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Tóm tắt nội dung (trích từ tài liệu gốc): Handbook of Sports Medicine and Science Tennis IOC Medical Commission Sub-Commission on Publications in the Sport Sciences Howard G. KnuttgenPhD (Co-ordinator) Boston, Massachusetts, USA Francesco Conconi MD Ferrara, Italy Harm Kuipers MD, PhD Maastricht, The Netherlands Per A.F.H. RenstromMD, PhD Stockholm, Sweden Handbook of Sports Medicine and Science Tennis EDITED BY Per A.F.H. Renstrom MD, P M Section of Sports Medicine Department of Surgical Sciences Karolinska Institutet Stockholm Sweden BlackweII Science 0 2002 by Blackwell Science Ltd a Blackwell Publishing Company Editorial Offices:

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Nội Dung Gốc (Tiếng Anh)

Handbook of

Sports Medicine

and Science

Tennis

IOC Medical Commission

Sub-Commission on Publications in

the Sport Sciences



Howard G. KnuttgenPhD (Co-ordinator)



Boston, Massachusetts, USA



Francesco Conconi MD



Ferrara, Italy



Harm Kuipers MD, PhD



Maastricht, The Netherlands



Per A.F.H. RenstromMD, PhD



Stockholm, Sweden

Handbook of

Sports Medicine

and Science

Tennis



EDITED BY



Per A.F.H. Renstrom



MD, P M

Section of Sports Medicine

Department of Surgical Sciences

Karolinska Institutet

Stockholm

Sweden



BlackweII

Science

0 2002 by Blackwell Science Ltd

a Blackwell Publishing Company

Editorial Offices:

Osney Mead, Oxford OX2 OEL, UK



  "el: +44 (0)1865206206

Blackwell Science, Inc., 350 Main Street, Malden, MA 02148-5018, USA



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The right of the Author to be identified as the Author of this Work has been asserted in accordance with the

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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in

any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by

the IJK Copyright, Designs and Patents Act 1988,without the prior permission of the publisher.



First published 2002



Library of Congress Cataloging-in-Publication Data



Tennis: handbook of sports medicine and science / edited by Per A.F.H. Renstrom.

          p. ;cm -[Handbook of sports medicine and science)



     Includes bibliographical references and index.

     ISBN 0-fi32-05034-9

     1. Tennis injuries-Handbooks, manuals, etc. 2. Tennis-Physiological

  aspects-Handbooks, manuals, etc. I. Renstrom, Per. 11. Series.

     (DNLM: 1.Tennis. 2. Athletic Injuries. 3. Sports Medicine. QT 260.5.T3 T311 20021

   KC1220. T4 T46 2002

  617.1'027'08879634-dc21



                                                                                                      2001052783



ISBN 0-ti32-05034-9



A catalogue record for this title is available from the British Library



Set in Melior by Graphicraft Limited, Hong Kong

Printed and bound in Great Britain at the Alden Press Ltd, Oxford and Northampton



For further information of Blackwell Science,visit our website:

www.blackwell-science.com

Contents                                         11 Specific problems for the young tennis player, 139

                                                     W.Ben Kibler

    List of contributors,vi

    Forewords by the IOC, viii                   12 Pathophysiology of tennis injuries-

    Forewords by the ITF, ATP, WTA and STMS, ix      an overview, 147

    Preface, xi                                      W .Ben Kibler

 1 Biomechanics of tennis, 1

    Bruce C. Elliott                             13 Foot problems in tennis, 155

 2 The tennis racket, 29                             Scott A . Lynch and Per A.F.H. Renstrom

    Howard Brody

 3 Shoes and surfaces in tennis: injury and      14 Ankle problems in tennis, 165

    performance aspects, 39                          Scott A. Lynch and PerA.F.H. Renstrom



   Karin G.M. Gerritsen, Benno M.Nigg and        15 Lower leg and Achilles tendon problems

                                                     in tennis, 176

    Ian C. Wright                                    Scott A . Lynch and Per A.F.H. Renstrom

 4 The physiological demands of tennis, 46

                                                 16 Knee injuries in tennis, 186

    Michael F. Bergeron and Joseph Keul              PerA.F.H. Renstrom and Scott A. Lynch

 5 Nutrition in tennis, 54

                                                 17 Spine injuries in tennis, 204

    Michael F. Bergeron                              Hartmut Krahl, Carsten B. Radas, Hans-Gerd

 6 Playing tennis in the heat: fluid and             Pieper and Ulf Michaelis



    electrolyte balance, 65                      18 Hand and wrist injuries in tennis, 223

    Michael F. Bergeron                              Arthur C.Rettig

 7 Medical care of tennis players, 75

    Babette Pluim                                19 Elbow injuries in tennis, 233

 8 Travel and jet lag, 96                            Per A.F.H. Renstrom

    Moira O'Brien

 9 Strength training, flexibility training and   20 Shoulder injuries in tennis, 248

    physical conditioning, 103                       David W .Altchek

    E. Paul Roetert and Todd S. Ellenbecker

10 Pre-participation profiling for tennis, 124   21 Rehabilitation principles of injuries in tennis, 262

    E. Paul Roetert and Todd S. Ellenbecker          W.Ben Kibler



                                                 22 The psychology of tennis: gaining the mental

                                                     advantage, 278

                                                     Robert S. Weinberg



                                                 23 ITF involvement in tennis medicine and

                                                     science, 291

                                                     Miguel Crespo and Machar Reid



                                                 24 Medical services in men's and women's

                                                     professional tennis, 296

                                                     Per Bastholt, JurgenDess, Sue Fleshman, Bill

                                                     Norris, Doug Spreen, Alex Stober, Kathleen A .

