Teaching Tennis can take a toll on the body. Here is a presentation for teaching pros on how to stay healthy on the court.

1. Skin and Bones
Staying Healthy on the Court
Stephan Esser USPTA, MD

2. Intro

3. Health Benefits of Tennis
• CV, strength, coordination, balance, plyometrics,
speed, flexibility
• METs:
– Doubles Tennis: 5
– Singles Tennis: 7-12
• “improved aerobic fitness, a lower body fat percentage, a more favorable
lipid profile, reduced risk for developing cardiovascular disease, and
improved bone health.’ Pluim et al 2007
• Cognitive function, neural connectivity, mood, Social engagement,
PA efficacy, problem solving, test scores

4. Topics
• Common Health Concerns
–Musculoskeletal
–Skin Care
–Hydration on Court

6. Tennis Injury
• BJSM 2006: Pluim et al
– Injury incidence 0.05-
to 2.9 per player per year
– Per hour of play 0.04- 3.0 injuries/1000 hours
• Junior Rugby 56.8/1000hrs JSMS Gabbett 2008
– Gender: slight inc in men > women
– Age: as age increases, risk of injury increases
– Volume: Unclear risk (tennis elbow)

7. Tennis Injury
• Abrams et al BJSM 2012
– LE>UE
– LE: ankle sprains, thigh strains, GS strain, Achilles
– UE: lateral epicondylitis, rotator cuff
– Back

8. Learning Points
• Get to know your body
– Basic Anatomy
– What can go wrong
• Know what you can do
– Preventing problems
– Basic Treatment
• When to see a doctor/when you need a good
Therapist

9. Why it Matters?

10. Back
Pain

11. Back Pain Stats
• > 80 % of Americans in a lifetime
• ≈ 30 % at any given time
• 2nd
leading reason to see a doctor
• Spending in 2005 = $85.9 billion
• Among Athletes highest rates:
– Football, gymnastics, wrestling etc.

13. Tennis Injuries
• Is tennis a risk factor for back pain or spondylosis?
– Hutchinson et al 1995:LBP #1 injury over 6 yrs in adol. elite
– Guilodo et al 1999: 633 subjects, No difference in rates of low
back pain between recreational players and non players or in
recreational players based on volume of play
– Marks et al 1988: 38% of 143 ATP players missed at least 1
tournament due to back pain
– Alyas et al 2007: MRI LS 33 asymptomatic elite juniors
• 5 normal MRI’s 28 Abnormal
• 23 with early facet arthrosis L5/S1 L4/L5
• 9 Spondys (L5), 2 with G1 and G2 –listhesis
• 2 acute/5 chronic stress reactions of the pars
• 13 with disc dessication, disc bulging

14. 80%80%
10%10%

17. Preventing Back Pain
• Maintain healthy Posture
– Awareness
• “Ergonomics”
– Core Strength
– Flexibility & Balance
– Ideal Body Weight
• Muscle Balance
– Weight training
– Cross-Training

19. Ergonomics

20. Core Strength
• Defined
– Abdominals: Rectus, Obliques
– Back Musculature: Extensors
• Function
– Provide spinal stability
– Improve spinal circulation
– Look Good
– Ball defense

21. Flexibility
• Maintain
– Hamstrings
– Quadriceps
– Lower Back
– Upper Back and Shoulders
– Abs

22. Preventing Back Pain
• Cross-Training:
– Challenge “Tissue” in different ways
– Develops complementary muscles
– Engages the nerves and brain
• Maintain Muscle Balance

23. Preventing Back Pain

24. Back Pain
• You can handle it:
– Mid-Low Back pain that improves with rest, ice
NSAID’s and core work over 2 weeks
– Pain with a clear cause: eg: Inc. serving, played a
tournament now with some mild LBP
• Self Treating
– 1-5 days of ’d activity: Soft-Brace, Ice, NSAID’s,
maintain light activity (stationary bike)
– 1-3 weeks of intensive core strengthening,
stretching, swimming

25. More Stats.
• Back Pain Free
– 50% of people in 1 week
– 75 % of people in 1 month
– 95% of people in 3 months

26. Back Pain
• See your Doc’:
– Extreme Pain
– Pain that fails to improve with “conservative”
management in 3-7 days
– Pain with associated symptoms:
• weight loss, fevers, chills, skin rash, night sweats
– Pain with numbness, tingling or weakness
down the legs
– Change in bowel or bladder habits
– Numbness in the groin area

27. Back Pain Wrap-Up
• Back Arthritis and degeneration is a normal
part of aging, but how we experience it varies
• 90% of back pain is “safe pain”
• You CAN do a lot to reduce the intensity,
frequency and duration of back pain
• You CAN manage most back pain on your
own
• There are times when you NEED to be
evaluated by a Doc

