Tennis-related injuries are common at all levels of the game - junior, recreational or pro tour. One of the most frequent is the infamous 'tennis elbow'. This is a typical chronic overuse injury. It seems to be associated with lack of forearm strength, or more specifically a strength imbalance between the wrist extensor muscles and wrist flexor muscles. This is particularly true of junior players who suffer from this problem. It is also associated with poor technique, relying on too much arm power to make the shots rather than body rotation. This arm-dominant technique places too much stress on the elbow and wrist joints and hence the injury. This technique-related cause is most common in recreational players.A second frequently seen chronic overuse injury in tennis is shoulder tendinitis. This is often a rotator-cuff impingement injury caused by repeated overhead and inward rotation movements of the arm. This leads to a dominance of the anterior deltoid and pectoralis muscles and a relative weakening of the rotator cuff in rear-shoulder girdle muscles. Mechanically this leads to an increasingly unstable and weak positioning of the shoulder joint, which stresses the tendons.
Watch your back
Back injuries are also common in tennis. In élite players, who have played many hours a week for many years, it is common to see right versus left side strength imbalances. Players have a dominant arm which leads to a dominant trunk rotation movement. Players often have a dominant leg which they are more comfortable balancing or moving on, which leads to a dominant hip movement. These imbalances can cause low-back problems if the player does not have the required core stability. In addition, many tennis shots and movements involve back extension and flexion, placing a lot of stress on the back musculature. Without sufficient strength and flexibility in the hips and spine, an élite player may overload the back. For recreational players, poor posture and insufficient core stability may lead to back problems when they play tennis. In this case, though, tennis would not be the primary cause of the injury but simply the activity that sets off symptoms.Other injuries in tennis are knee and ankle sprains. These are acute-accident injuries which are hard to avoid. However, an élite player would need to ensure sufficient strength in the leg muscles and develop good balance and movement skills to decrease the likelihood of a sprain. While sprains are accidents, common sense says that a strong, well balanced and agile player is at less risk than a weak, poorly coordinated player.
Injury prevention strategies
The most basic strategy for preventing tennis injuries, particularly back, shoulder and elbow problems, is to avoid overuse. This means not playing too much or too frequently, or not increasing the amount you play too quickly. Most recreational players will be able to play once or twice a week and avoid any shoulder or elbow problems, but if they increased this, then poor technique and lack of conditioning training would increase their injury risk dramatically. For the aspiring junior player or full-time pro, who have to play most days, the only way to prevent injuries is with a suitable conditioning programme. The following programme focuses on the elements a tennis player would need to avoid injury. These exercises are not meant to be definitive, but the muscles and movements that are being trained here are well designed to gain optimal benefits. Use this example to guide you in your own conditioning programme.
Everyday stretches for the following muscle groups must be performed. The goal is to achieve a good range of motion in all major joints: calf; hamstrings; quadriceps; hip flexors; groin; gluteals; low back flexors; upper back extensors; trunk rotators; pectorals; shoulder rotators; rear shoulders; triceps and forearms.
General strength training
For players who do not have a strong background in conditioning training, a workout like the following should be completed 2-3 times a week to develop a well-balanced all-body strength. For players who are already strong, this type of workout can be used once a week to maintain general strength levels year-round, or 2-3 times a week in a general phase a few times each year.Perform 3 sets x 8-12 reps of the following:
l dumbbell shoulder pressl single arm dumbbell row
l lat pull downs
l barbell squats
Build up to 3-4 sets of 20 reps of the following:
l back extensions.
Core-stability trainingPlayers must be able to isolate the transversus abdominis muscle and perform the abdominal hollowing exercise correctly. They must also be able to maintain a 'neutral' lumbar spine position during various movements. Primarily this involves recruiting 'tranversus' effectively along with other trunk and hip stability muscles. Exercise examples are: while lying on back lift one leg; while standing lift one leg; while standing up lean forward from the hips; while kneeling on all fours extend the leg behind. Players need to be able to use the gluteal muscles to stabilise the pelvis. Bridging exercises and hip extension movements focusing on gluteal recruitment over the back and hamstring muscles should be performed.Once the above basic skills are mastered, dynamic exercises such as the one-leg squat, while keeping the lumbar spine in neutral and the pelvis stable, will develop the ability of the player to maintain stability during movement on court.Also useful are cable rotation exercises using a pulley machine. The player mimics the forehand and backhand movement while maintaining good posture and core stability through the rotation movement.These exercise suggestions will ensure that the core-stability skills are transferred onto the court. It is always important to remember that sports-specific training is important to help athletes prevent injuries effectively.
Specific conditioning for shoulder and armThe following exercises will help develop strong shoulder rotator cuff and forearm muscles to help prevent elbow and shoulder tendinitis injuries:
1. Side-lying raise. 3 x 15. Lie on side. Using top arm, lift dumbbell up to 45 degrees. Lower slowly.
2. Band /cable external rotations. 3 x 15. Stand and grasp band/cable in hand. With elbow tucked into your ribs rotate the arm out, pulling against the resistance.
3. Russian arm circles. 3 x 15. Lie on front. Start with arms straight out above head, lift them off the floor and pull them down to your sides. Keeping them off the floor at all times continue to make big circles with your arms up and down. Progress to using small weights.
4. Modified lat raise. 3 x15. Perform a lateral raise movement with palms facing back and thumbs down. Lift your elbows to about 60 degrees to your sides only.
5. Wrist extensions. 3 x 15. Sit and place your forearm on your thigh with your elbow bent. With your palm facing down, grasp a dumbbell in your hand. Lift the weight pulling the back of your hand up by using the upper forearm muscles.
6. Band wrist supinations and pronations. 3 x 15. Supination: Position as 5 but grasp a resistance band and secure the other end of the band under your foot. Grasp the band between your thumb and hand with palm down. Rotate your wrist so the palm faces up. Slowly rotate back and continue.
Pronation: Change grip so that you grasp the band between your thumb and hand with palm up and rotate your wrist so the palm faces down.