                                                     Stroia, Paul Settles and Gary Windler



                                                     Index, 303



                                                 V

List of contributors                                    Joseph KeulMD, PhD (Deceased)Medizinische



                                                           Universitatsklinik, Rehabilitative/Praventive

                                                          SportMedizin, Hugstetter Strasse 55,0-79106

                                                          Freiburg, Germany



                                                        w. Ben KiblerMD, FACSM Medical Director,



                                                          Lexington Sports Medicine Center, 1221 S. Broadway,

                                                          Lexington, KY 40504, USA



David W. Altchek MD Hospital for Special Surgery,       Hartmut KrahlMD Professor, Wiirthstrasse21,81667



  535 East 70th Street, New York, N Y 10021, U S A        Munich, Germany



Per BastholtRPT F-06140 Vence,France                    Scott A. LynchMD Sports Medicine Section,



Michael F. BergeronPhD, FACSM Assistant                   Department of Orthopedics,Penn State University,

                                                          HersheyMedical Center,PO Box 850, Hershey, PA

  Professor of Pediatrics, Medical College of Georgia,     17033-0850, U S A

  Georgia Prevention Institute, HS-1640, Augusta,

  GA 30912-3710, USA                                    Ulf MichaelisMD Department of Orthopaedic



Howard BrodyPhD Professor, physics Department,            Surgery and Sports Medicine, Alfried Krupp

                                                          Hospital, Alfried-Krupp-Strasse 21,D-45117 Essen,

  Universityof Pennsylvania, 209 S. 33rd Street,          Germany

  Philadelphia, PA 19104-6396, USA

                                                        Benno M.NiggDr sc. nat. Director, Human

Miguel CreSpOPhD International Tennis Federation,

                                                          Performance Laboratory, Faculty of Kinesiology,

  TennisDevelopment Department, Bank Lane,                 The University of Calgary, Calgary, Alberta, Canada

  Roehampton, London SW15 5XZ, UK

                                                        Bill NorrisATC Boca Raton, FL 33498, USA

Jurgen DessRPT 92318 Neumarkt, Germany

                                                        Moira O'BrienMD Professor and Head, Anatomy

Todd S . EllenbeckerMs, PT, scs,cscs

                                                          Department, Trinity College, University of Dublin,

  Physiotherapy Associates, Scottsdale Sports             Dublin 2, Ireland

  Clinic, 9449 N . 90th Street, Suite ZOO, Scottsdale,

  AZ 85258, USA                                         Hans-GerdPieperMD Department of Orthopaedic



c. Bruce ElliottPhD Professor and Head, The                Surgery and Sports Medicine, Alfried Krupp Hospital,

                                                          Alfried-Krupp-Strasse 21,0-45117 Essen, Germany

  Department of Human Movement and Exercise

  Science, The University of Western Australia,         Babette PlUimMD, PhD Koninklijke Nederlandse

  Stirling Highway, Crawley 6009, Australia

                                                          Lawn TennisBond, Sport Medisch Centrum Papendal,

                                                          Papendallaan 60,6816 VDArnhem, The Netherlands



Sue FleshmanPT, ATC Sport Sciences and Medicine         Carsten 6. RadasMD Department of Out-patient



  Department, Sanex W T A Tour, 133 First Street NE,      Surgery, Orthopaedic Centre, St Josef-Stifi,Westtor 7,

  St Petersburg, FL 33701, U S A                          0-48324 Sendenhorst, Germany



Karin G.M. GerritsenMSC,PhD Assistant Professor         Machar ReidBSc ITFAssistant Research Officer,



  in Biomechanics, Department of Exercise Science and     International Tennis Federation, TennisDevelopment

  Physical Education, Arizona State University,Box        Department, Bank Lane, Roehampton, London SW15

  870404, Tempe,AZ 85287-0404, USA                        5XZ, UK



vi

                                                        LIST O F CONTRIBUTORS vii



Per A.F.H. Renstrom MD,PhD Professor, Section           Alex Stober RPT 90459 Nuremberg, Germany



  of Sports Medicine, Department of Surgical Sciences,  Kathleen A. Stroia MS, PT, ATC Associate Vice

  Karolinska lnstitutet, SE-171 76,Stockholm, Sweden

                                                          President, Sport Sciences and Medicine Department,

c. Arthur RettigM D Orthopedic Surgeon, Methodist         Sanex W T A Tour, 133 First Steet NE, St Petersburg, FL

                                                          33701, U S A

  Sports Medicine Center, ThomasA. Brady Clinic,

  Department of Education and Research, 1815 N.         Robert s. WeinbergPhD Professor and Chair,

  Capitol Avenue, Suite 560, Indianapolis, IN 46202,

   USA                                                    Department of Physical Education, Health and Sport

                                                          Studies, 109 Phillips Hall, Miami University, Oxford,

E. Paul RoetertPhDDirector of Administration, USA         OH 45056-1675, USA



  Tennis High Performance Program, 7310 Crandon         Gary Windler M D Sports Medicine Services, 321

