Sports Medicine: Tennis

Putting a tennis racquet in their children's hands at early ages, parents start their children in tennis in hopes of getting an athletic scholarship. As these children advance to new levels playing the sectional and national tournaments, a love for winning and a passion for the game of tennis give them the dream of becoming a tennis professional. Tennis is a muscle memory sport that requires hours and hours of practice to improve; even one day off can seriously hurt a player's game. Several hours a day of practice are necessary for kids who want to play college or professional tennis. As a growing number of kids are playing tennis, the tournaments are becoming increasingly competitive, which means that more hours of practice are necessary in order to keep up with the other players. Along with the increasing competition among junior players to become skilled enough to reach such high levels, the intensity of practices has increased as well. Many junior players lift weights or work out with personal trainers in addition to the many hours of tennis. Just as the pressure to improve strengthens, so has the technology in the manufacturing of racquets. New racquets add more power to shots, which can often be difficult for young bodies to handle. All these factors contribute to injuries. Although tennis is a non-contact sport that does not "contain the collisions or tackling common to football and soccer, the sport's injury rate among young participants is higher than any other youth athletic activity" (Whitbourne 3). At the 1996 Easter Bowl, a national junior tournament, a survey found that 62% of the 492 participants had at least one injury that required a visit to a doctor. Many of the players' common injuries are avoidable. In order for tennis to continue to increase in popularity, the sport needs to cut down the injury factor. The field of sports medicine, the methods of prevention and treatment of sport-related injuries, is essential to the welfare of the sport and its players.

Tournament level players follow a demanding training program. Reports show that 30-50% of sports injuries are caused by "muscle overload" (Dikeman). Especially for players who reach the later rounds, tournaments are very hard on the body. During a match, muscle spasms or metabolic accumulation happen frequently. Metabolic accumulation occurs when muscles are so tired from being overworked that they are no longer able to dispose of lactic acids and other waste products of the muscles; these wastes accumulate and cause pain. Vitamin C can sometimes ease the pain, but the best method is taking baking soda before playing. Baking soda decreases the amount of lactic acid that the muscles produce (Appleton). When the body is worked above its capacity, less blood travels to the muscles. Because the muscle has less blood, it begins to contract in order to preserve itself, which causes less blood to flow as the resulting contractions follow. By massaging the muscle, more blood flows to the muscle, decreasing the contractions and the pain. Deep tissue massage has become a popular form of therapy for muscle spasms, because it "incorporates very slow, deliberate and deep pressure" (Reveles), pressure that heals torn fibers caused by the contractions. Although a tennis player may leave the court feeling no pain, the next day s/he usually awakes to muscle soreness, making walking difficult. After pushing the body and its muscles to its limits in a match, the muscles tear from being strained and relaxed frequently throughout play. A muscle is made up of long cells that are connected to the tendon or bone called fibers. The fiber type determines the endurance or speed of contraction. There are two types of muscles fibers. The fast twitch fiber has "slow contraction and relaxation times," but it is "more resistant to fatigue and has more mitochondria and capillaries per fiber" (El-Khoury), which allows for more consistent flow of blood to these types of muscles. Distance runners have predominate slow twitch muscles, which are usually looser, making injuries rarer than with the other type of fiber, the fast twitch. The fast twitch fiber is "divided into subtypes," but, because it has "lower mitochrondrial content and it functions glycolytically, it is "better adapted for intense activities of short duration" (El-Khoury). Sprinters have predominant fast twitch fibers, which are tenser than slow twitch fibers, but allow the muscles to work harder. During a tennis match, players need both endurance and speed, which requires strong fast twitch and slow twitch muscles. Because a tennis player uses so many different muscles, the chances of injury are much greater. Tired muscles are injured more easily, because they absorb less energy. When muscles do not absorb as much energy, the muscle fibers tear. These microscopic tears in the fibers of muscles produce soreness; it usually does not hurt until 1 or 2 days after the injury-causing exercise. Often tablets of ibuprofen or a pain relief cream can alleviate the pain.

Oftentimes, flexibility decreases, because the fibers heal at a shortened length, but, by stretching, the level of flexibility can be regained. Muscle aches can best be prevented by finding the right balance between exercise and rest; an athlete must push his body, but he cannot become so obsessive that he overexerts his body.

There are several common recurring tennis injuries. Shoulder problems can hinder the career of a rising tennis star. After the first injury to the rotator cuff or the surrounding muscles, a recurring injury is very common due to incorrect rehabilitation. This stiffness is caused by overuse. By doing warm-up exercises, such as jogging or jump-roping, a person can strengthen these muscles, lessening the chance for injury. An ankle sprain, an injury whose pain focus is around the joint, is brought on by weak muscles that cannot handle the demands placed upon it. As swelling occurs, the foot should be iced and the person should rest. In addition to ankle sprains and shoulder problems, many people sprain their back. In order to produce a fast serve, strong stomach muscles are required to keep the back in the correct position. If the stomach muscles are not strong enough, the back gives out. The simple remedy of finding a firmer mattress can heal a strained back.


