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Sports Presentation Tennis Injuries

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Sports Presentation Tennis Injuries Au Ching Man (2) But Wai Man (3) Chan Yee Wah (17) Chui Pui Yu (44) Tung Shui Ping (126) Presentation outline Physiological and ... – PowerPoint PPT presentation

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Title: Sports Presentation Tennis Injuries


1
Sports PresentationTennis Injuries
  • Au Ching Man (2)
  • But Wai Man (3)
  • Chan Yee Wah (17)
  • Chui Pui Yu (44)
  • Tung Shui Ping (126)

2
Presentation outline
  • Physiological and physical requirements
  • Prevalence
  • Common injury
  • Shoulder injury
  • Elbow injury
  • Back injury
  • Conclusion

3
Physiological Characteristics (Konig, 2001)
  • VO2 Max 60-70
  • Mean HR 140-160/min
  • HR affected by psychological stress and
    Temperature
  • 70 alactic anaerobic, 20 lactic anaerobic, 10
    aerobic
  • Recovery from anaerobic work is aerobic
  • Require good cardiovascular endurance

4
Physical Requirements(Chandler, 1995)
  • Good agility
  • Maintain balance and control to hit the ball
    effectively
  • Power and strength
  • Sprinting, stopping, starting and bending
  • Muscle Endurance
  • Repetitive demand on the bones, ligaments, and
    muscles to absorb the shear force

5
Demands on different parts of body(Chandler,
1995)
  • Shoulder high loading, high velocity and large
    ROM
  • Elbow, forearm and wrist high load and absorb
    rotational torque
  • Hip and trunk
  • center of rotation
  • Transfer force produced by the legs to the
    shoulder
  • Abdominal muscles generate, transfer and
    decelerate forces in the trunks

6
Prevalence(Bylak, 1998)
  • LL injuries 2 X UL or spine injury
  • Ankle injury is the most common
  • E.g. sprain ankle
  • Gender
  • junior female gt junior males
  • LL injuries
  • wrist and hand injuries
  • Males has more shoulder and elbow injuries

7
Common injuriesin different parts of body
  • Rotator Cuff Tendinitis
  • Impingement
  • Shoulder Instability

Chronic stress and compressive injuries
Tennis elbow (Lateral and medial)
Abdominal Strain Repetitive and compressive stress
Tendinitis of extensor carpi radialis longus and
brevis
Adductor strain
Anterior knee pain Hamstring strain
Sprain ankle Calf strain Achilles Tendinitis
Plantar fascitis Stress fracture Tennis toe
8
Prevalence of shoulder pain in tennis players
  • Incidence rate of shoulder pain
  • 10 -30 among elite junior players (Todd S.
    1995)
  • 74 of men and 60 of women world-class tennis
    players have a Hx of shoulder or elbow injury
    (Todd S. 1995)
  • 3 common causes of shoulder pain
  • Subacromial impingement as most common shoulder
    injury
  • 97 of junior tennis players w/ shoulder symptom
    have subacromial impingement (Richard C. Lechman
    1988)
  • rotator cuff tendinitis
  • Shoulder instability

9
Risk Factors That Contribute to shoulder pain in
Tennis
  • Intrinsic
  • Biomechanics of tennis playing
  • Weakness in humeral/ scapular stabilizers
  • Muscle imbalance
  • Inflexibility
  • Age difference
  • Neck pain
  • Extrinsic
  • Poor techniques
  • Tennis racquet
  • Grip
  • String
  • Tennis ball

10
Tennis Biomechanics in Shoulder region
  • Serving
  • Hitting an overhead smash
  • .


Cocking phase90o abduction max ER0o forward
flexion Full retraction Ant. Capsule and internal
rotators maximally stretchedExternal rotators
maximally contracted.
11
Tennis Biomechanics in Shoulder region
  • Acceleration phase
  • ER ? IR
  • Abduction ? Forward flexion Lati dorsi, Pect
    maj, and Teres maj contract maximally
  • External rotators maximally lengthened.

