¶ Intro / Opening
Hey everyone, on today's episode we welcome Dr. Tom Verbka, a sports chiropractor and owner of Advantaged Chiropractic Clinic in Auburn, Alabama. He earned his diplomate from the American Chiropractic Board of Sports Physicians and is a leading expert on the management and prevention of sports injury.
On today's episode, we discuss the difference between chronic and acute injuries, lower cross syndrome, and how you should be properly fueling and hydrating during matches. So sit back, relax, and prepare to become a smarter tennis. All right, doctor Tom, welcome to the PU.
Well, thanks, Jonathan. Happy to be here.
Those are the words you've probably been waiting to hear your entire life.
How do you know?
For for the audience out there, I have had guests that I've never met who have become friends. You are a friend who has become a guest because our wives went to college together. And the reason why I wanted to bring you on is there are many players that suffer from injuries or
Not maximizing their bodies. I just had five people pull out from my camps. Uh, thank God I had a wait list, but they were all with injuries, right? And you have helped me with my back and my lower body issues, which I'm incredibly thankful for. So I thought I'd have you on, but where I want to start is
Like I said, most people in my camps are age forty to seventy, somewhere in that range. And like I said, there are a fair amount of injuries and throughout the course of a camp, people have aches and ailments. What are some of the most common things you see among athletes and tennis players in that age range?
¶ Acute vs. chronic injuries
Yeah, it if you just look at the data alone, the data shows that the grand majority of injuries on that age group, forty to seventy, are gonna be chronic injuries more so than acute. The acute are you know Running into your partner on the court, rolling an ankle, stepping on a ball, things of that nature.
We see'em. We just don't see'em as often as the chronic ones. The chronic ones are it's the load after load, game after game, and just not giving your body what it needs to perform at its best and to recover afterwards. Uh looking at the data again, it's the lower body injuries are greater than the upper body, and then the upper body is greater than like trunk and low back and things of that nature.
So the things that we have a tendency to see are we call them tendinitises. You know, a tendonitis is an overuse injury. And like we see jumper's knee or runner's knee a lot. Uh we see a lot of glute tendinopathies. Uh but like the this the big one, I guess the sexy one everybody thinks about is like tennis elbow. And once again, those are all just tendonitis. problems. It's just bad use, overuse. So how do we prevent those? That's so they uh to manage them a little bit better.
Yeah, so you actually literally just asked my question'cause if overuse is one of those things it's like, Well, we're still gonna have to serve and hit four hands and you have to hit a lot of them if you wanna get good. So what do you do with your body? What do you do with your training?
What do you do with your rehab or prehab so that you don't have let's just take tennis elbow. You don't have those overuse issues because you wanna play as much as possible. The answer is not to play less, hopefully.
Yeah, uh correct. And so it's like I I keep going back for a lot of my patients. is how many of'em rush to the courts and they go right back out there, they grab their uh their racket and they get on there and they they hit the ball a few times and they get into the game. They're not taking the time to do a a proper warm up. I mean, honestly, like I tell a lot of my patients Uh in that age range of forty to seventy, your best abilities you're available.
A lot of times you're just gonna outlast a lot of your opponents because you're not injured. So taking the time getting to the courts fifteen minutes early and have a pretty specific warm-up is a huge advantage. And the key is repetition. You do it ev you don't miss. You get there early. You do the warm up and you get ready to get onto the court versus rushing onto the court cold. And then the overuse injuries happen. So you're not properly warmed up, but now you are.
I I'm curious the psychological reason you think for this,'cause I know you have experience with this me with me as well where I I call you in a panic, hey my back is locked up. Can you FaceTime me, talk me through it? And you do beautifully. And I go, Doctor Tom, I swear I'm gonna do all the routines just like you told me to.
And eventually I fall off. And I know how bad I felt when I couldn't play. And yet that's the part that I neglect. So why do you think you said you have to be consistent with it? Why do people fall off with that even when they actually have had health scare?