28. Shoulder Pain

29. Shoulder Pain

30. Tennis Injuries
• Shoulder:
– 4-17% at any given time Abrams et al BJSM 2012
– Impingement, Instability, RTC –itis/tear, Labral
injury, Scapular Dyskinesis
– Predisposing:
• Relative RTC deconditioning, Excessive IR and ADD
strength and ER weakness, GIRD
• GIRD: >25 ° total difference (ER + IR)

31. Shoulder Pain
• Common Causes:
– Muscle Strain
– Bursitis/RTC Impingement
– “Rotator Cuff” tendinopathy or tear
– Arthritis
– Neck problems

32. Risks
• Age
• Family History
• Overuse/Mis-Use/Muscle Imbalances
• Trauma
• Other:
– Diabetes, Liver Problems, Nerve dysfunction

33. Why

34. Preventing Shoulder pain
• Muscle Balance
– Maintain “cuff balance”
– Avoid excess overhead weight-lifting (military
press, delt raises etc)
• Technique
– Serve, Forehand
– Grip Type/Contact point/FT
• Graduated training

35. Treating Shoulder Pain
• You CAN handle it
– Mild to moderate discomfort in the shoulder after
an increase in training
– Pain that improves in 1-7 days with “conservative”
measures
– Mild chronic pain which you have previously had
diagnosed and is well controlled

36. Treating Shoulder Pain
• Call your “Doc”
– Pain that doesn’t improve with a 1-4 days of
conservative care
– Pain with weakness, numbness or tingling
– Pain with associated neck pain
– Pain with all the “red flags” from back pain section
– Dislocation, persistent clicking, popping, grinding,
swelling, instability

37. What to do?
• Relative Rest: Day: 1-7
• ICE 2-4 x’s/ day
• Maintain Range of Motion
– Pendulums, Wall Walks etc.
• If improving: Band workout: Day 4-14
• +/- 7-10 days of NSAID’s

38. Shoulder Wrap Up
• Maximize Balance of Flexibility and Strength
– Cuff, Pecs, biceps, triceps
• Avoid Excess Overhead Cross-Training
• Maximize form/technique
• Get it Checked out:
– New or Persistent Pain
– New clicking, popping, catching, grinding,
instability
– With Associated Neck pain, numbness, tingling,
weakness to the arms

39. Elbow Pain

40. Elbow Pain

41. Elbow Pain
• Causes:
– Tennis Elbow / Lateral Epicondylitis
– Golfers Elbow / Medial Epicondylitis
– Trauma
– Ligaments
– Nerve Injury/ Arthritis/Gout

42. Risks for Tennis Elbow
• Technique: Grip Type ?
• Muscle Strength and Balance
• Frequency of Play
• Change
• String Tension
• Racquet Stiffness
• Grip Size/Type

43. Preventing Elbow Pain
• Technique
• Technique
• Technique
• Avoid Sudden Variation:
– Play Frequency / Racquet Width, Weight, Length /
String Type and Tension
• Conditioning
• Flexibility

44. Lateral Epicondylitis
• Treatment
– Modify Technique
– RICE
– NSAIDs
– Stretching and range of motion
– Strengthening
– Adjust Equipment
– Elbow band etc

45. Lateral Epicondylitis
• Non-Responsive:
– Acupuncture
– Cortisone Injections
– Platelet Rich Plasma
– Stem Cell
– Surgical Debridement

46. Elbow Wrap Up
• Adjust Technique
• Maintain Strength and Flexibility
• RICE etc.
• Modify Equipment
• Visit your Doc if failure to improve

47. Knee Pain

48. Knee Pain

49. Knee Pain
• Common Pre-disposing Factors:
– Genetics, Family History, Obesity, Trauma
– Muscular De-conditioning / Imbalance
• Causes:
– Arthritis
– Cartilage (Meniscal) Injury
– Ligament Injury: ACL, PCL etc
– Muscle Imbalance eg: Patello-femoral Syndrome

50. Knee Pain
• Things you can handle:
– Mild Intermittent Discomfort
– Previously Diagnosed low grade discomfort
• You need a Doc:
– Acute Trauma
– Moderate to Extreme Persistent Pain
– Swelling
– Catching, Popping, Clicking, Locking, Grinding,
Instability without a diagnosis

51. Knee Pain
• Prevention:
– Maximize Muscle Balance
– Maintain Hamstring and Quadricep Flexibility
– Exercise Form
– Balance Work
– Achieve “Ideal Body Weight”
– Diet?

