Range of motion in junior tennis players participating in an injury risk modification program.

This study evaluated changes in range of motion (ROM) in competitive male and female junior tennis players participating in a specific conditioning program over a two-year period. Subjects were also compared to an age and sex-matched control group of players not performing the exercises. Fifty-one tennis players, 29 male (mean age 13.6) and 22 female (mean age 13.2) entered the study. Baseline ROM measurements were performed on all players upon entering the study. The conditioning program employed standardised stretch-hold-relax flexibility exercises for all the areas tested. These exercises were taught to the players and each athlete was given a video of the exercises. Compliance with the program was assessed by exercise logs, the parents, and the athletes. High compliers were compared to low compliers. Mean changes in the combined ROM measurements over time indicate improvement in flexibility in most anatomical areas after one year of participation, with small improvements in the second year. With the exception of forearm supination, there were no differences between high compliers and low compliers. Compared to controls, the experimental group showed significant improvement in sit and reach, dominant and nondominant shoulder internal rotation, dominant and nondominant shoulder external rotation, nondominant gastrocnemius, dominant iliotibial band, dominant and nondominant hip internal rotation, dominant and nondominant hip external rotation, dominant and nondominant forearm pronation, and dominant wrist flexion. The areas of greatest significant change were in the shoulder and back, which correspond to the areas of most clinical risk of Injury. In conclusion, joint ROM can be positively influenced with a specific conditioning program.

Shoulder rehabilitation: clinical application, evaluation, and rehabilitation protocols.

This chapter has discussed and illustrated a shoulder rehabilitation protocol based on restoration of the anatomy, biomechanics, physiology, and motor firing organization that is responsible for normal shoulder function. Many protocols exist in the literature, most of which appear to achieve good results. There are no outcomes data to suggest the most efficacious protocols. Adherence to the basic principles outlined in these chapters appears to allow the best framework for constructing a good program.

Shoulder range of motion in elite tennis players. Effect of age and years of tournament play.

We studied glenohumeral rotational range of motion in 39 members of the United States Tennis Association National Tennis Team and touring professional program. We took goniometric measurements of internal and external rotation of dominant and nondominant shoulders at the glenohumeral joint with the humerus at 90 degrees of abduction. We categorized the tennis players by age and by years of tournament play. Results were analyzed by total rotation, internal rotation, external rotation, and dominant-to-nondominant shoulder differences. In our results, dominant internal rotation of the shoulder declined and the difference between dominant and nondominant internal rotation increased with both age and years of tournament play. Men and women tennis players showed the same degree of deficits in range of motion. Significant analysis of variance statistics were calculated for dominant internal rotation with years of total play, dominant total rotation with years of total play, and nondominant total rotation with age. Moderate negative correlations were found between dominant internal rotation and years of total play and dominant total rotation and years of total play. These results indicate a loss of internal rotation that seems progressive with longer periods of play. This loss of internal rotation of the shoulder is an absolute loss of motion because total rotation also decreases. Early detection and a corrective training program should be considered because adaptations may result in deleterious biomechanics affecting both performance and risk of injury.

Exercise training for tennis.

Tennis is a physically demanding sport. A complete conditioning program designed to address both the demands of the sport and the individual player's musculoskeletal base is important in tennis, particularly at the competitive junior and professional levels. Recreational players can certainly use conditioning to improve their level of performance, but the primary concern in this group is general fitness development and injury prevention. In the junior player, physical development should begin with a sound program for physical fitness, including flexibility, cardiorespiratory endurance, general strength, and muscular endurance. Once a sound fitness base has been developed, the competitive junior players should progress to conditioning for sport specific movements and for injury prevention. At the elite level, tennis players should have previously developed a sound general physical fitness base. These players can then spend a greater percentage of their conditioning time on athletic fitness and sport specific movement training, as well as injury prevention. By addressing all of the components of a total body conditioning program, the possibility of peak performance of the individual tennis player is enhanced.

Sport-specific conditioning.

The goal of the athlete is to optimize performance. The goal of the sports medicine physician is to minimize injury risk. By preparing the athlete's body for the mechanical and metabolic demands inherent in a particular sport, sport-specific conditioning programs can help achieve both these goals. Periodization of the conditioning program is the ideal framework for keeping the individual athlete's workload as high as possible without overtraining and injury.

Physiology of aerobic fitness/endurance.

