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.
The answers to this week’s question were provided by Drs. W. Ben Kibler and Gary Windler, both members of the USTA Sport Science Committee.
Dr. Kibler is a world-renowned orthopedist who has focused much of his research on topics aimed at better understanding injuries in tennis. Dr. Windler is a board certified orthopedist specializing in sports medicine with South Carolina Sports Medicine and Orthopedic Center in Charleston, SC and serves on the ATP’s Medical Services Committee.
Question: I am looking for some advice on the relationship between orthotics and injury. My daughter has played competitive tennis for 6 years. At age 10 she started training full time 5 days a week / three hours per day and playing approximately 12-15 Tournaments per year. When she began training full time she was starting to have some very mild plantar fasciitis symptoms and was fitted with orthotics to help distribute the impact load across the whole foot therefore allowing her play and train pain free.
She has now played for 2 years with orthotics in her shoes everyday. Recently she was fit with a new pair of orthotics but she had to remove them due to some "new" low back pain (The back pain became a complaint approximately three to four weeks after she started using the new orthotics). The pain was showing up during the uncoil, or follow through, of her two handed back hand. She has removed the orthotics and her back pain vanished within two days.
Question: Do you feel that orthotics reduce the risk of plantar fasciitis in women and also do the orthotics reduce the severity and frequency of ACL injuries?
Question: What are the professional tour players using (brand name & manufacturing materials) for orthotics?
Dr. Ben Kibler: Very few young people get plantar fasciitis. This is a problem seen more in older players with tight calf/leg muscles, over pronation, and weak hips, with occasionally loose joints. She may have had some foot pain, but it was probably not plantar fasciitis. Almost all of these problems at this age respond to stretching and core stabilization. Orthotics have never been shown to prevent any problem, but have often been given undue credit in the lay press. Shoes with a stiff sole distribute load better than the orthotics.
Orthotics have no effect on the presence or prevention of ACL injuries. Foot alignment is a minimal risk factor for ACL injuries. All the literature supports lack of core and hip strength as the major risk factor. As you know, ACL injuries are rare in tennis players anyway, so this should not be a factor in any decision about orthotics.
I don't know the relationship of foot orthotics to back pain, although there appears to be some type of connection in this case. However, her back pain, coming at the end of her follow through in the two-handed backhand, suggests some tightness in the hip and back and some weakness of the lumbar extensors as causative factors. She is very likely to have this combination at this age. The orthotics were probably the "final straw".
If she is this age and playing this much, she needs a good musculoskeletal exam including the High Performance Profile. I would suggest she stay out of the orthotics, get a serious stretching/strengthening program from a knowledgeable source, and see how she does.
Dr. Gary Windler: The actual cause of plantar fasciitis is unclear. The condition has been found to be associated with a variety of conditions including flat feet, hyper-pronation, a tight Achilles tendon and others. Orthotics are generally designed to make a biomechanical adjustment to the foot in order to treat plantar fasciitis and other conditions such as stress fractures, tendinitis, shin splints, etc.
Orthotics are not routinely recommended for players with normal biomechanics who are not having problems, solely as a preventive measure. Finally, the importance of choosing a shoe which is well made and is appropriate for the type of foot the player has, cannot be overemphasized in prevention of foot related problems.
I am not aware of any studies confirming a reduction in frequency or severity of ACL injuries when using orthotics. However, neuromuscular training programs in females have been shown to be effective in reducing the frequency of ACL injuries. Fortunately, ACL injuries in tennis are not common.
On the men's tour, the players’ orthotics are fit and fabricated by many different private orthotists using a variety of brands and materials. Many of the players on the WTA Tour are fit by the WTA Primary Health Care Practitioners.
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