Doctor’s Tips for Tennis Players: Knee Health

Tennis is a lifelong sport that can be played at any age. The sport keeps your body moving and is great for both physical fitness and overall wellness. By playing tennis all through your life you are doing something good for yourself but aches and pain can creep up on you – especially in the knees. Just as you are keeping your body healthy with tennis it is important to have healthy knees too so you can stay in the game. 

The following article is from our friends at Atlantic Orthopaedic Specialist (AOS). AOS is a partner of USTA Mid-Atlantic and provides athletic training services at many of our Regional and Sectional tennis events. In this article, AOS physician Dr. Bradley Butkovich outlines his approach to treating knee pain in tennis players and offers tips for evaluating options for improving knee health.


Don’t let knee pain keep you off the tennis court. Understand options for your knee health.

Is knee arthritis affecting your tennis game? I’m Dr. Bradley Butkovich at Atlantic Orthopaedic Specialists in Virginia Beach. My goal as a Sports Medicine Specialist is to keep you active and doing the things that you want to do on the court. I see many patients throughout the day who have been struggling with the aches and pains of knee arthritis. In fact the Center for Disease Control estimates that the prevalence of symptomatic knee osteoarthritis may reach 50 percent by age 851.

There are many risk factors that can contribute to the degeneration of the articular cartilage in your knee including: age, prior injury, and repetitive use2. An analogy that I like to use with my patients is comparing the articular cartilage with the tread of a tire. Over time and miles that tread wears thin in one area or another and eventually that tire may need to be replaced. However, there are many steps in the treatment flow chart that we go through prior to jumping to a knee replacement.

So, as a patient, what are my treatment options?

Well typically my first recommendation to a patient who has just began to feel the symptoms of arthritis is to begin a regiment of NSAIDs (Nonsteroidal Anti-inflammatory Drugs)for a short period of time and see if that can take care of it. If taking an NSAID before you play tennis allows you to play without pain then that is a relatively easy treatment option to begin with. If NSAIDs are not working then the next step on the flow chart is to consider a cortisone injection. This puts a strong anti-inflammatory directly to the source and typically gives patients adequate relief for a more extended period of time. In some cases, when working with patients who have more advanced knee arthritis, cortisone injections may become ineffective or only effective for a few days to weeks.

Often times, depending on the severity of the arthritis, we may consider Hyaluronic Acid injections as a treatment option. These are best described as a lubricating shot for the knee. The material lines and coats the degenerative joint and helps the knee to glide better across the articular cartilage. This has also been shown to be an effective treatment option that can provide some patients with 6 months or greater of adequate pain relief3.

Other treatment options to consider can be bracing methods such as unloader braces. This can be effective in patients with valgus (knock knee’s) or varus (bowlegged) knee deformities secondary to advanced osteoarthritis. The brace shifts the weight in your knee off of the arthritic area and onto the area of good cartilage. This is not something that necessarily needs to be worn all the time, but may be an option for helping with arthritic pain while on the tennis court or other exercise.

So how do I know when I need a knee replacement?

I always tell my patients that you will tell me when you are ready for surgery. Reasons to move forward with a Total Knee Arthroplasty include:

1.) Nothing is working to control your pain

2.) It is causing you to stumble, trip, or fall

3.) You are unable to do the things in every day life that you want to do

If you are meeting this criteria then the Total Knee Arthroplasty is the definitive treatment option for your knee arthritis. Many patients do very well with this procedure, as it will decrease pain and improve function by replacing the degenerative joint with new metal and plastic implants to restore the alignment of the knee.

I hope that you may find this information helpful in evaluating your knee health as you move forward with your tennis career. If you are interested in scheduling an appointment with me at either our Norfolk (DePaul) or Virginia Beach (Kempsville) locations, please call our office at 757-321-3311.

ButkovichAt Atlantic Orthopaedic Specialists, Dr. Bradley Butkovich is board certified in Orthopaedic Sports Medicine and Arthroscopy, as well as general orthopaedics. Dr. Butkovich is one of a few surgeons in Hampton Roads to have completed an accredited Sports Medicine Fellowship and to have received separate Board Certification in Sports Medicine through the American Board of Orthopaedic Surgeons.

AOS is a partner of USTA Mid-Atlantic and provides Athletic Trainers for several USTA Mid-Atlantic Regional, Sectional and other tennis events.


  1. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, Kalsbeek WD, Luta G, Jordan JM. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59(9):1207–13.
  2. Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME, Rome BN, Chen SP, Hunter DJ, Suter LG. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res. 2013;65(5):703–11.
  3. Newberry SJ, Fitzgerald JD, Maglione MA, O’Hanlon CE, Booth M, Motala A, Timmer M, Shanman R, Shekelle PG. Systematic Review for Effectiveness of Hyaluronic Acid in the Treatment of Sever Degenerative Joint Disease (DJD) of the Knee.

