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From Breakpoint To Advantage: A Practical Guide to Optimal Tennis Health and Performance

By Babette Pluim, M.D., Ph.D., and Marc Safran, M.D.

Table of Contents

Contents vii

Foreword xiii

Preface xv

Acknowledgements xvi

PART 1: PRINCIPLES OF INJURY PREVENTION AND REHABILITATION

1 The Biomechanics of Tennis 3

  • How to Hit the Ball with Power 3
  • Explanation of Terms 4
  • Movement Analysis 7
  • The Serve 6
  • Injury Risk during Serving 7
  • The Forehand 9
  • Injury Risk during the Forehand 10
  • The Backhand 12
  • Injury Risk during the Backhand 12
  • Summary 15

2 Physiological Demands of the Game 17

  • ATP and Energy 17
  • The Immediate Energy System 18
  • The Short-term Energy System 18
  • The Long-term Energy System 19
  • Measurement of Energy Capacities 20
  • Testing the Immediate Energy System 20
  • Testing the Short-term Energy System 20
  • Testing the Long-term Energy System 21
  • Summary 23

3 Racquets, Strings, and Balls 25

  • Material and Composition of the Racquet 25
  • Size of the Racquet Head 26
  • Stiffness 27
  • Length 27
  • Weight 27
  • Balance 28
  • Grip Size 28
  • Grip Material 29
  • Stringing Material 29
  • String Thickness 29
  • String Tension 29
  • Vibration Stoppers (string implant devices) 30
  • Pressurized and Nonpressurized Tennis Balls 30
  • The Size and Deformation of the Tennis Ball 31
  • Choosing Arm Friendly Equipment 31
  • Summary 31

4 Tennis Shoes and Playing Surfaces 33

  • Playing Surface 33
  • The Tennis Shoe 34
  • Cushioning 35
  • Stability 35
  • Stiffness 35
  • Outsole 35
  • Summary 37

5 Injury Prevention 39

  • Epidemiology of Injuries 40
  • Before Play 41
  • The Pre-participation Physical Examination 41
  • Warm-up 41
  • Flexibility and Stretching 42
  • Types of Stretching 42
  • Stretching Exercises 44
  • Strengthening Exercises 48
  • During Play 49
  • Racquets, Strings and Balls 49
  • Shoes and Surfaces 49
  • Protective Devices 49
  • Taping and Bracing 49
  • Protective Eyewear 50
  • After Play 51
  • Cooling-down 51
  • Massage 51
  • Whirlpool and Jacuzzi 51
  • Sleep 51
  • Muscle Relaxation Techniques 52
  • Breathing Exercises 53
  • Yoga 53
  • Pilates 53
  • Nutrition 54
  • Facility Checklist 54
  • Summary 56

6 General Rehabilitation Principles 57

  • Phases of Tissue Healing 57
  • Healing Time of Specific Tissues 58
  • Accute Phase 58
  • RICE 58
  • Therapeutic Modalities 59
  • Medications 59
  • Intermediate Phase 60
  • Early Mobilization 60
  • Range of Motion and Flexibility 60
  • Muscular Strength and Endurance 61
  • Alternative Training Methods 61
  • Proprioceptive Training 62
  • Therapeutic Modalities 62
  • Medications 63
  • Advanced Phase 63
  • Strengthening and Agility Exercises 63
  • Return to Play 63
  • Therapeutic Exercise Training for the Knee 64
  • Therapeutic Exercise Training for the Shoulder 67
  • Therapeutic Exercise Training for the Lower Back 71
  • Summary 74

