TENNIS AND COMMON INJUIRES : A PHYSIOTHERAPY PERSPECTIVE

 Introduction  

Tennis is one of the most popular sports in the world, owing to the unique combination of aerobic and anaerobic activity that is enjoyable for all ages and skill levels. At the competitive level, tennis is showcased through the dynamic exchange of intricate strokes and serves by some of the world’s most versatile athletes. However, the physical demands of this sport are known to put athletes at risk for a variety of musculoskeletal injuries. A recent study of professional tennis competitions found that over 50% of men’s and women’s departures from competition could be attributed to injury.

Biomechanics of Tennis  :-

Tennis involves a combination of explosive movements, rotational forces, and repetitive motions. Key actions include:  

- Serving: A complex motion that involves the shoulder, elbow, wrist, and core. The serve generates high forces, especially during the overhead motion.  

- Groundstrokes (forehand and backhand): These require rotational forces through the trunk and upper body, with significant stress on the shoulder, elbow, and wrist.

- Quick directional changes: Rapid side-to-side movements and sudden stops place stress on the knees, ankles, and hips.  

These movements, when repeated over time, can strain muscles, tendons, and joints, leading to overuse injuries.   The tennis serve is the most energy-demanding tennis motion, and has been shown to comprise nearly 45-60% of all strokes performed in a tennis match. The serve is characterized by five different phases of motion:

(1) wind-up,

(2) early cocking,

(3) late cocking,

(4) acceleration, and

(5) follow through.

Other stroke types include the forehand or backhand groundstroke, which each have three different phases of motion:

(1) racket preparation,

(2) acceleration, and

(3) follow through.

Physical demands and the importance of Kinetic chain and Injuries in Racket sports: -

Musculoskeletal joints such as the knee, shoulder, and elbow serve as links in the kinetic chain by absorbing, generating, and transmitting energy to the next link, completing a cycle of energy from the ground to the tennis ball at impact with the racket. In a single tennis match, this cycle is repeated numerous times and relies heavily on an athlete’s strength, endurance, flexibility, and technique. If energy transfer in one joint is not efficiently coordinated, subsequent joints can easily become overloaded. 

 For example, 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.

In turn, novice or recreational tennis players often use excessive and uncoordinated strength in the absence of efficient technique, which does not translate into increased ball velocity and rather overload the joint and increases risk of injury. These results imply that optimal technique can contribute immensely to maximizing injury prevention and minimizing loads placed on each joint.

 Tennis Elbow:-

One of the most prevalent tennis injuries presenting to general and specialty clinicians is lateral epicondylitis, commonly termed “tennis elbow”. Epidemiological studies estimated that up to 50% of tennis players will develop lateral elbow symptoms throughout their tennis career, with a primary population consisting of recreational tennis players. 

Consensus on cause of lateral epicondylitis does not exist; however, many different aetiologies have been proposed.

In addition to anatomical predisposition of the extensor carpi radialis brevis (ECRB) tendon to irritation, overloading of wrist extensors during the backhand tennis stroke is thought to be a key contributor to the prevalence of the condition.

 Despite lower utilization compared to forehand strokes and serves, the backhand stroke is important skill for tennis players. It can be performed using a one-hand or two-handed approach; however, the one-handed approach is more commonly associated with elbow pathology. This stroke is accomplished with the elbow extended and the wrist supinated, applying stress to the forearm extensor unit and transmitting particularly large forces to the ECRB at the lateral epicondyle.

 Numerous studies have identified both intrinsic technical skill factors and extrinsic equipment variations that contribute to the high prevalence of this condition in the recreational tennis player.

Grip tightness is a key feature of a powerful backhand stroke; however, it must be coordinated appropriately with phases of the backhand serve to prevent injury to the elbow. From this, physicians and rehabilitation specialists should communicate the importance of decreasing grip strength and relaxing forearm muscles in the follow-through phase of the backhand stroke. These modifications have serious implications for lateral epicondylitis prevention in recreational tennis players.

Treatment: -

There is no standard protocol for treatment of lateral epicondylitis. Nonoperative therapy is recommended before operative intervention. In the majority of cases, symptoms will resolve without treatment within 6 to 12 months, along with proximal muscle strengthening. When conservative treatment is selected by the patient and physician, nonsteroidal anti-inflammatory drugs (NSAIDS) are typically the first approach and are often recommended with splinting, stretching, and strengthening exercises.

 Additionally, physiotherapy that combines elbow manipulation and strengthening exercises targeting the extensor muscles of the forearm have proven to provide short term symptom relief. If symptoms do not improve with NSAIDS or therapy, corticosteroid or platelet-rich plasma injections may be considered, although there is a lack of evidence supporting the use of injections over other nonoperative treatments. A recent randomized control trial conducted by Coombes et al. compared 1-year postoperative outcome measures of three groups of lateral epicondylitis patients: those receiving physiotherapy with corticosteroid injection, those receiving physiotherapy only, and those receiving injection only.

These researchers did not observe a clear benefit when comparing these groups to control lateral epicondylitis patients, and in turn found that corticosteroid treatment resulted in less improvement and greater 1-year recurrence. Similar studies of conservative treatments have failed to find long term benefits.

Return to Sport Phase:  

   - Sport-specific drills to improve technique and reduce injury risk.  

   - Plyometric and agility training to enhance power and coordination.  

   - Education on proper warm-up, cool-down, and injury prevention strategies.  

Prevention:  

   - Regular strength and conditioning programs to address muscle imbalances.  

   - Technique modification to reduce stress on vulnerable areas.  

   - Use of supportive equipment, such as braces or taping, if needed.  

Key Points:

• Common upper extremity tennis injuries involve soft tissue and are usually a result of overuse.

  
  

• Tennis injuries have a complex association with biomechanical properties of tennis strokes and serves.

  
  

• Injury profile of tennis injuries vary by injury site, mechanism of injury, athlete experience level, and presence of known risk factors.

  
  

• Diagnosis can be a challenge and depends on a thorough understanding of current research topics.

Conclusion  

Tennis is a rewarding sport, but it comes with the risk of injury due to its demanding nature. By understanding the biomechanics and common injuries, physiotherapists can help players recover effectively and stay injury-free. Whether you’re a weekend warrior or a competitive player, proper technique, conditioning, and early intervention are key to enjoying the game for years to come.  

Chung, Kevin C., and Meghan E. Lark. "Upper extremity injuries in tennis players: diagnosis, treatment, and management." Hand clinics 33.1 (2017): 175.