Fun DIY Halloween Decorations – Tennis Themed

One thing tennis lovers know is that there is always a creative way to reuse dead tennis balls.  With Halloween season upon us, we’ve put together three spooktacular DIY Halloween decorations you can do with those scary dead tennis balls lurking in your basement, garage, trunk or bag.

We found these DIY craft projects are great activities to do with kids or grand kids or even during a Halloween party as an activity station.

Tennis coaches and tennis clubs, you can incorporate these craft projects into a Halloween-themed tennis lesson or tennis tournament for kids too.

So let’s raise the dead (ahem tennis balls that is) and have some Halloween fun making these awesome tennis inspired DIY Halloween tennis ball decorations.

DIY Halloween Tennis Ball Craft 


What you need: 1

1 can of tennis balls
4 googly eyes
Orange, green and black markers
3-4 pipe cleaners
1 piece of colored paper
Bottle tops (Gatorade or milk container tops recommended)


Start by making the base for the three Tennis Ball Halloween figures by gluing a bottle top to the bottom of each tennis ball.

Grab your markers and color 1 ball green, 1 ball orange and 1 ball black.



Let’s make a Tennis Ball Witch!

Step 1: Grab the green tennis ball on base; the top to the tennis ball can, glue, paper, scissors, 2 eyes, green marker and a pipe cleaner.


Step 2: Take your paper and cut out a half moon shape. 6

Step 3: Roll the half-moon shape to form a cone.


Tip – Stapling the corners together will secure it quickly

Step 4: Glue the cone to the top of the tennis ball can – you made a witch’s hat!


Step 5: Glue the witch’s hat to the tennis ball.


Tip – Tilt the hat a little off to the side so that your eyes fit later

Step 6: Take a pipe cleaner and cut it in half. Take half of the pipe cleaner and fold it over two times, twist together to keep secure – you made a witch’s nose! Glue the nose to the tennis ball.

Step 7: Glue 2 googly eyes to the tennis ball – good job! You’re tennis ball witch is complete!


Let’s make a Tennis Ball Pumpkin!

Step 1: Grab the orange tennis ball on base; the other half of the pipe cleaner you just cut for the witch’s nose, glue, and the black marker.


Step 2: Take the pipe cleaner and fold it in half two times, twist together to keep secure and glue onto the top of your tennis ball.

Step 3: Take the black marker and draw on your pumpkin face. Whew! That was a quick one – you made a tennis ball pumpkin!


Let’s make a Tennis Ball Bat!

Step 1: Grab the black tennis ball, 2 pipe cleaners, glue, and 2 googly eyes.


Step 2: Glue on your two googly eyes to the front of the tennis ball.


Step 3: Take a pipe cleaner and twist it closed at the end to make a loop. Do this to both pipe cleaners.


Step 4: Create indentations in the bottom of the pipe cleaner to form the bat wings. Do this to both pipe cleaners. You made bat wings!


Step 5: Glue the bat wings to the left and right side of your tennis ball. YAY! A tennis ball bat!


Step 6: Bonus step if you have any extra pieces of pipe cleaners. Cut two 1” pieces of pip cleaner and bend to form a triangle. Add these two “bat ears” to the top of your tennis ball.


Enjoy your tennis ball witch, pumpkin and bat to decorate your house for this haunting holiday – Happy Halloween!

Shell Wood is the Events Manager for USTA Mid-Atlantic. She enjoys crafting and repurposing items to bring a little pizzazz to our events.

Doctor’s Tips for Tennis Players: Achilles Tendon Injuries

There you are – out on the tennis court playing in a tough match to clinch your USTA League season and advance to Mid-Atlantic League Regionals. You’re playing tough and your opponent is starting to catch fire too. They hit a burner down the line and you lunge for the ball when – bang – out of nowhere you start experiencing searing pain in the back of the leg.

Greetings USTA Mid- Atlantic members. My name is Dr. Blake Moore with Atlantic Orthopaedic Specialists in Virginia Beach, VA. What I’ve just described is injuries to the Achilles tendon – everything from tendonitis to the dreaded Achilles tendon rupture.


Tennis players should be aware of Achilles tendon injury types and treatment options. Photo by Bruno Nascimento on Unsplash

Tendonitis is a term that indicates an overuse phenomenon where the tendon becomes inflamed and irritated in an attempt to heal itself. When this occurs in the Achilles tendon it can cause pain with every step and significantly restrict extracurricular activities. Some people will even go on to develop a form of Achilles tendonitis which appears as small amounts of bone growth in the Achilles tendon that can be seen on x-ray. This typically occurs following a long duration of these symptoms. The most extreme of Achilles injuries is those who report an Achilles tendon rupture. A rupture is where the tendon actually “pops” and fails. Following this type of explosive injury there is commonly a notable gap, often palpable, where there was once a strong connection from the calf muscle to the heel bone where the Achilles inserts.

