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Prevention of tennis injuries

Abstract

Injury rates in tennis are low. Optimal shoulder function requires good kinetic chain function, optimal stability, and coordination of the scapula in the overhead action. For an injury prevention strategy to be successful it is vital to be familiar with the injury incidence, injury severity, injury mechanism.

Keywords

Injury rate, serve, kinetic chain, injury mechanism

Summary

Tennis is a demanding sport physically, mentally and emotionally. We do know a lot about the inherent demands in tennis, in terms of forces, velocities, ranges of motion, and amount of tennis play. We also know some about the musculoskeletal base, in terms of maladaptations.
Great demands in tennis
The high demands can be shown by some relevant figures. The average point requires 8,7 changes of direction. Each change put a load of 1,5-2.7 times body weight on the planted knee (Kibler, Safran 2000). An elite young player practices 2,3 h per day 6,1 days per week
There are high body segment velocities, motions and loads. An elite player must generate 4000W of energy or 5 hp in each serve. Entire body is involved. Trunk rotation is about 350 deg/s. Shoulder rotation velocity 17000 deg/sec. Elbow extension 1100 deg/sec.
The serve was the predominant stroke accounting for 45% in French Open and 60% in Wimbledon of strokes during service games. The greater number of strokes per game on clay versus grass may contribute to earlier fatigue. (Johnsson et al. Br J Sports Med, 187: 901, 2006)
The overhead serve motion is unnatural and highly dynamic, often exceeding the physiological limits of the joint. Owing to overload of various anatomical structures, the shoulder is susceptible to injury. Optimal shoulder function requires good kinetic chain function, optimal stability, and coordination of the scapula in the overhead action. ( Van der Hoven, Kibler: Br J Sports Med, May;40(5):435-40, 2006). Internal rotation deficit results in tight posterior capsule causes anterior gleno-humeral translation External rotation excess may cause stretching of anterior and inferior capsular structures, anterior instability and internal impingement. Improved internal rotation strength is due to adaptation to serving motion.
Upper limb loading when bending the knee in the tennis serve has been studied. Players who flexed the knee 7.6 degrees were compared with those who flexed 14.7 degrees, in the backswing phase of the serve. Players who recorded a larger knee flexion recorded less normalized and absolute peak internal rotation torque compared with those with less flexion. Recommendation in summary was that all players should be encouraged to flex their knees during the backswing phase of the service action. (Elliot et al. J Sci. Med Sport Mar;6(1):76-87, 2003)
Injury rates in tennis are low
The rate is-2-20 injuries / 1000 athletic exposures or hours played. Very few reliable figures are available! Low back pain is common. 50% of elite players had a history of low back pain of at least one week duration. 46,7 % of retired players with back pain had abnormal radiographs of the lumbar spine (Sward et al 1990). Wrist pain is an increasing problem especially in women´s tennis. 29% had wrist pain in dominant arm and 25 % in non-dominant arm. Knee injuries are 19% of total. Muscle strain especially of the hamstrings, when charging towards the net. Achilles tendon injury has 5,5% incidence in players over 40 years of age.
Is tennis a predisposing factor for degenerative shoulder disease? The prevalence of gleno-humeral osteoarthritis in the dominant shoulder was greater in former elite tennis players than in sedentary controls. ( Maquirrian, et al. Br J Sports Med.40(5):447-50, 2006)
Injury prevention
Can inherent biomechanical and physiological demands of hitting and running be modified? Utilization of kinetic chain sequencing from the ground reaction forces creates optimum proximal force generation, interactive movements in distal segments produces efficient long axis rotation of the arm before ball impact. Specific alteration in mechanics such as incomplete flexion of the knees in cocking or incomplete cocking of the shoulder may create increased loads in the shoulder and elbow. These mechanical problems should be addressed by detailed coaching analysis and training. Stretching does not solve the problems!!!
For an injury prevention strategy to be successful it is vital to be familiar with the injury incidence, injury severity, injury mechanism. Remember that old recurrent injury is the most common risk factor (Tropp 1985). 19% of all injury in football is reinjury (Ekstrand 2005)
Effective medical service is vital for successful prevention. ATP offers extensive medical service for the men´s professional tour and the Sony Ericsson WTA Tour is the largest premier professional sport for women worldwide. Comprehensive health care inherently treats the whole person. Attempts have been made to modify the amount of tournament play such as the season is this year two weeks shorter for the men. The women will now take a three weeks break in the summer. The effects on injury incidence is yet not clear.
The International Tennis Federation (ITF) is the world governing body of tennis. The ITF Sport Science and Medicine Commission (SSMC) comprises the core sciences of biomechanics, physiology, psychology, nutrition, motor learning and sport medicine. Injury registration to establish the factors that are associated with injury and tennis, using the results to implement policies and strategies to minimise such injuries is a key research project. . Racket Power is studied for its role in injury production performance on nature of tennis, including: ball speed.
Take home message
The adaptive response to the physical demands in tennis techniques not the least the serve is started to be understood. The adaptive response results in loss of flexibility and strength and may result in injury. Every coach much include adequate prevention programs for this! Some mechanical problems may be addressed by detailed coaching analysis and training.
The basics for an injury prevention strategy to be successful it is vital to be familiar with the injury incidence, injury severity, injury mechanism.

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CV

Name

Per

Surname

Renstrom

Curriculum vitae

Per Renström took his MD in 1972 and his PhD 1981. Full professor in orthopedics and sports medicine, University of Vermont, USA 1988-1997, thereafter at Karolinska Institutet, Stockholm, Sweden. Emeritus since 2007

Published 334 full scientific publications, 163 original in peer reviewed journals. Author of 16 books, 68 full book chapters. Has received the highest honors by FIMS and ISAKOS. Was inducted in “Hall of Fame” by AOSSM 2009.

Vice president FIMS, president ISAKOS and presently member IOC Medical Commission. Medical director ATP, member ITF Medical and Scientific Commission, former president SMTS and was physician Swedish Davis Cup team.

History

Member for

2 years 28 weeks