¶ Being consistent with your routines
It it's it really boils down to time. The number of times I hear in my my practice, ah, doc I didn't have time. I didn't have time. It's like, well yeah, time for a lot of other things. It's not a priority. And so you just gotta prioritize. Like if you know that you have to be at the court the game start at three thirty, you need just need to trick yourself and say, No, I I have to be at the courts at three fifteen. It's you just have to really just emphasize that time aspect of it and
I mean I'm a I'm a very structured person in terms of my time allocation. So like uh I definitely would tell myself like hey if the game starts at three thirty, I have to be at the courts at three ten'cause I need to be ready for my warm up to three fifteen to go play at three thirty. And so it's just a matter of prioritizing and tricking yourself into find making that time and putting it on the calendar to do it.
I think it's comical that you just said you're own you're you're structured with time, as if you're not structured with everything.
Well that's fair.
Um so hopefully people listen that and they're gonna take it to heart. The reality is there's gonna be a lot of people who still show up five minutes before a match. Yep. If that's the case, if there's nothing you can do, there was traffic, work ran late, whatever, and you only had five minutes to warm someone up physically, how would you prioritize that five minutes?
Uh I would do an active warm up. You know, a lot of times people talk about like get on the court and you know, stretching a hamstring. You know, think people have a tendency to think about static stretching. And that's good for elongating muscle, but the goal is like, what are we trying to do? We're trying to prepare your body for activity and athletic endeavors. So an active one.
So get on the court a few minutes early and utilize the court. Do some shuffles side to side from, you know, the double's alley back and forth, uh, some acceleration into the service line, some gentle backpedals. You're just trying to get your body warmed up, trying to get your tissue loosened up, get your heart rate up a little bit. It's just kind of preparing for the event versus going in cold and now you're trying to sprint.
from from go. So it's just a like taking that five minutes is enough sometimes. But I like to get in there a good fifteen minutes, take the time, be consistent with it. Do the a lot of the s uh you know, once again the consistency of the 15 minutes it builds up oh time after time after time. My one of my favorite things uh another doctor told me was uh he goes you ever go to the gym one time and you walked out and you said that did it.
Buff, I did it. No, it's the time after time, it's the consistency of it all. So, you know, five minutes may not seem like a lot, but day after day after day, that five minutes adds up to uh a good warm-up and preparing yourself to prevent those chronic type injuries.
So you mentioned earlier the data shows in order, lower body, then upper body, then more like core trunk. I forget the exact phrase you use. But let's start with the lower body then. You love to remind me on a very regular basis that I have weak glutes and that is the issue of everything.
Is that a common thread across tennis players or athletes of this age range where it's like that is the reason for a lot of the other lower body injuries? Is it specific to each person? What does that look like?
¶ Lower cross syndrome
Uh it's um now granted we're the majority of these type of injuries can stem from these uh functional movements or lack thereof. And you know, we have the acute injuries like I was talking earlier, like if you stepped on a ball and you sprained your ankle, you sprained your ankle. But the most of the time the chronic ones kind of stem from uh something that we like to refer to as lower cross syndrome. Uh it's a basis of uh it's based off of Yonda's work.
shows that there's an imbalance within the pelvis. Basically we have inhibited glutes and an inhibited core and then you have a tighter low back and tight hip flexors. And so it creates that imbalance within your uh uh your your trunk basically. And then for your upper body we talk about upper cross syndrome, where we have a type like
cervical spine, a tight chest, and we have weaker inhibited uh anterior muscles or deep cervical flexors and uh inhibited muscles between the shoulders. So it creates that poor posture. And that's kind of exactly I saw you set up real quick. But the idea is if we can correct a lot of those, the imbalances go away and then the overuses stop. So that's what we we look at, we focus in on a lot with both of those.
Okay, so lower cross,'cause I vaguely remember you telling me I'm like a patient zero for that and like textbook.
