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March 01, 2015

Smashing through tennis injuries

Upper body strength and endurance conditioning programs help reduce tennis-related orthopaedic injuries


ROSEMONT, Ill.—An estimated 11 million Americans play tennis each year. In tennis, as in many sports, the repetitive motions and large loads of force on the shoulder and elbow joints of tennis players can greatly increase risk for injury. Sudden stops and shifts in motion also can lead to lower extremity injuries. A literature review published in the March issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) discusses ways to help recreational and professional tennis players minimize injury risks.
“Acute [sudden, sharp onset] injuries occur more frequently and often affect the lower extremity. Chronic injuries also occur, but these tend to commonly affect the upper extremity,” says orthopaedic surgeon Joshua S. Dines, MD, lead study author.
Recreational Player Injuries
Tennis elbow likely affects recreational players more than it does professionals. Recreational players tend to hit their backhand strokes with their wrists in a more flexed position—bending the palm down towards the wrist. The flexed position causes repetitive microtrauma to forearm muscles and tendons that normally help stabilize the wrist when the elbow is straight. Weakened from overuse, these muscles can develop microscopic tendon tears, inflammation and pain, often seen in tennis elbow. Professional players tend to increase wrist extension—raising the back of the hand—just before ball contact. Treatment of most tennis elbow cases includes rest and physical therapy including stretching. Corticosteroid injections, when indicated, can greatly reduce inflammation after an injury. When nonsurgical treatment fails, surgery can be successful in most cases to remove tissue or repair affected tendons.
Professional Player Injuries
Professional tennis players tend to injure the inner side of the elbow due to excessive wrist snap on serve and forehand strokes, open-stance hitting, and short-arming strokes. Symptoms may include excessive tenderness and pain and/or weakness while extending the wrist, raising the back of the hand, against resistance.
“Tennis-specific preventive programs can address the muscular imbalances identified in musculoskeletal profiling studies from elite players and may help to reduce the incidence of injuries that these athletes experience,” says Dr. Dines. These exercises include squats, which strengthen the legs to enable them to generate power and absorb loads better; trunk rotations; and stabilization exercises for the shoulders and wrists.
Evolution in tennis equipment and play surfaces also affects the type and frequency of injuries. Newer racquets and strings have improved performance through faster racquet head and ball speeds, improving player performance. But increased ball spin may be associated with increased injury rates. Research has also shown that muscles are sensitive to surface stiffness. Frequently switching from hard to soft surfaces could be related to injuries in the lower extremities.
Tennis Injury Prevention Tips
  • Hit the ball at the center of the three racquet “sweet spots” to minimize loads on wrist and arm: these will reduce the vibrations that occur.
  • Reduced grip forces decrease the vibration load on the arm and help minimize the chances that tennis elbow will develop.
  • A multidisciplinary approach using bracing along with proprioceptive training and muscle recruitment evaluation can be an effective program to prevent ankle sprains for tennis players.
March 2015 Full JAAOS Table of Contents
  • Guest Editorial: One Size Does Not Fit All: Involve orthopaedic implant patients in deciding whether to use prophylactic antibiotics with dental procedures
  • Management of Segmental Bone Defect
  • The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice
  • Multiple Epiphyseal Dysplasia
  • Evaluating the Progression of Osteolysis after Total Knee Arthroplasty
  • Tennis Injuries: Epidemiology, Pathophysiology, and Treatment
  • External Beam Radiation Therapy for Orthopaedic Pathology
  • Reverse Shoulder Arthroplasty for the Management of Proximal Humerus Fractures
  • AAOS CPG Summary: Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age
  • AAOS CPG Case Study: Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age
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Disclosures. Dr. Joshua S. Dines or an immediate family member has received royalties from Biomet; is a member of a speakers’ bureau or has made paid presentations on behalf of Arthrex; and serves as a paid consultant to Arthrex and ConMed Linvatec. Dr. Bedi or an immediate family member serves as a paid consultant to Pivot Medical and Smith & Nephew; has stock or stock options held in A3 Surgical; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine. Dr. Ellenbecker or an immediate family member serves as an unpaid consultant to the Hygenic Corporation. Dr. Windler or an immediate family member has stock or stock options held in Stryker. Dr. David M. Dines or an immediate family member has received royalties from Biomet; serves as a paid consultant to Biomimetic and Tornier; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Biomet and Tornier; and serves as a board member, owner, officer, or committee member of the American Shoulder Surgeons. None of the following authors or any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Williams, Dr. Dodson, and Dr. Altchek.

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