Tendon disorders comprise 30 to 50 percent of all activity related injuries.1 Yet, Achilles tendinopathy affects athletes, recreational exercisers and even inactive people.  Current research suggests that there is a significant correlation between the prevalence of Achilles tendonitis and those who suffer from other diseases such as obesity, hypertension, and steroid use.2

What can be done for Achilles Injury? 

Most patients see a dramatic decrease in their symptoms following the completion of a conservative care protocol – treatments that avoid invasive measures. Many who experience Achilles tendonitis related symptoms improve with a home stretching program and 6-8 weeks of physical therapy once their acute symptoms subside.

It is not uncommon when I see patients with debilitating/severe symptoms for me to place patients in a walking boot with a heel lift to immobilize, and minimize the tension on the Achilles tendon. This can often decrease pain and discomfort and get patients back to activity such as tennis quicker.

For those who do not feel significant symptomatic relief there is evidence to suggest benefits from platelet rich plasma injections and extracorporeal shockwave therapy which is a non-surgical and non-invasive treatment that uses shock wave outside the body to stimulate healing.

As a last result, if all conservative efforts fail, there is an operative procedure that can be performed. Naturally, as with any operation this requires significant time away from tennis and downtime during recovery so it is avoided at all costs.

Now, I mentioned Achilles tendon ruptures. The Achilles tendon is the largest, strongest tendon in the body and is critical for climbing, running and explosive movements which you often use on the tennis court. It’s necessary for anything from serving a tennis ball to carrying groceries up the stairs. The Achilles tendon can rupture for multiple reasons including injuries, medications, or biomechanical malalignment, and typically occurs when the Achilles tendon is stretched in a traumatic fashion. Patients frequently report a sudden “pop” and a sensation of someone kicking them in the back of the leg with no one there.

Achilles tendon ruptures can be treated either operatively or non-operatively if caught early and treated appropriately following time of injury. Non-operative treatment typically includes casting and physical therapy whereas surgical treatment aims to reattach the tendon and restore function. Many people are shocked to hear that research shows outcomes are essentially the same regardless of treatment plan. Recovery after an Achilles tendon rupture is possible! A recent study revealed that 70% of NFL, MLB and NBA players returned to participation in the following season after surgical treatment.3

If you or someone on your tennis team or at your tennis club is suffering from nagging ankle pain or suffers a sudden injury, we at Atlantic Orthopaedic Specialists are here for you. Please email my Athletic Trainer, Riley Fontaine, MSAT, ATC, OTC at and we will be glad to get you an appointment!

Blake_Moore_AOSDr. Blake Moore is an Orthopaedic surgeon who specializes in foot and ankle injuries. He is a physician with Atlantic Orthopaedic Specialists in Virginia Beach, Va. AOS provides Athletic Trainers for several USTA Mid-Atlantic Regional, Sectional and other tennis events.

1. Nicola Maffulli, MS, MS, PhD, FRCS(orth), et al (2003). Types and epidemiology of Tendiopathy. Clin. Sports Med, 22, 675-692. 

2. Robert J. de Vos, MD (2010, January 13). Platelet-Rich plasma injection for chronic Achilles Tendinopathy. JAMA, volume 303, 142-149.

3. Trofa, David P., et al. “Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.” The American Journal of Sports Medicine (2017): 0363546517713001.)

This is Mid-Atlantic Tennis: Hunter Koontz

This post is part of a series that tell the stories of how tennis has influenced people’s lives in the Mid-Atlantic Section and how lives are positively shaped by tennis. Just a few weeks ago, stand-out Mid-Atlantic player Hunter Koontz made his professional tennis tournament debut at the Citi Open in Washington, D.C. And while this was a momentous moment, what’s more impressive is how he is influencing lives on and off the court too.

If you talk to diehard tennis fans about the Citi Open, a professional tennis tournament in Washington D.C., and ask them their favorite time to go to the event, most will say the first weekend. I’m sure you’re asking yourself “but why?”  That’s simple: The first Saturday and Sunday of the event, professional ATP and WTA players are walking the grounds freely to their practice courts (tip: snag those autographs and selfies!) and you can watch local players grinding it out to get one step closer to the Main Draw.

And such was the case for Richmond native, Hunter Koontz. You may know him as a top ranked junior player in Mid-Atlantic or stand out player at Virginia Tech (Blacksburg, VA), but at Citi Open on Sunday, July 29, Koontz was leaving it all out on the court battling France’s Vincent Millots (11) in Round 1 of Men’s Qualifying.