12
Tennis Biomechanics in Shoulder region
  • Follow-through phase
  • Rapidly IR of shoulder
  • Eccentric contraction of the external rotators
  • Full protraction of scapula

13
Mal-adaptation of tennis players
  • Muslce imbalance
  • Post. capsule tightness
  • Droop shoulder

14
Cocking phase
Follow-through phase
Eccentric overloading of ER
Lengthening of Scapular stabilizer
Repetitive eccentric overload of IR HF
Weakness/ fatigue of rotator cuff
Drooping of dominant shoulder
Overstretch sh. ant. capsule
Overstretch and microtrauma of post. Sh. capsule
Altered Scapular humeral rhythm
Post. Capsule tightness
shoulder instability
Rotator cuff tendinitis/Impingement
15
Age
  • Older tennis player
  • Actual impingement or degeneration
  • X-ray change in AC jt, narrower subacromial
    space, or increase size in greater tuberosity due
    to chronic wear

16
Neck problem
  • Neck pain will cause compensatory movement of GH
    and scapulo-thoracic joint
  • Cause myotomal change can alter the strength and
    endurance of the cervical, scapular and GH joint
    muscle

17
Extrinsic factor-Tennis Racquet
  • Size
  • Mid-sized (90-1002 inches)


Handle -Y-shaped throat configuration -Largest
grip comfortable
Weight heaviest racquet (without sacrificing
technique)
18
Extrinsic factor-String
  • String type
  • - high quality synthetic (Pluim B.M., 2000)
  • - thinner (Pluim B.M., 2000)
  • String tension
  • -?? by 3 5 pounds (Lehman RC, 1988)
  • string pattern
  • -High-density
  • (Pluim B.M., 2000)

Recommendation
19
Extrinsic factor-Tennis balls
  • new
  • pressurized (Field LD et al, 1995, Pluim B.M.,
    2000)

Recommendation
20
Rehabilitation of shoulder injury
  • Training of scapular stabilizers Rows, shrug and
    wall push up
  • minimise stress GH jt ??recruit of scapular
    activity
  • (Moesley et al,1992, cited in Ellenbecker,
    1995)
  • Training of rotator cuff
  • Normalize unilateral 15 -30 of IR dominance
    (Ellenbecker, 1991, cited in, Ellenbecker, 1995)
  • -Isokinetic internal and external rotation ex at
    90o abducted position in scapular plan
    (Greenfield et al, 1990, cited in Ellenbecker,
    1995)
  • Before return to full competition
  • -Com or Cybex compare players strength
    (Plancher et al, 1995)

21
Rehabilitation of shoulder injury
  • Inflexibility
  • - stretching to restore IR ROM
  • Tennis-specific training
  • Repetitive exercise
  • Eccentric training
  • Plyometric trainging (tennis stroke include
    prestretch followed by full-range concentric
    contraction)

22
Prevalence of elbow injury in tennis player
  • Lateral epicondylitis 40 to 50 (Roetert
    EP1995, Field LD et al, 1995)
  • Medial epicondylitis less common (Field LD et al,
    1995)
  • Lateral Medial 51(Kibler, 1989, Powers,
    1982)
  • Age 35-55 most common, (Nirschl, 1988)

23
Aetiology of elbow injury
  • Intrinsic factors
  • Backhand technique
  • One-handed
  • Two-handed
  • Overhead stroke and top spin
  • Arm position
  • Age
  • Skill level
  • Extrinsic factors
  • Tennis Racquet
  • Racquet weight
  • Handle of tennis racquet
  • String tension
  • Tennis balls

24
One-handed backhand technique
  • Ball contact far from fulcrum lever (shoulder)
  • Greater torque
  • Rapid arm and shoulder fatigue
  • Lateral epicondylitis

25
One-handed backhand stroke
  • Failure to lock the wrist during one-handed
    backhand stroke
  • Eccentric wrist extensor contraction,
  • ? stress on the tendinous attachment of muscles
    near the epicondyle
  • Recommend one-handed backhand stroke with long
    backswing
  • ? ball-and racket impact force,
  • ? external torque on the wrist in the one-handed
    backhand stroke
  • Wrist extensor muscles are contracted firmly lock
    the wrist during ball-and-racket impact

