Common Tennis Injuries, Why They Occur, and How to Stay On The Court!
Tennis, by nature, is a very dynamic sport with constant repetitive movements requiring aerobic and anaerobic sources of energy. Athletes from the novice to professional level rely heavily on an athlete’s strength, endurance, flexibility, and technique to stay healthy. If energy is not properly dissipated along the kinetic chain, the body has a tendency to break down. Overuse injuries are most common in the upper body while acute/sudden injuries are most common in the lower body. The most common upper body injuries for tennis players are shoulder impingement, GIRD (glenohumeral internal rotation deficit), labral tears, and tendinopathies of the shoulder and elbow (tennis and golfer’s elbow). Regarding the lower body, the most common injuries are muscle strains and ligament sprains primarily affecting the knees and ankles. Overall, it has been reported that there is an injury incidence range of 0.04 to 3.0 injuries per 1,000 hours played for tennis athletes. 4,1
There are thousands of risk factors leading to injuries but the most common for tennis athletes are the following: rotator cuff weakness, scapular dyskinesis (poor shoulder blade stability), poor shoulder range of motion, inadequate equipment from shoes to racquets, and poor biomechanics with tennis specific movements. The rotator cuff is made up of 4 muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. Over time, if there are strength imbalances, poor shoulder blade coordination, and/or range of motion deficits in the shoulder, this can lead to abnormal stresses causing hypertonicity of the rotator cuff muscles, especially the posterior/back portion of the rotator cuff (teres minor/infraspinatus), decreased space of the glenohumeral joint, and/or decreased range of motion, especially internal rotation. If this occurs, the risk for rotator cuff tears, labral tears, shoulder impingement, and other injuries exponentially increases.
Furthermore, if the athlete is not equipped with correct footwear, racquet size, string technology, and grip, these factors can also put an athlete at risk for both acute and chronic/overuse injuries. If an athlete has poor footwear that does not support the body properly, it puts abnormal stress on the body and often leads to ankle and knee sprains and/or muscular strains due to the high variability of the sport requiring quick changes of direction. Custom moldable orthotics are often recommended to increase support within footwear and assist with force distribution. Also, if an athlete is playing with a racquet that is too big or strings or grip that is not a good fit, this can cause increased “shock/stress” through the body negatively affecting the kinetic chain leading to injury. Working closely with healthcare professionals and a tennis coach is important for the athlete to be set up for success.
A biomechanical study of the tennis serve found that the mechanical loads transmitted to the shoulder and elbow increased by 17% and 23% in the absence of proper knee flexion when attempting to produce a velocity similar to that of a serve performed with correct knee flexion. 3 Another study by Kibler et al. calculated that the leg-hip-trunk link produces 51% of the total kinetic energy during tennis movements. The tennis serve is the most intense movement in the game of tennis. If breakdowns occur at a given point in the chain with any tennis specific movements, this can result in injury or manifest as an injury further down the chain over time.5
Doctors of Physical Therapy are known as movement specialists focusing on the musculoskeletal system. As reported above, several injuries occur due to a breakdown in the kinetic chain secondary to poor biomechanics. Physical therapists are experts in identifying faulty movement patterns and weaknesses putting athletes at risk for injury. In San Diego, CA at Water and Sports Physical Therapy, physical therapists have been incorporating 3D infrared technology that tracks joints without sensors to analyze sports specific movements. This allows us to accurately identify weaknesses, establish a unique rehabilitation plan, and significantly decrease the risk of injury. Through the use of a variety of manual therapy techniques, reassessments with our infrared software to track progress, and rehab-based exercises, our physical therapists can improve joint mobility, restore resting tone of muscles, improve coordination/motor control, and increase strength in order to help athletes stay on the court.
Other recommendations for injury prevention include a proper warm-up and cool down, supportive footwear, and correct string technology and racquet size. When warming up, it is important to encourage athletes to avoid static stretching and instead focus on a dynamic warm-up within a comfortable range of motion. For a cool down, athletes should be focusing on static stretches of tight muscles, holding each stretch for at least 30 seconds to 1 minute. Also, supportive footwear needs to be a primary focus for athletes. . Research consistently shows that proper arch support is very important to help prevent injuries.1 Lastly, athletes need to make sure that their racquet size, string technology and grip are fit specifically to them to avoid abnormal forces being transmitted through the body when hitting a tennis ball.3,4
Water & Sports Physical Therapy has been helping professional athletes prevent injury and get back to their sports for over 25 years. We were chosen by the Padres to be the official physical therapists because of our effectiveness in getting athletes healthy, feeling good, and back on the field quickly. Water and Sports Physical Therapy is family-owned and operated and has 8 state-of-the-art clinics in San Diego. We incorporate both aquatic/pool and land-based treatments to get athletes feeling and performing at their highest potential. Call us today for a free infrared analysis as part of your evaluation, and view our website for video and details of our infrared analysis system.. We accept most insurances. (858)488-3597 www.WaterandSportsPT.com. Locations: Carmel Valley, Downtown, UTC, Poway, Scripps Ranch, La Jolla, Mission Beach, & Coronado
Written by: Dr. Brittany Lillie PT, DPT, OCS, CSCS
References:
1. Pluim BM et al. Tennis Injuries: occurrence, aetiology, and prevention Br J Sports Med. 2006 May;40(5):415-23. 2. Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther. 2015 Sept-Oct; 19(5):331-339. http://dx.doi.org/10.1590/bjpt-rbf.2014.0109
3. Chung et al. Upper Extremity Injuries in Tennis Players: Diagnosis, Treatment, and Management Hand Clin. 2017 February ; 33(1): 175–186. doi:10.1016/j.hcl.2016.08.009.
4. Fu et al. Epidemiology of Injuries in Tennis Players. Current Reviews in Musculoskeletal Medicine (2018) 11:1–5 https://doi.org/10.1007/s12178-018-9452-9
5. Dines et al. Tennis Inuries: Epidemiology, Pathophysiology, and Treatment. J Am Acad Orthop Surg 2015;23: 181-18 http://dx.doi.org/10.5435/ JAAOS-D-13-00148
