As a global sport, tennis is becoming increasingly popular. Tennis, which is known to have a very high popularity, particularly in European countries, has made great progress in our country as well at both the amateur and the professional level. The body-brain coordination of those who are interested in tennis, which requires more calories to be burnt compared to other sports (such as cycling, skiing), becomes more rapid over time. In addition, leg muscles develop, and the person gains dynamism, flexibility and endurance.
Tennis carries a risk of orthopedic injuries like other competition sports, with approximately two thirds of injuries caused by overuse. One third of the injuries are traumatic injuries and they develop acutely. Regionally, elbow problems (tennis elbow), shoulder injuries, stress fractures (small fractures occurring in specific areas due to extremely repetitive, forceful, accumulative movements), ankle sprains and ligament injuries, muscle strain and injuries are the most common injuries. Studies have reported that a significant portion of the injuries occur in the lower extremities (thighs, legs, feet and ankles), followed by the upper extremities (such as the shoulder, arm, elbow, and wrist) and the chest region. It is emphasized that acute, i.e. sudden injuries occur in the lower extremities, while chronic injuries occur in the upper extremities.
Most tennis-specific injuries can result in job loss and disability. Therefore, it is important to determine the risk factors and prevent tennis-related injuries.
The Relationship Between Tennis Injuries and Age
Studies have reported that the relationship between tennis injuries and age is not significant. It was also reported that there was no difference in terms of the male and female genders. However, the relationship between the types of injuries and age is frequently emphasized. Accordingly, shoulder injuries for example, were found to be more common in the middle-age group, while tennis-related back and low back pain and stress fractures were found to be more common in the adolescent population. It should be noted that tennis-related injuries tend to increase with advancing age.
Stress fractures refer to small cracks in the bone. Pain and swelling are replaced by chronic pain over time. The hardness of the court surface, such as an asphalt one etc., imposes an overload on the bones of the lower extremities, particularly the feet. Stress fractures are less common in clay or grass courts
Stress fractures are associated with very fast training programs as well as hard surfaces. Muscle fatigue leads to increased stress, particularly in the tarsal bones of the foot (tarsal navicular), typically resulting in cracks. The metatarsal bone of the foot that is the most affected by this is the second one (the second metatarsal). While this type of fracture mostly occurs in the foot, it can also occur in the long bones of the leg.
The most effective method to prevent stress fractures is to intensively warm up and stretch before the games, and to implement an appropriate strength and endurance program. In addition, taking short breaks for resting during intense training may be preventive.
Ankle Sprains and Ligament Injuries
Ankle sprains can occur on any surface. This is because tennis is a sport that requires versatile movements. Sudden runs and jumps often lead to improper landings and ankle sprains. It must be remembered that clay courts are riskier for ankle sprains. Most sprains are healed by resting, fixation, ice and sometimes, pain medication. Wearing shoes that support the ankles, avoiding unknown surfaces, and warming up and cooling down before and after the activity are useful measures.
The athlete's holding of the racket and their grip of it with their hand are the most important movements that initiate the hitting mechanisms in sports, particularly in tennis. During the sports activity, the elbow joint can be exposed to accumulative, repetitive micro-traumas. Tennis elbow can be described as the local inflammation at the location where the muscle tissue that lifts our wrist upwards (called an extension) attaches to the outer protrusion of our elbow joint. This problem is 10 times more common in the beginners of tennis compared to the golfer's elbow, which is the inner synonym of tennis elbow. Studies have shown that tennis elbow develops mostly in recreational athletes. Although the level of evidence is not high, there are studies reporting that the non-dominant hand of people who use both their hands for backhand, reduces the risk of the formation of a tennis elbow by absorbing the coercive forces.
Factors that lead to this problem include the selection of a heavy racket that causes stress at the attachment location (extensor origin), non-standard heavy balls, and rackets (cordage of the racket) that are strung too tight or too loose. The primary complaint is the pain located in the lateral section of the elbow, which can spread to the forearm, while gripping the racket, clenching, and lifting the wrist up. The reason for most athletes to consult a doctor is the typical pain they experience while lifting their wrist up (extension) or shaking hands.
