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Physiotherapy


Tennis Injuries

Introduction

Tennis is more athletic and fast paced sport where injuries may be quite common. It is usually played between two players (Singles) or two teams of two players (Doubles).Racket and a ball are needed to play tennis.

While playing tennis the arm goes back and bends, then gets straightened while going up. Arm lurches forward hitting the ball and body leans forward. All the movements occur in fraction of seconds.

Tennis injuries occur to any part of the body due its nature of sport. Sprained ankles are common due to sudden change of direction from one place to other while playing.

Common Tennis Injuries

Wrist Injuries

Carpel tunnel syndrome occurs due to compression of the median nerve leading  to pain and tingling sensation in wrist and hand.

Tenosynovitis of the wrist

Elbow Injuries

Tennis Elbow – It also occurs in individuals who don’t play tennis. This is due to overuse and repetitive wrist extension and improper grip of the racket.
Tennis elbow is the inflammation or degeneration of the tendon which attaches to the lateral epicondyle present on the outer side of the elbow. Extensor carpi radialis brevis muscle in involved.
Radial Nerve Entrapment –Nerve passing through the lateral epicondyle is involved.
Elbow bursitis

Shoulder Injuries

Rotator cuff injuries - Due to repeated strain.

Impingement syndrome – This occurs due to overhead nature of serving  shots while playing tennis. This leads to shoulder strain irritating the tendons and muscles.

Shoulder injuries are common due to extra power needed to generate powerful stroke while playing.

Achilles tendinitis and Calf strain occur due to overuse injuries.

Avoid playing on hard surfaces like Cement, Asphalt, Synthetic courts.

Back injuries

While playing on hard surface courts and irregular landing during play leads to Back pain and injuries.

Wear heel inserted shoes to absorb shock which prevent Low back pain.

Knee injuries

Knee pain is also common causing excessive strain on the joint while running to hit the ball.
Patellar tendinitis
Hamstrings strain
Osteoarthritis of knee also occurs in athletes. It is degenerative disease with stiffness and pain of joints in morning.

Leg injuries 

Ankle sprain – Sudden sideways movements during tennis cause ankle to twist leading to ankle sprain.
Treatment – Ankle brace gives support and improves healing.
Achilles tendinitis

Muscle cramps

Cramp is a sudden intense pain in the muscle which contracts involuntarily and forcibly which does not relax.

Skin abrasions and wounds

They occur due to fall while playing tennis causing outer layers of skin to rub off.

Sprains and Strains

These are acute injuries causing Pain, Swelling, Bruising and Movement loss in the joint.

Overtraining syndrome

This occurs due to repeated training and overuse of the same muscles beyond their limit and capacity during competition/work-out lead to over training syndrome.

Physical Therapy Treatment

Diet

Proper nutrition should be taken. Improper diet prevents from early recovery. A balanced diet includes:

    Carbohydrate intake which help in refueling muscles
    Proteins to rebuild muscles
    Drink plenty of water to keep hydrated.
    Vitamins and Minerals

Wrist Exercises

Finger Exercises

Shoulder Exercises

Rest to the injured limb
Ice therapy
Compression bandage
Elevation of the injured part if needed
Medicines like pain killers
Modalities like heat, straps, and supports.
Seated row exercises
Lateral pull downs 
Military press/Shoulder press
Side raises and external rotation with dumbbells
Medicinal ball exercises
Rotator cuff muscle strengthening stabilizes the shoulder joint and decrease hyper mobility.

Leg Injuries Treatment

Rest for few days depending on the severity. Slow, Gentle movements. Then strengthening exercises of ankle.
If the sprain is more severe, then surgery may be needed to repair the ligament. Physiotherapy treatment done after surgery.

- Rest for some time.
- Isometric and strengthening exercises for quadriceps muscle.
- Stretching exercises, Range of motion exercises of the knee.
- Soft tissue massage – Stroking technique is used from upper thigh region to the knee. This stretches the muscle fibers and improves muscle contraction.
- Pain relievers like aspirin also help.
- Avoid full leg extensions with knee bent as this may rupture the kneecap making the condition worse.

Knee Injuries Treatment

Rest the part. Slow, Gentle Passive and Active movements of the joint. Later Stretching and Strengthening exercises of the knee.
Knees kept strong by leg lifts, strengthening exercises by machines.
Wearing Ace bandage on knee help in preventing the injury to get worse.
Quadriceps exercises
Squats
Leg press
Cycling
Lunges
Leg extensions
Leg raises for adductors and abductors along with stretches.

