• Prevention & Treatment of the 5 Most Common Tennis Injuries

    Common Tennis Injuries

    The rivalry of today’s elite tennis players, such as Rafael Nadal and Roger Federer has propelled the popularity of tennis to an unprecedented level. However, even elite tennis players suffer from injuries and these injuries can also affect recreational players. By understanding more about common tennis injuries you can learn that there are steps you can take to prevent them. This guide is designed to help you stay injury free.

    Research evidence has shown that there are around 54 injuries per 1000 tennis matches played, which is about half the number of injuries that occur during the same number of soccer matches. There is also less risk of injury during tennis compared with individual sports such as running and golf. The injury risk during tennis can be further reduced if you understand some of the most common injuries that occur in tennis and have a strategy to avoid tennis injury.

    1. Sprained Ankle

    Sprained ankles are relatively common in tennis players. Roger Federer, Andy Roddick and Andrew Murray have all suffered sprained ankles. The sudden sideways movements that are required during tennis can cause the ankle to twist, particularly if the surface is slippery or the player is fatigued.

    A twisted ankle causes damage to ligaments and other soft tissues around the ankle. The damage causes bleeding within the tissues, which produces a swollen ankle that can be extremely painful.

    What can you do to prevent sprained ankles?

    Applying an ankle brace to the ankle can help to reduce the risk of ankle sprains and it’s a strategy that is employed by tennis pros such as Andrew Murray and Roger Federer.

    Previous research has shown the injury incidence in people with taped ankles was 4.9 ankle sprains per 1000 participant matches, compared with 2.6 ankle sprains per 1000 participant matches in students wearing ankle braces. This compared with 32.8 ankle sprains per 1000 participant matches in subjects that had no taping or bracing.

    What should you do if you suffer a sprained ankle?

    In the first few days following an ankle sprain it is important to follow the PRICE protocol – protection, rest, ice, compression and elevation (never apply ice directly to the skin). An cryotherapy is the most effective method of providing ice therapy and is the professional’s choice. A cryo cuff is ideal for home use as it is the safest and most effective method of ice therapy. It can provide continuous ice cold water and compression for 6 hours and significantly reduce ankle pain and swelling. Alternatively if you have to apply ice at home, the use of an ice bag is recommended. This is a safe method of ice application to avoid the risk of an ice burn.

    Rehabilitation with a chartered physiotherapist significantly improves the level of ankle function. Wobble board training in the later rehab stage is designed to assist the re-education of the proprioceptive system. Previous research has suggested that patients with ankle instability who underwent wobble board training experienced significantly fewer recurrent sprains during a follow-up period than those who did not follow the training programme.

    2. Shoulder Pain & Shoulder Bursitis

    Shoulder pain can occur in tennis players because there are repeated stresses during tennis strokes, particularly the serve. There are several sources of shoulder pain in tennis players, but one of the most common causes is shoulder bursitis. Bursitis is inflammation of a sac of fluid called a bursa.

    In the shoulder frequent overuse of the rotator cuff muscles (a group of small muscles, situated close to the ball-and-socket joint of the shoulder, that provide stability to the ball and socket) can cause the bursa to get impinged between the muscles and the bony prominence of the shoulder, leading to inflammation. This causes pain whenever the arm is raised.

    What can you do to prevent shoulder bursitis?

    For tennis players attention must be paid to flexibility, strength and endurance of the shoulder muscles. Shoulder stabilisation exercises under the supervision of a chartered physiotherapist can also help prevent impingement. In addition, any increases in the amount of training or competition must be gradual so as not to overload the shoulder. In particular, repetitions of the service action should be increased gradually to allow the body to adapt to increased workload.

    What should you do if you suffer shoulder bursitis?

    The first aim of treatment is to reduce the amount of inflammation through ice therapy (never apply ice directly to the skin) and anti-inflammatory medication prescribed by a doctor. A cryotherapy wrap is the most effective method of ice therapy treatment at home. It is easy to use and stays cold for 6 – 8 hours. Alternatively, a reusable cold pack can be used with a wrap that fixes the cold pack in place. If kept in the freezer this can be used again and again. If you don’t have access to a freezer where you play tennis, then instant cold packs provide a quick disposable method of ice therapy. Once the inflammation and pain has settled, exercises to regain full movement can begin, followed by a carefully graded strengthening and stabilising programme.

    3. Calf Strain

    The calf muscle group consists of the gastrocnemius, soleus and plantaris muscles, situated at the back of the lower leg. Their function is to pull up on the heel bone and these muscles are most active during the push-off when a tennis player has to move quickly to react to an opponent’s shot. A calf strain occurs when the muscle is forcibly stretched beyond its limits and the muscle tissue becomes torn.