Yep.
How does someone improve those imbalances when you're talking about hips, lower back, glutes, all those things? Like what are some exercises or what are some things people can do to prevent having that syndrome?
Yeah, it's e so the idea is like if we look at a cross, we have tight hip flexors and a tight low back, and we have a weak core and we have weak glutes. So how do we fix it? We stretch and we stretch and we exercise and we exercise. So we look for like the hip and glutes, we look for a lot of extension type of exercises through the hip. For the core, it's a lot of transverse abdominis activation on the front side.
Talk about a basic simple uh hip flexor stretch. We talk about like a child's pose or a child uh uh any type of like a uh trunk twist for the lower back just to open that up. Some basic stuff. Once again, we're not trying to like I mean this isn't rocket science here. We're sp five minutes can take you a long ways of just addressing all those little issues.
I wanna take a step back actually,'cause I'm I'm not over it yet. You said that people don't warm up Because of priority, right? Like cause you say I don't have time, but you had time to get to the match in time, right? Yep. But we all know logically we can't play unless we're healthy. And we also can't swing the way we want to unless our body works that way.
So you're telling me all this stuff oh we can do these glute bridges, we can do these things and I I do them especially when I'm hurting and the second I feel good, I stop. I'm just like everyone else, which bothers me, but I am.
Why do you think that's not a priority? Because I think a lot of people will hear, Oh, that makes sense. My glutes are weak, my core, this this is all working together. And they might do this for a week and then shut it down. So why do you think this does not become the top priority when your health is your biggest weapon?
It's it's out of sight, out of mind. You know, I I going back to the consistency aspect of it, that let the consistency is just the management of it. If you took five minutes and worked on some of that stuff And we could prevent that bigger issue'cause I guarantee when your y your back goes out, you spend more than five minutes taking it care of it. So the idea is if you just did five minutes a little bit every day.
You don't have to then spend a half an hour trying to get prepared to go play in pain just to try to finish a match and everything else. But to me it's out of sight, out of mind. And it's just a matter of once again prioritizing, making it part of that warm-up.
Okay, so we did lower body. You you talked about upper body is the next one and I don't know if you remember this, but in North Carolina I was having like golfers elbow on the inside. I I told the story to so many people. And I was telling you like, Oh, it hurts to serve to my players and it bothers me a little bit in golf, but honestly more in tennis. Even though I was playing more golf and tennis.
Yeah.
you kind of looked around, you like poked a couple parts of my body, you're like, does it hurt here? It had nowhere near my right arm. And I remember you said like, oh my second rib was out of place or something. Yeah. And you laid me down, you did this whole thing, and then you popped it, and I swear to God, like within thirty seconds, my right elbow was already feeling better, probably placebo,'cause you're like you were.
I wish I was that good on all of my patients. Right.
Right, right. But so like I I guess my question is when people feel elbow pain, tennis elbow or shoulder, is it often strictly because of that? Or do you find a lot of times it is because something else is out of whack and it's leading to that imbalance?
¶ Structural problems vs. functional problems
Yeah, that's leading to the imbalance. It's the difference between a structural problem and a functional problem. Like with your having that elbow issue, I I figured it was a you know, we tested the elbow real quick. Structurally sound, and with some simple orthopedic tests, they rule that out, which then it says, okay, then you've got a functional deficiency.
And so we talk about the Yonda. Yonda's model is basically you may be having pain at the elbow, but your pain is somewhere above or below it. So we we wanna check your neck. We if you check your uh shoulder.
We look for a deficiency there and then it would go to the elbows. We check the wrist. We look all the way up and down that kinetic chain to see where the deficiency was. And for you, you're holding that shoulder up and a lot of the musculature, uh levator scap, muscles like that attached to the first and second rib and it was elevating it and was basically you're serving
Over the top with a shrugged shoulder versus keeping this down and going over the top with it. So that's uh how I we determined that.