Prevention

Injury prevention methods are similar to all most all the sports but slight variations regarding protective equipments and conditioning exercises should be taken care of.

Warm-up Program

It should consist of 5 min Cardio/Pulse raising exercises like Jogging, Cycling, and Skipping etc. 
Stretching exercises 
Jogging

    Benefits

     - Increasing temperature of muscles.
     - Increases blood circulation and oxygen to muscles.
     - Increase the speed of nerve impulses making the muscle action faster.
     - Increase the range of motions of the joints.
     - Improves the performance of the joint action.

Stretching Exercises

    All muscles and joints stretching to be done. This helps in preventing injuries.
    Good stretching program for upper and lower limb muscles is to be done.
    Stretches should be static without any bounce and held for at least 30 sec.

Cool-down Program

    It consists of gentle jogging followed by light stretching.

    Benefits

- Gradually lower your heart rate

- Restoration of blood and oxygen to muscles as they were before exercise program

- Removes toxic and waste products 
- Reduces muscle soreness present after activity.

First Aid Kit

    Adhesive bandages, Adhesive tape, Ace bandages
    Ice packs
    Pain killers
    Sterile gauze pads,
    First aid cream/Disinfections cream/Analgesic cream
    Scissors
    Cloth swatches for making slings in case of emergency.

Sports Massage

    Regular sports massage help in flushing of toxic and waste products.
    Relaxes the muscle stress.
    Releases tight lumps and bumps in the muscles.
    Give more importance to Lower limbs.

Dress appropriately

Proper Shoes - Good sneakers/Shoes with skid resistant soles. Always examine the shoe soles and if smooth areas are seen replace them as soon as possible.

- Wear comfortable and appropriate shoes which absorb the force impact during landing on hard and uneven surfaces.
- Shoes should also have ankle support. 
- Heel support should be there to prevent moving improper movement.
- Shoes should have good cushioning effect and should provide support and stability to the arch of the foot. 
- Ankle support reduces ankle sprains.
- Thick rubber outsoles should be enhanced near toes. Reinforced middle foot support.
- While playing tennis, shoes with medial arch and heel cup may alleviate pain.

Proper socks

- The sock should not allow the foot to slide more inside the shoe. Cotton socks absorb perspiration and add support to the foot.
- Two pairs of socks/Special padded tennis socks can be worn which give extra support to the foot.

Racket

- Lighter and stiffer racket which reduces the vibrations and impact forces which passes to the arm while playing is to be used.
- Larger head size also reduces transfer of vibrations to the arm muscles and tendons.
- Dry racket regularly to avoid blisters.

- Grip size of racket

a.Too small grips help in wrist shots straining elbow and wrist leading to tennis elbow and injury.
b.Measurement from center of the palm to top of the middle finger should be similar to grip circumference.
c.Hard gripping and extra strain on the wrist muscles leads to injury. Large grips avoid the free movement of the racket.
d.Small grip is good for small hands and large grip good to large hands

      - String type on the racket

a.Polyester strings lasts longer but have less elastic nature transferring pressure to the arm while powerful stroke is given.
b.Natural-made strings are better.

Fitness maintenance

    General conditioning of health.
    Aerobic Exercises
    Muscle Strengthening Exercises.
    Stretching Exercises

• Forearm and Shoulder girdle strengthening exercises help in tennis play.

• Complete body conditioning balances body avoiding stress and injuries. Tennis is a one sided sport and can soon develop one side of the body more leading to muscles strength and activity imbalance.

• Avoid landing on ball of the foot to prevent Achilles tendon injury.

Focus on technique

- While serving the ball/hitting over head shot, avoid arching your back which reduces risk of back injury and strain.

- To hit the ball overhead and while serving, bend your knees and raise your heels balancing your upper body weight.

• Minor injury should also be treated as early as possible as this may lead to severe injury in later stage.

• Good fitness training and trainer are also necessary. During practice also wear good and protective shoes.

• Use a sunscreen lotion in summer and moisturizer in winter season while playing to protect the skin.

• To reduce lower limb injuries, play on well maintained outdoor and indoor courts with good surfaces.

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