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Ask the High Performance Lab -- Nov. 15

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.

All answers to this week’s Ask the Expert Column are provided by Dr. Gary Windler, a member of the USTA Sport Science Committee as well as the ATP’s Medical Services Committee. Dr. Windler is a board certified orthopedist specializing in sports medicine with South Carolina Sports Medicine and Orthopedic Center in Charleston, SC. As the ATP Traveling Sports Medicine Fellow in 2000, and the Tournament Physician for the WTA’s Family Circle Cup tournament since 2001, Dr. Windler has gained unique and valuable insights into tennis medicine at the professional level. Dr. Windler is also the team physician for the professional soccer, ice hockey, and baseball teams in Charleston as well as for Charleston Southern University.

Q: I recently tore a ligament in my ankle – the doctor says to stay off it for 3-4 weeks. When I return to the court, how long should I continue to wear the ankle brace? I have one of those air braces that allow your ankle to say straight and not twist.

A: The key to a rapid recovery and safe return to tennis following an ankle sprain is a proper rehabilitation program. This includes ice, elevation and compression in the early stages in order to reduce pain and swelling, followed by a progressive ankle exercise program designed to regain motion, strength and coordination. Ankle braces can be helpful in the recovery process by providing compression and mechanical support.

For mild sprains, use of an ankle brace may be discontinued once the ankle has been fully rehabilitated. More severe ankle sprains can result in permanent instability (looseness) of the ankle, in which case the use of an ankle brace during tennis and other sports activities may be recommended on an ongoing basis.

Q: I have developed a pain in the arch area of one of my feet. I have been told it is plantar fasciitis, and different people have recommended different things. I cut back on my tennis, put gel inserts into my shoes, and have tried to stretch - and it is much better - but it still flares up every other week or so. Are there some exercises that could help prevent this? Is total rest for an extended time the only real cure?

A: Plantar fasciitis is an overuse injury to the broad ligament (plantar fascia) on the bottom of the foot at its attachment to the heel bone. Although the actual cause of this painful condition is not known, it has been associated with many different factors like overtraining, a flat arch, a high arch, over pronation, being overweight and/or improper shoe wear. Rest from aggravating activities is an important component of treatment. Biking and swimming can be substituted for tennis to maintain fitness during this "rest" period.

Stretching exercises for the plantar fascia, the calf muscles and Achilles tendon are recommended. Other helpful measures include frequent icing, use of a night splint, arch taping, heel inserts, orthotic innersoles and proper shoes. Your doctor may recommend anti-inflammatory medications or a cortisone injection. Although recovery may take six months or longer, symptoms will resolve in over 80% of cases. Shock wave therapy and surgery are considerations for those who continue to have significant pain.

Q: I had knee surgery a couple of years ago for a torn meniscus. I'm still playing 2-3 times per week, but think it would be good to have one of those knee sleeves on hand for support. I'm 39. Any recommendations on the best knee sleeve for support.

A: Surgery on a torn meniscus does not significantly affect the stability of the knee and therefore an external "support" (brace or sleeve) is generally not necessary. However, following this type of surgery, it is important to rehabilitate (stretch and strengthen) the muscles which support the knee, primarily the hamstrings and quadriceps.

Though knee supports do not take the place of well conditioned muscles, they may be of some benefit, primarily by keeping the area warm and providing a psychological sense of support. If you wish to wear a knee support, choose one that fits well, is comfortable and does not impair your ability to bend the knee or move well on the court.

Q: My 15 year old tennis player is recovering from a bout of medial epicondylitis due to overuse. He's getting conflicting advice from his trainer and the physical therapist as to whether to ice the tendon after play and strength training sessions. Do you have any thoughts?

A: Though the use of ice has played a prominent role in the treatment of sports injuries, some confusion still exists regarding when to use it and how effective it is. Ice promotes constriction of blood vessels. Therefore, it is extremely helpful in reducing bleeding and swelling that may occur in the first 24-48 hours following an injury. It also has an anesthetic effect, reducing local pain when adequate cooling is achieved. In a player recovering from medial epicondylitis, if pain and/or swelling occurs following playing or exercises, ice applied for 15-20 minutes may be beneficial.

If you would like to submit a question that may be answered by our Health & Fitness team or want to share an idea for a future column, please click here.



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