PART 2: A COMPLETE INVENTORY OF TENNIS INJURIES

7 Injuries of the Upper Body 77

  • Bump on the Hand or Wrist (ganglion cyst) 77
  • Snapping Wrist (subluxating extensor carpi ulnaris) 78
  • Clicking, Painful Wrist (triangular fibrocartilage tears) 80
  • Wrist Sprain 81
  • Wrist Pain in Young Players (wrist epiphysitis) 82
  • Tendinopathy (tendinitis) around the Wrist 83
  • Pain Moving Thumb (De Quervain's tenosynovitis) 85
  • Squeaker's Wrist (intersection syndrome) 86
  • Hamate (hook) Fractures 86
  • Tennis Elbow (lateral epicondylitis) 87
  • Golfer's Elbow (medial epicondylitis) 90
  • Elbow Pain in Young Children (Panner's Disease) 92
  • Osteochondrits Dissecans of the Elbow 92
  • Medial Epicondylar Apophysitis 93
  • Posterior Impingement Syndrome of the Elbow 94
  • Sprain of the Ulnar Collateral Ligament 96
  • Cubital Tunnel Syndrome (Ulnar Neuritis) 97
  • Ulnar and Humeral Stress Fracture 98
  • Traction Apophysitis of the Shoulder 98
  • Little Leaguer's Shoulder (stress fracture of the proximal humeral epiphysis) 99
  • Shoulder Instability 99
  • Dislocation of the Shoulder 101
  • Pinching Rotator Cuff Tendons (Impingement Syndrome) 103
  • Rotator Cuff Tear 106
  • SLAP Lesions 108
  • Snapping Scapula 111
  • Separated Shoulder (acromioclavicular joint separation) 112
  • Clavicular Osteolysis 113
  • AC Arthritis 113
  • Biceps Tendinopathy (Tendinitis) 114
  • Biceps Tendon Rupture at the Shoulder 116
  • Biceps Tendon Subluxation 117
  • Shoulder Muscle Wasting (suprascapular neuropathy) 117
  • Scapular Winging (serratus anterior palsy, long thoracic nerve injury) 119
  • Thoracic Outlet Syndrome 120
  • Summary 122

8 Injuries of the Lower Body 123

  • Muscle Strains 123
  • Tennis Leg (calf muscle strain) 124
  • Strain of the Anterior Thigh (quadriceps muscles) 126
  • Strain of the Posterior Thigh (hamstring muscles) 127
  • Strain of the Inner Thigh (adductor muscles) 128
  • Stress Fractures 130
  • Stress Fracture of the Forefoot (Metatarsals) 131
  • Stress Fracture of the Lower Leg (Tibia & Fibula) 131
  • Bump on the foot (Bunion) 132
  • Turf Toe 133
  • Stiff Big Toe (hallux rigidus) 134
  • Morton's Neuroma (interdigital neuritis) 135
  • Tarsal Tunnel Syndrome 136
  • Heel Pain Syndrome (plantar fasciitis) 137
  • Heel Pain in Young Players (calcaneal apophysitis,
  • Sever's disease) 139
  • Tendinopathy of the Achilles Tendon 140
  • Achilles Tendon Rupture 142
  • Ankle Sprain 143
  • Chronic Ankle Instability 145
  • Anterior Ankle Impingement 146
  • Posterior Ankle Impingement 148
  • Tendinopathy and Rupture of the Posterior Tibial Tendon 148
  • Tendinopathy and Rupture of the Peroneal Tendons 149
  • Peroneal Tendon Subluxation 150
  • Chronic Exertional Compartment Syndrome 152
  • Shin Splints (medial tibial stress syndrome) 153
  • Meniscus Tear 154
  • Meniscal Cyst 156
  • Medial Collateral Ligament Sprain 157
  • Anterior Cruciate Ligament Injury 159
  • Anterior Knee Pain (Pain in the Front of the Knee 161
  • Patellofemoral Pain Syndrome 161
  • Jumper's Knee (Patellar Tendonitis) 164
  • Osgood Schlatter's Disease 166
  • Sinding-Larsen-Johansson Syndrome 168
  • Hoffa's Disease (infrapatellar fat pad syndrome) 168
  • Pes Anserinus Syndrome 169
  • Iliotibial Band Syndrome 170
  • Popliteus Tendinopathy (Popliteus Tendinitis) 172
  • Osteitis Pubis 173
  • Bursitis of the Hip 175
  • Tendinopathy of the Outer Hip Muscles 175
  • Piriformis Syndrome 176
  • Hip Labral Tears 178
  • Summary 179

