Tennis Medicine
(Redirected from Tennis)
Other Names
- Tennis Medicine
Background
- This page focuses on medicine as it relates to Tennis
History
- Tennis in its modern form originated in England in the late 19th century[1]
- Spreading around the world with an estimated 89 million players[2]
Epidemiology: Incidence
- Estimates of incidence rates of injuries overall are 0.5 to 2.9 injuries per player per year[3]
- McCurdie et al reported injury data from Wimbledon from 2003 to 2012[4]
- They reported an injury rate of 20.7 injuries per 1000 sets played
- Male players had a lower injury rate (17.7 per 1000 sets played) in comparison to women athletes (23.4 injuries per 1000 sets played)
- 11% were deemed to be recurrent injuries and 16% were classified as chronic pre-existing
- Pluim et al reported on injuries in elite junior athletes over a 32 week program[5]
- Overuse injuries were the most common health problem occurring in 47% of the reported injuries
- 13% of the injuries were reported as acute
- 1 in 8 players are playing with pain every week
- Lynall et al studied injury rate in recreation players[6]
- They reported an overall injury rate of 4.9 injuries per 1000 practice or match with higher injury rates during match play
Epidemiology: Injury Patterns
- Most commonly injured body areas[7]
- In women athletes the most common injury distribution was shoulder, foot, wrist, and knee
- In males the knee, ankle, and thigh are the most common injury sites
- Author noted seeing an increase in UE injuries over the 5 year study period
- Maquirrian and Baglione studied locations of injury that caused early match retirement[8]
- Lower extremity injuries 42%, upper extremity injuries 25%, and trunk 17%
- ATP and WTA injury report
- Spine, foot/ankle, and shoulder being the most common injuries in professional athletes
- Gruchow and Pelletier[9]
- In recreational tennis players 50% of them will develop lateral elbow symptoms
Epidemiology: Missed Playing Time
- In recreational players lateral epicondylitis is the most common reason for missed playing time[9]
- For professional players and elite junior athletes a prolonged absence from the game is due to a lower extremity injury and inactive for an average of 73 days post-injury[8]
Introduction
Introduction to Tennis
- Tennis is played on a tennis court that varies in surface type, hard concrete surface, clay, or grass
- Can be played with 2 people or 4 people
- Amature and professional players normally play the best of 3 sets a player must get to 6 games to win a set
- If the set score is tied at 5 games to 5 games must win by 2 games or at 6 all a 7-point tiebreak is played
- Amateurs will often play a 10 point tie break instead of a 3rd full set
- Penalties can be awarded for unsportsmanlike conduct that can result in a point, game, set, or match award to an opponent
Equipment
- Players are required to have a tennis racket and tennis ball to play the sport
- Tennis rackets have 3 main parts the grip, neck, and head
- Grip is where the player will grasp the racket
- Neck is the middle portion
- Head is the top of the racket recreational players will use a large head size racket and professionals will use a small racket size head
Court
- Tennis courts will vary in surface type
- Tennis courts consist of a net that spans from on side to the other in the middle of the court
- Singles lines and doubles line our painted on the court as well as a service box
- The singles lines are used for players who are play 1 on 1
- Doubles lines are used when 2 players play against 2 other players
- The service box is the lines that are about halfway from the next to the base-line
Rules
- Tennis play starts by deciding who will begin to serve and what side they will start play on
- Serves are used to began the point
- To win a point a player must either hit a winner or an opponent make an error
- An error consist of a player hitting the net or out of the lines
- Players alternate service games
- Once a player wins 6 games that player has won a set, tennis is usually played best 2 out 3 sets
General
- Fast movements with rapid change of directions with frequent overhead motions
- The ball can travel at speeds up to 212km/h (132mph)
Defining Exposure
- Technique can vary across different skill levels and can stress joints to a different degree
- Level and intensity of play varies amongst different skill levels leading to a risk of different injuries for amateurs vs elite athletes
Governing Bodies
- Association of Tennis Professionals: https://www.atptour.com/
- Women's Tennis Association: https://www.wtatennis.com/
- International Tennis Federation: https://www.itftennis.com/
Risk Factors
Timing of Injury
- Higher risk for injury in competition than practice
- Most of match play injuries were acute
- While 69% of practice injuries were gradual onset[10]
Playing Surfaces
