Andre Agassi's Battle With Back Pain

After fighting painful, chronic back pain for years, tennis great Andre Agassi retires from the court and prepares to serve up the next chapter of his life.

Medically Reviewed by Michael W. Smith, MD

On Sept. 3, as he said goodbye to his fans at the U.S. Open, retiring tennis star Andre Agassi dabbed away tears. His lower lip quivered while he spoke, his voice on the verge of breaking during the minute-long farewell.

"You have given me your shoulders to stand on to reach for my dreams, dreams I could never have reached without you," he told the crowd at New York's Arthur Ashe Stadium.

For those watching, it was one of two indelible images from the final moments of Agassi's storied 21-year career. The other image is of Agassi in pain, his agile body seizing up during his last match, his long-injured back rebelling against the demands long made upon it.

Agassi, 36, had announced his retirement six weeks before, at Wimbledon. Though many factors influenced his decision, "I can't suggest that the pain didn't play a big part," he says. "It starts with your body and moves to your mind."

Asked how long he'd been suffering from back problems, he thought for a moment before timing it to a milestone in his life: his son's birth. Five years ago.

"It was a physical issue that grew to be a real physical concern," Agassi says of the degenerative disc disease spondylolisthesis, which caused one of the vertebrae in his lower back to slip out of place. As the disease progressed, the disc began pinching his sciatic nerve, a condition called sciatica that causes low back pain that shoots down the leg. By the end of the Open, even the injections of cortisone and other anti-inflammatories that he'd been taking since March could no longer help. He lost his final match to 25-year-old Benjamin Becker, a German who'd turned pro the year before and was ranked 112.

Still, when it was over, thunderous applause filled Arthur Ashe Stadium. The crowd gave Agassi a four-minute standing ovation as he rested in a courtside chair before making his goodbyes. To Agassi, it was not a loss. He had accomplished what he set out to do: finish the match, despite the pain.

"It was such a perfect end to what I consider to be a wonderful journey," Agassi says. "My goal was to do this as long as possible, and even if I'd been in a healthy place, I would have had to make this decision eventually."

When WebMD spoke with Agassi, about a month after his final match, he had yet to begin adapting to his new life. In fact, he says, it's business as usual.

"Of course, I [no longer] have to worry about training, about physical rehabilitation. I don't have to focus in those confines. But I'm as busy now, if not busier. It's quite typical, really. After each of the last 11 Opens, I've tended to shut down a bit and try to make up for lost time," he says. "My goals and commitments are always pushing me forward. I don't think the new lifestyle has been felt yet."

One thing he doesn't feel anymore, he says, is the pain.

"Now, I'm fine. I haven't been pushing my body to its limits. Tennis -- it's a pretty ballistic sport that we play. The pain has been a function of what I've asked of my body."

Agassi played his first professional match at age 16. But tennis had been part of his life even before he was conscious of it. As an infant, a tennis ball dangled above him as he lay in his crib, hung there by his father, a former boxer who had represented his native Iran in the 1948 and 1952 Olympics. Emmanuel "Mike" Agassi, who immigrated to the United States as a young man and settled in Las Vegas, wanted his child to be a champion.

He got his wish. In 1992, Andre, his fourth child, took the title at Wimbledon. He was 22.

Victory piled upon victory, as Agassi won both the U.S. and the Australian Opens, rising to No. 1 in the three years after Wimbledon. He became famous, however, for more than just his playing. Agassi brought an upstart's attitude to the game, flouting convention in spandex, denim cutoffs, and rock-star hair. His millions in prize money bought him a Lamborghini, a Ferrari, and three Porsches. On TV, he was the face of the Canon Rebel camera. You remember the slogan: Image Is Everything.

That image was complex, though. For the cameras, Agassi was all flash. But there was another side to him. In 1994, he founded the Andre Agassi Charitable Foundation, which has raised more than $60 million for recreational and educational programs for at-risk children in southern Nevada. The foundation continues to support both the Andre Agassi Boys & Girls Club and the Andre Agassi College Preparatory Academy, both in Las Vegas.