    What can you do to prevent a calf strain?

    Diet can have an effect on muscle injuries. If a tennis player’s diet is high in carbohydrate in the 48 hours before a match there will be an adequate supply of the energy that is necessary for muscle contractions.

    However, if the muscles become short of fuel, fatigue can set in, especially during long matches. This fatigue can predispose a player to injury. Carbohydrate and fluids can be replenished during matches by taking regular sips of a sports drink between games.

    What should you do if you suffer a calf strain?

    The immediate treatment consists of the ‘PRICE’ protocol: Protection of the injured part from further damage, Rest, Ice, Compression and Elevation. The aim of this protocol is to reduce bleeding within the muscle tissue. Ice therapy in the form of ice pack applications should be continued until the acute pain has settled.

    Many people find that a neoprene calf support provides reassurance and therapeutic heat following a calf muscle injury. The rehabilitation after this period involves gradually stretching the muscle to elongate the scar tissue and progressively increasing the muscle strength. Once this has been achieved, the player can begin tennis-specific exercises. To reduce the risk of re-injury, this should be done under the supervision of a chartered physiotherapist.

    4. Stress Fracture of the Back

    A stress fracture of the back, or lumbar spine, is one of the more common bone injuries in young tennis players. Lower back stress fractures are usually characterised by an ache in the lower back which is exacerbated by sporting activities and eased by rest, although a small percentage of people with a stress fracture can be pain free. Typically it is sore when the patient bends backwards, particularly if standing on one leg. If a lower back stress fracture is suspected, a doctor may decide to refer the patient for a scan to confirm the diagnosis.

    What can you do to prevent a stress fracture?

    Serving in tennis requires a combination of spinal hyperextension (bending back) together with rotation and side bending of the trunk. This puts a lot of stress on an area of the vertebra called the Pars Interarticularis and this is where stress fracture develops.

    Practising the service should be carefully monitored by the coach to ensure the lower back is not being overloaded. This is particularly important in adolescent players who have just experienced a growth spurt as they are known to be more at risk from this injury. Core stability exercises can help prevent back problems in tennis players.

    What should you do if you suffer a stress fracture of the back?

    In most cases, complete rest from tennis is the treatment of choice. This would usually be for a period of 6 weeks to allow the bone to heal. In the early stages, a soothing heat pack can reduce back pain and alleviate back muscle spasm. During this period, a progressive exercise programme may commence, under the supervision of a chartered physiotherapist. This usually starts with exercises to increase the muscular stability in the lower back.

    5. Tennis Elbow

    Tennis elbow is inflammation of the muscles and tendons of the forearm as they attach to the humerus (upper arm) bone. This inflammation is caused by prolonged gripping activities such as hammering, driving screws, weight lifting, playing certain musical instruments, canoeing, digging in the garden, driving and, of course, racquet sports.

    Tennis elbow causes pain when the lateral epicondyle (outermost part of the elbow) is touched and also if the elbow is straight and the hand is moved forward and back at the wrist. The pain is exacerbated by gripping activities and in some cases simple things like turning a door handle can cause intense pain.

    What can you do to prevent tennis elbow?

    Tennis elbow is usually caused by gripping activities, and gripping either too hard or for too long can bring on the pain. Make sure the item that you are gripping, whether it’s a tennis racquet, a hammer, or a canoe paddle, is the correct size for your hand. If it is too small it will cause you to grip too hard. If you play tennis for the first time in a long while, or you have to do a strenuous activity such as decorate a room in one weekend, make sure you take regular breaks and stretch the muscles which work over the wrist by doing ‘limp wrist’ and ‘policeman halting traffic’ type stretches.

    For those who have suffered from tennis elbow in the past it may be a good idea to wear a tennis elbow compression strap. They work by preventing the wrist extensor muscles (that run along the outer side of the forearm) from contracting fully, thus reducing the strain on the elbow.

    What should you do if you suffer tennis elbow?

    The success of rehabilitation of tennis elbow is dependent upon first controlling the inflammation. Depending on the severity of the condition, this may be alleviated simply by rest or with the use of anti-inflammatory medication or a corticosteroid injection. However, in long standing cases where there is degeneration of the extensor tendons, anti-inflammatory medication, especially corticosteroid injections, should be avoided. This is because they can hinder tissue healing and in fact cause more degeneration. Ice therapy, using an ice pack, can be very effective in relieving the symptoms of tennis elbow.

    The final part of tennis elbow rehabilitation is a strengthening programme for the extensor tendons. It’s crucial that the load and number of repetitions are carefully recorded and progressively increased under the supervision of a chartered physiotherapist. This ensures that the overload on the tendon is carefully controlled and gradually increased.

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