  Boulevard, Key Biscayne, FL 33149, U S A

                                                          Middleton Boulevard, Summerville, SG 29485-8027,

Paul SettlesDirector of Player Services, ATP Tennis       USA



  International Headquarters, 201 ATP Tour Boulevard,   c . Ian Wright MSc Human Peqformance Laboratory,

  Ponte Vedra Beach, FL 32082, USA

                                                          Faculty of Kinesiology, The Universityof Galgary,

Doug S p e l l ATC Terrace Park, OH 451 74, USA           Calgary,Alberta, Canada

Forewords by the IOC                                     Tracing its beginnings from games played some

                                                         hundreds of years ago, the sport of tennis underwent

The sport of tennis was one of the nine sports           major changes during the latter part of the 19th

included for men participating in the Games of the I     century. During the 20th century, the sport spread

Olympiad as held in Athens in 1896. Men'stennis          internationally and it is currently practised in

appeared in each of the following Olympic Games          virtually every country of the world.

until the year 1924. Women's tennis competition in

the Olympic Games was introduced in 1900 in Paris           Success in tennis requires a tremendous amount of

and continued until 1924,with the exception of 1904      physiological variables. These variables are further

in St Louis. Because of controversies related to the     supplemented by the needs for proper nutrition,

participation of amateur versus professional athletes,   hydration, strategy, and being psychologically

tennis disappeared from the Olympic programme for        prepared. Developments in both sports medicine and

over 60 years until its reintroduction in 1988 in Seoul  sports science during the last 50 years have resulted in

with a completely open competition.                      stronger, faster, better skilled tennis players who are

                                                         utilizing the most efficient and effective equipment

  Despite the extended hiatus, tennis must be            that the engineers and biomechanists can design. With

recognized as having an important history within         the enhanced challenges and stresses to the human

the Olympic programme. It is, therefore, entirely        body, injury prevention and injury rehabilitation

appropriate that this Handbook on the sport of           have become important issues for sports medicine

tennis takes its rightful place among the other sports   physicians, health personnel, and coaches.

that have already appeared in the IOC Medical

Commission series of Handbooks of SportsMedicine            Our thanks go to Professor Per Renstrom and the

and Science.                                             contributing authors for this Handbook on Tennis

                                                         who have collaborated to produce an up-to-date

  My sincere appreciation goes to the Chairman of        and complete coverage for all of the biomechanical,

the IOC Medical Commission, Prince Alexandre de          biological and clinical aspects of tennis play. This

Merode, and to the IOC Medical Commission's Sub-         publication will prove to be an invaluable reference

commission on Publications in the Sport Sciences.        for everyone involved with the game of tennis.



                                                         Prince Alexandre de Merode

                                                         Chairman. IOC Medical Commission



Dr Jacques Rogge

IOCPresident



viii

Forewords by the ITF, ATP,                                   six continents in over 50 countries on a variety of

                                                             playing surfaces-from carpet to hard courts to grass

WTA and STMS                                                 and clay. Until one considers that the average match

                                                             lasts 1 112 to 2 hours and may last as long as four; that

Foreword by the InternationalTennis                          players may have to compete as many as 5 days in a

Federation                                                   row, sometimes with two matches a day, before get-

Tennis is a sport for all ages and requires speed,           ting a day off. Take a look at the teeming activity that

dexterity and endurance,especially at the professional       is the training room on day one of an ATP tournament

level. Tennis is also an intellectual sport that requires    and you will have a sense for how physically demand-

court sense and strategic thinking. At the highest           ing professional tennis can be.

level, the professional tennis player competes nearly

every week of the year, requiring fitness levels that are       Those of us on the ATP Medical Services Com-

very high and an ability to play with consistency on a       mittee are increasingly aware of the physical demands

variety of surfaces at locations around the world.           placed on professional tennis players and the import-

                                                             ance of providing the highest standards of medical

   The International Tennis Federation (ITF)takes            care for them on a tournament-by-tournamentbasis.

pride in its leadership of the Joint Tennis Anti-Doping      Whether you are a player, coach, athletic trainer,

Programme in conjunction with the ATP and the WTA            physiotherapist, or physician, we hope that this

Tour. The ITF's Sports Medical Commission is pro-            handbook will provide some insight into the most

active in studying all areas that pertain to the overall     common tennis medical problems of professional

health of tennis players. These areas include physiology,    tennis players, as well as the preferred treatment

nutrition, bio-mechanics, the effect of the evolution of     protocols recommended by ATP Medical Services

equipment on players,mental preparation and other            personnel.

specificissues such as jet lag, altitude, heat and humidity

and the effects of playing tennis at a very young age.       Paul Settles

                                                             Director of Player Services

  The ITF, the world governing body of tennis,

welcomes the Handbook on Tennis. This book, with             Foreword by the Women'sTennis Association

contributions from internationalscientists and experts,

will prove to be a very useful tool, a comprehensive         Tennis presents unique challenges with one-on-

guide to sports medicine as it pertains to tennis.           one competition, typified by its demand for total

                                                             athleticism, and necessitating the mental and

Francesco Ricci Bitti                                        physical strength to sustain an eleven month

President, ITF                                               season that spans the globe.