9 Injuries of the Trunk and Spine 181

  • Low Back Pain (nonspecific) 181
  • Facet Syndrome 183
  • Herniated Disc (ruptured or slipped disc) 185
  • Spondylolysis and Spondylolisthesis
  • (vertebrae fracture and slippage) 186
  • Rib Stress Fractures 188
  • Abdominal Muscle Strains 189
  • Whiplash (Cervical Strain and Sprain) 191
  • Summary 192

PART 3: MEDICAL ISSUES

10 Brain and Nervous System 195

  • Tension Headache 195
  • Migraine 195
  • Exercise Induced Headache 196
  • Cervicogenic Headache 197
  • Ringing in the Ear (tinnitus) 198
  • Summary 198

11 The Eye 199

  • Injuries of the Eyelid 199
  • Eye Scratches (corneal erosion) 200
  • Red Eye (conjunctivitis) 200
  • Blood in the Eye (hyphema) 201
  • Eyelid Inflammation (blepharitis) 201
  • The Common Stye 201
  • Bump on the Eyelid: Inflammation of
  • Oil Gland (chalazion) 202
  • Dry Eyes 202
  • Thickenings on the White of the Eye
  • (pinguecula and pterygium) 202
  • Cataracts 203
  • Retinal Detachment 204
  • Fracture of the Eye-Socket 204
  • Vision Disorders 205
  • Visual Training 206
  • Summary 206

12 Skin Disorders 209

  • Blisters 209
  • Callus 210
  • Corns (clavi) 211
  • Tennis toe (black toe) 211
  • Ingrown Toenail 212
  • Excessive Sweating 212
  • Insect Stings 212
  • Tick Bites and Lyme disease 213
  • MassageRash (folliculitis) 214
  • Athlete's foot (tinea pedis) 215
  • Cold Sores (fever blisters) 215
  • Warts (verrucae) 216
  • Sun Related Disorders 217
  • Sunburn 217
  • Skin cancer 217
  • Summary 219

13 The Heart and Blood Vessels 221

  • Athlete's Heart 221
  • Premature Heartbeat 222
  • Racing Heartbeat (tachycardia) 222
  • Fainting Spells (syncope) 223
  • Inflammation of the Heart Muscle (myocarditis) 223
  • Atherosclerosis (hardening and narrowing of arteries) 224
  • High Blood Pressure 225
  • Heart Attack 225
  • Sudden Exercise Related Cardiac Death 226
  • Upper Extremity Vascular Injuries 227
  • Cold Finger (digital ischemia) 227
  • Blood Clot in the Arm (effort thrombosis
  • of the upper extremity) 228
  • Axillary-Subclavian Artery Compression 228
  • Summary 229

14 The Respiratory System 231

  • Hay Fever (allergic rhinitis) 231
  • Sinusitis 232
  • Viral Upper Respiratory Tract Infection 233
  • Exercise Induced Asthma 233
  • Respect the Anti-doping Program 235
  • Summary 235

15 The Digestive System 237

  • Stomach flu (viral gastroenteritis) 237
  • Food Poisoning 238
  • Traveler's Diarrhea 239
  • Heartburn 240
  • Stitch 241
  • Irritable Bowel Syndrome 241
  • Summary 242

16 Other Medical Conditions 243

  • Diabetes Mellitus 243
  • Glandular Fever 245
  • Anemia 245
  • Summary 246

PART 4: SPECIAL ISSUES

17 Heat Stress 249

  • Heat Production 249
  • Fluid Loss 250
  • Salt Loss 251
  • The Risks of Playing in the Heat 251
  • Sports Drinks 253
  • Drinking during a Match 254
  • Drinking after a Match 254
  • Summary 256

18 Nutrition and Supplements 257

  • Carbohydrates 257
  • Protein 258
  • Fat 259
  • Vitamins 261
  • Minerals 261
  • Antioxidants 262
  • Creatine 262
  • Miscellaneous products 262
  • Summary 263

19 Doping and Drug Testing 265

  • What Is Doping? 265
  • The List of Prohibited Substances and Methods 266
  • What Is the WADA? 266
  • Who Can Be Tested? 266
  • When Can a Test Occur? 266
  • Who Administers the Testing? 266
  • The Therapeutic Use Exemption 266
  • Player Notification of Testing 267
  • The Testing Procedure 267
  • Test Results and Reporting 267
  • Penalties 267
  • Announcement of Suspensions 268
  • Nutritional Supplements 268
  • Summary 268

