The young British player who crossed the Atlantic to save his tennis dream

By Colin Haines, MD, Spine Surgeon at VSI in Reston, VA

Every summer we watch the best tennis players walk onto the grass at Wimbledon. What we don’t see are the players who never make it that far — not because they lacked talent, but because something in their body broke and nobody could tell them why.

Dilhan Wasantha was on that trajectory. A former number one player in Great Britain at 12&U, an LTA Youth National Series champion, a four-time Tennis Europe title holder — he was moving toward the professional circuit. Then his back stopped cooperating. He had a diagnosis — Bertolotti syndrome. But for nearly two years, the medical system around him could not provide solutions to reduce or eliminate his pain and keep him in the game.

He looked everywhere. He searched the United Kingdom, then all of Europe. Talked with people in Asia. He could not find the answers he needed until one night, up late in pain, he found me discussing Bertolotti Syndrome solutions on a podcast. I was four thousand miles away, but I could help him. So he got on a plane to visit me at VSI and keep his tennis dream alive.

What we get wrong about young athletes with back pain

The pattern is familiar. A young athlete develops low back pain. It’s blamed on training load, mechanics, a strain, growing. They get physical therapy and core work. When that fails, injections, acupuncture, dry needling and more. Each buys weeks or months, then the pain returns — because none of them addressed what was generating it.

Dilhan went through all of it. Physiotherapy. Steroid injections. Ablations. Chiropractic decompression. A full year with a physical therapist. He was diligent and disciplined, and he got worse anyway.

By early 2024, five minutes of play left him unable to stand. He tried to finish a match anyway, went into spasm, and couldn’t move for two days. That was when he stopped playing tennis.

But this was never just a tennis problem. Within a year he couldn’t stand still for five minutes or walk any distance. He was coaching from a chair. At a museum, he wasn’t looking at the exhibits, he was looking for somewhere to sit down.

An eighteen-year-old should not be organizing his life around the location of chairs.

Why this condition hides

Dilhan has Bertolotti syndrome. The lowest lumbar vertebra has an enlarged transverse process that forms an abnormal joint — a pseudo-articulation — with the sacrum. It’s present from birth. Most people who have it never know. But in some patients, especially athletes who load and rotate the lumbar spine thousands of times, that joint becomes a pain generator and can irritate the nearby nerve roots.

It hides for three reasons. The imaging finding is common enough that it gets dismissed as incidental — because usually it is. The symptoms mimic a dozen more common conditions. And it doesn’t respond to the standard ladder of care. When PT, injections, and ablations give only temporary relief, that failure is itself diagnostic information: if you’re treating inflammation and nerve signals but the problem is bone contacting bone, you will keep getting the same result.

Dilhan worked that out himself. In his first message to us, before we’d ever spoken, he wrote that anti-inflammatories weren’t touching his standing pain, that decompression brought brief relief, and that he suspected bone-on-bone contact at the pseudo-joint. He was right. He figured out the problem. He just needed the solution.

Very few surgeons focus on symptomatic Bertolotti syndrome. It’s too common to attract rare-disease research, too easily dismissed as incidental to be taken seriously, too specific for routine spine training. So it falls between the cracks. This isn’t good news for the people who experience it — they are often young, athletic, and told for years that their pain is a strain, or a weak core, or something to manage.

I made it one of my focuses because of what happens to those patients. By the time they reach me, many have been searching for years — even decades. Worst of all, they’ve stopped expecting to be believed. That’s the part that gets me. Over and over I am meeting people in pain who can’t find anyone who even recognizes the name of what they have, much less knows what to do about it.

So I talk and write about Bertolotti’s a lot. Because I want people to know there are solutions if this impacts you. Dilhan found me that way. And that’s why he’s sharing his story. Because if this is the cause of your pain — you need to know there are ways to fix it. You need to know others have found their way to solutions and are getting back to doing all the things they love in life…pain free.

What we did, and where he is

Dilhan’s imaging showed the Bertolotti anatomy alongside facet joint syndrome and disc pathology — pain rarely arrives alone. We performed a Bertolotti resection, removing the pseudo-articulation so the bone-on-bone contact simply isn’t there anymore. For an athlete who intends to rotate his spine thousands of times a week for a living, preserving motion mattered enormously. Two days later my colleague Dr. Niteesh Bharara performed PRP injections, and rehab began.

Within weeks, Dilhan noticed the thing I listen for above every data point: the pain he was in was surgical pain, not his old pain. That was gone.

He rebuilt slowly — five minutes on the court, then thirty. Once a week, then three times. He’s now playing four to five days a week and back in the gym, recently starting plyometric training. That’s a real milestone: you don’t put a lumbar spine through explosive repeated loading unless it’s ready.

He’s documenting all of it publicly on social media. Since he started, other Bertolotti patients have messaged him with questions — because they couldn’t find anyone either. He has now become the resource he needed and didn’t have — ensuring that it exists for others.

He’s also once again activating his tennis dreams. Dilhan intends to turn professional. He’s once again aiming for that goal. Most players don’t get there until twenty-three or twenty-four, so the clock he thought had run out, still has more time on it. Count me among the many cheering him on.

For anyone else out there searching for solutions — especially if they’re for Bertolotti Syndrome, I hope Dilhan’s story is a wonderful reminder about the power of not giving up — on the court or off. If you know something in your body isn’t right…keep going. Keep searching for answers. Even if you have to cross an ocean and travel to another country. Life’s too short to live with pain.

Dilhan Wasantha is documenting his recovery on Instagram (@dilhanwasantha) and TikTok (@justballtennis).

*Colin Haines, MD, is a spine surgeon at the VSI Spine Solutions. Learn more at VSISpine.com.*