Understanding muscle injuries in tennis

Whether it is stretching to a wide forehand or simply moving to the ball, the physical nature of tennis means muscles are under pressure. That is why avoiding muscular injuries is paramount – especially given that any recovery from such ailments is a process that can’t be rushed.

There are two sorts of muscular injuries – structural and functional. Structural is when muscle fibres are damaged. Functional differs as no physical damage has occurred, such as with delayed onset muscle soreness.

Understanding muscles
Muscles are made up of tiny bundled fibres wrapped in fascia to hold it together. An injury can occur anywhere along the muscle-tendon-bone chain, but most happen at the junction between muscle and tendon as this is the weakest point. A structural muscle strain is when any number of these fibres tear. This could be a partial tear where a small percentage of fibres are damaged, or a complete tear where the whole muscle ruptures. This most commonly occurs in muscles that cross over two joints, such as hamstrings which connect hips and knees, as they are longer and generate more force.

Muscular injuries in tennis
Abdominal strains are common. The rectus abdominus – more commonly referred to as the ‘sixpack’ muscle – is used heavily in the tennis service action, both to stop the trunk going backwards but also to accelerate the trunk into flexion.

A calf tear is a more common injury for social players, particularly those in the over 35 age group. As the body ages and generally becomes less active, calf muscles lose condition. That’s when putting a rapid burst of strain on the muscle becomes dangerous, especially if it’s a sudden movement like sprinting for a drop shot.

Delayed onset muscle soreness can leave any player feeling like they have spent 10 rounds in a boxing ring. This happens when muscles suffer microscopic damage after being used beyond their capacity. This sets off a chain of events within the muscles that releases proteins and stimulates an inflammatory response. This fuels the body to repair itself over two to three days. This process is often painful, which is the body’s way of telling you to take it easy. Exercise can still be done during this time, but it is advised to do so at a lesser intensity to prevent further damage to the muscles.

Prevention
Maintaining muscular strength and conditioning is imperative to prevent injury. Training should cover what is expected from muscles, including lower intensity endurance as well as power, speed and coordination. This helps prevent both structural and functional injuries.

Strengthening abdominal muscles needs to focus on the specific demands of tennis. Doing sit-ups and crunches is not adequate, as they only involve the trunk moving to a flexed position. Exercises need to also focus on the decelerate motion the trunk makes during a service action.

Warming up muscles before exercise also reduces injury risk. Static stretching is important for improving flexibility, even if it has not proven to prevent injuries. Recent research suggests a dynamic warm up, which includes lower intensity variations of the movements muscles are put through in a match situation, is a more beneficial option. Lower body exercises that enhance balance and landing techniques are also regarded as good prevention routines.

The road to recovery

The body needs to go through set stages to heal a muscular injury.

Recovery: step one
Immediately after an injury, the body starts the healing process with inflammation to clean up debris and bring ‘good’ cells to the area to start repairs. There is debate whether icing in this early stage is actually beneficial, as inflammation is a crucial component of setting up the repair of a muscle injury. As icing reduces inflammation, this can impact the quality of the healing. Non-steroidal anti-inflammatory drugs should be avoided for the same reason.

Complete rest and immobilisation is not recommended, as movement within pain limits will assist the healing process. Gentle and pain-free muscle contractions circulate fluid away from the injury, removing waste products caused by the inflammatory process. Elevation and compression is helpful.

Recovery: step two
When pain has settled and the injured muscle can contract against resistance, the muscle repair process has matured and a strengthening program can be implemented. It typically takes seven to 10 days to reach this stage.

Strengthening should focus on the injured muscle, but also address any weaknesses or imbalances that may have been a contributing factor. As healing continues, resistance can steadily increase towards endurance and faster movements.

Recovery: step three
Once full strength has been restored, it is time to return to court. This typically takes between four and six weeks. However MRI scans have taught us that the healing process does not actually conclude at this point, continued rehabilitation is needed for several weeks after returning to competition to prevent reoccurrence.

Rob Brandham, APA Sports Physio, BPhysio, MPhysio (Sports), has experience managing musculoskeletal injuries in AFL, soccer and rugby. He has worked at the Australian Open and Tennis Australia. Rob is based at the St Kilda Road Sports and Physiotherapy Centre.