Sports Medicine: Just the Facts

CHAPTER 91 • TENNIS 537

shape, a curved design is necessary for proper fit and

dual tension straps to control tension completely

across the entire brace is best.

• Nonoperative treatment summary: Tennis, like
  many other repetitive action sports, alters the muscu-
  losketal system in nonhealthful ways. The shoulder
  and elbow muscle tendon units become fatigued,
  weakened, imbalanced, and ultimately injured.
  Rehabilitation exercises to correct these deficiencies
  are critical to cure. Maintenance exercises that coun-
  teract the bodies’ maladaptation to tennis mechanics
  are essential to prevent recurrence.


• The other key component in prevention of the tennis
  related overuse injuries is to control excessive force
  overload. These approaches as noted include quality
  stroke technique, equipment (racquet, strings, and the
  tennis court surface), the intensity, frequency, and

duration of activity and quality counterforce bracing

(e.g., curvilinear designs).

• Treatment surgical:The goal of nonoperative treat-
  ment is to revitalize degenerative tendinosis tissue. If
  this fails, surgical intervention regarding tennis elbow
  (medial and lateral) and shoulder tendinosis (includ-
  ing full cuff rupture) can be highly successful. The
  goal of surgery is to resect the pain producing tendi-
  nosis tissue and or repair ruptured tissue.


• The indications for surgery are a failed quality reha-
  bilitation program and an unacceptable quality of life
  as determined by the patient.


• Return to tennis stroke mechanics protocol:After
  rehabilitation or surgery, the following return to tennis
  practice schedule protocols are suggested:
  1.Medial tennis elbow practice schedule return
  guidelines (Table 91-1).

TABLE 91-1 Medial Tennis Elbow Practice Schedule Return Guidelines

TOURNAMENT PLAYER RECREATIONAL PLAYER∗

DAY DURATION TECHNIQUE DAY DURATION TECHNIQUE

1 15 min B only (2 handed); 1 15 min L only
L (no late strokes)
2 20 min B (2 handed); L; 2 20 min L; B
Few F (2 handed)
3 30 min B; L; Few F (not T); F; 3 35 min Same as day 2
(no late strokes),
(no topspin)
4 35 min B; L; BV; F (no T) 4 40 min L; B; F; BV
5 40 min B; L; BV; F (no T); 5 45 min L; B; F; BV; few O
Few O (to F court only)
6 45 min B; L; BV; F; (no T); 6 1 h L; B; F; BV; O
O (to F court only)
71 h Same as day 6 7 1 h L; B; BV; F; O; few S
81 h (a.m.) B; L; BV; F (no T) FV; 8 1 h L; B; F; BV; O; S; F;
(no late strokes ever!) (No late strokes ever!)
91 h All strokes easy 9 Resume normal
practice/play schedule
10 1 h (a.m.) Same as day 9
15 min (p.m.) B; L; F

11 1 h (a.m.) B; L; BV; F (not T); O;
30 min (p.m.) FV;S; (no T or AT)
B; L; BV; F; (no T)

12 1 h (a.m.) B; L; BV; F; O; FV; S;
45 min (p.m.) (no T or AT)
B; L; BV; F; O
13 1 h (a.m.) Same as day 12
1 h (p.m.) Same as a.m.

14 1 h (a.m.) B; L; BV; F
1 h (p.m.) Same as in a.m.

15 Resume normal
practice/play schedule

*Progression for recreational player refers to the actual playing days, not chronological days.

Code for Tennis Practice Schedule

F =Forehand T =Topspin FV =Forehand volley

AT =American twist S =Serve L =Lob

U =Underspin BL =Backhand lob B =Backhand

FL =Forehand lob SL =Slice O =Overhead

BV =Backhand valley

Caution

1. Use Medical Count’R-Force® at all times.


2. Hit easily—hit through the ball.


3. Stay in balance.


4. Stay in the hitting zone.


5. No late strokes.


6. Keep eye on ball.


7. Avoid frame shots.


8. Ice sore areas immediately after play.