Foreword by the Associationof Tennis                           In order to remain in the game and at a high level of

Professionals                                                competition, professional tennis players must utilize

One doesn't immediately think of professional tennis         and incorporate the latest trends in sports medicine.

when consideringthe most physically demanding                The IOC Handbook on Tennis identifies and outlines

sports. Until, that is, one considers that the professional  the steps every elite tennis player must take in order

tennis season spans eleven months and is played on           to excel, a daunting but invaluable undertaking. A

                                                             resource has been created that allows the tennis

                                                             community (coaches,players, physiotherapists,

                                                             physicians, certified athletic trainers, etc.) to access

                                                             and apply the principles of tennis medicine in

                                                             the creation and advancement of a successful

                                                             professional tennis player.



                                                               On behalf of the Sanex WTA Tour and its group of

                                                             sports sciences and medicine experts, it is my honor

                                                             to be able to share our pleasure associated with the



                                                             ix

x FOREWORDS



publication of this book and we look forward to the     newsletter with the ITF, ATP and Sanex WTA. The

positive repercussions it will have in the game of      STMS also organizes courses regularly every year in

tennis; truly a sport for a lifetime.                   the field of medicine and science in tennis, including

                                                        management of injuries and medical problems in

Kathleen A. Stroia                                      tennis.

Director of Sports Sciences and Medicine, WTA

                                                          There is a great demand in tennis for this kind

Foreword by the Society for Tennis Medicine             of handbook. Because of increasing pressures and

and Science                                             intensity, there is a heightened risk of injury and other

                                                        medical problems. Therefore, the STMS feels that this

The STMSwas founded in 1990 to promote, educate         handbook is essential reading and congratulatesthe

and disseminate information about medicine and          IOC for its initiative in producing this publication.

science in tennis. The STMS has initiated a newsletter

which is now distributed worldwide as a joint           Per A.F.H. Renstrom

                                                        President, STMS

Preface                                                        A major concern for the sport is the extended

                                                            length of the season for top-level tennis players.

Tennis is a truly international sport enjoyed by            Tournaments are offered during 10 months of the

millions of people of all ages around the world. The        year and this allows little time for recovery and basic

players experience tennis as an exhilarating game           training. Few other sports have such a lengthy

resulting not only in stimulating competition but           season. Another risk factor may be the conduct of

also in conditioning, general health benefits and           tournaments on different surfaces,including hard

camaraderie. For spectators,tennis is one of the most       court, clay and grass. The shift from one surface to

exciting and popular sports, not the least because of       another may very well be the cause of a number of

its ingenious scoring system. Because of this, a tennis     injury problems, especially when changing from

match can be very dramatic and ever changing like a         a clay surfaceto a hard court with high friction,

theatrical production by Shakespeare. A player can at

some point seem to have lost a match but, in the end,          The increasing intensity of the game and the

emerge as the winner after three to five intensive sets.    associated physical demands also involve an

                                                            increased risk of injury and other medical problems.

   At the top competitive levels, tennis can be a very      The ATP, Sanex WTA and ITF provide excellent

demanding sport,both physically and mentally.               medical services by assigning well-educated and

Regular participation in the sport provides excellent       specialized physiotherapists andlor athletic trainers

cardiovascular exercise, improves the body's general        to all major tournaments around the world. Well-

functional capacity, and promotes both coordination         qualified medical doctors are also available at all the

and balance. This is of special importance for older        tournaments for top players. The medical services

tennis players. Tennis is definitely a sport for all ages,  provided in tennis on a worldwide basis are probably

from 3 to 103 years old.                                    the best any international sport can offer. The ITF

                                                            has founded a medical and science committeethat

  The sport of tennis provides an all-round game            reviews and coordinates the medical and scientific

with quick starts and stops, repetitive overhead            concerns in tennis. The Society for Tennis Medicine

motions,and involvement of all the muscles of the           and Science (STMS)provides education and

body. During the last 10to 20 years, the game of tennis     disseminates information through newsletters

has developed enormously as facilitated by the new          and conferences in cooperation with the other

designs for rackets and other equipment and new             international organizations. Top-level tennis players

playing techniques, with special reference to serving.      are presently offered excellent medical services but,

Training methods have also improved. The players            as always, further improvement is possible, especially

at the top level are now stronger and faster than           for the players below top level and for recreational

ever before. The rackets are larger, wider and stiffer,     players.

allowing for serve velocities of greater than 200

kilometres per hour (130miles per hour). The players           This IOC Handbook on the medicine a n d science of

are playing much more from the back court with an           tennis should constitute a valuable reference in the

open stance that permits the generation of greater          effort to improve the information available to tennis

forces. The game is much more intense and                   players at all levels of competition. The aim of this

demanding as compared to 10 years ago.                      publication is to provide all tennis players, their

                                                            coaches and the associated health care personnel with

                                                            an authoritative reference in which basic information

                                                            is described in a clear format concerning common

                                                            injuries and medical problems that can be sustained

                                                            during tennis play. The available information in this

                                                            book can then aid them in considering what kind of

                                                            immediate, short-term or long-term treatment is

                                                            available, leading to the decision as to the necessity

                                                            of consulting a medical doctor.



