3. Health Benefits of Tennis
• CV, strength, coordination, balance, plyometrics,
speed, flexibility
• METs:
– Doubles Tennis: 5
– Singles Tennis: 7-12
• “improved aerobic fitness, a lower body fat percentage, a more favorable
lipid profile, reduced risk for developing cardiovascular disease, and
improved bone health.’ Pluim et al 2007
• Cognitive function, neural connectivity, mood, Social engagement,
PA efficacy, problem solving, test scores
6. Tennis Injury
• BJSM 2006: Pluim et al
– Injury incidence 0.05-
to 2.9 per player per year
– Per hour of play 0.04- 3.0 injuries/1000 hours
• Junior Rugby 56.8/1000hrs JSMS Gabbett 2008
– Gender: slight inc in men > women
– Age: as age increases, risk of injury increases
– Volume: Unclear risk (tennis elbow)
7. Tennis Injury
• Abrams et al BJSM 2012
– LE>UE
– LE: ankle sprains, thigh strains, GS strain, Achilles
– UE: lateral epicondylitis, rotator cuff
– Back
8. Learning Points
• Get to know your body
– Basic Anatomy
– What can go wrong
• Know what you can do
– Preventing problems
– Basic Treatment
• When to see a doctor/when you need a good
Therapist
11. Back Pain Stats
• > 80 % of Americans in a lifetime
• ≈ 30 % at any given time
• 2nd
leading reason to see a doctor
• Spending in 2005 = $85.9 billion
• Among Athletes highest rates:
– Football, gymnastics, wrestling etc.
12.
13. Tennis Injuries
• Is tennis a risk factor for back pain or spondylosis?
– Hutchinson et al 1995:LBP #1 injury over 6 yrs in adol. elite
– Guilodo et al 1999: 633 subjects, No difference in rates of low
back pain between recreational players and non players or in
recreational players based on volume of play
– Marks et al 1988: 38% of 143 ATP players missed at least 1
tournament due to back pain
– Alyas et al 2007: MRI LS 33 asymptomatic elite juniors
• 5 normal MRI’s 28 Abnormal
• 23 with early facet arthrosis L5/S1 L4/L5
• 9 Spondys (L5), 2 with G1 and G2 –listhesis
• 2 acute/5 chronic stress reactions of the pars
• 13 with disc dessication, disc bulging
24. Back Pain
• You can handle it:
– Mid-Low Back pain that improves with rest, ice
NSAID’s and core work over 2 weeks
– Pain with a clear cause: eg: Inc. serving, played a
tournament now with some mild LBP
• Self Treating
– 1-5 days of ’d activity: Soft-Brace, Ice, NSAID’s,
maintain light activity (stationary bike)
– 1-3 weeks of intensive core strengthening,
stretching, swimming
25. More Stats.
• Back Pain Free
– 50% of people in 1 week
– 75 % of people in 1 month
– 95% of people in 3 months
26. Back Pain
• See your Doc’:
– Extreme Pain
– Pain that fails to improve with “conservative”
management in 3-7 days
– Pain with associated symptoms:
• weight loss, fevers, chills, skin rash, night sweats
– Pain with numbness, tingling or weakness
down the legs
– Change in bowel or bladder habits
– Numbness in the groin area
27. Back Pain Wrap-Up
• Back Arthritis and degeneration is a normal
part of aging, but how we experience it varies
• 90% of back pain is “safe pain”
• You CAN do a lot to reduce the intensity,
frequency and duration of back pain
• You CAN manage most back pain on your
own
• There are times when you NEED to be
evaluated by a Doc
30. Tennis Injuries
• Shoulder:
– 4-17% at any given time Abrams et al BJSM 2012
– Impingement, Instability, RTC –itis/tear, Labral
injury, Scapular Dyskinesis
– Predisposing:
• Relative RTC deconditioning, Excessive IR and ADD
strength and ER weakness, GIRD
• GIRD: >25 ° total difference (ER + IR)
35. Treating Shoulder Pain
• You CAN handle it
– Mild to moderate discomfort in the shoulder after
an increase in training
– Pain that improves in 1-7 days with “conservative”
measures
– Mild chronic pain which you have previously had
diagnosed and is well controlled
36. Treating Shoulder Pain
• Call your “Doc”