Yep. So w one thing I always find interesting being around you, and I'm curious what little things people are doing, even when they're just at rest. So I remember uh we went to an Auburn football game. I come back, I ask you for a Tylenol because I have a headache.
And I remember you were so offended. You were like, You don't take Tylenol here. He's like, I wat you said you watched me watching the game. I was leaning forward with my neck for three and a half hours and you're like, Now you have tension. Just lay down, you know, and you worked on me for like two minutes, headache gone.
So what are some things? I know I'm already slouching, I'm already in my own head watching you. What are some things we do when we're just at rest, whether watching TV, having dinner, that we can improve that could also just help our tennis game or our bodies in general?
¶ Improving how you sit
Well, you gotta just think about it in terms of what do we spend the m grand majority of our day doing? A lot of people sit at desk and everything else and we were talking about that upper cross syndrome. So if I was turned to the side and I sit like this with poor posture I mean this is the epitome of an upper cross syndrome. When head's forward, I got a tight neck, my chest is closed, it tightens.
We're showing the weakness in the on the front and the backside. And so I tell patients all the time, I preach all day better posture, but I catch myself with poor posture. But the key is I catch myself. So I may catch myself a hundred times a day in a forward position, but I sit up and I correct it a hundred times a day. Versus most people don't catch themselves one time and never correct it. So having a little bit of awareness.
It goes a long way. I have a lot of my patients, they take little sticket notes and they put it on their computer that says, sit up. And, you know, when they see that's the reminder during their day to then sit up with better posture to help minimize some of those issues that they're having.
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¶ Hydration
Yeah, so hydration is a big part of it. I mean the grand majority of your body is water. And so if you're a little dehydrated and like the grand majority you're requiring a lot of your muscles to go perform, but you're dehydrated. So think of it as almost like beef jerky.
And that beef jerky, you know, it may taste good, but it rips and tears easy and and becomes extremely vulnerable, especially the the uh I'm gonna call it chronologically more mature we get. I don't wanna say we get older, but The idea is is like we if we stay hydrated, we just are giving the muscles what it needs so it can heal and recover and everything else.
We talk about about eighty ounces of water a day, but if you are then out in the heat or you're sweating or you're doing physical activity, we try to add in about eight ounces of water per about thirty minutes per exercise, depending on the temperature.
Make sure when we are sweating, you have a with a little bit of awareness of that, you're losing some salts and that's where the electrolytes come into play. I mean, y you don't have to go out and get a super sugary drink or anything like that. You can.
Or you can just take some to kinda go old school, the old Gatorade, where you just do a half a teaspoon of some kosher salt and a lemon in some water. I prefer that. I think it's a little more refreshing. But it doesn't take a lot. It's super cheap to to stay hydrated. It's just we forget.
Does it matter at all? the time spent drinking. So for example, if the night before I go, Oh, I got a match tomorrow, let me just crush a hundred ounces real quick or I do that in the morning, do I have to do that over time, over days? Like does it matter?
Yeah, it does matter. It's actually it's better to try to have a nice steady. You I I always tell patients you have eight you have you know, all day to drink eighty ounces. You don't have to do it in the morning, you don't have to do it at breakfast. You have all day. So just try to incorporate it throughout the day. Try to be even throughout the day too. So and the the old test is when you go to the bathroom and you look at your you know at your urine, it should be a more pale color.
of yellow. If it's clear, you're probably overhydrating a little bit and you probably drink too much water in that one full swoop. So you want to have that pale yellow color.
And then in match, you were saying, you know, eight ounces per, you know, thirty minutes. Obviously, summer's gonna be coming up. It's gonna be super hot. So is it more than that? Is it possible? Like some people when they drink a lot, especially in a match, they tell me they almost feel like bloated, like it's like swishing around, but also you don't want to get dehydrated. So what's the balance as people approach the summer and they're sweating like crazy, especially in the South?