- Hard courts lead to shorter stopping distances and higher peak loads, higher ball speeds increasing stress on upper extermities[11]
- Clay courts, the slowest tennis surface, sliding becomes more relevant causing an increase stress on the body[12]
- Switching surfaces frequently may be a risk factor
- No association between court surface and injury rates among players that played primarily on one particular court surface[12]
Predictors of Time Loss
- Kovalchik[13]
- Total load significantly increases the risk of time loss
- Load defined as volume and intensity of physical activity
- Age increases this likelihood
- No agreement as to how load is best distributed to prevent injury
- Total load significantly increases the risk of time loss
Overuse
- Tennis is not limited in duration to length of play as result chronic overuse conditions are common
- Serving is the most demanding stroke in tennis[14]
- Most common overuse injuries include internal impingement and superior labrum anterior to posterior tears[15]
- Other injuries included in UE are tendinopathy in medial and lateral elbow, tendinitis and subluxation of the ECU, and disc degen pathologies
- LE injuries include ankle sprain, meniscal knee, tendinopathy at knee and hip
Causes of Injury
- 47% of injuries come from overuse
- 13% of injuries are acute
- Majority of injuries occur during match play
Injury Severity
- 60% of injuries required medical treatment[16]
- 20% required absence from school/work
- 3.3% acute and 2.2% chronic required operation[17]
Return From Injury
- Average 13 day lay-off time for acute[18]
- Average 20 days lay-off for chronic
HEENT
General
- Tennis being a non-contact sport low risk for acute HEENT injuries
- Accidental contact with the ball could pose the biggest risk to this region
- Pueringer et al studied tennis-related maxillofacial injuries reported in the ED over 9 years[19]
- They estimated 14,000 tennis-specific maxillofacial injuries ED visits per year
- 45% due to Lacerations
- 33% contusions/abrasions
- 11% concussions
- 8.5% Fracture and 1.5% dental injury
- They estimated 14,000 tennis-specific maxillofacial injuries ED visits per year
Head
- Accounts for an estimated 27% of tennis-specific maxillofacial injuries in the ED[19]
- Concussion are the highest reported complaint for this area
- Mild traumatic brain injuries are rare but can occur if the velocity of the ball is greater than 40 m/s[20]
Eyes
- 800 eye injuries from tennis-related trauma occur every year[21]
- Most common eye injury is a contusion/abrasion in this area
- Long-term sun exposure can increase the risk for cataracts, macular degeneration, and pinguecula
Nose
- Accounts for the most likely ED visit in the HEENT region
- Fracture is the main injury in this area
- Contusion/abrasion second most common
- Injuries in this region occur due to hit by the ball or player's own racket
- Doubles would yield a chance of getting struck by the ball due to player's location on the court
Axial
General
- McCurdie et al found in professionals axial injuries are the 3rd most common injury site
- Lumbar is the most common region for axial injuries
- Twisting, flexion, and extension that commonly occur in tennis technique can cause lumbar pain
- Asymmetry in tennis players due to single-hand dominance can predispose players to lumbar imbalances
- Renkawitz et al showed the daily home back exercises program was successful in improving pain ratings related to lumbar pain[22]
- Elite athletes have a higher rate of lumbar disc herniation and facet arthropathy[23]
- L4/L5 is almost exclusively the site of injury
- Mostly due to the repetitive motion of the serve
- Atraumatic rib stress fracture due to overuse can occur, incidence unknown[24]
- 1st rib is the main site for this type of stress fracture
- Athletes with a repetitive overhead throwing motion have a higher risk
- Can present as posterior shoulder pain
Upper Extremity
General
- UE injuries are mostly chronic
- 25% of injuries in professional athletes are UE
- 8.2 UE chronic-onset injuries per 1000 matches
- Kovacs et al most common injuries for professionals and elite junior athletes[25]
- Shoulder is most common UE injury followed by the wrist and elbow in professional athletes
- 25% of elite juniors have shoulder injuries, 9% wrist injuries, and 3% elbow injuries
- Vriend et al[26]
- Recreational players had a 29% incidence rate of UE injuries
- Most common is lateral epicondylitis
- Most chronic injuries are in the UE for recreational players
Shoulder
General
- Second most common cause of departure from the sport for both sexes[27]
- Excessive loading on the upper extremity can be caused by improper technique
- Technique modifications can be a method of injury prevention and treatment
- Shoulder structures can become weak or dysfunctional as a result of chronic overload and muscle asymmetry caused by repetitive tennis motions<[28]
- Pain and functional deficiency will occur in overhead movements
