HOW TO ACE IT ON THE COURT

The rivalry of many top-notch elite tennis players has brought the sport to a new level.  Tennis is a complex physical sport requiring full body participation. Two-thirds of injuries are due to overuse, with the remaining one-third due to acutely or traumatic events. While some injuries may be random occurrences most can be minimized/prevented by proper conditioning, technique, & equipment.

​ Perhaps the most well known injury, “Tennis elbow “ or lateral epicondylitis occurs with repeated stress and strain to the outside area of the elbow or extensor muscles, and generally occurs as a result of repetitive and prolonged gripping, twisting or sustained contraction of forearm or wrist flexion / extension with the elbow extended. Most experts believe overloading is due to a faulty backhand technique, such as when the elbow leads the racquet, combined with late strokes and Increased wrist action to complete the hit. Treatment may involve over-the-counter anti-inflammatory agents, ice/heat, and physical therapy to address the Soft / Joint mechanics and Dry needling to decrease scar tissue and promote appropriate scar alignment and collagen. Proper strengthening of the extensor muscles and surrounding muscle groups of the wrist and shoulder is important. Paying attention to the technical aspects, such as modifying grip and stroke form aides to reduce recurrence. Racquets with larger heads that increase the surface area, and string tension at the manufactures lowest recommendation, are preferred.

Repeated overhead, backhand, and long lever arm strokes can result in overuse and subsequent tendinitis, or inflammation of the rotator cuff tendons. (RTC) and bursa. The RTC is composedof 4 muscles that surround the joint and act in concert along with the scapular muscles to elevate and rotate the shoulder complex in multiple planes . Dysfunction in any one of these components can lead to pain, swelling, and
weakness. RTC tendinitis in tennis players is usually the result from excessive overhead serving particularly if you hold your arm at a 90°
angle from your side. When fatigued or weak, increased “play” of the ball in the socket of the joint can irritate the tissues. Treatment generally consist of ice, OTC anti-inflammatory drugs and engaging in PT or a program to facilitate a balance between flexibility, stability and endurance of the shoulder girdle, core and rib cage. Changing serve technique and mechanics will assist in injury reduction.

A common underlying cause in both calf and Achilles tendon injuries is a tight calf muscle. The calf is composed of the gastroc and soleus
complex and the Achilles tendon. Where the GS meets the Achilles tendon is called the musculo-tendinous (MT) Junction, and is a transitional
zone of weakness. The majority of tears and ruptures occur at this area. An Achilles rupture is a snapping or tear of the tendon in 2 pieces.
Typically a forceful push off, eccentric loading, i.e. coming down from a jump or deep squat, lunge, or abrupt impact can cause damage. Tendinitis, or inflammation of the tendon, generally occurs over time. Tennis Leg is an incomplete rupture of the inside portion of the GS muscle, usually related to an abrupt push off such as a sprint, or when lugging , pushing off one leg to reach a wide ball. Common symptoms include a tight or achy feeling in the back of the care and difficulty raising up on the toes. Both Achilles ruptures / strains and other tendinitis conditions are commonly associated with over pronation of the foot, so consider orthotics/ shoe inserts and proper shoes. Treatment for calf and tendon injuries may include Physical Therapy to elongate and remodel the  scar tissue, and to promote a balance between flexibility and eccentric strength. A good warm up followed by proper stretching can help diminish injuries.

One of the most costly, yet overlooked / unattended injuries is the ankle sprain, regardless of the cause of injury. The abrupt side to side activities, variable speed and direction change, and stop and go maneuvers render the foot and ankle prone to injury. Fatigue often plays a part injury. Persons with tight gastrocnemius, over pronate or have increased joint mobility/laxity, and muscular imbalances are more susceptible. Lateral (outside) ankle sprains are prevalent in most sports, but particularly tennis. Rolling of the ankle in either condition can damage the tendons and ligaments, and create a stretching injury to the surrounding nerve bundles. Recurrent ankle sprains are more common in the lateral ankle , and can lead to chronic instability and early degenerative joint changes. Often times it would be better to fracture the bone then to sprain an ankle! The immediate treatment to the ankle is to provide compression ice and elevation while protecting it. Placing the foot and ankle in a walking boot or "CAM" is recommended for at least two weeks. 40% of people with an ankle sprain will have a recurring injury. Proper early immobilization can never do you any harm as it allows for the joint to be in a good position to promote proper scar tissue formation and healing. PT for joint protection, while addressing flexibility, functional retraining of the lower leg,
core, ankle is recommended to avoid recurrent injury. Promoting balance, coordination, proprioception and sequencing , such as on a
wobble board, bosu, balance discs, and agility training. Proper inserts/shoes are helpful.