Yeah, th so kinda goes back to the idea is you don't need to sit there and chug water. It's sip on water. That's kinda the the key to it is you know, adding in eight ounces of water over a a match of thirty minutes is not a lot of water. And so it's more of just get your mouth wet, wet you know, wet your whistle a little bit and uh keep it going versus just saying, okay, I played for thirty minutes.
eight ounces, it's probably not the best idea'cause like you said, your body's you know, your parasympathetic sympathetic system's kinda going crazy because of, you know, you're in a competition. So it's not thinking I need to be digesting food right. It's so you just need to give a little bit out of the time.
It's amazing how impressionable you are as a kid'cause now that I'm thinking of this question I realize I haven't really ever searched for the correct answer and it might be right. But I had an uncle Who told me that if you drink water when it's really, really cold, which feels great in the summer when it's hot, your body actually doesn't pro like you want it room temperature. Not obviously hot.
But I w I've always just gone, oh, that must be true. And I've never even chat GPT'd it. I've never looked at any research on it. I've just been like, oh yeah, you shouldn't drink really, really cold water. Is that fact or fiction?
I've heard it both ways. Uh I heard it doesn't matter and I've heard and I personally prefer room temperature water and For me I I go with the room temperature'cause it's a little bit of a shock to the system too. Yeah, think about it that way. When you chuck you know, if you're gonna try to pound some cold, ice cold water
You know, and you're you're once again I was talking about that parasympathetic, sympathetic change during competition, your body th you don't want it to tighten up and everything else. So that's why I always go into the I'm a room temperature guy all the way.
All right, let's move on to the fueling aspect, the food side. I always get snacks for my camps. They're out there for three straight hours. What is the best food, snack, intake that you can have on the court during a match? Let's say you're feeling a little down, you're getting tired, it's been a long match. What is the best thing you can do for that energy there?
¶ Best food during a match
Whew that's d it's during the moment, sometimes you just need to get the sugar back. I mean so like we kinda have to laugh about it a little bit. Like to me like the greatest it's the cheat code if for post match is chocolate milk. 'Cause it got that ratio of protein and carb and it's just like it's you know, it's uh it's a liquid, it just gets to your system, it hits that sugar, it hits the protein, it hits hits you just right. I just don't know how
satisfying chocolate milk will be in the middle of a match though, you know? So but like a um any type of sh like a sugar. I mean that's kinda going into the Gatorades and stuff like that. 'Cause like they actually have a lot of those mixes now that are more of that shooting for that uh ratio to try to get the the blood uh or get the sugar into your system a little bit quicker for that instant energy. So those are some of the better ones to be doing.
So what about the food though? Would you say like I always get bananas from my campers? There are bars out there, I've seen like little gels, which I would assume is a healthier version of a quick sugar When I was younger, uh USCA coaches used to tell me like they would literally be like, Bring Skittles, eat five Skittles. Like it's just gonna get in your system quickly.
What is what is the food or the snack that you should be eating on a changeover when you're like third set's about to start? I'm feeling it. I feel a little weak. I feel a little tired. What do I put into my system then?
Uh I I prefer I'm a runner. So uh the goo goose and the the running gels are really nice because they are I mean it's just gets in your system and you feel pretty darn quick. great however i will remind people if you've never tried it before don't start the during the math
'Cause it could cause some GI distress and some other issues, like practice with this stuff, you know. So that's a nice little tip for some uh some people thinking about some of that. But like doing the Skittles, oh, we got a visitor.
Oh there she is. I've been waiting for that.
But what do you think? But during the match, having some like five skills, things like that. I mean it's an instant sugar rush. I like to think there's some better choices out there. Uh like f fruit. Like going into some of that. Like a slice of like a slice of orange, things of that nature are great, because then it's like instant sugar, but you're not getting you're getting better sugars.
