Tennis injury prevention and sprinting injury prevention exercises

Here is the second of our concise prevention briefs for popular sports. This time: tennis and sprinting

Tennis-related injuries are common at all levels of the game - junior, recreational or pro tour. One of the most frequent is the infamous 'tennis elbow'. This is a typical chronic overuse injury. It seems to be associated with lack of forearm strength, or more specifically a strength imbalance between the wrist extensor muscles and wrist flexor muscles. This is particularly true of junior players who suffer from this problem. It is also associated with poor technique, relying on too much arm power to make the shots rather than body rotation. This arm-dominant technique places too much stress on the elbow and wrist joints and hence the injury. This technique-related cause is most common in recreational players.
A second frequently seen chronic overuse injury in tennis is shoulder tendinitis. This is often a rotator-cuff impingement injury caused by repeated overhead and inward rotation movements of the arm. This leads to a dominance of the anterior deltoid and pectoralis muscles and a relative weakening of the rotator cuff in rear-shoulder girdle muscles. Mechanically this leads to an increasingly unstable and weak positioning of the shoulder joint, which stresses the tendons.

Watch your back
Back injuries are also common in tennis. In élite players, who have played many hours a week for many years, it is common to see right versus left side strength imbalances. Players have a dominant arm which leads to a dominant trunk rotation movement. Players often have a dominant leg which they are more comfortable balancing or moving on, which leads to a dominant hip movement. These imbalances can cause low-back problems if the player does not have the required core stability. In addition, many tennis shots and movements involve back extension and flexion, placing a lot of stress on the back musculature. Without sufficient strength and flexibility in the hips and spine, an élite player may overload the back.
For recreational players, poor posture and insufficient core stability may lead to back problems when they play tennis. In this case, though, tennis would not be the primary cause of the injury but simply the activity that sets off symptoms.
Other injuries in tennis are knee and ankle sprains. These are acute-accident injuries which are hard to avoid. However, an élite player would need to ensure sufficient strength in the leg muscles and develop good balance and movement skills to decrease the likelihood of a sprain. While sprains are accidents, common sense says that a strong, well balanced and agile player is at less risk than a weak, poorly coordinated player.

Injury prevention strategies
The most basic strategy for preventing tennis injuries, particularly back, shoulder and elbow problems, is to avoid overuse. This means not playing too much or too frequently, or not increasing the amount you play too quickly. Most recreational players will be able to play once or twice a week and avoid any shoulder or elbow problems, but if they increased this, then poor technique and lack of conditioning training would increase their injury risk dramatically. For the aspiring junior player or full-time pro, who have to play most days, the only way to prevent injuries is with a suitable conditioning programme. The following programme focuses on the elements a tennis player would need to avoid injury. These exercises are not meant to be definitive, but the muscles and movements that are being trained here are well designed to gain optimal benefits. Use this example to guide you in your own conditioning programme.

Flexibility training
Everyday stretches for the following muscle groups must be performed. The goal is to achieve a good range of motion in all major joints: calf; hamstrings; quadriceps; hip flexors; groin; gluteals; low back flexors; upper back extensors; trunk rotators; pectorals; shoulder rotators; rear shoulders; triceps and forearms.

General strength training
For players who do not have a strong background in conditioning training, a workout like the following should be completed 2-3 times a week to develop a well-balanced all-body strength. For players who are already strong, this type of workout can be used once a week to maintain general strength levels year-round, or 2-3 times a week in a general phase a few times each year.

Perform 3 sets x 8-12 reps of the following:
l dumbbell shoulder press
l single arm dumbbell row
l lat pull downs
l barbell squats
l lunges.

Build up to 3-4 sets of 20 reps of the following:
l crunches.
l back extensions.

Core-stability training
Players must be able to isolate the transversus abdominis muscle and perform the abdominal hollowing exercise correctly. They must also be able to maintain a 'neutral' lumbar spine position during various movements. Primarily this involves recruiting 'tranversus' effectively along with other trunk and hip stability muscles. Exercise examples are: while lying on back lift one leg; while standing lift one leg; while standing up lean forward from the hips; while kneeling on all fours extend the leg behind.
Players need to be able to use the gluteal muscles to stabilise the pelvis. Bridging exercises and hip extension movements focusing on gluteal recruitment over the back and hamstring muscles should be performed.
Once the above basic skills are mastered, dynamic exercises such as the one-leg squat, while keeping the lumbar spine in neutral and the pelvis stable, will develop the ability of the player to maintain stability during movement on court.
Also useful are cable rotation exercises using a pulley machine. The player mimics the forehand and backhand movement while maintaining good posture and core stability through the rotation movement.
These exercise suggestions will ensure that the core-stability skills are transferred onto the court. It is always important to remember that sports-specific training is important to help athletes prevent injuries effectively.