– Pain that doesn’t improve with a 1-4 days of
conservative care
– Pain with weakness, numbness or tingling
– Pain with associated neck pain
– Pain with all the “red flags” from back pain section
– Dislocation, persistent clicking, popping, grinding,
swelling, instability
37. What to do?
• Relative Rest: Day: 1-7
• ICE 2-4 x’s/ day
• Maintain Range of Motion
– Pendulums, Wall Walks etc.
• If improving: Band workout: Day 4-14
• +/- 7-10 days of NSAID’s
38. Shoulder Wrap Up
• Maximize Balance of Flexibility and Strength
– Cuff, Pecs, biceps, triceps
• Avoid Excess Overhead Cross-Training
• Maximize form/technique
• Get it Checked out:
– New or Persistent Pain
– New clicking, popping, catching, grinding,
instability
– With Associated Neck pain, numbness, tingling,
weakness to the arms
42. Risks for Tennis Elbow
• Technique: Grip Type ?
• Muscle Strength and Balance
• Frequency of Play
• Change
• String Tension
• Racquet Stiffness
• Grip Size/Type
43. Preventing Elbow Pain
• Technique
• Technique
• Technique
• Avoid Sudden Variation:
– Play Frequency / Racquet Width, Weight, Length /
String Type and Tension
• Conditioning
• Flexibility
44. Lateral Epicondylitis
• Treatment
– Modify Technique
– RICE
– NSAIDs
– Stretching and range of motion
– Strengthening
– Adjust Equipment
– Elbow band etc
50. Knee Pain
• Things you can handle:
– Mild Intermittent Discomfort
– Previously Diagnosed low grade discomfort
• You need a Doc:
– Acute Trauma
– Moderate to Extreme Persistent Pain
– Swelling
– Catching, Popping, Clicking, Locking, Grinding,
Instability without a diagnosis
51. Knee Pain
• Prevention:
– Maximize Muscle Balance
– Maintain Hamstring and Quadricep Flexibility
– Exercise Form
– Balance Work
– Achieve “Ideal Body Weight”
– Diet?
52. Knee Pain
• Treatment:
– RICE
– Strengthening and Muscle Balance
– Guided or personal Physical Therapy Program
– NSAIDs
– Cortisone injections
– Cartilage Supplementation to the joint
– Platelet Rich Plasma/Stem Cells
– Surgery
53. Knee Pain Wrap Up
• Maximize Muscle Balance
• Improve and Maintain flexibility
• Follow up with a “Doc” for evaluation of new
or persistent pain, popping, grinding, swelling
or instability
• Staying active does NOT worsen knee arthritis
but may cause pain if you have known arthritis
or other common proble
59. Foot Pain
• You can handle it:
– Ankle Sprain you can walk on right away
– Mild discomfort with a known diagnosis
• Time to see a Doc:
– Acute injury with immediate swelling, bruising,
extreme pain, inability to walk
– Persistent pain, swelling, clicking, popping,
grinding or instability
– Numbness, tingling, weakness in the foot
60.
61.