Recommendation
26
Two-handed backhand techique
  • Relies on trunk rotation to generate force in the
    forward swing phase of stroke

27
Overhead stroke top spin
  • Overhead stroke increase valgus load
  • lead to medial epicondylitis
  • Top spin cause forced pronation
  • Aggravate symptoms at pronator muscle origin
    (Field LD et al, 1995)
  • Mean elbow joint angle was 15 degrees at ball
    impact instead of full extension (Elliott and
    Christmass, 1995)
  • Long backswing during preparation phase will
    significantly reduce the peak resultant impact
    and the risk for tennis-related UL overuse

Recommendation
28
Arm position
  • The 90-degree-angle position (Nirschl,1988)
  • Forces in the medial elbow are great
  • Increase chance of medial elbow injury
  • High arm elevations
  • (Nirschl, 1988)
  • Diminish medial elbow force load

Recommendation
29
Skill level
  • Lateral epicondylitis in unskilled player gt
    skilled player
  • ?kinematics characteristics of unskilled players
    backhand stroke (Nirschl, 1988)

30
Skill level
  • Skilled player
  • Strike the ball with
  • center of the head
  • of the racquet
  • Unskilled player
  • More miss-hits near the periphery of the racquet
    gtgtmore racquet vibration, shock, twisting gtgt
    microtrauma
  • Oscillations of tennis racquet for
  • different ball impact locations
  • (Roetert et al, 1995)

31
Extrinsic factor-External Support
  • Elbow counterforce bracing
  • constrain key muscle groups
  • Decrease elbow angular acceleration
  • Decrease EMG muscle activity (Groppel, 1986)

Recommendation
32
Extrinsic factor-Racquet
  • Metal racquets are not recommended for players
    with elbow problem (Gruchow and Pelletier, 1979)
  • Dont use long-body racquet if having elbow
    problem (Pluim B.M., 2000)
  • Heavy racquet head increase torque about the
    elbow joint by shifting moment arm away from the
    elbow (Field LD et al, 1995), it is not
    recommended for players recovering from injury
  • Cushion grip bands can further reduce vibration
    transfer to the forearm (Hatze H, 1992)

33
TennisBack problem---Back pain
  • Unilateral sports
  • ?stronger muscles on dominant side
  • ?muscle imbalance
  • ?mechanical instability
  • ? back pain

34
Tennis characteristics
  • Great Compressive, shearing force act on the
    lumbar spine
  • 4 strokes
  • Serve, volley,forehand and backhand stroke
  • Lumbar Flexion, extension combined with rotation
  • (Marks
    Wiesel, 1988)

35
Serve
Flexion with rotation
Hyperextension with rotation
36
Forehand stroke
Shoulder, trunk, and hip rotate together
Minimize the force on the back
Extension of Knees
Back hand
37
Intrinsic Players characteristics
  • Alignment
  • Increased lumbar lordosis
  • Weak local spine stabilization muscle
  • Local muscle Transverse Abdominals
  • Multifidus
    co-contraction

38
Extrinsic Training court
  • surfaces
  • Eg. Composition court
  • ? greater impact force to L.L and then
    transmitted to back may cause injury
  • Preventive measure
  • Court surface for training back pain player
  • eg. Clay shock absorption
  • ( Watkins,1996)

39
Management Recommendation
  • -Pain relief
  • Prevent recurrence of low back pain
  • Stabilization exercise
  • Local muscle first Transverse abdominis and
  • Multifidus
  • ( static ?
    dynamic)
  • ?Global muscle rectus abdominus
  • obliquus abdominis
    externus and
  • internus, etc.