- The presence of SD is associated with other shoulder injuries in tennis players[29]
Glenohumeral Internal Rotation Deficit
- Kibler et al[30]
- Characterized by a > 18-degree loss of internal rotation in the dominant shoulder
- Deep posterior shoulder pain
- Serving kinetics of repetitive abduction-extension motion tightens the posterior capsule causing a decrease in the internal rotation ability of the athlete
- Incident rate unknown
- Incidence in 22.3 per 100,000 patients in the general population[31]
- Serving plays the largest role in the etiology of these injuries
- 2% of sports medicine referrals are for SLAP tears
- No known incidence rate specific to tennis
- Most pain will occur on the serving motion and effect other overhead motions[32]
- Seen mostly in older tennis players
- Can occur in younger players due to overuse
- Rest, NSAIDs, and physical therapy has shown to help tennis players return to full activity within 3 months[33]
- Serving motion as well as ground strokes can contribute to injury development
- Pain can be felt on the finishing aspect of a tennis swing
- Epidemiology unknown
Elbow
- Most prevalent in age group between 45-54 years old[34]
- 50% of tennis players develop pain around elbow and 75% of those with pain are true tennis elbow[35]
- Spontaneous recovery within 1-2 years in 80-90% of patients[36]
- Common in tennis due to improper technique
- Leading elbow, wrist extension, and open racquet face near ball contact are the technical errors that increase the likelihood of tennis elbow[37]
- Improper tennis racquet grip size for the player is another risk factor[38]
- Part of the treatment protocol can be decreasing or increasing grip size
- Most common among elite tennis players[39]
- Can result from advanced technical deficits
- Open stance hitting and short-arm strokes
- Serves and forehand strokes are the main source of injury
- Most players can return to play in 3-6 months[40]
- Most commonly presents as a repetitive strain injury[41]
- Due to sudden increase in play, changing string tension, or use of heavier balls
- Pain with forehand and serve strokes mainly
- Extreme cases pain can occur from even gripping the racquet
Wrist
- Rare in tennis players but can become a career-ending injury[42]
- Risk factors are the type of grip on the racquet, tightness of grip, and the spin put on the ball
- Weight and size of racquet can also be a factor
- Overuse is the main source of injury in tennis[43]
- Participation in tennis at an early age can contribute
- Return to play on average is between 5-6 months
- Repetitive use in groundstrokes is the main cause[44]
- Varying grips on the racquet can increase the likelihood of injury
- Increased grip pressure can increase the chance
- Non-dominate wrists are more likely in the location of the injury
Torso
General
- Toroso is involved in every tennis stroke
- Most painful motion is usually the serve
- Injuries to the torso is the 3rd most common site[45]
- 17% of professional early match retirements are due to trunk injuries
- Recurrence of toros injuries is common mainly in professional players[46]
- Most injuries involve the rectus abdominal muscle that is contralateral to the dominant arm
- Due to the large amount of angular momentum in the service motion the trunk rotation and flexion of the abd muscles places them at a higher risk of injury
- Chow et al studied trunk muscle activity[47]
- No difference in muscle activation in different serve types
- Bilateral differences in muscle activation of the RA and external oblique
- Estimated return to play ranges from 3 weeks to 8 weeks[48]
- Pluim et al[49]
- 2.84 groin injuries per 1000 playing hours
- 25% of all acute injuries in elite junior athletes are groin injuries
- Produced during sudden changes of direction when running side to side mainly attempting to stop laterally
- Moreno-Perez et al[50]
- Level of play is directly proportional to the risk of groin injuries
- Decrease range of hip abduction and rotation increase risk
- May be detected before onset of symptoms through regular screening of adduction strength[51]
- Athletic pubalgia can occur due to overuse or continuing to play with adductor strain[52]
Lower Extremity
General
- Most common location of injury for all levels of play[53]
- Most LE injuries are acute in nature
- 39%-59% of injuries in adolescent tennis players are in the LE[54]
- Ankle most common followed by knee and hip[55]
- 35% of the injuries were ligament sprains and muscle strains
- Average of 22 days away from competition/practice due to LE injuries[56]
Hip
- Side-to-side movements with sudden stops and changes of direction cause groin muscle strain
- 27 days out of competition is the average recovery time
- Most common hip injury in tennis
- Most severe hip injury in tennis
- 153 days out of competition is the average
- Overuse and advanced age are risk factors