62. Foot Pain Wrap Up
• Maintain leg strength, balance and flexibility
• Appropriate equipment
• Any traumatic event with persistent
symptoms get it checked out
• Remember RICE
65. Skin
• Largest Organ in the body
• Function:
– Protect
– Maintain hydration
– Detoxify
– Thermoregulation
– Activate Vitamin D
– Sex Appeal or Repellent
66. Skin
• What Can go Wrong:
–Sunburn
–Skin Cancer:
• Squamous Cell
• Basal Cell
• Melanoma
67. Quick Stats
• Most common of all cancers
• 1:5 Americans in a lifetime
• Non-Melanoma: 2 million cases/yr
– Inc. of 300% since 1994
• Melanoma: 68, 000 cases /yr
69. Risks
• Unprotected and/or excessive exposure to
ultraviolet (UV) radiation
• Fair complexion/ Family History
• Occupational exposures to chemicals
• History of multiple or atypical moles
• Severe sunburns as a child
• Dietary intake
• Smoking exposure
70. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check
71. Sunscreen
• Broad Spectrum: UVA & UVB
• ≥ SPF 30
• Apply 15-30 minutes before exposure
• Re-apply every 2 hours if sweating/in water
• Don’t Forget:
– Hands, ears, neck, back of legs, lips
72. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check
74. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check
76. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Monthly Home Skin Check
– Yearly Doctor Skin Check
78. Skin Wrap Up
• Wear Sunscreen daily
• Wear Sun-Protective Clothing
• Fill up on colorful foods
• Avoid known “cancer causers”
• Do regular skin checks
• Know your ABCDE’s
• Follow up with your Doc’
79.
80.
81. Daily Reccs:
• Ideal: water, fitness waters, sport beverages,
club soda, mineral water, and flavored water
• Very good: 100% fruit juices, lemonade,
tomato and vegetable juices
• Good: raw fruits and vegetables
• So-so: soft drinks, decaffeinated coffee,
yogurt, skim milk
• Avoid: caffeine and alcoholic beverages
– act as diuretics
10-12 cups of
water/ day
10-12 cups of
water/ day
82. Hydration
• 80kg male ≈ 48 L of body water
• Lose 0.5-2.5 L H20 per hour of tennis
• 1-2% H20 loss before you feel “thirsty”
86. On Court
• Drink 7 to 10 oz of fluid every 10 to 15
minutes and/or every changeover
• Carbohydrate Electrolyte Drink:
– Provides Glucose
– Replenishes Electrolyte Loss
– Enhances Water absorption
88. Hydration Wrap-Up
• Prevent Hypo-hydration
– Stay ahead of needs
– Focus on H20 rich beverages and foods
– Avoid foods that dehydrate: Alcohol, Caffeine,
high protein, high fat foods
• Maximize hydration throughout the day/
match
• Re-hydrate post day / end of match
89. Conclusion
• “The first wealth is health” RWE
• There is a lot you can do to stay healthy
– Get to know the basics
– Make a plan
– Make changes when necessary
• Recognize when to seek help
• Some problems need a “team approach”
Editor's Notes
One MET: Resting metabolic rate at 3.5 ml O2/kg/min
You need to be healthy to do your job, without a healthy body you can’t do what you enjoy and need to do to make a living, support your family and have fun………
http://drrobertlaprademd.com/publications/pdf/Articles/Pre%202005/1995%20Injury%20surveillance%20at%20USTA%20boys%20tennis%20championships.pdf
Five players (15.2%) had a normal MRI examination and 28 (84.8%) had an abnormal examination. Nine players showed pars lesions (10 lesions; one at two levels) predominately at the L5 level (9/10, L5; 1/10, L4). Three of the 10 lesions were complete fractures; two showed grade 1 and one grade 2 spondylolisthesis, both of which resulted in moderate narrowing of the L5 exit foramen. There were two acute and five chronic stress reactions of the pars. Twenty three patients showed signs of early facet arthropathy occurring at L5/S1 (15/29 joints) and L4/5 (12/29 joints). These were classified as mild degeneration (20/29) and moderate degeneration (9/29), with 20/29 showing sclerosis and 24/29 showing hypertrophy of the facet joint. Synovial cysts were identified in 14 of the 29 joints. Thirteen players showed disc desiccation and disc bulging (mild in 13; moderate in two) most often at L4/5 and L5/S1 levels (12 of 15 discs).
Up to 70% of tennis players………have shoulder complaints…..
Talk about acromion, humerus, rotator cuff impingement
40-50% of recreational tennis players have had tennis elbow
Sun protection factor = amount of comparable time it takes to cause sunburn in un-coated vs coated skin area.
Only refers to UVB protection