Aerobic fitness and aerobic endurance are two separate components of aerobic metabolism. Aerobic fitness, best measured by VO2max, is a measure of oxygen transport and utilization. Aerobic endurance is not measured in a VO2max test because it does not measure the ability of the muscle to perform prolonged work. Endurance fitness may be a complementary measurement to VO2max, providing additional information regarding the capacity of the muscle for long-term work. The muscle is the primary site where increases in mitochondrial enzymes improve aerobic endurance capacity. Aerobic endurance may be more closely related to health-related fitness than aerobic fitness. conditioning must be specific to the sport or activity, progressing from general aerobic fitness in the off-season to sport-specific aerobic fitness/endurance during the playing season. Aerobic fitness/endurance decreases rapidly with detraining. Adequate, aerobic fitness/ endurance specific to a particular sport may help prevent injury in terms of delaying fatigue and improving the strength of the tendons and ligaments. A properly initiated sport-specific aerobic conditioning program is essential for maximal performance to be reached in most any sport.

A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis.

Plantar fasciitis is a repetitive microtrauma overload injury of the attachment of the plantar fascia at the inferior aspect of the calcaneus. The diagnosis of plantar fasciitis is common among athletes in many sports, primarily those sports that involve running. Common treatments for plantar fasciitis, including ice, stretching, ultrasound, and shoe inserts are helpful in reducing the symptoms. However, recurrence of the problem is common. By understanding the potential biomechanical causes of this disorder it may be possible to correct the anatomical and biomechanical variables that cause plantar fasciitis and reduce the rate of recurrence as well as speed the rehabilitation process. It may also be possible to identify predisposing maladaptations that can be corrected, therefore, preventing the initial occurrence of plantar fasciitis.

Shoulder strength, power, and endurance in college tennis players.

Twenty-four college tennis players were tested for bilateral shoulder internal/external rotation strength on a Cybex 340 isokinetic dynamometer; they were positioned supine with the glenohumeral joint abducted to 90 degrees. Subjects produced significantly (P less than 0.01) more torque in internal rotation at 60 and 300 deg/sec in the dominant arm compared to the nondominant arm. Subjects also produced significantly more power in internal rotation at 60 deg/sec in the dominant arm. No significant differences between the dominant and nondominant arms were seen in internal rotation power at 300 deg/sec or in the internal rotation endurance ratio. No significant differences were seen in external rotation on any measurement. By significantly increasing the strength of the dominant shoulder in internal rotation without subsequent strengthening of the external rotators, muscle imbalances may be created in the dominant arm that could possibly affect the tennis player's predisposition to injuries caused by overloading of the shoulder joint. This study suggests that external rotation strengthening exercises should be implemented in tennis conditioning programs to maintain muscle strength balance, and possibly reduce the chance of overload injury.

Principles of rehabilitation after chronic tendon injuries.

This article describes a framework for the evaluation, diagnosis, and management of tendon injuries that result from repetitive microtrauma overload. These injuries are commonly called tendinitis injuries, but are more often degenerative lesions. The initial management of acute tendon injuries with rupture is usually quite different than that of chronic injuries, but the functional rehabilitation of the acute injuries can follow the same framework.

Musculoskeletal adaptations and injuries due to overtraining.

Overtraining places a demand on the musculoskeletal system that may lead to damage to the musculoskeletal system, as well as to clinical, functional, and biomechanical adaptations that may be detrimental to sport performance. The types of injuries identified range from overt, which are obvious injuries that will usually prevent athletic performance for some period of time, to the subclinical, which decrease performance, but may be seldom recognized. These injuries apparently may be avoided or lessened in severity by a combination of several methods. A thorough preparticipation evaluation is important to detect subtle adaptations in strength and flexibility that can result from overtraining and may increase the athlete's chances of injury. A good sport-specific conditioning program is necessary to give the athlete a strong musculoskeletal base on which to build athletic skills and to decrease the risk of overtraining adaptation. In many sports, prehabilitation exercises can be performed for those musculoskeletal areas that are under high stress in a particular sport. Also, a maintenance conditioning program that extends through the season may be important to maintain fitness throughout the season. Following proper principles of conditioning, including specificity, recovery, and progression, are important. A complete and accurate diagnosis of the injuries that do occur is necessary so that proper treatment may follow. This can be facilitated by understanding the types of clinical presentations of injuries, and the different anatomical and functional alterations that may be acting to cause or to continue the clinical presentation. By following these general guidelines, safe participation in sporting activities as well as performance will be enhanced. The exact point where "training" becomes "overtraining" is difficult to define, especially prospectively. An exciting area of sports medicine research will be to define the anatomic parameters and exercise doses that will cause overtraining, and to devise fitness examinations and training programs that will allow maximal performance with minimal overload risk. At the present time, retrospective studies do indicate that adaptations occur in muscles, tendons, and bones in response to high training loads, and these particular adaptations are not beneficial to performance and may be associated with increased injury risk. Since the optimal exercise dose is not known, provision for evaluation of these adaptations and prehabilitation of all noninjured areas or proper rehabilitation of all injured areas will best prepare the musculoskeletal system for training.

