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Tennis Injuries

Tennis Injuries. Presented by Cheng Yuk Han Bjork (28) Choi Yik Ming Jason (38) Chu Po Wang Kelvin (42) Leung Yee Ling Winnie (82). Common tennis injury region and prevalence-1.

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Tennis Injuries

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  1. Tennis Injuries Presented by Cheng Yuk Han Bjork (28) Choi Yik Ming Jason (38) Chu Po Wang Kelvin (42) Leung Yee Ling Winnie (82)

  2. Common tennis injury region and prevalence-1 Kibler et al. Fitness evaluations and fitness findings in competitive junior tennis players clinics. Sports medicine 1988;7:2.

  3. Common tennis injury region and prevalence-2 USTA. Injury breakdown of elite U..S. junior tennis players. Complete conditioning for tennis 1998;pp184-185.

  4. Tennis • 4 major stroke • Serve(overhead) • Forehand • Backhand • Volley

  5. Serving & overhead stroke Stage Action Body action Phase Trunk and pelvic rotation Prepare for explosive build up of power Wind up -- Early cocking Sh. moving to abd. and ext. rot. Elb. moving to F. trunk rot. Cocking Gradually build up explosive power Sh. in 900 abd. & full ext. rot. Elb. in 900 F. trunk rot., ext. & side F. Late cocking

  6. Serving & overhead stroke Sh. int. rot & add. Elb. E Wrist F. trunk F. & rot. Release of power Acceleration -- Absorption of energy & deceleration Sh. int. rot. & add. Elb. E Wrist F. trunk F. & rot. -- Follow-through

  7. Forehand stroke/volley Action Body action Phase Backswing Sh. ext. rot. & abd Elb. F. Wrist in neutral Trunk rot. Prepare for explosive build up of power Release of power acceleration Sh. int. rot. & add Elb. F. Wrist in neutral Trunk rot. Deceleration & power absorption Sh. further int. rot. & add Elb. F. Wrist in neutral Trunk rot. Follow-through

  8. Backhand stroke/volley Body action Action Phase Backswing Sh. Add & int. rot. Elb. Ext or F. Wrist in neutral Trunk rot. Prepare for explosive build up of power Release of power Sh. Abd & ext. rot. Elb. moving to ext. Wrist in neutral Trunk rot. acceleration Sh. Abd & ext. rot Elb. ext. Wrist in neutral Trunk rot. Deceleration & power absorption Follow-through

  9. Physiological characteristics of tennis playing

  10. Agility Physiological characteristics of tennis playing Fast lateral movement occur frequently in tennis Match Leuthi et al. (1986) Gecha and Torg (1989) Involve sharp, side-to-side movement Seliger et al. (1973) 88% aerobic, 12% anaerobic. Tennis is belonged to Sub-maximal loading physical activity Cardiovascular endurance

  11. Speed Behm (1987) Strength and power allow tennis players to accelerate their bodies over the court and strike the ball with maximum impact Chardler (1995) The loads on the glenoid in throwing = 2 BW Strength and power Leach (1988) Tennis depends upon quick bursts of speed interspersed with several slower gliding steps

  12. Upper Limb Injuriesincidence of shoulder injury range form 10% to 30% among elite junior players. More than 80% of all tennis injuries are caused by overuse (Todd, 1995)

  13. Shoulder - Impingement Syndrome • Intrinsic factor • repetitive use of arm at or above shoulder level in overhead stroke and cocking produces inflammation and wear of rotator cuff • shoulder in > 800 abduction and full external rotation

  14. Shoulder - Impingement Syndrome • Intrinsic factor • imbalanced rotators muscle strength leading to overload rotator cuff injury • Extrinsic factor • training error - the use of excessive shoulder external rotation to compensate trunk rotation

  15. Shoulder: Instability • Intrinsic factor • eccentric dynamic stabilizers overload • tendinitis resulted from eccentric overload leads to reflexive pain inhibition which alter the proper functioning of the glenohumeral and scapular stabilizers • anterior joint capsules and ligaments are then chronically stretched in late cocking and overhead stroke

