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Ask the High Performance Lab - May 1

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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Todd Ellenbecker, Chairman of the USTA Sport Science Committee. Todd is a physical therapist and clinic director of Physiotherapy Associates Scottsdale Sports Clinic in Scottsdale, Arizona.
All answers to this week's "Ask the High Performance Lab" column are provided by Todd Ellenbecker, Chairman of the USTA Sport Science Committee.

Todd is a physical therapist and clinic director of Physiotherapy Associates Scottsdale Sports Clinic in Scottsdale, Arizona. He received his degree in physical therapy from the University of Wisconsin-LaCrosse in 1985 and a master's degree in exercise physiology from Arizona State University in 1989.

In addition, he is a certified sports clinical specialist, an orthopedic clinical specialist by the American Physical Therapy Association, and a certified strength and conditioning specialist. He is also a certified USPTA tennis teaching professional.

From Richard Labarthe of Oklahoma City, Oklahoma: I have a 14 year old daughter who plays junior tennis at a high level. Recently she had to default in a sectional tournament when she began to experience sever "stinging" in her right (dominant) arm, primarily above the elbow, especially when hitting forehand drives and serves.

Though initially thought to be an injury to her triceps tendon, a visit to an orthopedist revealed that the injury is actually to her radial nerve, which as I understand it, runs the length of the arm. The doctor put her on a medicine to alleviate the nerve irritation (a medicine given to adults suffering from shingles) and also prescribed an anti-inflammatory medication.

Apart from this, he stated that there is really nothing to do but lay off for awhile and to give it a try after 10 days or so. Are you familiar with this type of tennis injury and possible alternative treatments such as acupuncture?

Todd Ellenbecker: Richard, peripheral nerve injury in the arm of an overhead athlete can occur from the repetitive stresses brought about by throwing, serving, or hitting forehands. Initially, you must let the inflammation in the nerve decrease as you have been told.

A complete evaluation of your daughter’s mechanics is important to determine if excess load or stress is imparted to the elbow or upper extremity to ensure a complete recovery. Additionally, evaluation of the entire arm for strength and flexibility deficits is also important.

While no direct evidence exists for acupuncture for this type of treatment alternative methods can be used in some cases, but typically after the more mainstream methods have been tried and deemed unsuccessful.

From Leonil Gan Lim of Tupelo, Mississippi: I recently had a complete rupture of my right Achilles tendon during a championship match 12-11-05. I had surgery for this (using a fiber wire) to reattach both ends 2 days after this injury. What are my chances of getting back into competitive playing again… or do I just have to take it easy from now on?

Todd Ellenbecker: Leonil – Sorry to hear of your injury. You should consult the physician who performed the surgery to gain information regarding the strength of the repair, the status of the torn tendon at time of surgery and also evaluate the success of your rehabilitation carefully. It is important that you re-gain full range of ankle motion (especially ankle dorsiflexion – moving your toes toward your nose) before you even attempt to do functionally demanding activities.

Additionally, ensuring that your entire lower limb (hip, knee and ankle) have strength levels equal to the uninjured side is important. It may also be of benefit when you first return to activities that you wear a small heel lift in your shoes to take stress off the repaired Achilles tendon. However, you must wear the lifts in both heels or you will simulate a leg length difference. Orthotics may also be indicated based on your foot type, but this can be evaluated by your physician.

Many patients who have had an Achilles rupture do return to full activity following rehab. Unfortunately, this is a common tennis injury due to the rapid multi-directional movements inherent in the game of tennis.

From Gary Geiger of New York, New York: I have a sciatica problem, most likely for not warming up. What do I do now, I can’t play with pain?

Todd Ellenbecker: Gerd, this is a common problem that can be caused by many factors. One of which is poor flexibility. Additionally, lack of core strength, bad or improper tennis mechanics are additional factors. Be sure to have a physician provide a comprehensive examination of your back.

Choose if possible an orthopaedic surgeon or neurologist who has completed a spine fellowship which is specialized training in spine examination and treatment. Additionally, choosing a physician who works with athletes or active individuals is also important.

Simply resting or doing nothing is not good advice in nearly any situation involving sciatica.

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