Functional biomechanical deficits in running athletes with plantar fasciitis.

Plantar fasciitis is a relatively common injury that occurs in running athletes. The disease entity is a good example of an overloaded process of the plantar fascia at its calcaneal insertion. This study was designed to examine the strength and flexibility findings in the muscles that are put on tensile load during running, and which are responsible for controlling the forces on the foot during stance and pushoff, thus modifying the overload. Three groups of athletes underwent physical examination, including checking ankle range of motion in plantar flexion and dorsiflexion. Cybex peak torque measurements were taken at 60 and 180 deg/sec. The groups were a control group of 45 athletes with no symptoms, a group that included 43 affected feet with symptomatic plantar fasciitis, and a group that included the 43 unaffected contralateral feet. Analysis of data showed dynamic range of motion deficits in 38 of 43 affected feet, static range of motion deficits in 37 of 43 affected feet, deficits in peak torque at 60 deg/sec in 41 of 43 affected feet, and deficits in peak torque at 180 deg/sec in 37 of 43 affected feet. Statistical comparison of range of motion showed that the group with symptomatic plantar fasciitis was significantly restricted compared to both control and unaffected contralateral feet groups. Statistical comparison of peak torque showed that the symptomatic plantar fasciitis group was significantly lower than both other groups at both velocities. This study documents strength and flexibility deficits in the supporting musculature of the posterior calf and foot that are affected by plantar fasciitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Flexibility comparisons of junior elite tennis players to other athletes.

Flexibility measurements were obtained in 86 junior elite tennis players and compared to the flexibility measurements of 139 athletes involved in other sports. The measurements obtained included sit and reach flexibility, quadricep flexibility, hamstring flexibility, gastrocnemius flexibility, shoulder internal rotation, and shoulder external rotation. All measurements except sit and reach flexibility were obtained goniometrically. Tennis players were significantly tighter in sit and reach flexibility, dominant shoulder internal rotation, and nondominant shoulder internal rotation. They were significantly more flexible in dominant shoulder external rotation and nondominant shoulder external rotation. The flexibility differences found in tennis players suggest adaptations to the musculoskeletal demands of their sport. These results suggest that a sport-specific flexibility program may be necessary for junior elite tennis players in order to promote maximum performance and help prevent flexibility-related injuries.

A musculoskeletal approach to the preparticipation physical examination. Preventing injury and improving performance.

Preparticipation physical examinations provide information concerning an athlete's ability to participate safely in sports. By collecting information specific to the musculoskeletal system in addition to that from a general medical examination, information can be gained that may improve performance and help prevent certain injuries. Two thousand one hundred seven athletes from a variety of sports from the junior high to the college level were examined using specific tests for flexibility, strength, and endurance. Females were significantly more flexible than were males on all flexibility measurements, and males were significantly stronger than were females on all strength measurements. Upper-body athletes were tighter in dominant side internal rotation and significantly looser in dominant side external rotation. Lower-body athletes, especially females, were significantly tighter in the leg muscles. These results indicate that the adaptations of the musculo-skeletal system are sport specific and depend on the body area that is placed under stress.

The effect of the squat exercise on knee stability.

Past studies have produced conflicting results as to the effect of squat exercises on knee stability. One hundred male and female college students were measured using a knee ligament arthrometer on nine tests of knee stability. Over an 8-wk training program, full or half squats did not consistently affect knee stability compared to non-squatting controls. To measure the effect of long-term squat training 27 male powerlifters (14 Elite or Master Class) and 28 male weightlifters (8 Elite or Master Class) were measured on the same tests. Powerlifters were significantly tighter than controls on the anterior drawer at 90 degrees of knee flexion. Both powerlifters and weightlifters were significantly tighter than controls on the quadriceps active drawer at 90 degrees of knee flexion. Data on powerlifters and weightlifters were also analyzed by years of experience and skill level. No effect of squat training on knee stability was demonstrated in any of the groups tested.