                                                            xi

xii PREFACE



  The contributorsto this book have been chosen          David Altchek, who is ATP medical director and

from the outstanding experts in the field of tennis      the US Davis Cup physician, has described current

medicine and science. They are all experienced in        management of shoulder injuries which has become

participating i n the many sports medicine/sports        an increasing problem in tennis. Hartmut Krahl, a

science conferences and meetings organized by the        former medical director of the ATP and his coworkers

STMS, ATP, Sanex WTA and ITF. The Handbook               from the ATP tournament in Essen, have discussed

leads off with a description of the biomechanics         how to manage back problems. Arthur Rettig, the

in tennis and an evaluation of the different strokes in  medical doctor for the Indianapolis ATP Tournament,

tennis as contributed by an internationallyrecognized    has presented his views on the management of

expert in this area, Bruce Elliott from Australia.       hand and wrist problems. The undersigned has,

Different aspects of the racket and the ball are then    in cooperation with Scott Lynch, discussed knee,

discussed by Howard Brody, the ITF'srecognized           lower leg, ankle and foot problems as well as elbow

expert in this field, who has completed extensive        problems in tennis. Tennis is very much a sport where

research in this area. An evaluation of shoes and        a strong mind is very important. The psychological

their relation to the playing surface is discussed by    aspects of tennis competition have, therefore, been

Karin Gerritsen.                                         discussed by Robert Weinberg.



  Michael Bergeron discusses current research              As mentioned above, the medical services offered

information regarding the physiological and              to the top-level tennis players by the ATP, Sanex WTA

nutritional demands of tennis as well as the risks       and ITF at every tournement are of the highest quality

involved with playing in the heat. Babette Pluim,        and rather unique in international sports. In two

editor of the STMS Newsletter and a leading tennis       chapters, these organizations describe their activities

physician, has written about the medical concerns        in the field.

in tennis. Moira O'Brien presents her views on the

problems experienced during international travel.           It is an honour to have been invited by the IOC to

                                                         coordinate this project. We are very grateful that so

  Physical conditioning for tennis becomes more          many of the leading experts in tennis medicine and

and more important each year. Paul Roetert and Todd      science have been willing to share their expertise

Ellenbecker, who have worked for many years with         and advice with us. I would also like to thank

the United States Tennis Association (USTA),present      Sue Mattingley, Julie Elliott and Nick Morgan of

their views on strength and flexibility training,        Blackwell Publishing for their administrative help,

conditioning and physiological preparation. Younger      editorial assistanceand patience throughout the

players experience increasing injury problems and        time-consuming work in the production of this book.

their specific problems are discussed by Ben Kibler,     Many thanks also to Professor Howard G. Knuttgen for

who is former president of the STMS and current          his strong support along the way.

member of USTA's medical committee. He includes

a discussion of the background (pathophysiology)            It is our sincere hope that this book will be of value

for tennis injuries and the rehabilitation principles    to all persons involved with the sport of tennis and,

after injuries have occurred with the aim of returning   especially,to the players of all ages and at all levels

players to competitive play as quickly as possible       of competition around the world.

following an injury.

                                                         Per A.F.H. Renstrom,MD, PhD

  The various injury problems are described by           Stockholm 2001

persons with extensive experience in the field.

Chapter 1                                                  margin for error are an accepted example of modern

                                                           technique. Coaches must therefore decide when they

Biomechanics of tennis                                     should teach the multisegment topspin forehand,

                                                           used by a majority of leading professionals. In the

Introduction                                               multisegment forehand,the individual segments

                                                           of the upper limb move relative to each other in a

As the term suggests, biomechanics involves a study        coordinated manner to produce a high racket speed.

of the structure and function of the human body            The alternative to this stroke is the forehand where

using mechanics. Biomechanics of tennis therefore          the whole arm swings forward predominantly as a

deals with the mechanical basis of tennis, with            single unit.

particular emphasis on the techniques used in              4 The biomechanical basis of stroke production.

stroke production. The criterion measure in tennis,        The time of contact between the ball and the strings,

that is successful performance in an injury-free           a biomechanical consideration in strokeproduction,

environment,makes it imperative that coaches and           varies minimally (5 ms) irrespective of string tension.

medical/paramedicalpersonnel have an understand-           The movement of the racket and ball together with a

ing of biomechanics.                                       vertical racket face at impact are therefore the key

                                                           mechanical determinants of a successful topspin

  The primary objective of a coach should be to            groundstroke.

develop `goodtechnique'.The coach who has an

understanding of biomechanics can integrate the              This chapter will be divided into three sections.

personal characteristicsof the player with sound           The first, reviews a number of general biomechanical

stroke mechanics to develop skills that suit the           factors that influence stroke production, while the

individual. Sports science and sports medicine             second section deals with research specific to each

personnel use these individual player characteristics      of the strokes. The third section is on the analysis

to structure appropriate training and rehabilitation       of technique, a key factor in the successful modifica-

programmes.                                                tion of stroke production. Chapter 2 deals with bio-

                                                           mechanical considerations of equipment design and

  The individualized mechanical model for per-             tennis.

formance must be developed with consideration

of four broad areas.                                       General mechanicalfactors

1 Past experiences of the coach. Years of coaching

or experiencesas a player may have led a coach for         The following mechanical factors are common to all

example to the conclusion that a semi-western or           tennis strokes and as such should be treated separately

western forehand grip should be adopted in prefer-         to a discussion of individual stroke production.

ence to a continental grip when hitting a topspin

forehand drive.                                            Time of ball contact

2 The individual characteristics of the player. The

physical characteristics (e.g. lack of strength) or flair  The time of contact between the ball and the strings

of a player may dictate that a particular technique be     varies minimally from 3 to 6 ms (Plagenhoef 1979;

considered when deciding what should be learned            Brody 1987).No other fact has had more influence

(8.g. double-handed backhand).                             on the game, as it is not possible (withinthe laws of

3 The current techniques used by champion players.         the game) to significantly alter this time. The racket

High-speed forehand drives that clear the net with a       must therefore be in the desired position at impact,

                                                           so that the relative path and speed of both the racket

                                                           and ball determine the type and amount of spin

                                                           imparted, rather than any sudden movement that is

                                                           attempted while the ball is in contact with the strings.

