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How to avoid injury while playing
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By Susie Strachan
May/June 2019

Whether you play tennis, badminton, pickleball or other racquet sports, your goal this outdoor season might be to perfect your serve, backhand or overhead smash.

The last thing you want to think about is getting an injury from the sport you love playing. Yet, as the season wears on, chances are you may find yourself suffering from soreness in your neck, back or shoulders. You may even suffer that classic injury among the sporty set, tennis elbow.

That's because most injuries related to racquet sports happen over time, according to Shanna Semler, a physiotherapist at the Pan Am Clinic.

"A lot of injuries for people playing tennis and other sports don't come about traumatically," says Semler. "Yes, some people might break a wrist or sprain an ankle, but the majority of injuries come on slowly, through overuse or overloading."

People who may have been sedentary through the winter and then pick up a racquet and start playing in a summer league are especially at risk for injury, says Semler.

One of the most common injuries is tennis elbow, which occurs when the tendons of the upper forearm accumulate micro-injuries, leading to a burning or sharp pain on the outside of the forearm.

"The annual incidence of tennis elbow is one to three per cent of the population," says Semler, noting that the statistic includes those who get the injury through other repetitive tasks, such as working on a computer, as a labourer, or playing video games. In a city like Winnipeg, with a population of just over 700,000 people, that works out to about 7,000 people a year.

Semler says the injury is more common among people between the ages of 30 and 50, and usually affects the dominant arm. "It's five times more common than golfer's elbow, which is almost the same injury, but on the inside of the forearm," she says.

Tennis elbow diagram

Another very common injury is rotator cuff tendonitis, or impingement syndrome. This occurs when players make overhead moves with a relatively heavy racquet, inflaming the muscle and tendons that stabilize the ball and socket joint of the shoulder.

"Often, we don't have great scapular [shoulder] muscle control in the ranges needed for racquet sports, because we don't do as much overhead activity in our daily life. You need very good shoulder stability and control if you want to be an overhead athlete," she says.

In order to prevent overuse injuries, it's important to warm up to your racquet sports season, says Semler.

"Contrary to what many people think, just being strong isn't necessarily going to prevent over-loading injuries to your tendons," she says.

"While strength is important and correlates with tendon strength, you need to practise the arm and leg movement patterns required for your specific sport, so that your muscles are prepared to execute the movements needed. You are also helping your tendons adapt to the loading that happens in your sport, making them tougher and more resilient," she says.

That's especially true if you've taken a period of time away from playing.

"Even if you are a good and fit tennis player, if you've taken a break, it's a good idea to spend two to four weeks doing some pre-season training," she says.

Semler recommends two things to help you - and your tendons - prepare for the season.

The first is making an appointment to see a physiotherapist, to learn about sport-specific strengthening exercises, and identify any areas where you may have some imbalances that could be addressed before an injury occurs.

"Any physiotherapy clinic in the city should be able to do an assessment," she says, adding that you don't need a doctor's referral to make an appointment.

"They'll look at your range of motion, strength, and neuromuscular control to see if there are any factors affecting mobility, power and control of your joints. Then, they will give you a personal set of exercises to address any potential areas of weakness or imbalance."

A follow-up may be included to assess how you are progressing with your exercises, and to determine if you should move on to more difficult exercises to strengthen the muscles required for your specific sport.

The second thing is to start on a series of rotator cuff and scapular stability and endurance exercises that can be done daily, prior to the season starting.

To avoid tennis elbow, it can be helpful to stretch what are called the extensors and flexors of the forearm. "This can be as simple as bending your wrist, while straightening your elbow," she says. "If you haven't experienced an injury to the area, you could also do some simple lifting with a small weight, in what we call an eccentric wrist extension. This helps toughen the tendon and muscles."

For the rotator cuff and scapular area of the shoulder, rowing movements using thera-band tubing will increase your strength and stability.

"I like the tubing exercises because they make you stand up straight and tall, and work on your posture at the same time," she says. "It also mimics the upright posture of playing tennis better than bending over and lifting weights on a bench. You can pull straight back by bending your elbows, which is fairly easy. Or you can pull back with your arms straight, which is a little tougher. The third option isn't as easy, but addresses an important commonly weak area of the rotator cuff. For this exercise, rotate your arm outward at the elbow, pulling the band across your body."

Diagram of a rotator cuff injury

With regard to the lower body, static calf stretches will lengthen muscles and tendons in the leg, relaxing them and easing soreness.

"You could also perform what we call a dynamic stretch prior to playing to prepare the muscles for the quicker movements they are going to do on the court. This involves getting into the calf stretch position leaning against a wall and moving the other leg up and down in a marching motion, so that the stretch includes some movement."

Semler emphasizes that these are general exercises and may not be appropriate in specific cases. "It's always best to consult your physiotherapist, and definitely don't do any moves that cause you pain," she says.

A final point: don't do too much activity too quickly. Just as marathon runners have to increase their distance gradually, it's not a good idea to jump straight into a tennis league that has you playing doubles four times a week.

If you are taking lessons, ask your instructor about sport-specific warm-ups and exercises to prevent injury, and focus on learning correct technique.