52. Knee Pain
• Treatment:
– RICE
– Strengthening and Muscle Balance
– Guided or personal Physical Therapy Program
– NSAIDs
– Cortisone injections
– Cartilage Supplementation to the joint
– Platelet Rich Plasma/Stem Cells
– Surgery

53. Knee Pain Wrap Up
• Maximize Muscle Balance
• Improve and Maintain flexibility
• Follow up with a “Doc” for evaluation of new
or persistent pain, popping, grinding, swelling
or instability
• Staying active does NOT worsen knee arthritis
but may cause pain if you have known arthritis
or other common proble

54. Foot Pain

55. Foot Pain

56. Foot Pain
• Common Causes:
– Trauma
–Ankle Sprains
–Plantar Fasciitis
– Stress Fractures
– Corns
– Bunions

57. Prevention
• Strength and Range of Motion
• Flexibility
• Proprioception / Balance
• Appropriate Equipment
• Diet: Consistent Caloric Consumption
– Vitamin D, Calcium
• Avoid excessive repetitive training

58. Treatment
• Sprains/Strains:
– RICE / Rehab / NSAIDs
• Plantar Fasciitis
– Stretching, Ice Rolling, Tennis Ball Work
– Splinting, Physical Therapy, Cortisone, Surgery

59. Foot Pain
• You can handle it:
– Ankle Sprain you can walk on right away
– Mild discomfort with a known diagnosis
• Time to see a Doc:
– Acute injury with immediate swelling, bruising,
extreme pain, inability to walk
– Persistent pain, swelling, clicking, popping,
grinding or instability
– Numbness, tingling, weakness in the foot

62. Foot Pain Wrap Up
• Maintain leg strength, balance and flexibility
• Appropriate equipment
• Any traumatic event with persistent
symptoms get it checked out
• Remember RICE

64. Skin

65. Skin
• Largest Organ in the body
• Function:
– Protect
– Maintain hydration
– Detoxify
– Thermoregulation
– Activate Vitamin D
– Sex Appeal or Repellent

66. Skin
• What Can go Wrong:
–Sunburn
–Skin Cancer:
• Squamous Cell
• Basal Cell
• Melanoma

67. Quick Stats
• Most common of all cancers
• 1:5 Americans in a lifetime
• Non-Melanoma: 2 million cases/yr
– Inc. of 300% since 1994
• Melanoma: 68, 000 cases /yr

68. Skin

69. Risks
• Unprotected and/or excessive exposure to
ultraviolet (UV) radiation
• Fair complexion/ Family History
• Occupational exposures to chemicals
• History of multiple or atypical moles
• Severe sunburns as a child
• Dietary intake
• Smoking exposure

70. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check

71. Sunscreen
• Broad Spectrum: UVA & UVB
• ≥ SPF 30
• Apply 15-30 minutes before exposure
• Re-apply every 2 hours if sweating/in water
• Don’t Forget:
– Hands, ears, neck, back of legs, lips

72. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check

73. Sun-Protective Clothing

74. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Yearly Doctor Skin Check
– Monthly Home Skin Check

75. “Internal” Sunscreen

76. Skin Care
• Prevention:
– Avoid Excess Exposure
• Sunscreen
• Clothing
• Scheduling
• Location: Court Side
– Internal Sunscreen: 20-30% Cancer Risk
• Quit Smoking
• Avoid excess oxidizers
• Fill up with the good stuff: Colorful fruits and veggies
– Monthly Home Skin Check
– Yearly Doctor Skin Check

77. Know your ABCDE’s

78. Skin Wrap Up
• Wear Sunscreen daily
• Wear Sun-Protective Clothing
• Fill up on colorful foods
• Avoid known “cancer causers”
• Do regular skin checks
• Know your ABCDE’s
• Follow up with your Doc’

81. Daily Reccs:
• Ideal: water, fitness waters, sport beverages,
club soda, mineral water, and flavored water
• Very good: 100% fruit juices, lemonade,
tomato and vegetable juices
• Good: raw fruits and vegetables
• So-so: soft drinks, decaffeinated coffee,
yogurt, skim milk
• Avoid: caffeine and alcoholic beverages
– act as diuretics
10-12 cups of
water/ day
10-12 cups of
water/ day

82. Hydration
• 80kg male ≈ 48 L of body water
• Lose 0.5-2.5 L H20 per hour of tennis
• 1-2% H20 loss before you feel “thirsty”

83. Sweat
• Constituents:
– H2O
– Sodium
– Chloride
– Potassium
– Magnesium

84. Risks
• HypOhydration
– Impaired heat control
– Altered Immunity
– Kidney dysfunction
•  endurance ≈ 30%

85. Pre-Match
• Water
• Carbohydrates
• Quick Sugars

86. On Court
• Drink 7 to 10 oz of fluid every 10 to 15
minutes and/or every changeover
• Carbohydrate Electrolyte Drink:
– Provides Glucose
– Replenishes Electrolyte Loss
– Enhances Water absorption

87. After Play
• Replenish
–H20
–Carbohydrate Meal
–Electrolytes
–Calories

88. Hydration Wrap-Up
• Prevent Hypo-hydration
– Stay ahead of needs
– Focus on H20 rich beverages and foods
– Avoid foods that dehydrate: Alcohol, Caffeine,
high protein, high fat foods
• Maximize hydration throughout the day/
match
• Re-hydrate post day / end of match

89. Conclusion
• “The first wealth is health” RWE
• There is a lot you can do to stay healthy
– Get to know the basics
– Make a plan
– Make changes when necessary
• Recognize when to seek help
• Some problems need a “team approach”