Tennis anyone?
It’s that time of year again for strawberries and cream, Pimm’s and Lemonade and engrossing ourselves in the on-court battles playing out in front of our TV screens. Wimbledon is back and with it comes the lure of dusting off our racquets and hitting the courts in a bid to emulate our tennis idols. Even for more avid tennis enthusiasts or regular tennis players, this is the time of year people are more likely to increase their time on court to make the most of the long evenings and warm weather.
Tennis itself is undeniably a sport that has a wide range of benefits, from maintaining strength, agility, balance and co-ordination, to the less widely acknowledged social and psychological benefits. Previous studies have shown that people who play tennis are more likely to have a reduced risk for developing cardiovascular disease, improved aerobic fitness as well as bone health(1). Unfortunately however, as with most sports there are some common injuries we tend to see within physiotherapy in the tennis population and more often than not these involve tendons.
Before we move on, it’s probably worth a very brief anatomy lesson. In short, a tendon is a strong fibrous tissue that attaches a muscle to a bone, so that the muscle can move the bone and consequently our limbs. As you might expect, with tennis being a multi-directional and high impact sport involving all limbs, it is not uncommon for people to start to develop pain from their tendons. The cause and contributing factors for tendon pain is complex and still open to debate, but what is widely accepted is that most tendon problems tend to develop from overload(2) , or more simply doing too much, too frequently and without sufficient time to recover.
In new or first time cases, once the activity or load has reduced, the tendon tends to settle on its own accord without much need for intervention. Unfortunately however in clinic, most ongoing tendon problems are seen in middle aged to older adults, where even small increases in activity can cause repeat flares of tendon pain(3). In the context of tennis therefore, suddenly and repeatedly hitting the courts when someone hasn’t played in a while increases their risk of developing a tendinopathy.
From a physiotherapy and evidence based perspective, there are probably a few key principles when managing a tendinopathy. The first is around education and ensuring patients understand the importance of reducing the load. In terms of tennis, this may be reducing the duration of play, frequency or even stopping play for a period of time to allow the tendon to settle. The second is around implementing a load-based programme, where the tendon is subject to gradually increasing load, but with sufficient recovery periods in between. Addressing strength, flexibility and control within the limb and wider kinetic chain is also important from a future prevention perspective. A good example of this is in tennis elbow (a tendinopathy on the outside of the elbow) where patients are often found to have weakness in their shoulder rotators(4).
So if you’re considering heading back to the courts or thinking about playing a lot more than normal, take your time and allow sufficient time for your tendons to adapt to what you’re asking them to do. If you’re still struggling however, then consider booking an appointment with one of us to guide you along the way.
Enjoy the Tennis!