Specific conditioning for shoulder and arm
The following exercises will help develop strong shoulder rotator
cuff and forearm muscles to help prevent elbow and shoulder tendinitis injuries:

1. Side-lying raise. 3 x 15. Lie on side. Using top arm, lift dumbbell up to 45 degrees. Lower slowly.
2. Band /cable external rotations. 3 x 15. Stand and grasp band/cable in hand. With elbow tucked into your ribs rotate the arm out, pulling against the resistance.
3. Russian arm circles. 3 x 15. Lie on front. Start with arms straight out above head, lift them off the floor and pull them down to your sides. Keeping them off the floor at all times continue to make big circles with your arms up and down. Progress to using small weights.
4. Modified lat raise. 3 x15. Perform a lateral raise movement with palms facing back and thumbs down. Lift your elbows to about 60 degrees to your sides only.
5. Wrist extensions. 3 x 15. Sit and place your forearm on your thigh with your elbow bent. With your palm facing down, grasp a dumbbell in your hand. Lift the weight pulling the back of your hand up by using the upper forearm muscles.
6. Band wrist supinations and pronations. 3 x 15. Supination: Position as 5 but grasp a resistance band and secure the other end of the band under your foot. Grasp the band between your thumb and hand with palm down. Rotate your wrist so the palm faces up. Slowly rotate back and continue.
Pronation: Change grip so that you grasp the band between your thumb and hand with palm up and rotate your wrist so the palm faces down.

And now sprinting injuries
As you might imagine, most sprinting injuries involve the legs, with hamstring and calf strains and Achilles tendinitis being among the most common. Lower-back problems are also frequent and knee injuries can occur as well. Knee injuries tend to be quadriceps tendinitis or patella tendinitis type injuries. The reason why most of the injuries are muscle strains or tendinitis type is that sprinting involves high forces and a large range of motion which place the muscles under great stress. Sprinting is a linear running sport and obviously involves no contact, so there are few knee or ankle joint sprain injuries.
An important example of the high muscle forces involved in sprinting is the function of the hamstrings. During the sprint running action the hamstrings have two roles to play. The first role is to contract eccentrically as a knee flexor just before footstrike and, in the first part of ground contact, to control the knee extension force of the quadriceps and stabilise the knee for the ground impact force. Second, during the second half of the stance phase the hamstring contracts concentrically, this time as a hip extensor, powerfully driving the leg backwards. This concentric hip extension force from the hamstrings is one of the main driving forces in sprint running. The neuromuscular system has to be well coordinated to control these different hamstring functions in such a fast movement as sprinting, and if the hamstrings are not sufficiently strong and flexible they will be unable to meet this demand and the chances of hamstring strain increase. A complication that can place extra strain on the hamstrings is that during sprinting the trunk must remain upright and stable. The stabilising muscles of the stomach, low back and the gluteals should perform this role; however, if the core strength is not as good as it should be, the hamstrings will also have to stabilise the trunk, thus placing even more strain on them. The upshot ? If you want to avoid hamstring strains from sprinting, you need both strong hamstrings and strong core muscles - namely the gluteals, low back and abdominals.
Good core strength will also ensure that during each ground contact phase the pelvis remains level and lifted up, which allows greater power from the legs to be converted into horizontal speed. It will also reduce the risk of low-back injuries which are quite common in sprinters.
Generally speaking, to help reduce risks of muscle strains and tendinitis type injuries in sprinting, athletes need to ensure they have very good range of motion in the all the leg muscles and joints. This takes the strain out of this very dynamic movement. Importantly, though, sprinters should focus on dynamic flexibility training, to ensure that the flexibility they possess can be achieved actively throughout the whole range of motion. Research has shown that when there is a large gap between active and passive range of movement, injury risks are increased. (Active range of movement is a result of the athlete's own muscles, whereas passive range of movement is a result of an external stretching force.)

Injury prevention strategies
The first step for a sprinter who wants to avoid injury is to ensure full flexibility in all muscles with a regular stretching routine. In addition, part of each workout (often as an extended warm up) should be devoted to dynamic flexibility exercises. These dynamic flex exercises should focus particularly on ankle flexion and extension and hip flexion and extension range of movements. Most sprinters and their coaches know a whole set of these exercises.
The second step in injury prevention is to develop very good functional strength, including core stabilisation skills. Follow the suggested exercises for core stability above to ensure good recruitment of the transversus, gluteals and low-back muscles. Once these exercises have been mastered, more advanced core strength exercises can be used such as gluteal leg raises and back extensions on a Swiss ball, straight-legged dead lifts with a barbell, as well as the usual crunch type abdominal exercises.
When choosing strength exercises for the legs, always go for free weight, multi-joint exercises ahead of machines. If the muscles are not trained to work together in a coordinated fashion then the benefits for injury prevention are dramatically reduced. Exercises such as leg extensions for the quadriceps and leg curls for the hamstrings are probably quite useless as these are not movements involved in sprinting. Squats, dead lifts and power cleans should be the main choices for the legs. Ensure you learn correct techniques before moving on to big weights since poor lifting can affect the low back.
The following hamstring exercise progression is one of the best for sprinters.

Hamstring buck lifts
Lie on your back with your legs slightly bent and your feet up on a bench so your hips are flexed about 30 deg. Place the soles of your feet (not your heels) in contact with the bench.
Pushing down into the bench with your feet - and thereby recruiting the hamstrings - lift your hips off the floor until your back is fully extended. Complete three sets of 15 reps.
Once this exercise is comfortable, progress to the buck lifts with one leg. When this in turn becomes comfortable, progress to doing the buck lifts on one leg on a Swiss ball.
The pull of the hamstrings from the foot, extending the hip in the buck lift exercise is exactly the same as the pull of the hamstrings during ground contact in sprint running, making it totally functional in relation to sprinting. Once you can get to the Swiss ball level of the buck lift exercise, your hamstrings will be in great shape for sprinting.
Raphael Brandon