the opposite hand to push the wrist in a flexed position. Hold each stretch for 20 to 30 seconds.

To strengthen the quadriceps and hamstrings:

* Grab your right ankle from behind with your hand. Pull your foot toward your buttocks. Switch legs. Hold each stretch for 20 to 30 seconds.

* Lie on your back, raise your leg, and loop a towel around your foot. Straighten your leg and pull the towel to bringing the thigh closer to the body. Switch legs. Hold these stretches for 20 to 50 seconds.

Gary Gilyard is an orthopedic surgeon with a private practice in suburban Detroit. He specializes in sports medicine and sees both golf and tennis injuries in his office. He finds that many people "decide to play tennis to get in shape instead of getting in shape and then playing tennis. Players need to strengthen their cardiovascular systems. It would eliminate 80% of injuries," he explains.

Inflexibility invites muscle strains and tears. Before going out on the court, Gilyard echoes what fitness experts say--stretch the calf and other muscles to decrease the chance of tearing. "It doesn't mean stretching for two minutes before going out on the court. Two and three times a day, for 10 or 15 minutes, improves general flexibility," he explains. Gilyard's patients range from middle school students to seniors near 70 years of age. They come in for Achilles heel (foot) and rotator cuff injuries.

Depending on the physical condition of a player, Gilyard will sometimes recommend comprehensive body conditioning with activities such as swimming or Pilates. With tennis, it's a good idea to achieve an ideal body weight first. Overdoing it otherwise may result in problems like a heart attack. Sit-ups and other common conditioning activities are helpful as well.

Gilyard says players need to be honest with themselves. If you hurt a shoulder while playing tennis, ice it and take anti-inflammatory medicine. If it's not feeling significantly better by the next day, go to the doctor. A rotator cuff injury is when the ball and socket joint in the shoulder are disrupted. The shoulder can slide back and forth and its blood supply can be compromised.

In golf, Gilyard sees shoulder and back injuries, herniated disks, and arthritis. "People think golf is a sport for which you don't need to do any body conditioning," he says, "but you do."

"You're not going to get a broken bone playing golf," Gilyard, a golf player himself, admits. Nevertheless, swinging a golf club is "a very, very violent twisting motion in your lower back that can easily damage it over time."

For both golf and tennis players, he has a succinct piece of advice: "If you're a newcomer, you will be a better player if you get your body in proper condition. You'll enjoy it more and you'll be better at it-and learn a lot quicker."