Tennis elbow is an injury individual to the sport. Pain on the outer side of the elbow is caused by weak forearm muscles that cannot keep up with the training regimen or improper form on the strokes. By strengthening the wrist muscles, a tennis player can avoid tennis elbow (PTPN). Further prevention becomes possible if an athlete strengthens the muscles around the injured joint in order to make up for its weakness. By allowing a bigger range of motion, future damage can be avoided.

The newest type of racquet is the long body. Adding anywhere from a quarter of an inch to 2 inches to the racquet length adds a new dimension to the game. They have become more popular than the standard length; two out of three frames sold are long body racquets (The Tennis Co.). Long body racquets offer power and control. The advancing technology of racquets has increased the speed of the ball, creating more injuries. It is much easier to injure a part of the body with an over-sized racquet. The "torque effect on shots hit off-center" makes the arm "more susceptible to injury" (PTPN). Choosing the correct racquet that suits one's game and body type is an important factor in injury prevention.

Often overlooked is the importance of supportive shoes. When a person is walking, the heel bone touches the ground first. Thousands of pounds per square inch of pressure concentrate around the heel area, making injury very common. When too much stress is placed on the heel, it gives out. Many tennis players strain their Achilles tendon due to improper footgear. Excessive pronation, "the normal flexible motion of the foot that allows it to adapt to ground surfaces and absorb shock" (Stege), can stretch the plantar fascia. Children especially injure their heels as they grow and become increasingly involved in athletic activities. Although resting seems to relieve the pain, this disappearance is only temporary. Shoes that fit well all over and that are designed to reduce shock absorbency and support the heels are necessary. Shoe inserts, called orthotic devices, combat heel pain very successfully. Although these devices require a prescription, they custom-fit to your foot and fix the "biomechanical imbalance," the inability of the heel to handle the pressure, by providing support and controlling the extent of pronation.

The most important method of prevention is stretching. Stretching "decreases muscle tension, increases range of motion, coordinates freer and easier movement, and allows for better performance" (Sports Medicine). As a person stretches a muscle, the muscle becomes longer, allowing for more flexibility and less resistance to intense exercise. The length of a muscle is proportional to its power; a longer, more stretched muscle will have more power. Stretching is essential to staying in shape, because "a powerful, or long, muscle can handle the wear and tear of a few set of tennis, while a weak, or short, muscle will give out" (Fiske 17). Especially in cold weather, stretching prevents injuries that result from tight muscles. Warm-ups are very important, because they adjust the muscles to the demand of the activity. Before playing, tennis players warm-up by hitting at half-speed. After playing, stretching is essential in preventing soreness during the days that follow. There are two factors that determine a meaningful stretch: isolation and leverage. Isolation works only the muscles one is trying to stretch. By concentrating on fewer muscles, the resistance needed to be overcome is substantially less. Isolation gives the player more control over the stretch and makes changing the intensity of the stretch much easier. Having control over the intensity level and the speed of change of the stretch is leverage. When a person controls the leverage, overcoming the resistance of tight muscles becomes much easier, because the person has the understanding of what the stretch is doing to his body or a "mechanical advantage over the stretched muscle" (Appleton). By stretching, the body works better and responds better to the intensity of tennis.

The role of a physical therapist is to observe activities in order to heal current injuries and prevent future ones. Before treating an injury, physical therapists examine the history of the patient by giving questionnaires that explain past injuries and pain. An important part of the recovery process is the physical therapist's "review of daily activities log" (The Role of the Physical Therapist), which closely monitors everything that the patient does. Under these circumstances, it is often possible for injured players to play tennis if they are extremely cautious and meticulous about following the doctor's orders. Because of this system, a player has less time off and his/her game does not fall to as low of levels as a longer duration of not playing tennis would do. Physical therapy also works to strengthen certain muscle groups that were not injured, but that when strengthened can prevent injuries in the future. Because it also involves different types of exercise, such as cycling, jogging, and weight work, physical therapy keeps an injured person in shape during the recovery period. Physical therapy is not only healing an injury, but also training the body to guard against future injuries. Perhaps if physical therapy were used before injury with junior athletes in demanding sports, like tennis, injury rates would be cut down.

Being cautious and catching an injury early on is essential for treatment. Although methods such as icing, massaging, resting, stretching, and strengthening work well against minor injuries, for severe cases, surgery is necessary. Over-working and pushing through pain without treating it does not improve one's tennis; the work is counter-productive, because it produces injuries that can end one's tennis career. As the game of tennis advances, so will the products and methods that heal and prevent injuries. For now, educating young athletes is the most important factor in preventing their injuries. Even common stretches, such as touching one's toes, can be damaging to the body in the future. Repeatedly do this stretch can lead to a herneated disc later in life. An alternative to this stretch in order to stretch the same muscle group, the hamstring and its surrounding muscles, one can bend over only a few inches at the hips with the leg in front of the body. Learning about injury-causing exercises and their alternatives will be the most effective way to combat the growing number of injuries in the junior tennis world. Through this research, children and parents will be able to live the dream that tennis gives to those who work hard and fight to win.

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