Mid-Atlantic standout, Hunter Koontz serves during his first professional tennis tournament appearance

A set down, the second set got tighter and the cheers got louder. In the stands were Koontz’s former high school teammates from Deep Run High School (Richmond, VA), friends from Virginia Tech, fellow Richmond natives, and the loudest of all – Country Club of Virginia members. Koontz, an Assistant Tennis Pro at the Country Club of Virginia, noted “a few of the CCV members were really bringing the fire with the cheering which really meant a lot to me.”  Obviously Koontz has played hundreds of tennis matches in his lifetime, but this one in particular gave him a little extra energy to take the second set with all of the support in the stands.

Blaine Davies, a former high school tennis teammate at Deep Run, was in the stands living every point with Koontz. “The coolest part of watching Hunter play was that I know it had to be inspiring for any Richmond kids in the crowd to see someone from our area competing at a professional tennis tournament.”  To that point, Koontz hopes he can inspire the juniors he works with at CCV to reach their tennis goals and cultivate the next generation of greats in his hometown. Working with CCV Head of Junior Tennis, Mason Wright, Koontz focuses on junior league play and game-planning clinics to help youth excel on and off the court.


Koontz inspiring the next generation of tennis greats, signing autographs for young fans

While Koontz couldn’t hold off Millots in the third set he was “happy those that came to support got to see a fun match with some exciting points” at his first professional tennis tournament.

Davies, who recently joined the USTA Mid-Atlantic Section staff as a recreation programs assistant, was smiling ear to ear as Koontz walked off that court. “What sticks out for me the most is how lucky I was growing up playing tennis in Richmond. Hunter was such a supportive teammate; he created a strong team culture and helped everyone improve.” Koontz may not realize the impact he has made in his local community with each individual he has come across on the tennis court. Luckily, when asked about his five year plan, Koontz responded “I would like to think I will be in Richmond teaching tennis and helping as many people as I can.” Also on the agenda is marrying his fiancé, Madison, in June 2019. “Things could look a lot different in five years. Perhaps I will have started to work on Hunter Jr.’s hand-eye coordination by then…”

Play Tennis This Fall in Northern Virginia – Try Combo Mixed!

If it has been a while since you have played USTA Leagues in Northern Virginia or if you have been playing tennis recreationally and want to ease into more organized play, USTA Mid-Atlantic has the perfect solution for Northern Virginia players – NOVA Combo!

The NOVA Combo Mixed League is a USTA League offering in the Mid-Atlantic Section for players age 18 and older that want to play doubles and have fun playing tennis in the Northern Virginia area! This fall, Combo will be offered in coed teams and in team NTRP levels of 6.5, 7.5, and 8.5.

In the NOVA Combo League:

  • Players of different abilities can partner up and play together (up to a 1.5 differential)
  • Partners can combine ratings to equal the team’s rating
    • For example in the 7.5 level of Combo, a player with a 3.5 rating can partner with a 4.0 player.
  • Teams can advance to a Regional Championship
  • Emphasis is on a social and fun experience – join in the action with some friends or get connected to a team and make some new ones! Just like tennis is a lifetime sport, tennis friends are friends you will have for life.
  • League play starts September 15

There are five steps to get started playing in the NOVA Combo league:

Step 1: Renew or join USTA as a member

As a USTA Member, you’ll not only get more involved in the game you love, but you’ll enjoy many perks. You’ll get discounts on US Open merchandise, travel, entertainment and more. You’ll get early access to tickets and discounted seats and top tournaments. And you’ll have the chance to play in recreational leagues – such as NOVA Combo – and tournaments in the Mid-Atlantic and nationwide.

Step 2: Get your NTRP (National Tennis Rating Program) up-to-date

NTRP ratings are used to identify and describe characteristics of tennis-playing ability and help you understand which level you should play at based on a variety of factors. New players can self-rate to obtain an NTRP rating (please note that a USTA Account is needed to obtain a self-rating). You can also contact Cassie Nocera, at the USTA Mid-Atlantic office to help you through this process.

Step 3: Find a NOVA Combo team

The best way to find a NOVA Combo Mixed team is to contact the Local League Ambassador, Alice Hume. Local League Ambassadors are champions for USTA Adult Leagues in the Mid-Atlantic. Alice works day-to-day to coordinate league play and ensure seasons run smoothly. She is currently forming teams for NOVA Combo Mixed league play, so now is the best time to contact her to get on a team.

Step 4: Register for your team

Once you find your team, you can go to USTA’s TennisLink site to register online for the season.

Step 5: Grab your tennis racquet and hit the courts

Get your racquet in shape – check those strings and overgrip – and head out to your favorite tennis courts to get ready to play. The NOVA Combo Mixed League season will start on Sept. 15. Your team captain will be in touch with you about matches, when and where you will be playing and other opportunities to get together with your team.

If you have other questions or need help, contact Cassie Nocera or email You can also browse other Leagues happening in the Mid-Atlantic on the USTA Mid-Atlantic league calendar available here.