Injury prevention for tennis and other racket sports
Alex Cockram and James Tolley provide essential injury prevention exercises for tennis and other racket sports.
Tennis has been described as a sport in which players have to respond skillfully to a continuous series of emergencies, such as sprinting to the ball, reaching, jumping, lunging, changing directions, stopping and starting (Roetert & Ellenbeceker, 1999). The repetitive nature of the sport exposes players' bodies to regular stresses and potential injuries especially, through the shoulders and lower back. Ankle and elbow injuries have also been identified as common problems in tennis players (Bylak & Hutchinson, 1998).
Research has shown that an adequate strength & conditioning programme can improve players' maximal force and power production, reduce the incidence of injuries and contribute to faster recovery times, thereby reducing the number of missed practice sessions and competitions. Injury prevention or prehabilitation should form a key part of any strength & conditioning programme and this article will guide what we consider the key prehabilitation exercises for tennis and other racket sports.
Shoulder injuries are one of the most common and include rotator cuff strains, impingement, labral tears and instability. Shoulder rehabilitation and prehabilitation programs traditionally emphasise strengthening the rotator cuff. The rotator cuff is comprised of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. Because of the extensive range of motion available at the shoulder, the ligaments alone cannot provide enough stability throughout all planes of movement. The muscles of the rotator cuff provide active stability to maintain joint integrity.
In a rotator cuff conditioning programme, both internal and external rotation should be exercised; however, extra emphasis should be placed on external rotation. The infraspinatus and the teres minor are the external rotators and are weaker than the internal rotators. This is because the internal rotator muscles are aided by major mobilisers including pec major and latissimus dorsi, whereas the external rotators work in isolation. All tennis strokes require external rotation to some extent; however, the movements with the greatest stress are the serve, overhead & forehand.
In terms of suitable exercises for the shoulder, we recommend nine integral shoulder movements utilizing resistance bands and one with dumbbells, although you can mix, and match as required.
For tennis players who are just starting or who have suddenly increased their training load, a common overuse issue is the shortening of the coracobrachialis. This muscle is located across the front of your shoulder and is used to bring the arm forward. To prevent this problem from occurring, you should stretch regularly with the arm positioned behind the torso. A doorframe is ideal for creating this position and stretch.
Although many shoulder injuries require rotator cuff strengthening, a comprehensive rehabilitation program must also include scapular stabilization exercises. The main muscles providing scapular stabilization are the rhomboids, trapezius, and serratus anterior. The weakness of the scapular muscles will lead to dysfunction of the scapulohumeral rhythm, which may cause or lead to a shoulder injury (Binkley, 2006). During normal scapulohumeral rhythm, the scapula slides over the rib cage and is held in place by the serratus anterior. If weakness occurs, the scapula will stand prominently from the rib cage when the arm is protracted against resistance. This is known as winged scapula.
The exercises we recommend to build the rhomboids, mid trapezius and serratus anterior for scapula stabilisation include standing row using resistance bands, swiss ball dumbbell reverse flies, or wide grip bent over row using weights. Incline press-ups are a good remedial exercise to build up to full press-ups, which strengthen arms, back and chest.
The lower back is an area of the body that is prone to regular stresses, especially during the arch on the topspin second serve and overhead strokes. Therefore, it is important to incorporate rotation and extension to mimic the service action. A common overuse injury is due to a weak and short quadratus lumborum, a muscle that attaches the rib cage to the spine and top of the pelvis.
A simple exercise to increase lower back strength is the back extension using a swiss ball. Movements on the ball include straight back raises and back raise with twists. Another key twisting exercises are medicine ball strokes. These can be done on the forehand, backhand and overhead with emphasis placed on developing explosive power through the twist. We train our athletes in these movements to reflect patterns on the court. A typical interval would include five forehands, five backhands and five overheads repeated eight times with thirty seconds rest between intervals.
Another aspect of back stabilisation involves developing good core strength. The plank and side plank are key exercises to achieve this. Throughout the exercise, you should activate your core by pulling in your stomach and contracting your glutes (buttocks). There should be no sagging of the hips or rising of the gluts, and you should remain along a linear plane throughout the hold. It is important to keep perfect form. As they are isometric exercises, you should try to build up the amount of time you can stay in the position without your back sagging. Ideally, hold the plank for one minute, then the side plank for one minute on both sides. An advanced version of the side plank incorporates raising the top leg; this requires additional stabilization and activates the hip abductors
Elbows & Wrists
Everyone has heard of 'tennis elbow'. The medical name for this condition is lateral epicondylitis. It is a lesion to the common extensor origin with the primary site being the tendon of the extensor carpi radialis brevis. Similarly, 'golfers elbow' or medial epicondylitis affects the muscles on the medial side of the joint. It is essential to strengthen the muscles of the forearm and ensure that no shortening occurs. Forearm strengthening exercises include squeezing a tennis ball, wrist circles using a weighted object, dumbbell wrist curls with the forearm pronated and supinated and pull/chin-ups. We find that pull-ups using a thick bar (over 1½ inch diameter) have a very positive impact on forearm strength. If you cannot do a pull-up, then grip the bar, jump up, and then slowly lower your body weight down. When stretching your forearms, it is vital to keep the elbow fully extended and ensure you stretch both flexors and extensors.
The overhead squat is a key exercise in developing overall strength and stability. Shoulder activation is key in maintaining the overhead bar position while keeping your spine in its neutral position, i.e. a slight lumbar curve. This combined with flexion of the hips and activation of the core muscles to maintain this correct alignment throughout the squat makes it a powerful exercise. The overhead squat can be incorporated into warm-ups both as a dynamic stretch and as a tool to develop flexibility, as a warm-up we would recommend three sets of 15 repetitions using a wooden dowel or PVC pipe. Once you are comfortable with the form weight can be added incrementally.
As mentioned earlier, tennis requires sudden changes in direction. Ankle and knee sprains are common, and rehabilitation techniques may be used to help reduce the risk of such injuries. A stability disc provides an unstable surface to train proprioception (your body's ability to know where each segment is in time and space). Stand on the stability disc at first with your arms open to aid your balance, when you can hold this position for a minute, progress to standing with your arms by your side again when you can do this for a minute, try with your eyes shut. More advanced functional movements may also be performed on the stability disc, a single leg squat performed for 10-15 repetitions with or without dumbbells is an excellent exercise.
We view these exercises as essential in the prevention of common injuries in tennis and players of all ages and abilities should try to incorporate them into their strength and conditioning programs. Athletes from other racket sports could also benefit from them due to the similar repetitive and multidirectional nature of these sports.
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About the Author
Alex Cochram is a Certified Strength and Conditioning Specialist and SAQ trainer with an honours degree in Sport and Exercise Science from The University of Bath. He was a committed Lawn Tennis Association scholar at university and has travelled extensively throughout his tennis career. His goal is to offer the knowledge and skills gained from experiences as a semi-professional tennis player, a sports scientist and a strength and conditioning coach to all athletes, especially at the elite level.