All right, so I want to finish this. I I'm looking for three actionable tips. And I know that a lot of this depend each person's body is different, where they are in their journey. I get all that. So you have a tough question to answer here. Um, but I want three action steps that you could give a majority of my listeners moving forward that you feel pretty confident. Like, you know what, if they all did these three things.
They're going to be on a trajectory, a path with their body that not only will allow them to play better, play longer, stay healthier, feel better. So I want to know what your number one action tip would be.
¶ 3 action steps you can take
Uh let's start with the low hanging fruit.
Okay. Let's start with three.
Look at your equipment. Let's check your grips. Let's check the the string tension. I mean, these are the little things that go a long way. Like people, the number of times I have people that come to me and they say Oh my this my tennis elbow flared up. I've been playing for years and never had it. And I'll say, well, tell me about what's been going on. Well, I just got this new racket and I had it tightened. Well, there you go. I mean, that's some low hanging fruit. Look at your shoes.
Did you get a new pair of shoes? You've never broken them in and you went out and you have blisters on your feet. Now you're limping because of the blisters and your low back starts to hurt. These are like some of the lowest hanging fruit that's out there. So let's make sure that you're breaking in your equipment, you're breaking in the shoes, you're not trying
New things.
Things the day of a mask So that's some of the the easiest one. Number two, hydration. Oh, it's so easy to stay hydrated and it, you know, you have all day, carry around a little jug with you. Try to get your 80 ounces in uh in a day. Your body's gonna feel it. And number three is a just a 15-minute warm-up. Get to the match a little bit earlier. If you can just get a little bit of that uh warm-up, get your body ready, it can prevent a lot of those injuries.
You know, the best way to pre uh you know to fix an injury is to prevent the injury first. So if you can just warm up, do a good job on that, and I'm gonna give you a fourth after the match, then we can have nice little five minute cooldown. you know, go for a walk, loosen it up. You know, I know a lot of people have those foam rollers and the Theraguns now. Use'em. I mean that's when your body can really uh benefit from uh uh some of those type of
tools. I mean you guys got enough tennis balls laying around. You can get on those on a wall and roll out some of your uh the tension in your shoulders or in your hip. These are some easy things to be doing that everybody can be doing. It's just you gotta prioritize it.
Now I wanna give I wanna give you one last chance because you said hydration. You said um you know getting your shoes right, your equipment right. All the things you just said are so easy to do and they're also easy not to do, right? And a majority of people listening, including me, do not do these things. And I always leave conversations that we have, I'm like, oh, you know what? I of course I have ten minutes. Of course I have fifteen minutes before Padell to get there and do this correctly.
I want you to sell me or convince me or give me a little extra boost so I don't leave here doing the same old thing. You convince me that I'm gonna use this time correctly and do these little things. What do you got for me?
If you don't have time now, when will you have time to fix it? Because that's the w the one thing that patients come into my office and they oh I barely you know, I don't have time, I don't have time, I don't have time. Well now you're here in my office Now we're fixing the problem, this bigger problem that we could have stove off a long time ago by taking a few minutes. to before you played, now we're having to fix it after the fact and that takes a lot more time.
I love it.
Doctor Tom, like I said, I I can't speak highly enough about you just because from first hand experience, you have worked wonders with me, you have educated me. Um, hopefully people got a ton out of this. I know I have. But like I said, you are a friend who has now become a podcast guest. I think you might be the first reverse one in history. But thanks for coming on. We all learned a ton.
Thanks buddy.
All right, I want to thank Dr. Tom for coming on the show. He's a great friend and has helped me dearly with my ailments over the years. So I highly recommend following his advice to make time now so you don't spend more future time dealing with a chronic injury.
On a side note, we've already had thirty doubles players sign up for my online doubles academy. Players are sending me videos, I'm able to give personalized feedback, as well as conducting live Zoom call coaching sessions each week. It's been a blast and I can't wait to see how these players improve over the next year. If you want more info on the Academy, click on the link in the show notes. As always, thanks again for listening. I hope you just improved it tennisly.