                                                           [Speed is used interchangeablywith velocity for

                                                           ease of reading.)



                                                                                                                                 1

2 CHAPTER 1



Grip firmness                                             the closing speed of both ball and racket (addition of

                                                          speed of the ball and racket irrespective of direction)

Tennis coaches believe that grip firmness at impact       rather than the influence of grip firmness. Significant

is generally critical to success in stroke production.    increases in rebound coefficients for an increase in

Studies featuring central impacts, using a number         grip pressure, particularly for off-centre impacts, were

of different experimental designs (propellingor           reported for closing speeds more closely related to

dropping balls at freestanding or clamped stationary      match conditions (30m.s-l, Elliott 1982;38 m.s-',

or swinging rackets) show that rebound ball speed is      Plagenhoef 1979)whereas at a lower closing speed

not significantly affected by the level of grip pressure  (10.6 me-', Grabiner et al. 1983)no significant

[Elliott 1982; Grabiner et al. 1983; Missavage et al.     increase was reported.

1984;Knudson 1989).Theoretical support for this

result is provided by Liu [1983),whose model              The generation of racket speed

predicted that the rebound coefficient (ball speed

postimpact/ball speed preimpact) is principally a         Coaches are continually posed the question of how

function of the elastic nature of the impact between      to enable their pupils to develop more power in their

the ball and strings,which is practically independent     stroke production,that is hit the ball with a higher

of the condition of grip firmness.                        forward speed, while still maintaining an acceptable

                                                          level of control. Recent changes in stroke technique

  A decrease in rebound coefficient was generally         (e.g.service, Elliott et al. 1995; forehand, Elliott et al.

reported for off-centre impacts. Hatze (1976)reported     1989a)have further caused them to ponder iflwhen

that theoretically, an off-centre impact would be         selected aspects of stroke production should be taught

accompanied by an increase in racket recoil, which        to young players. This section provides a framework

decreased postimpact ball speed. Plagenhoef (1979)        for coaches to assess changes in technique associ-

using photography and an instrumented racket              ated with the development of high-speed stroke

reported that the further away an impact occurred         production.

perpendicular to the long axis (from the centre),the

lower was the rebound coefficient (2.5 cm, 15%            The use of elastic energy

reduction; 5.0 cm, 40% reduction). Postimpact ball

speeds were less affected by off-centre impacts along     `Prepare early' is a phrase commonly used by coaches.

the long axis, where reductions of only 10% were          The logic behind such a statement is that for the ball

reported for impacts near the end of the racket com-      to be hit at the appropriate time and not `late'requires

pared to speeds for central impacts. These reductions     this early preparation. The question then arises as

in rebound speed were accompaniedby increases in          to whether performance is in fact hindered by this

the forces transmitted to the hand (Plagenhoef 1979;      early preparation, as elastic energy stored during

Elliott 1982).                                            the `stretch cycle' of the movement may not be of

                                                          benefit during the `shortencycle' of the activity.

  Higher off-centre rebound coefficients were associ-     This stretch-shorten cycle is observed in tennis as a

ated with an increase in grip pressure (Elliott 1982).    counter-movement during the racket backswing or

An approximate 20% increase in rebound coeffici-          movement preparation phase (i.e. bending of the legs

ent was reported (approx.0.47-0.57) for a change          during the split step in a volley) that precedes the

from a `lightto tight' grip for off-centre impacts,       actual forwardswingof the racket [external followed

whereas central impacts increased to a lesser degree      by internal rotation of the upper arm) or movement

(0.64-0.69) (Elliott 1982). Grabiner et al. (1983)also    to the ball (theshortening phase).

investigated the relationship between resistance to

rotation (about the long axis) and postimpact ball           The theory underlying the use of elastic energy

speed following off-centre impacts. They reported no      in stretch-shorten cycle activities is a relatively

significant differences between postimpact ball speed     simple process. During the stretch phase (eccentric

for two extreme conditions of grip firmness (maximal      contraction)the muscles, tendons and associated

pressure clamped and free standing).However, they         tissue are actually stretched and store elastic energy.

suggested that this result may have been influencedby

                                                              BIOMECHANICS 3



     l2OL                                                     for a groundstroke or as part of the split step in serve-

                                                              volley and approach shot-volley play. The rapid

        0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00          flexion of the knees must obviously be controlled,

                                                              otherwise the body would drop into a full squat

                              Pause time (s)                  position. This stopping of the downward movement

Fig. 1.1 Loss of elastic energy with increase in pause time.  has been shown to apply stretch to the muscles and

(Modifiedfrom Wilson et aJ. 1991.)                            other tissues of the lower limbs, which results in

                                                              the storage of energy. This stored energy may then

                                                              at least partially, if the movement of knee flexion is

                                                              quickly followed by knee extension, be used to assist

                                                              the lower limb drive in moving a player to the ball.

