Injury Prevention Strategies for Young Elite Tennis Players
Russell Gunner, C.A.T. (C)

The demands that are placed on young competitive tennis players can result in various forms of injury. The concept of rehabilitation is often over looked when dealing with developing athletes because of their incredible ability to heal quickly and adapt to the increasing demands placed upon them. The fact remains that these young athletes can also suffer from overuse injuries as a result of the repeated overhead strokes unique to the sport. The overloading of soft tissues, especially when the athlete is still growing, can lead to a number of problems. It should be noted that the onset of injury can start many months or even years before the symptoms appear.

Injury Prevention for Young Elite Tennis Players

Regardless of age, one of the weakest links limiting tennis players involves the shoulder joint. This joint is referred to as a "ball and socket" that is able to move in many different directions allowing such motions as a tennis serve to occur. The requirements on the surrounding muscles and ligaments to control the motion at the shoulder and still produce the necessary force and power wanted in a competitive serve are quite high. In developing tennis players, there is often an imbalance between stability and strength of the shoulder muscles. This can result in unfavorable changes with the positioning of the entire shoulder girdle and upper limb, thus predisposing the athlete to injury. The most common musculoskeletal problems associated with the upper extremity in young tennis players include:

• forward displacement of the shoulder joint (head of the humerus/upper arm bone; shoulder blade) can result in constant irritation and swelling of muscle attachments (tendons) which can cause severe pain and discomfort

• decreased range of motion of the shoulder and arm can prevent a fluid overhead service motion in turn causing the athlete to compensate with altered biomechanics; either towards the body (internal rotation) limiting the follow through, or instability of the shoulder with the arm moving away from the body (external rotation) limiting the cocking phase of a serve

• the above two problems can occur secondary to a pre-existing weakness of the rotator cuff muscles which hold the head of the upper arm bone into the joint capsule, or weakness of the muscles that stabilize the shoulder blade against the rib cage

• poor posture: head forward and a rounded upper back can lead to degeneration of the joints in the spine, neck and back pain

• weak grip strength of the forearm muscles can decrease the athletes ability to control racquet speed, generate power or absorb vibration from the tennis ball

The most effective rehabilitation will focus on correcting the root of the problem and not just alleviating the symptoms. After pain and swelling are under control, treatment should include a relevant stretching and strengthening protocol. Considering the musculoskeletal problems listed above, appropriate treatment goals would include:

• stretching out tight structures in the back of the shoulder (posterior capsule of the joint) to allow for proper alignment and greater range of motion in the joint

• strength training to improve endurance of the rotator cuff muscles which are responsible for maintaining stability and proper alignment of the shoulder joint; and increasing power, the amount of force the surrounding muscles can generate during a tennis serve

• sport-specific exercises incorporating various skills required during a tennis match, with progressions at a pace that is appropriate for each individual athlete

Recognition of the common musculoskeletal problems that young competitive tennis players are faced with is a key step in the prevention of serious injury and the promotion of a long and successful tennis career. Club Physio Plus is working in conjunction with the Ontario Racquet Club Tennis Academy to develop a strategy that focuses on monitoring and maximizing the pre- and post-season functional status of their elite amateur tennis players.