20 Overtraining and Burnout 271

  • Overtraining 271
  • Burnout 272
  • Summary 275

21 The Travelling Player 277

  • Jet lag 277
  • Vaccinations 279
  • Malaria 279
  • Sexually Transmitted Diseases 280
  • The Travel Kit 281
  • Summary 282

PART 5: SPECIAL TENNIS GROUPS

22 Junior Players 285

  • Growth and Maturation 285
  • Physical Capacities 286
  • Aerobic Power 286
  • Anaerobic Performance 286
  • Strength 287
  • Co-ordination 288
  • Flexibility 288
  • Heat Stress 289
  • Epidemiology of Injuries 290
  • Summary 290

23 Veteran Players 291

  • Use It or Lose It! 291
  • Aerobic Capacity 292
  • Strength Training 292
  • Co-ordination 293
  • Flexibility 293
  • Cardiovascular Risks 293
  • Heat Stress 294
  • Osteoporosis 294
  • Epidemiology of Injuries 295
  • Total Joint Replacement 295
  • Summary 296

24 Women's Issues 297

  • Body size 297
  • Injury patterns 297
  • The Female Athlete Triad 298
  • Eating Disorders 298
  • Menstrual Dysfunction 300
  • Osteoporosis 301
  • Pregnancy 301
  • Stress Urinary Incontinence 303
  • Summary 303

25 Wheelchair Tennis Players 305

  • Why Play Wheelchair Tennis? 305
  • Who Can Play Wheelchair Tennis? 305
  • Equipment 306
  • Wheelchair 306
  • Strapping 307
  • Clothing 307
  • Racquet 307
  • Conditioning 307
  • Injuries 308
  • Wrist Pain 308
  • Elbow Pain 309
  • Shoulder Pain 310
  • Trunk 310
  • Ailments 311
  • Bladder Infection 311
  • Seizures 312
  • Heat Stress 312
  • Autonomic Dysreflexia 313
  • Wheel Burns 313
  • Pressure Areas 313
  • Summary 314

PART 6: MANAGING AND DELIVERING TENNIS MEDICINE PROGRAMS

26 The Sports Physician 317

  • The Tournament Physician 317
  • The Role of the Tournament Physician 317
  • Medical Rules 318
  • The Team Physician/Federation Doctor 319
  • The Role of the Team Physician 319
  • Pre-participation Physical Examination 319
  • Education and Counseling 320
  • Preparing for Travel 320
  • The Medical Bag 320
  • Medications 321
  • Respect the Tennis Anti-Doping Program 322
  • Sports Medicine Center Physician 322
  • Summary 323

27 The Athletic Trainer and Physiotherapist 325

  • Why A Certified Athletic Trainer or Sports
  • Physiotherapist Is Necessary 325
  • Education of the Certified Athletic Trainer 326
  • Education of Sports Physiotherapists 326
  • The Role of the Trainer or Physiotherapist 327
  • The Trainers and Physiotherapists on the Professional Tours 327
  • Trainers and Physiotherapists at Local Tournaments 329
  • Trainers and Physiotherapists Responsibilities -- Pre-tournament 328
  • Trainers and Physiotherapists Responsibilities -- During the Tournament 328
  • Trainers and Physiotherapists Responsibilities -- Post-tournament 329
  • Summary 330

28 Strength Training for Tennis 331

  • Intensity, Duration, and Frequency 331
  • Velocity 332
  • Equipment 332
  • Basic Exercise Program 332
  • Shoulders 332
  • Arms 337
  • Elbow, Wrist and Hand 338
  • Upper Back 340
  • Addominals 341
  • Back and Trunk 343
  • Hips and Groin 347
  • Thigh and Knee 349
  • Lower Leg, Ankle, and Feet 350

References 353

Index 365

About the Authors 373

Book Specifications
Chapters 28
Sections 6
Pages 400
Illustrations 500
Index Yes
References Yes
Cover Paperback
Size 8.5 × 11
ISBN 0-9722759-1-6