All game, no pain: Avoid tennis injury
tennishead headed to the new 'Pure Sports Medicine' facility in south west London to find out more about preventing and treating tennis injuries
We all like to chase balls around the baseline like Rafa once in a while, but without the right preparation, those spontaneous bursts of Nadal-like imitation could be a sure-fire way to end up crocked. Andrea Havill – Specialist Musculoskeletal Physiotherapist at the new ‘Pure Sports Medicine’ facility at David Lloyd Raynes Park (South West London) – talks to tennishead about her time as physio to the pros on the WTA tour, and advises on preventing those typical tennis injuries...
tennishead: Tell us about your time working on the WTA Tour.
Andrea Havill: I started working with the ITF two years ago, doing a few tournaments, and it progressed on to the WTA tour. My first tournament was Zagreb in 2008. I did a few tournaments after that, in France, Eastbourne, Wimbledon, Tokyo and at the China Open in Beijing.
th: What are the most prevalent tennis-related injuries?
AH: From recreational players, probably the most common thing is acute muscle sprains, hamstring injuries, things like that. It usually stems from the fact that players haven’t warmed up properly. Tennis elbow tends to be the most regular chronic problem, or rotator cuff problems around the shoulder.
th: Did you treat elite players on the WTA Tour with similar injuries?
AH: Because elite players are getting treatment daily, things don’t tend to develop into a chronic tennis elbow, or a rotator-cuff injury because you tend to keep on top of things and you’re working a lot on injury prevention. The girls might come in and have an hour, or an hour and a half session every day if they choose to book in, so you can easily manage what’s going on with their bodies.
In comparison, someone who plays recreationally might have a niggle and ignore it for a month or two months before they seek treatment - that’s where people tend to develop more chronic problems.
th: What is the worst injury you’ve had to deal with on the WTA tour?
AH:Probably one of the worst things was an acute tendinitis of the wrist muscles which meant that she physically couldn’t play – it's not something you can just strap up and get on with. We probably had about three days to settle that down properly and manage it well so she could play in her final.
th: Are there long-term repercussions from trying to manage a significant injury in such a short space of time?
AH:With any sport there’s that fine line between patching them up so they can get through their events or risking long-term damage. At the moment I’m getting lots of marathon runners through, so the question is, do you get them to the point where they could do it, but probably have a lot of repercussions after, or just say 'no you can't compete'.
There is that fine line, and certainly in elite level sport you do have to be very, very careful.
th: What are the biggest physical issues with recreational players?
AH: Here at David Lloyd, you’ve probably got a lot of people who don’t do anything in the week and then come and play two or three times at the weekend. Or if they come in the evenings they might have been sat at their desk for 12 hours that day. They tend to have not eaten properly, they don’t drink enough water and they might have been drinking lots of coffee during the day so their preparation for exercise is minimal.
At elite level, that preparation is key, because if you’re dehydrated you are much more prone to injuries.
th: How crucial is the warm-up then?
AH: Warm up’s are key, not necessarily just stretching, but actually opening up and getting range of movement through your joints. If you’re really stiff through your hip area and really stiff through your back, then when you’re playing tennis you’re just going to rely on your shoulder to do all the work. But if you’ve got more range of movement through your whole body, then you put less strain through your shoulder and your elbow. If you watch a lot of the top players, they really use their whole body – rotating through the hips, pelvis and the trunk – rather than a lot of recreational players, who tend to put more work through just their upper body and arms and get more injuries as a result.
th: What sort of advice would you give to a player who comes to you asking how to prepare effectively for tennis?
AH: We try to be holistic and look at everything, so I would talk through nutrition and hydration and make sure they do a better warm-up. This would include getting their heart rate up a little bit so their blood flows and then doing some ‘range of movement’ activities to make sure they’re not too stiff when they start playing.
Most people just tend to go straight into tennis and they don’t necessarily do any core work or even any stretching. If you’re stiff in your mid-back for instance, you need to do some range of movement exercises during the day, in the morning or at night.
th: How do lifestyle choices affect a player’s physical aptitude or proneness to injury when playing tennis?
AH: A lot of people sit at work all day, get hunched over, get stiff through their thoracic spine and their pec muscles, and then find it difficult to open up their chest and get good extension through their shoulders. They then don’t necessarily have the control of the muscles around their scapula, and that’s what tends to lead to a lot of impingement, rotator cuff tears and things like that.
th: Why then, do elite players become injured if they are strengthening these muscles on a regular basis?
AH: If you look at the sheer number of hours they are playing each day – they might be doing a warm up, then a doubles and a singles match in one day, so it often comes down to sheer amount of use. There’s also been a lot of research into the physical effects of tennis, and there’s a pattern among players of losing internal rotation [from the shoulder]. Professional players also tend to get excessive external rotation [of the shoulder], so the whole biomechanics of your shoulder and the way muscles have to work changes. It doesn’t matter how well you preserve yourself over time, it’s going to have a knock-on effect eventually.
th: Can the nature of tennis as a predominantly one-sided sport cause physical ailments?
AH: Obviously, tennis is a one-sided sport so you expect one arm to be stronger than the other for instance, but it’s important that players don’t neglect the other side. It’s a completely false economy to say ‘oh we need to balance you up completely’. It’s about understanding the sport enough to know what’s normal.
With players on tour, physical imbalances are only significant when they become a problem, you could get one person that’s completely imbalanced and never have any niggles in their whole life. The next person could have far fewer differences in their symmetry, but have lots of problems, so it’s very individual to the player.
th: How important is stretching?
AH: There’s been a lot of mixed evidence recently about stretching, in terms of both how valuable it is, and whether it is actually potentially harmful. The main problem is that it's very difficult to measure the change from a stretch. But I would say it is key to make stretching as dynamic as possible, rather than holding static stretches. For example if you are stretching out your hamstring, and you hold it there, if you do it too vigorously you almost have a reflex action where your muscle tightens up as protective mechanism. Doing a lunge to get the hip-flexor stretching out and then angling to bring the adductors for instance is more of a natural movement where you ease in to the stretch and don’t get a harsh reaction.
th: So warming up the muscles before play is pretty crucial...
AH: Think of it like a lump of plasticine – when it's cold, it just snaps. And when it's warm its more pliable. You have plastic and elastic properties of your muscles, and its exactly the same idea – when you warm them up, they’re going to stretch more easily.
Andrea Havill was speaking at the media launch of the Pure Sports Medicine facility at David Lloyd Raynes Park. For more information, go to www.puresportsmed.com.