                                                              Knee extension and the acceleration of the body

                                                              upward increases the reaction force from the court

                                                              and therefore allows the players to drive in the

                                                              direction of the next stroke.



On movement reversal, during the shortening phase,            The distance over which racket speed

the stretched muscles (which are in a better position         can be developed

to produce force) and tendons recoil back to their

original shape and in so doing a portion of the stored        One of the main reasons of having a backswing is to

energy is recovered and assists the movement.                 increase the distance over which racket speed can be

Research has shown that the use of elastic energy is          developed during the forwardswingto the ball. In a

reduced if a delay occurs between the stretch and             straight backswing (often taught to beginners),the

shorten cycles of an upper limb movement (Wilson              racket is taken back in a relatively straight line, before

ef al. 1991) (see Fig. 1.1)I.n the upper limb, after a        stopping in the backswing position, prior to swinging

period of approximately 1 s, 55% of the stored energy         forward to the ball. This type of backswing, which is

is lost; after 2 s, 80% of the stored energy is lost; and     easy to learn, is very good in developing ball control.

after a 4-s delay all stored energy is lost.                  It may even use some of the elastic energy stored

                                                              during the stretch cycle. However, the distance the

  The recovery of this stored energy tends to occur           racket moves forward to the ball is often not sufficient

relatively quickly and is thus of major benefit early         to allow the development of a high racket speed at

in the forwardswing phase of the stroke or in the             impact.

movement to the ball (Wilson et al. 1991).This is

of major benefit to young children, who need the                The looped backswing was introduced in ground-

assistance of this energy source, to overcome the             strokes (it has always been used in the serve)to

inertia (swingweight) of the racket during the early          increase the distance over which racket speed could

section of the forwardswing of for instance the               be developed during the forwardswingto the ball.

forehand or serve.                                            In the service action, the racket is kept away from

                                                              the body when `looped'behind the back (Fig. 1.2),

  Speed of movement around the court is also related          which effectively increases the distance over which

to the ability to `use elastic energy'. Groppel(l984)         the player can develop racket speed when swinging

wrote: `regardless of the position a skilled player           up to the ball.

assumes while awaiting the opponent's shot, upon

or just prior to impact by the opponent, the player             The looped backswing requires more coordination

will unweight'.As the player flexes at the knees              than the straight backswing and therefore control may

(accelerates downward) the reaction force from the            suffer initially. However, once correctly developed

court is lowered (unweighted).This unweighting                this form of backswing allows for the production of

is an integral part of tennis movement, whether               greater racket speed and therefore more power in

it be before a return of serve, moving to position            stroke production as compared to the straight back-

                                                              swing. If a pause is required between backswing and

4 CHAPTER 1



Fig. 1.2 The backswing position in the service action.     points during the forehand drive. The only joint

                                                           movement that has been shown to occur very late in

forwardswing phases of the groundstroke then the           the forwardswing (and therefore not in proximal-to-

racket should stop near the top of the loop to increase    distal sequencing)for the service (Elliott et al. 1995)

the distance over which racket speed can be generated      and forehand strokes (Elliott et al. 1997)is internal

for impact. Research has shown that 2.7 m.s-l of extra     rotation of the upper arm.

speed was generated with an increase of only 30 cm

of racket drop during a looped forwardswing.                  Recent developments in forehand and backhand

                                                           stroke production have created some concern among

The use of coordinafedmovemenfs                            coaches. The need for greater trunk rotation and

                                                           the use of individual segments of the upper limb

In tennis, where a high racket speed is generally          (arm, forearm and hand) in an attempt to generate a

required, a number of body segments must be                higher racket speed has created a need for changes in

coordinated if success is to occur. The motion of          coaching methodologies. The extension at the elbow

segments in high-speed tennis strokes is generally         joint during the forwardswingof a backhand drive

sequenced in a proximal-to-distal fashion. One of          (note flexed elbow in Fig. 1.4) increases the racket

the most popular principles underlying the descrip-        speed at impact. Rotation of the trunk and shoulders

tion of this sequencing is the `summationof speed'         in the backhand not only increases the distance over

principle. This concept suggests that the speed of the     which the racket can generate speed but also adds

distal end of a linked sequence (theracket) is built       another segment to the total movement (the trunk)

up by summing the individual speeds of all segments        that if coordinated with upper limb movements can

participating in this sequence, although the prin-         assist in building racket speed.

ciple does not provide a mechanical explanation of

how this is achieved. It is generally believed that joint     In the serve, a `legdrive' and `bodyrotation',just to

rotational speed data provide the clearest descrip-        name two segments,are essential features of stroke

tion of proximal-to-distal sequencing.Furthermore,         technique. Most coaching texts include a section that

these data enable coaches to visualize a movement,         deals with the flow or summation effect in the service

as motion is generally characterized as a series of        action (as shown below),which leads to optimal

coordinated segment rotations. Figure 1.3shows             racket speed at impact.

