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Injury Prevention on Your Court2017
Stephan Esser MD, USPTAwww.tennismedicine.com
Goals
• Review 3 major concepts related to injury
• Explore opportunities for prevention
• Practice some on site assessment
• Have Fun
Concepts related to Injury
• Time
• Technique
• Training/Conditioning
Time
• Frequency
• Duration
• Volume
• The Too’s
– Too Far, Too Fast, Too Soon
• Inadequate Recovery Time
Time
• Frequency:– < 5 times per week
• Duration:– < 2 hrs per time
• Volume: Total Time– < 16 hrs per week
• Recovery:– Consider Age, Conditioning, Total Health, On-
Court Goals etc
Technique
• Common technical errors which increase the risk of injury
Upper extremity Injury
• Late Contact– Forehand• Medial Epicondylitis, wrist injuries, shoulder injuries
– Backhand• Lateral Epicondylitis (tennis elbow), wrist injuries,
shoulder injuries
Contact• General Recommendations• Awareness, demonstrations, Videos of player• Begin back swing sooner• Split Step when opponent hits ball• Shorten/Modify swing path• Accelerate racket head speed• Strengthen core, proximal legs• Evaluate racket weight, length, head size• Evaluate ball type for age, skill level
Open Stance Forehand
• Dominant Hip Loaded in Internal Rotation
– Loss of range of motion
– Increased rates of hip injury
Open Stance Forehand
Open Stance Forehand
• General Recommendations– Vary Stance in practice and play
– Maintain Hip Flexibility• Pre and Post sports participation stretching
– Dynamic pre and Static post
– Improve Hip Abductor Strength (outer buttocks)• Demo
Abbreviated Service Motion
• Bringing the racket up when midway back increases risk of “rotator cuff impingement”
• May encourage limited use of core and legs
Abbreviated Service Motion
• General Recommendations– Avoid sudden and high volume changes– Bring elbow past line of the shoulder prior to bringing
elbow up to shoulder height• Avoid “impingement position”
– Maximize posterior shoulder strength and pec flex.– Pre-match RTC exercises and shoulder motion
• Demo: ER at 0 and 90, scapular pinches, kick backs
– Post-match capsular stretching• Demo: cross body, “ sleeper stretch” , Foam roller chest
stretch
Low Back Injury
• Key Technical Issues– Avoid repetitive Spinal hyperextension < 15• < 25% of total serve volume as topspin when < 15• Consider waiting for extreme “topspin” serves till > 14
– Focus on core, hamstring and quad strength first– Vary serve type, avoid sudden increase in volume
Forehand Grip Type
• Power– Heel of the hand behind the “strings”– Facilitates an “early contact point”• Core, shoulder rotation, legs involved
– FH: Eastern = Semiwestern > Continental
• Control– Face of raquet at contact– Facilitates biomechanically “friendly” wrist motion
Volley Grip Type
• Continental– Symmetric raquet face side to side– Wrist in an “L conformation”/neutral position of
support and stability
Muscle Firing Patterns
• Excess Forearm Firing– Late contact, wrist, elbow and shoulder injury
• Tips– Cognitive: awareness, taglines “Don’t kill the
hummingbird”, breathe out, grunt, shadow stroke with music etc
– Physical: Carry raquet in non-dominant hand, evaluate for inadequate muscle strength or poor technique, inadequate core, leg and shoulder strength, “compensatory” forearm dominance
Training/Conditioning
• Consider body regions for– Inadequacy vs Overdevelopment– Overuse and Misuse
Training/Conditioning
• Shoulder– Common patterns• Tight pecs, Weak Posterior shoulder
– Answer• Stretch pecs, Strengthen Posterior Shoulder
Training/Conditioning
• Handout/Breakout
Training/Conditioning
• Use movement screen to evaluate “at risk” players
• Confirm players participating in age/goal/play level appropriate cross training
Take Homes
• Time/Technique/Training (Conditioning)• Plan Warm ups and cool downs• Look for functional asymmetry• Be aware of predisposing weak/tight regions
• Shoulder and hip key
• Avoid sudden changes in technique or volume• Develop preventive strategies• You can be an advocate for injury prevention
Thank You!
Stephan Esser MD, USPTAwww.tennismedicine.com