When you do hit the court, remember to warm up your muscles by doing sport-specific moves through the full range of motion. Swing your arms in forehand, backhand and overhead motions and do dynamic calf stretches, says Semler.

"Racquet sports include weight shifting and cutting from side to side. Do some warm-up drills, like grape vine stepping (cross-over stepping) or high-stepping with your knees up. Dynamic lunges will get you ready to participate right before you do the sport," she says, adding that you should do some slow stretches after you have finished play, to help cool down and relax your muscles.

This season, listen to your body when smashing that ball, lobbing the birdie or punching volleys in pickleball.

"If you begin to get pain during a game, and especially if it lasts for more than two weeks, your elbow or shoulder is delivering a message," says Semler. "The sooner you give it some attention, the sooner you'll be back on the courts."

Susie Strachan is a communications specialist with the Winnipeg Regional Health Authority.

An ounce of prevention

Racquet sport injuries are a fairly common occurrence. But, with proper preparation, they can be prevented, says Shanna Semler, a physiotherapist at the Pan Am Clinic. Here are a few exercises Semler recommends before heading out onto the court. And remember, you should do these exercises regularly for about two to four weeks in advance of playing your first game of the season.

Helpful exercises for preventing tennis elbow

Exercise: Stretching Extensors

Photo demonstration of the Stretching Extensors exercise

Extend one arm out with elbow straight and use the other hand to grasp it at the side of the thumb and bend the wrist downward. Turn wrist towards the small finger to increase the stretch.

Frequency: Do two reps of 20 to 30 seconds each, twice a day.

Exercise: Stretching Flexors

Photo demonstration of the Stretching Flexors exercise

Hold the palm of one hand with the other hand while keeping your elbow straight on the affected arm and pull your hand back gently to feel a stretch in the forearm.

Frequency: Do two reps of 20 to 30 seconds each, twice a day.

Exercise: Eccentric Wrist Extension

Photo demonstration of the Eccentric Wrist Extension exercise

Hold a weight in your hand and rest your forearm on a table with your elbow straight, so your wrist is over the edge, palm facing down. Lift the weight and your hand - as high as possible using the opposite hand - while keeping your forearm on the table. Then, slowly lower the weight completely. The purpose of the exercise is to strengthen the lowering portion of the movement only.

Frequency: Do two sets of eight to 10 reps, every other day.

Helpful exercises for preventing rotator cuff injuries

Exercise: Band Rowing

Photo demonstration of the Band Rowing exercise

Stand and tie an elastic band in front of you at waist level and hold an end in each hand. With your shoulders down and back, pull your arms back by bending the elbows and retracting your scapulas. Slowly return to the initial position and repeat.

Repetition: Do two sets of 10 reps, every other day.

Exercise: Strengthening Extension/Retraction

Photo demonstration of the Strengthening Extension/Retraction exercise

Stand and tie an elastic in front of you at waist level. Hold tightly an end in each hand. Keep palms facing backwards. Keeping the elbows still, shoulders down and torso stable, pull elastic backwards as you pull shoulder blades together and arms back. Palms stay facing backward. Slowly return to initial position and repeat.

Frequency: Do two sets of 10 reps, every other day.

Exercise: External Rotation with Elastic

Photo demonstration of the External Rotation with Elastic exercise

Anchor a resistance band at elbow height at your side. Tuck your chin, keep good posture, and with your elbow remaining by your side, slowly rotate your arm away from your belly against the resistance of the band. Make sure your elbow does not come away from your body. Return and repeat. Keep the elbow bent at 90 degrees.

Frequency: Do two sets of 10 reps, every other day.

Helpful exercises for preventing lower body injuries

Exercise: Standing Calf Stretch

Photo demonstration of the Standing Calf Stretch exercise

Stand and place both hands on a wall, with your feet about half a metre from the wall. Place one leg behind the other and lean your body forward without bending the back knee until you feel a stretch in your back calf. Maintain the stretch and relax.

Frequency: Do two reps of 30 seconds each, twice a day.

Exercise: Dynamic Calf Stretch

Photo demonstration of the Dynamic Calf Stretch exercise

Lean into a wall with one leg stretched behind, heel on the floor and toes pointing forward. While leaning forward, bring the front knee up toward your chest and then back to the starting position. You should feel a stretch in your back leg during this exercise.

Frequency: Do one set of five reps, each side before playing.

Source: Shanna Semler, Pan Am Rehabilitative Services, Pan Am Clinic

Images provided by Physiotec (www.physiotec.ca)

General warm up

 
 

Many people think they should warm up before playing a game like tennis or pickleball by doing various stretching exercises with their arms and legs.

But it is actually much more beneficial to warm up doing sport-specific moves through the full range of motion required, according to Shanna Semler, a physiotherapist at the Pan Am Clinic.

For example, if you are about to play tennis, warm up by swinging your arms in forehand, backhand and overhead motions and do dynamic calf stretches, suggests Semler.

"Racquet sports include weight shifting and cutting from side to side. Do some warm-up drills, like grape-vining or high stepping with your knees up. Dynamic lunges will get you ready to participate right before you do the sport," she says, adding that you should do some slow stretches after you have finished play, to help cool down and relax your muscles.