Stress fractures are the result of increasing training too rapidly without adequate down time. With muscle fatigue, the bone takes the brunt, and cannot adjust rapidly enough to absorb the stress and starts to crack. Most common in the foot, fractures of the spine are commonly found due to the hyper extension, rotation, and lateral bending required during a serve. Decreased bdominal and core stability is associated with increased risk of fractures, and is more prevalent in the younger tennis players who experience growth spurts. Rest for approximately six weeks to allow for the bone to heal combined with flexibility exercises to lower extremities and muscular stabilization to the core and pelvis area should begin once clinical healing has occurred. Just a note, stress fractures may take 6–8 weeks to show on the x-ray. As with any new sport, consult a coach/rep to educate about form and function. Veterans of the sport can always benefit from a check up to fine tune as well. Put the Love back in your game and play like an Ace!

​                                      Dr. Allie


​Visit either of our 2 Revolution Rehabilitation locations for a complimentary analysis, address your injury needs and for helpful links,  exercises, and tips!

It’s summer time in the Rockies!   Are you ready for golf?  Breaking out the swim suit?  Tackling the yard cleanup and maintenance? It might be a good time to focus on improving your core, but what does that really mean? Core exercises are part of a well rounded fitness program but aside from sit ups and push-ups many core exercises are neglected.  The abdominal area has been marginalized to include just one muscle, the most superficial...rectus abdominis,  the coveted “Six-pack”,  but the anatomy and function go much deeper..
 
Function:
The majority of our recreational and daily activities depend on the stability of the core muscles, be it reaching overhead to grasp an object, swinging a golf club, pushing open a door, or simply getting out of bed. The core is capable of a multitude of actions, but  the primary function is in maintaining good posture and spinal alignment. Functions also include stabilizing the rib cage when you cough or sneeze, increasing pressure in the chest cavity such as when you hold your breath, stabilizing the pelvic floor for urinary and bowel function and to assist in labor/delivery. Essentially your core is the “foundation“ of your house.
Weak core muscles can leave you susceptible to poor posture, spine and muscle injuries, and can lead to long standing neck and back dysfunction. Research has shown a correlation between injury and altered core strength in professional athletes, and a higher incidence of back pain in those patients who typically had a sedentary job and lifestyle.
 
Anatomy: Go Deep!
Anatomically the  “core “ is a complex mass of tissue comprised of muscles,  ligaments , bones and organs. The core muscles can be divided into two groups: 
 
The first group are  the deep core and “local ” stabilizers of the spine, due to their proximity and closeness to the spinal column .These include the transversus abdominis and lumbar multifidus and generally coactivate to provide spinal segmental stabilization and maintain the spine in a neutral position. In addition these muscles provide fine-tuning motor control and proprioception to provide finite spinal stability. The second more shallow group of muscles provide “global” stabilization to the spine, pelvis, and thorax. These muscles include the rectus abdominis, internal and external obliques , erector spinae, quadratus lumborum, and hip musculature including the glutes and the hip flexors. These muscles produce high forces to counterbalance any resistance or action imposed on the spine, and are more of a secondary stabilizer. 
 
Core Strength vs Core Training? 
The terms core strength and core training have been something of a buzz....so is it core training or just a fancy way of saying tone and defining your abs?
In essence, Core-strength training is directed at training the deep trunk muscles, however independent or isolated  training in this area remains challenging.

Training is best focused on multiplanar, multijoint and combined  movements that emulate and activate the muscles in a more natural, functional manner, and are more effective and attainable. Research has shown that resistance training, which generally isolates individual muscle groups , can be more challenging for those who have a history of back pain because those muscles tend to shut down in the presence of disuse  or discomfort.

​Functional training helps you develop better posture by supporting your spine in helping with things like balance, coordination, functional movement patterns and when  working in multiple directions, various speeds, and against different levels of resistance. Movement patterns that work your core are going to work more than one muscle group and you benefit from the results much faster and can aid in injury recovery and reduction.
 
Go with your GUT! :
Building  core strength and control promotes a sturdy central link in the chain connecting your upper and lower body. Weak, tight, or unbalanced core muscles and surrounding tissue can undermine your ability to have a fun and productive life. Engaging in a program that includes core stabilization, flexibility, and cardiovascular training will build up your balance and stability , bring more power to your athletic and daily pursuits, and aid in injury prevention. While it’s important to build a strong core, keep in mind that overtraining abdominal muscles and ignoring muscles of the back, hip and pelvis can set you up for injury. If chiseled washboard abs are your holy Grail, it is still wise to embrace in a functional training program and trim body fat through diet and aerobic exercise.
 
Avoid getting stuck in the middle rut...visit one of our locations at Revolution Rehabilitation for a complementary consultation to assess your training and injury needs, and get back your groove!
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Visit our website for helpful tips and links for your core training regimen!

Motion is Lotion!!
Dr. Allie