40
Conclusion
  • Pre-conditioning
  • Choosing equipment
  • Correct technique
  • Rehabilitation

41
QA
42
References
  1. Adelsberg S The tennis stroke An EMG analysis
    of selected muscles with rackets of increasing
    grip size. American Journal of Sports Medicine
    1986 14 139.
  2. Bylak J, Hutchinson MR Common Sports Injuries in
    Young Tennis Players. Sports Medicine 1998 26
    119-132
  3. Chandler TJ Exercise Training for Tennis.
    Clinics in Sports Medicine 1995 14 33-46
  4. Hirsch R.P., 1988, Prevention and treatment of
    elbow and shoulder injuries in the tennis player,
    Clinics in Sports Medicine, vol. 7, No. 2, April
    1988
  5. Ellenbecker TS Rehabilitation of shoulder and
    elbow injuries in tennis players, Clinics in
    sports medicine 1995 14 87-107.
  6. Field LD et al, Elbow injuries, Clinics in sports
    medicine 14 no. 1, Jan 1995

43
References
  1. Goldie I. Epicondylitis humeri (epicondylitis or
    tennis elbow) a pathogenetical study. Acta Chir
    Scand Suppl 339 (1964)1 119
  2. Groppel J, Nirschl RP A biomechanical and EMG
    analysis of the effects of counterforce braces on
    the tennis player. Am J Sports Med 14 195,
    1986Lehman RC Surface and equipment variables in
    tennis injuries. Clin Sports Med 7 229, 1988
  3. Hatze H The effectiveness of grip bands in
    reducing racquet vibration transfer and slipping.
    Med Sci Sports Exerc 24 226, 1992
  4. Haake S.J. and Coe A.O., Tennis Science
    technology, p.321-332 Pluim B.M., Rackets,
    strings and balls in relation to tennis elbow,
  5. Hennig EM, Rosenbaum D, Milani TL Transfer of
    tennis racket vibrations onto the human forearm.
    Med Sci Sports Exerc 24 1134, 1992Nirschl RP
    Muscle and tendon trauma Tennis elbow, In Morrey
    BF (ed) The elbow and Its Disorders, ed 2.
    Philadelphia, WB Saunders, 1993
  6. Kibler WB, Chandler TJ, Uhl TL, et al A
    musculoskeletal approach to the preparticipation
    physical exmination. Preventing injury and
    improving performance. American Journal of Sports
    Medine 1989 17 525-53

44
References
  • .Konig D et al Cardiovascular, metabolic, and
    homonal parameters in professional tennis
    players. Medicine Science in Sports Exercise
    2001 33 654-658
  • Lee HWM Mechanism of Neck and Shoulder Injuries
    in Tennis Players. Journal of orthopedic and
    sports physical therapy 1995 21 28-37
  • Lee WM (1995), Mechanisms of Neck and Shoulder
    Injuries in Tennis Players. Journal of
    Orthopedics and Sports Physical Therapy. 21(1)
    28-37
  • Lehman RC(1988), Shoulder Pain in Competitive
    Tennis Player. Clinics in Sports Medicine.7(2)
    309-327
  • Marks MR, Haas SS, Wiesel SW Low back pain in
    competitive tennis player. Clincs in sports
    medcine 19887277-287.
  • Plancher KD, Litchfield R, Hawkins RJ
    rehabilitatiopn of the shoulder in tennis
    players. Clinics in sports medicine 1995 14
    111-137.
  • Watkins RG The spine in sports. Ch 46 Tennis.
    New York Mosby, 1996 499-504.

45
EMG study of tennis during serving(Glousman,
1993)
46
Serving Action
47
  • Windup
  • Minimal low muscle activity of all sh. Girdle
    muscle
  • Racket is brought up ? sh. Extend passively by
    weight of racket trunk rot.
  • Cocking
  • Max. ER (infra teres min.) abduction
  • Deltoid activity is low (abd is done by trunk
    rot.)
  • Supraspinatus ? stabilization
  • Serratus ant. ? rot. And stabilize scapula
  • Subscapularis in late cocking ? decelerate ER

48
  • Acceleration
  • Max. IR by subscapularis, pect maj. lati.
    Dorsi.
  • Serratus ant. Max. activity ? stabilize scapula
  • Follow-through
  • activity of IR, peak activity of ER
  • Sarratus ant. ? upward rot. and protraction
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