  16. Shoulder Rehabilitation • Rotator cuff strengthening and posterior capsule stretching • Scapular musculature strengthening • Propeller muscles strengthening • PNF (D2 Pattern) • Plyometrics training • Progress to sport specific exercises

  17. Shoulder Rehabilitation • Training Advice • The forces at the shoulder in result from the summation of the kinetic chain activity which starts with the ground reaction force in the legs and proceeds to the shoulder. • Basic strength of LL and trunk is essential in conditioning exercise

  18. Elbow - Tennis Elbow • Occur in 50% of tennis players in their playing lifetime (Kamien, 1990) • Intrinsic factor • common extensor tendons, especially the extensor carpi radialis brevis, are put under strain by vigorous wrist extension in backhand stroke

  19. Elbow - Tennis Elbow • Extrinsic factors • heavy racket • using high string tension racket • using small grip size relative to hand size • playing in hard court surface for extended period of time

  20. Tennis elbow rehabilitation • Acute care Treatment : RICE principle • Post-acute care • Early submaximal exercise – isometric and manual resistance exercise • Gentle stretching to forearm muscles • Distal muscle group strengthening

  21. Tennis elbow rehabilitation • Other considerations: • Forearm braces – alleviate elbow pain in 75 to 89% of players(Gruchow & Pelletier 1979; Kamien 1988; Nirschi 1974; Priest et al 1980) • Racket material and size – racket made of high proportion of fibreglass absorbs vibrationbetter(Brody 1985) • String tension – low string tension of 28 to 32lb (Kamien 1990)

  22. Tennis elbow rehabilitation • Grip Size - racket torque is best controlled by largest comfortable grip size (Bernhang et al 1974) • Court Surface – hard and clay court • Stroke technique Advice

  23. Low Back Injuries

  24. Low Back Pain • In the USA Men’s Professional Tennis Tour • 38% of players missed a tournament because of LBP • In the US Open 93 • 81 players received medical evaluations • 18 of these with Low back complaints

  25. Lumbar strain • Primary cause • Results from repetitive muscle contraction which leads to mm exhaustion, ischemia and local lactic acid accumulation • Muscle at risk • Posterior: Erector spinae & Multifidus • Anterior: Abdominal muscle

  26. Posterior • Erector spinae & Multifidus • Repetitive mm contraction by trunk extension and rotation

  27. Anterior • Abdominal muscle • Repetitive mm contraction by trunk flexion and rotation

  28. Secondary causes or Predisposing factors • Overuse Injuries • Shoulder/upper trunk injury/inflexibility • Hamstring injury/inflexibility • Low back inflexibility • Lower extremity fatigue

  29. Rehabilitation for primary cause • Relative rest and pain relief at the acute phase • Local ice application & Stretching to reduce spasm • Ultrasound and massage also can help in decrease mm spasm • Gradual flexibility and strengthening program will follow • Train advice on the stroke techniques

  30. Prevention for secondary causes • Identify the predisposing factors • Proper training advice to give athletes sufficient rest time • Specific stretching program to tight mm group • Education to athletes to pause the match or training when there is any limbs injury or fatigue

  31. Lower Limb Injuries

  32. Knee injuries(Patellofemoral pain syndrome)(16% of tennis players suffering from ant. Knee pain) Patella Lateral tilting Mechanism Repetitive Abnormal patella tracking to the lateral side and cause excessive compressive loads

  33. Patella Lateral tilting Causative factors Intrinsic factors: • Biomechanical imbalance • increased Q angle (more common in female athletics) • excessive external tibia torsion • exaggerated pronation • VMO insufficiency • Lack of proper stretch (ITB tightness )

  34. Patella Lateral tilting Causative factors Extrinsic factors: • court surface (hard surface) • shoes design (no proper arch support) • training error

  35. Patella Lateral Tilting Rehabilitation • PRICE immediate after injury • Patella taping /brace (keep patella in a relax position) • (Tomas J, 2001) knee brace can decrease patelloferomal pain and patella instability • Quadriceps strengthening (especially VMO) • Stretching (especially ITB) • Orthotic device (e.g. heel lift, for correcting excessive pronation.) • Proper shoes wear, court surface, training intensity