Knee/Thigh
General
- 15 days out from completion is average for knee/thigh injuries
- 8% of lower extremity injuries in tennis come from the knee
- Most common injury in the thigh
- 3rd most common overall injury in college athletes[57]
- Muscle imbalance that is common in tennis players increases the likelihood of thigh muscle strains[58]
- Kujne et al[59]
- Not common in tennis players with an incident rate of 1.8%
- Demands on the ACL in recreational players are unknown
- Landing after the service motion was a great area of pain following an ACL tear
- No significant impairment in other strokes
- Lundblad et al[60]
- Grade 1 MCL sprain is the most common type in tennis
- MCL injury rate is 0.33 per 1000 hours
- College teams can expect 1 MCL sprain per season
- Average time off is approximately 23 days
- High risk for tennis players due to the twisting, turning, and lateral movements that frequently occur
- Astur et al[61]
- Incidence rate for meniscal injury 0.44 per 1000 hours of play
- Slightly lower risk for men than women
- Players between the ages 33-66 years old were more likely to need surgical intervention
- Overuse is the main cause in tennis players
- Incident rate unknown
- Other similar sports (basketball and volleyball) range from 31-44% of elite athletes[62]
Ankle and Foot
- Most commonly occurring acute injury in tennis[63]
- Accounts for 20%-25% of all tennis injuries
- Days missing from competition can vary due to the severity of the sprain 14 days is the average amount of time away from competition
- Mimimun time away is 4 days and the maximum was up to 187 days
- Professionals and collegiate players will often preventatively tape their ankles to help prevent sprains
- Common tennis injury due to the repetitive impact on feet
- Most common location is the metatarsal foot bones
- Maquirriain & Ghisi[64]
- Incident rate of 12.9% over a two-year period
- Navicular bone was the most affected
- Elite junior tennis players were the highest-risk
Prevention
General
- Before match starts there is an allotted 5-minute warm-up
- Currently there is minimal tennis-specific injury prevention research
- Focusing on balance with and without resistance aims to reduce the risk of injury overall in tennis[65]
- Most injuries are due to overuse, especially in elite junior athletes taking days off after long matches is an important way to minimize risk
Lower Extremity
- Junior players often develop musculoskeletal asymmetries in their lower extremities strengthening these asymmetries could minimize the risk of injury
Upper Extremity
- Due to relative service motion placing a heavy strain on external rotators strengthening the internal rotators to prevent asymmetry
Torso
- Increasing abdominal strength and balance to help prevent herniation and abdominal wall strain
Equipment
- Although a direct link to risk of injury is not established, there have been numerous studies demonstrating variations in racquet/string specifications and set ups can alter biomechanics, which are themselves associated with injury mechanisms
- Changes in racquet mass, balance, stiffness, and string tension have been shown to affect joint loading, vibration transmission, and muscle activation patterns during tennis strokes, all of which are biomechanical factors implicated in the development of overuse injuries such as lateral epicondylitis and shoulder pain
- Racquet
- Mass
- Biomechanical studies demonstrate that lighter racquets require greater shoulder joint power and higher internal and external rotation moments to achieve similar ball velocities compared to heavier racquets. This increased demand on the shoulder and upper limb musculature may elevate the risk of overuse injuries, particularly during the serve[66]
- Increased racquet mass also are associated with reduced vibration loads transmitted to the wrist and elbow, which is implicated in the pathogenesis of lateral epicondylitis
- However, increasing racquet mass and polar moment of inertia can increase joint moments and torques at the elbow and shoulder during tennis strokes, particularly during the serve, which can increase upper limb loading and contribute to injury risk.[67][68]
- Balance
- racquet balance that increases the polar moment of inertia (e.g., head-heavy racquets) is associated with increased upper limb joint loading and may increase injury risk[69]
- Stiffness
- Increased racquet stiffness is associated with increased injury risk in tennis players, particularly for upper limb overuse injuries such as lateral epicondylitis (tennis elbow) [70]
- Head Size
- larger racquet head size is associated with reduced transmission of vibration to the arm and may lower the risk of upper limb overuse injuries[71]
- Grip size
- Biomechanical studies demonstrate that there is an optimal grip diameter that minimizes grip force and wrist extensor muscle loading, which may reduce the risk of overuse injuries.
