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Sports & Tennis Injuries

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What We Do

We have worked at many sporting events and with sports teams. Most notably would be our work in the world of tennis. We have worked at Grand Slams, ATP, WTA, ITF and LTA nationally and internationally providing the following physiotherapy services:

 

  • Injury treatment
  • Tennis specific rehabilitation programmes
  • Taping and strapping
  • Tournament cover
  • On-court treatment
  • Match preparation
  • Recovery strategies
  • Training programmes
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What we treat

Tennis Injuries

Most upper extremity tennis injuries are chronic and result from non-contact mechanisms, and most injuries result from the serve. The kinetic chain that generates a serve is largely responsible for being the root cause of upper extremity injuries in tennis. The athletes vary in terms of their serve and groundstroke styles.

How we look at tennis players' technique

The serve has been broken down to:

  1.  Wind-up
  2. Early cocking
  3.  Late cocking
  4. Acceleration
  5. Follow through

Forehand or backhand groundstrokes have been broken down to:

  1. Racket preparation
  2. Acceleration
  3. Follow through

The kinetic chain, or the route of energy that flows through the body during a serve or groundstroke, allows for effective transfer of energy to the ball. The hip, knee, shoulder, elbow, and wrist joints serve as sequential links in the kinetic chain that absorb, generate, and transmit energy. During these strokes, safe and efficient energy transmission through the kinetic chain depends on endurance and technique. As energy transfer between links becomes inefficient secondary to fatigue or poor technique, joints in the chain can become overloaded and subsequently injured. In an energy flow comparison between injured and non-injured tennis players, injured players demonstrated lower quality of energy flow through the kinetic chain, lower ball velocity, and higher rates of energy absorbed by the shoulder and elbow joint compared with non-injured players.

 

Tennis Elbow

Our physiotherapists have worked extensively in tennis both with recreational and professional players and tennis elbow is a condition we see a lot. In professional athletes the pain will be on the inside of the elbow due to the way they hit the ball. In recreational players the pain tends to be on the outside of the elbow – this is called lateral epicondylitis. In more experienced players lateral epicondylitis is due to an increase of wrist extension just prior to ball impact , and in more novice players it is likely to be due to striking the ball with their wrist in more flexed position at impact. Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. We will firstly ask you questions about string tension, racket weight and grip size as many of these problems can be greatly eased by asking the advice of a tennis coach or racket stringer about the above. If you have the correct string tension, racket weight and grip size then physiotherapy is the next option. We will assess, not only the elbow, but your whole technique as it is rarely just an elbow problem. It is more likely to be a combination of biomechanical ‘inefficiencies’ which manifest themselves in a painful elbow.

Our approach would be:

  •  Manage the pain
  •  Improve the range of movement throughout the kinetic chain
  •  Improve shoulder stability, wrist strength and elbow control
  •  Balance and position sense (proprioception) is also very important
  • Progress to increasing the load, skill and speed of upper limb in generally and wrist and elbow movements in particular

It is not only sports people who experience tennis elbow, many keyboard users will have similar problems due to the ergonomics of their workstation, or simply how long they are spending at their desk on the computer.
Whatever the cause, be rest assured that your physiotherapist will thoroughly assess and diagnose the problem and will explain the underlying cause. Treatment may be hands on initially with an increasing emphasis on exercises and education. Your physiotherapist will progress the difficulty of these on an individual basis until we achieve self-management or resolution. Many people with tennis elbow say that it never goes away. This need not be the case. With the appropriate treatment, management, and education we can and have achieved resolution of the condition.

Rotator Cuff
The rotator cuff is a group of four muscles attaching from the shoulder blade (scapula) to the top of your arm bone (humerus). These muscles are important in stabilising your shoulder joint during movement and allow the arm to move in many directions. As a result, the rotator cuff is at risk of overuse injuries especially from overhead movements which rely heavily on shoulder movement at speed and with load. If there is insufficient assistance from the rest of the body, the muscles and tendons around the shoulder joint become overloaded and may develop inflammation and tissue changes called tendinitis or tendinopathy. Normal age-related degeneration of these tendons means that 60% of people over the age of 60 will have a rotator cuff tear. Shoulder pain is the third most common presentation in musculoskeletal medicine after low back pain and neck pain. Degeneration and progressive mechanical failure of the rotator cuff is a normal age-related process in all populations. Many of these tears are asymptomatic, meaning that we don’t even know we have them and that we can function normally. If there is pain and reduced function, studies have shown that non-operative, conservative management such as Physiotherapy has good functional outcomes. The evidence says that there is no doubt that non-operative management of rotator cuff tears is indicated for many patients with degenerative tears. That doesn’t mean that you will have to live with pain and poor shoulder function. You will receive a thorough assessment and diagnosis of the problem so that you understand the cause and the best course of treatment. Much of what we do as physiotherapists is to achieve the most efficient movement patterns to enable you to get back doing what you love. Our goal is to keep you moving and to safely reintroduce movements which will return to your sport better than you were before.
Wrist pain and TFCC injuries
Ball-racquet location and grip tightness are important parameters when assessing the cause of a wrist or elbow problem in tennis players.
Wrist Injuries

