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Ask the Lab: Knee Problems & Tennis Elbow

May 25, 2008 12:25 PM

PLEASE NOTE: The medical opinions in USTA.com's Ask the High Performance Lab are responses intended for the average player. Please consult with your primary physician before beginning any new exercise program.

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    From Michael W Hart, California: I am an avid 65 year old tennis player that is currently suffering from what most 65's suffer from - bad knees. I know that there are "Dynamic Warmups" that I have seen put out by the USTA. I am a member in Northern CA and wonder if there is a way for me to receive them on the net?

    Michael, thank you for your question. There is downloadable strength and conditioning information on the USTA Player Development website, under the Strength and Conditioning link. On this page, choose the USTA Strength and Conditioning Program link and you will find you have access to over 60 dynamic warm-up, strengthening, and movement exercises.


    From Denise Slaughter of Bloomfield, CT: What is tennis elbow? Also, are there any exercises for the arm you would recommend to help prevent it?

    Dr. Riewald: Tennis elbow, also known as lateral epicondylitis, is an inflammation of the wrist extensor tendons where they attach on the outer side of the elbow. Tennis elbow is one of the more common injuries in tennis, and it is estimated that over 50% of all tennis players will encounter it at some point in their tennis careers.

    Tennis elbow is an overuse injury that is characterized by pain on the outer part of the elbow, particularly when hitting backhands and/or after play. (This is different from “golfer’s elbow”, or medial epicondylitis – an inflammation of the wrist flexor tendons where they attach on the inside of the elbow.

    Tennis players can also experience golfer’s elbow, although less frequently.) The treatment for tennis elbow, if caught early, is icing, limiting activity that causes pain, and stretching and strengthening of the forearm muscles. If not caught early, treatment may require more aggressive methods like a corticosteroid injection or prolonged rest.

    Tennis elbow prevention is based on developing sound technique and building strength and flexibility in the muscles of the forearm. In terms of technique, one of things to focus on is your wrist position at the point of ball contact. The hand and wrist should be in line with the forearm, and not flexed or extended, to allow the muscles to best handle the forces that are generated. We recommend meeting with a teaching pro to evaluate your technique if tennis elbow is a problem.

    As for strength and conditioning, you should try to strengthen and stretch the wrist flexors and wrist extensors regularly. Information is available on the USTA Player Development website under Strength and Conditioning/ Injuries and Tennis Technique on how to do this.

    Select the “Prevention of Elbow and Shoulder Injuries” or the “Prevention of Wrist Injuries” links to learn about exercises to prevent tennis elbow. One other exercise, not included on the website, is to improve grip strength by squeezing a low pressure tennis ball or racquetball.

    Another important piece of anecdotal information is that we tend to see elbow injuries increase when players switch equipment – either rackets or string. For this reason, we recommend players take some time to do some pre-hab strengthening and flexibility training for the forearm muscles starting several weeks before making that equipment change.


    From Elisabeth Pickelsimer of Charleston, SC:
    For over 1 1/2 years my right iliotibial band is so tight at its insertion point just below the lateral side of my knee that it prevents me from moving to my lateral right. I've tried to stretch the band to no avail. Any suggestions?

    Dr. Riewald: The iliotibial band (IT band) is a band of connective tissue that runs along the outside of the thigh from the hip to the knee. Pain can occur near the outside of the hip but more commonly it arises on the outside of the knee. The pain is caused by increased friction beneath the IT band (rubbing over bone) that can result when the fibers in the connective tissue shorten.

    There are a number of factors that can contribute to IT band syndrome including poor shoes, poor flexibility in the calf, thigh and/ or hips, strength imbalances, poor running mechanics/ overpronation, a leg length discrepancy, or increasing training to much, too fast.

    Treatment of IT band syndrome should be approached in much the same way as any musculo-tendinous injury – ice, avoidance of activities that cause pain, and use of anti-inflammatory medication. IT band syndrome can also be helped by stretching and massage. There are several stretches that can be performed to target the IT band. Some of these are illustrated at the following website: (http://www.nismat.org/ptcor/itb_stretch/index.html).

    Another method commonly used to treat IT band syndrome is self massage, using a foam roll. Lying on your side, place the foam roll under the affected hip. Slowly roll your body across the foam roll until it reaches your knee and then roll back to the starting position. Start gradually and try to build up the time and the number of times you “roll over” the IT band.

    Please note that there may be some pain as you massage and break up the scar tissue. You should also strengthen the muscles of the hip, particularly the muscles on the outside of the hip. A good exercise is the monster walk.

    If pain persists, you should seek the advice of an orthopedist who may provide more aggressive treatment methods and/or prescribe orthotics.




    The answers to this week's column come from Scott Riewald, PhD. Dr. Riewald is the USTA Administrator of Sport Science, he reports to Paul Lubbers, Director of Coaching Education. Dr. Riewald and the Sport Science staff work with Coaching Education to provide information to the coaches of top American players through seminars, workshops and newsletters.

    Past Riewald Columns:
    Strength & Flexibility Exercises
    Playing in the Sun & Jumping Rope
    Banned Substances & Youth Strength Training

    About the Author:

    Dr. Riewald:
 

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