The same year, an injured wrist drastically reduced his ability to compete, and he played only 24 matches that season, less than a third of what he played in previous ones. His ranking plummeted to 141 in 1997. He found himself competing in Challenger Series tournaments, a circuit for pro players who couldn't make the top 50.

From that low point came a new focus on the game. Agassi discarded his flashy getup and donned conservative tennis whites. (He started shaving his head in 1995.) He worked out until his body was in the best shape it had ever been. He rethought and reworked his game. And he began the climb back to No. 1.

In 1998, he rocketed from 141 to 6. No player had gone from so low to so high so quickly. By 2003, he had won eight Grand Slam titles. He is one of only five players to win all four Grand Slam singles events.

Agassi's home life changed direction as well. His first marriage, to actress Brooke Shields, ended in divorce in 1999. Two and a half years later, Agassi married retired tennis great Steffi Graf. They have two children: 5-year-old Jaden and a daughter, Jaz Elle, 3.

By the time of his last Grand Slam victory -- the 2003 Australian Open -- Agassi's back had been hurting for months.

"I thought it was my hip," says Agassi, who says his only mistake in caring for his back was not getting it diagnosed sooner.

Would an earlier diagnosis have made any difference? Probably not, says Alan S. Hilibrand, MD, associate professor of orthopaedic surgery and neurosurgery and director of orthopaedic medical education at Jefferson Medical College and the Rothman Institute in Philadelphia.

"From age 20 on, all people experience a process of drying out of the discs in the spine. In other words, everyone has degenerative disc disease," says Hilibrand, who is also a spokesman for the American Academy of Orthopaedic Surgeons.

Those discs act as cushions between vertebrae, helping to hold them in place. As they dry out, they begin to lose this ability, and the likelihood of one of the vertebrae slipping increases. When that starts to happen, the resulting condition is known as degenerative spondylolisthesis.

Lower back pain is the most obvious symptom, though many people have no symptoms at all. The drying out of the discs, says Hilibrand, can lead to painful tears in the fiber that surrounds them. How severe the pain is varies from person to person. "Some people, for genetic reasons, are very susceptible to that pain," he says.

Athletes have an advantage over couch potatoes when it comes to preventing back pain. Why? Because their strong trunk muscles are better able to support the spine, Hilibrand explains. They can also withstand a lot of suffering.

"Agassi obviously has very strong trunk muscles, but I don't think he would have gotten where he did without a great tolerance for pain."

This type of back pain is very familiar to Justin Gimelstob, a 27-year-old professional tennis player and friend of Agassi's. He underwent emergency back surgery in early September and at the U.S. Open suddenly found himself with two herniated or slipped discs after eight or nine years of back pain.

"The sport is tough on the back," says Gimelstob, who has commiserated with Agassi over their suffering. What frustrates athletes like Gimelstob is that the pain often strikes without warning, throwing off his rhythm. It was the same for Agassi, he says: "That's what Andre was feeling -- that inability to be properly prepared when you don't know what's going to happen."

Agassi doesn't anticipate needing surgery, especially now that he is out of the game. So, what is he preparing for now? In addition to his continued work with his foundation, he's bound to keep competing, if not on the court then in his new business ventures. He and Graf are working on an international chain of resort communities. They also unveiled plans for a luxury hotel, the Fairmont Tamarack, in Idaho.

"It's a lane change, not an exit," Agassi says of his new projects.

No matter how strenuous his new work may be, it won't require the superhuman physical conditioning demanded of him by tennis. And that's just fine with Agassi. For now, he's quite happy to miss a workout or two -- or three.

"To go to the gym and train now would feel more empty than focused," he says. "[Physical training] will always be a part of my life, but right now there would be too much nostalgia."

Show Sources

SOURCES: Andre Agassi. Alan S. Hilibrand, associate professor of orthopaedic surgery and neurosurgery, director of orthopaedic medical education at Jefferson Medical College and the Rothman Institute, Philadelphia; spokesman, American Academy of Orthopaedic Surgeons. Justin Gimelstob, professional tennis player. Handout on Health: Back Pain, NIAMS/NIH Booklet, 2005. WebMD Medical Reference from Healthwise: "Low Back Pain."

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