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.
Common Tennis Injuries and Conditions:
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.
SHOULDER TENDINITIS / IMPINGEMENT:
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!
Visit either of our 2 Revolution Rehabilitation locations for a complimentary analysis, address your injury needs and for helpful links, exercises, and tips!