- However, modest deviations (±1/4 inch) from the recommended grip size do not significantly alter forearm muscle firing patterns or activity [72]
- Mass
- Strings
- Tension
- biomechanical studies suggest that higher string stiffness increases vibration and shock transmission to the arm, which may theoretically increase risk for conditions like tennis elbow, but this remains speculative.[73]
- studies also demonstrate that higher string tension or stiffness increases forearm muscle fatigue, which could theoretically contribute to overuse injuries
- Tension
See Also
References
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- ↑ Pluim BM, Staal JB, Windler GE, Jayanthi N. Tennis injuries: occurrence, aetiology, and prevention. Br J Sports Med. 2006;40(5):415–423.
- ↑ McCurdie I, Smith S, Bell PH, Batt ME. Tennis injury data from The Championships, Wimbledon, from 2003 to 2012. Br J Sports Med. 2017;51(7):607–611. doi: 10.1136/bjsports-2015-095552.
- ↑ Pluim BM, Loeffen FG, Clarsen B, Bahr R, Verhagen EA. A one-season prospective study of injuries and illness in elite junior tennis. Scand J Med Sci Sports. 2016;26(5):564–571. doi: 10.1111/sms.12471.
- ↑ Lynall RC, Kerr ZY, Djoko A, Pluim BM, Hainline B, Dompier TP. Epidemiology of National Collegiate Athletic Association men’s and women’s tennis injuries, 2009/2010–2014/2015. Br J Sports Med. 2016;50(19):1211–1216. doi: 10.1136/bjsports-2015-095360
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- ↑ Gruchow H W, Pelletier D. An epidemiologic study of tennis elbow. Incidence, recurrence, and effectiveness of prevention strategies. Am J Sports Med 19797234–238.
- ↑ Labelle H, Guibert R, Joncas J.et al Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta‐analysis. J Bone Joint Surg Br 199274646–651
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- ↑ Grawe BM, Fabricant PD, Chin CS, et al. Clinical Outcomes After Suture Anchor Repair of Recalcitrant Medial Epicondylitis. Orthopedics. 2016;39(1):e104–107.
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- ↑ Chung KC, Lark ME. Upper extremity injuries in tennis players: diagnosis, treatment, and management. Hand Clin. 2017;33(1):175–186. doi: 10.1016/j.hcl.2016.08.009
- ↑ Abadi, Mokhammad R., et al. "Incidence rate of musculoskeletal injuries among professional tennis players during 2019 international tournaments in Indonesia." Journal of sports science & medicine 20.2 (2021): 268.
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- ↑ Maquirriain, Javier, Juan P. Ghisi, and Antonio M. Kokalj. "Rectus abdominis muscle strains in tennis players." British journal of sports medicine 41.11 (2007): 842-848.
- ↑ Pluim et al. (2016) Pluim BM, Loeffen FG, Clarsen B, Bahr R, Verhagen EA. A one-season prospective study of injuries and illness in elite junior tennis. Scandinavian Journal of Medicine & Science in Sports. 2016;26(5):564–571. doi: 10.1111/sms.12471
- ↑ Moreno-Pérez et al. (2017) Moreno-Pérez V, Lopez-Valenciano A, Barbado D, Moreside J, Elvira JLL, Vera-Garcia FJ. Comparisons of hip strength and countermovement jump height in elite tennis players with and without acute history of groin injuries. Musculoskeletal Science and Practice. 2017;29:144–149. doi: 10.1016/j.msksp.2017.04.006.
- ↑ Crow et al. (2010) Crow JF, Pearce AJ, Veale JP, VanderWesthuizen D, Coburn PT, Pizzari T. Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players. Journal of Science and Medicine in Sport. 2010;13(2):202–204. doi: 10.1016/j.jsams.2009.03.007.
- ↑ Renström P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980;14:30-36
- ↑ Dines J.S., Bedi A., Williams P.N., et al. Tennis injuries: Epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. 2015;23:181–189.
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