Wrist injuries are also common in tennis players depending on how they hit the ball as the load delivered to the wrist during the forehand stroke varies depending on hand grip position. There are four traditional single-handed hand grip positions

  1. the Continental,
  2. Eastern,
  3. Semi-Western,
  4.  and the Western
  • The Eastern grip position is found to be associated with radial-sided wrist injuries while the Western and semi-Western grip positions are associated with ulnar-sided wrist injuries
  • The impact position of the ball on the racquet and grip tightness can affect force transmission on the wrist. Off-centred impacts substantially increased wrist extension torque when compared with an impact that occurred at the centre of the racquet.
  • Increased grip pressure resulted in a decrease in racquet rotation in the hand and a 20% increase in wrist extension torque compared with the normal grip. Ball-racquet location and grip tightness are important parameters when assessing the cause of a wrist or elbow problem in tennis players.
  • The triangular fibrocartilage complex (TFCC) is a load-bearing structure between the lunate, triquetrum, and ulnar head. Its function is to act as a stabilizer for the ulnar aspect of the wrist. With the repetitive movements that are a feature of tennis, it is at risk of either acute or chronic degenerative injury.
  • Forced compression on the ulnar side of the wrist as well as over stretching the complex may result in injury to the TFCC.

Treatment follows a full assessment and if imaging is required to confirm the diagnosis we will request an MRI, however, on most occasions this will not be necessary. We will look at the whole chain of movement and aim to make this as efficient and effective as it possibly can be in order to ease the strain on the upper limb and on the wrist in particular. Specific exercises will also be advised for the injured area and there will be some hands on treatment to help ease symptoms and provide pain relief.

What we treat

Calf and Achilles tendon injuries
Calf tears and Achilles tendinitis and tendinopathy are common in tennis and other sports.
Achilles tendinitis
Achilles tendinitis is the inflammatory stage of an overuse injury in the Achilles tendon. Overuse injuries occur due to poor biomechanics of the foot, ankle, hip, knee and pelvis; playing too much on a hard court, weak/tight calf muscles and incorrect footwear. Treatment is multifactorial and will address the whole biomechanics of the body as well as the health of the muscle/tendon complex itself. Achilles tendinitis often progresses to Achilles tendinopathy as the inflammatory changes then become structural changes within the tendon.
Achilles tendon rupture
An Achilles tendon rupture is far more severe than tendinitis. You may feel a sudden snap in the lower leg, as if someone has kicked you in the back of the foot. You will not be able to push your foot into the ground (plantarflexion) as the link between the calf muscle and the heel has been broken. This can be treated with surgery or conservatively, but it is always worth seeking an immediate surgical opinion. Your surgeon will be able to advise of the best course of treatment, whether that is surgery to repair the ruptured tendon, or conservative boot or casting. Both approaches will require physiotherapy rehabilitation to get you back to sport.
Calf muscle tear
Calf muscle tear or tennis leg is a very common injury in racket sports players. It is common for people who have had this injury to report that they feel as though they have been shot in the back of the leg. It is important to stop playing immediately and seek professional advice. This may take several weeks to resolve.
Ankle sprains
Ankle sprains are the most common acute musculoskeletal injury and can be mild to severe in their presentation. Usually, the ligaments will not have completely ruptured and with some guided rehabilitation you will be back on court hitting a few balls in about 4-6 weeks. Some take longer and some less time to resolve depending upon the severity of the injury. Ankle braces and taping can hasten the return to play and players will often use them as a reminder to help prevent future re-injury. Ankle supports and taping alone will not prevent re-injury; a comprehensive rehabilitation programme is necessary to achieve the best functional outcome.
Tennis toe
Tennis toe can occur as the toes are jammed against the toe-box (shoe toe housing) of the shoe during tennis’s quick starts and stops. Tennis toe is a haemorrhage under the toenail that can be quite painful. You can prevent tennis toe by keeping your toenails cut short, wearing shoes that provide adequate toe space and by tying the laces on your court shoes up to prevent the foot sliding to the front of the shoe.

Book Your Appointment

If you have any questions then please get in touch! We would be delighted to hear from you. Alternatively if you’re ready to book you can click Book Online below.  

What Our Clients Say

Wimbledon Physio

"Thank You for the brilliant job you’ve done- I feel I’ve improved massively since starting with you. "

- Peter S

Thank you Katherine! I went to see Katherine after experiencing sharp pain in one of my knees. She was brilliant in guiding me through diagnostic (turned out I had Chondromalacia patellae) and helping me rebuild strength to be able to race again. It was a long and tricky recovery, but the efforts paid off and Katherine’s support was amazing.

- Laurent J

A truly gifted Physio! Katherine has been my go-to Physio for a number of years. She has an incredible insight to the workings of the human body and her intuitive way of working has me quickly back on track with an understanding of how I can help myself with whatever was going on that made me go see her in the first place! I love the way she approaches whatever ‘problem’ I present with in a whole system way. That’s rare. And that’s why I value her so much.

- Laurent J