  36. Ankle injuries Sprain ankle Mechanism Landing or turning in ankle inverted, plantar-flexed and adducted position after jumping or an extended stride *Tennis involve side-side mov’t and sudden turning and stopping very often. • Sprain laterally > 80%

  37. Sprain ankle Causative factors intrinsic factors: • Weak ankle muscles (especially evertors) • Lack of proper stretch (tight TA tendon) • Extrinsic factors: • court surface (uneven ground) • shoes design (worn-out/unsuitable)

  38. Sprain ankle Rehabilitation • PRICE immediately after injury • Early mobilization within pain free range to maintain/restore ROM • Strengthening ex. (esp. evertors) • Proprioceptive ex. (e.g.balance training) • Joint protection by taping/brace • (William J. 1990) ankle brace decrease the recurrent of sprain ankle by increase ankle stability • Proper shoes wear, court surface (even ground)

  39. Achilles tendinitis Mechanism Repetitive pulling or irritation of TA or tendon sheath * Symptoms commonly located at 2-5 cm proximal to the insertion into the calcaneous.

  40. Achilles tendinitis Causative factors • Extrinsic factors: • Court surface (hard court surface) • Shoes design (no proper arch/TA support) • Training error Intrinsic factors: • Biomechanical imbalance (excessive pronation, short Achilles tendon) • Limb length discrepancy • Lack of proper stretch (tight gastro-soleous complex)

  41. Achilles tendinitis Rehabilitation • PRICE immediate after injury • Proper stretching • Tapping (reduce TA loading) • Strengthening (esp. eccentric exercise) • Orthotic device (e.g. Heel Life, reducing excessive pronation and reduce TA loading) • Proper shoes wear, court surface, training intensity • * Chronic inflammation may cause degeneration and damage to the tendon, and possible partial or complete rupture

  42. Proper Shoes wear Tennis Shoes and Socks • Reinforcement at the toe • A well-padded sole at the ball of the foot • Firm sides of the shoe • A well-cushioned heel • Medial arch support • Try socks that wick away perspiration and reduce friction to avoid blisters.

  43. Training Advice 1) Court Surface • Most synthetic courts and hard courts speed the ball up, the quick pace of the points on the harder surface may cause increased stress on the legs 2) Warm up • Get warm by brisk walking or jogging and then do stretching exercise before starting to play

  44. Training Advice • Condition for physical fitness 1)Muscular strength • Lower limb, upper limb and trunk • Suggested intensity • Offseason – 2-3 sets and 5 to 12 repetitions of moderate intensity progressing to high intensity exercise • Preseaon – 3 sets, 2 days per week of high intensity exercise • Inseason – 2 sets, 1 to 2 days per week of high intensity exercise

  45. Training Advice 2)Cardiorespiratory endurance • more intensive aerobic training in the off- season, progressing to interval training and eventually sprint training during tennis season. • Suggested Training : • Offseason : 2 to 3 miles of running, 3 days per weeks • Preseason : Ten 220-yard dashes with 45 seconds rest, 3 to 4 days per week • Inseason : Sprint and agility drills, 1 to 3 times weekly

  46. Training Advice 3)Muscle endurance • A function of both strength and aerobic endurance 4)Range of motion • Suggested flexibility exercises: • Cross body shoulder stretch, triceps stretch, groin stretch, hamstring stretch, calf stretch and quadriceps stretch

  47. Reference • Dines DM & Levinson M. The conservative management of the unstable shoulder including rehabilitation. Clinics in Sports Medicine 1995 Oct 14: 797-813. • Kamien M. A rational management of tennis elbow. Sports Medicine 1990; 3:173-191 • Kibler WB. Biomechanical analysis of the shoulder during tennis activities. Clin Sports Med 1995 Jan 14:1 79-85 • Lee HW. Mechanisms of neck and shoulder injuries in tennis players. J Orthop Sports Phys Ther 1995 Jan 21:1 28-37 • Todd SE. Rehabilitation of shoulder and elbow injuries in tennis players. Clinics in Sports Medicine 1995 Jan;14:87-105

  48. The End Q & A session

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