The treatment involves stretching the wrist extensor, i.e. the lifting structures, isometric exercises, and light-weight exercises. The application of ice alone is not useful without such isometric and resistance-based exercises. Other applications are; the tennis elbow brace worn on the forearm (which can be effective by reducing the tension at the muscle attachment location), steroid injections, the PRP (plasma containing a level of platelets that is higher than the limit values) therapy, the extracorporeal shock wave treatment, and surgical treatment.
As in all sports where the ball is overhead, tennis also places an extreme amount of stress on the shoulder joint and the surrounding tissues. Shoulder and elbow joints are exposed to excessive strain in every overhead movement, particularly in serving. The athlete should be familiar with the techniques for the effective use of the kinetic chain, particularly in serves, overhead spikes and long shots. Kinetic chain refers to the coordinated connection of the entire upper extremity (arms, elbows and wrists) to the lower extremity (thighs, legs, knees, feet-ankles) during activities and motions. In other words, the kinetic chain causes the risk of injury to the shoulder and the upper extremities to increase simultaneously with the problems in the hip, groin or abdominal muscles.
The rotator cuff has the function of keeping the shoulder joint in the socket during shoulder movements. The inflammatory condition called tendinitis which is caused by the excessive force placed on the rotator cuff during overhead spikes and repeated serves can result in movement restrictions and in time, a condition with a challenging treatment, called "impingement". Impingement can cause a person to become unable to perform even the simple daily activities. Impingement may either occur outside the shoulder joint (subacromial) or within the joint. In such cases, tears causing severe pains may develop in the section of the rotator cuff that faces the joint. In cases of internal impingement, i.e. the impingement within the joint, it was observed that the inward rotation of the arms of the patients was limited as much as the increase in the outward rotation ability.
Helping the patient to gain full mobility so that s/he can complete the inward rotation of the arms, in particular, and strengthening the rotator muscles at the back as well as the shoulder bone (scapula) should be prioritized in the treatment.
Injuries around the hip are reported to occur in nearly 25% of athletes, particularly the elite ones. Hip injuries result in impingement due to the asymmetric growth of the groin muscles and groin pain. Bone spurs (osteophyte) around the hip are twice more common in older female elite athletes in particular, compared to runners.
According to a study, injuries to the anterior cruciate ligament of the knees, patellofemoral joint pains, and patellar tendinitis known as jumper's knee are the common knee problems for tennis players.
This is a phenomenon that is similar to the tennis elbow. It refers to the chronic strain in the inner section of the gastrocnemius muscle, also known as the calf muscle of the leg. It occurs in one sixth of the athletes who engage in tennis-related activities.
Back and Lower Back Problems
More than nearly one third of tennis athletes have chronic back pain. According to the authors, repetitive and powerful serves over a long period of time are responsible for back pain. Back pain is more common in young athletes who hit topspin serves than those who hit flat or slice serves. This may result in the occurrence of spondylolysis or spondylolisthesis, known as a slippage in the lower back, much more frequently and severely during the elite period of young athletes.
How to prevent injuries
Hard tennis courts made of asphalt or waxed concrete create more stress on the body. Any landing movement on the hard court poses a risk for the formation of stress fractures. Clay or grass courts create less stress on the bones as they are softer. However, the higher rate of the gliding movement in soft courts may lead to injuries known as strains or sprains, particularly in the knee and ankle ligaments. In a study, the frequency of injuries experienced by treated elite tennis players on a hard or clay court was found to be 2.5-3 times higher than those on a grass court.
Workouts designed for flexibility in training programs can be effective in preventing such strains.
How to prevent stress fractures
Warm-up and stretching exercises must definitely be performed before the game. Resting during breaks should prevent excessive strain during training. Another way to prevent stress fractures is to engage in different activities such as swimming or cycling which are alternative low-impact activities.In conclusion, tennis, which is a popular sport, makes the player become vulnerable to injuries in the lower and upper extremities. Injuries in the upper part of the body are chronic, while injuries in the lower part of the body are usually acute. The characteristics of the court surface; the vibration effect of the racket features and the position of the racket grip; the habit of warming up and cooling down before and after training; and the proper learning and practice of the overhead serving style, particularly in the beginning period are important factors to consider for the prevention of injuries