how these joint rotations influence segment end

                                                           Leg drive + Trunk rotation + Upper arm elevation +



                                                           Forearm extension + Upper arm internal rotation,



                                                           forearm pronation and hand flexion



                                                           The role of muscle strength and endurance



                                                           The relationship between selected physical capacities

                                                           such as muscle strength and performance is relatively

                                                           easy to assess in sports such as weightlifting. How-

                                                           ever, such a relationship is very difficult to quantify in

                                                           tennis. Varied relationships have been found between

                                                           muscle strength and serving speed (Ellenbecker 1989),

                                                           although more recently Kleinoder (1990) showed

                                                           that a specifically designed exercise programme can

                                                           improve racket speed. A prospective study by Elliott

                                                           et al. (1990)was not able to predict with any certainty

                                                           those physiological (fitness) or kinanthropometric

                                                           (physical capacities)variables that would allow

                                                           superior tennis performance to be identified for

                                                           11-,13-and 15-years-olds. Players must obviously

                                                        External rotation                  BIOMECHANICS 5



                                                        Abduction/flexion             A Upper arm rotation

                                                                                      rn Upper arm abduction/flexion

                                         "Flo           Forearm supination            A Forearm flexionlextension

                                                        Forearm flexion               0 Forearm pronationlsupination

                                                        Palrnar flexion

                                                        Radial flexion                o Hand palmarlflexion



                                                                                      0 Hand radiallulnar flexion



                                          "I            Internal rotation             L

                                                        Forearm pronation

                                         2 -151         Forearm extension



                                                        Palmar extension

                                                        Ulnar flexion



                                         t-20

Fig. 1.3 Summation of segment            -25 I          I     I             I         I      I  I

velocities (speed)in the tennis

                                         -0.25          -0.2  -0.15         -0.1      -0.05  0  0.05



forehand. (From Takahashi et al. 1996.)                                     Time (s)



Fig. 1.4 The backswing position in the backhand drive.        develop sufficient muscle strength and endurance to

                                                              perform effectively in a long match. An increase in

                                                              muscle strength means that a lesser ptmentage of total

                                                              strength is needed for each movement, whirh may

                                                              assist in the ability to repeat the performance and

                                                              protect the body from injury. Strength development is

                                                              certainly needed for instanre i n the shoulder region,

                                                              not only to produre the high upper arm rotational

                                                              values for stroke production but also to protect the

                                                              region froni injury.



                                                              The role of equipment design



                                                              Redriers arr' referred to the chapter on the tennis racket

                                                                                         how changes in tiesign and string

                                                                                        stimpart ball 5pec.d.



                                                              Margin for error and rally speed



                                                              An understanding of the concept of 'margins of error'

                                                              is essential for any coach attempting to develop

6 CHAPTER 1



Table 1.1 Error margins for a groundstroke                 Table 1.2 Error margins for a service hit at

hit with different levels of spin and speed.               varying heights and speeds. (Modified from

(Modified from Brody 1987.)                                Brody 1987.)



          80 km.h-'  108 km.h-l               120 km.h-'   Height               108 km.h-'  145 km.h-' 180 km.h-'

          (50 mph)   (67 mph)                 (75 mph)                          (67 mph)    (90 mph) (112 mph)



-          9.0"            - __               2.00                                          _ __ . . ~ _

           5.0'                               0.0"

No spin   10.5'      3.4"                                  2.03 m (80 inches) 1.9           0.6              0.0

Backspin                                      4.0"         2.54 m (100 inches) 2.6

Topspin              1.20                                  3.05 m (120 inches) 3.5          1.4              0.8



                     5.8"                                                                   2.1              1.6



Approximate values for waist-height impacts.               Approximate values for a flat service technique.



high-performance players. Brody (1987) provides            Horizontal errors and bail speed in groundstrokes

a very comprehensive coverage of this and other

tennis topics.                                             Although many coaches emphasize stance as a key

                                                           determinant in postimpact ball direction, the real

Spin and rally speed                                       factors that must be considered are: the angle of the

                                                           racket face and direction of the racket speed. Stance

Many players who are capable of rallying at a given        of course may affect both these factors. The poorer a

level often experience a loss of control when              player's timing the larger the angular error. If a ball

attempting to hit the ball harder or when required to      leaves the strings at an angle of 6.5"from its aimed

rally with a better player. The vertical error margin      direction, it will end up approximately 2.75 m

(the difference in the angle the ball leaves the racket    horizontally (at the baseline] away from the point at

for a shot that will just clear the net to the one that    which it was aimed (Brody 1987).Table 1.3clearly

clears the net easily and lands on the baseline) is        shows that the effect of horizontal angular error (error

reduced as ball speed increases (Table 1.1)(Brody          in racket angle compared to aiming point) decreases

1987).Backspin also reduces this margin for error,         as a function of racket speed. However, it is important

particularly if a player hits the ball with 'power',       for coaches to also understand that the differences

while topspin increases the margin for error. The          at high speeds are not as large as those in the lower

relative importance of topspin increases for an            range. Therefore, if blocking a return of service (close

increase in ball speed.                                    to 0 m+-l racket speed),aim more for the central



Success as afunction of height in the serve                Table 1.3 Horizontal angular error as a                &0

                                                           function of racket speed. (Modified from

It is evident from Table 1 . 2 that if a player wishes to  Brody 1987.)                                           !I:

develop a high-speed service, it is also necessary to

impact the ball as high as possible from the court,                                                                a-

A near fully extended body and a good 'leg drive'

such that the body is off the ground at impact will        Racket speed (m+-')                   Angle of deviation (")

obviously enhance service technique. For instance a

ball hit 2.03 m from the court's surface has no chance       ( O ft's-')                                                   -~

of success if hit at 180 km.h-l. Brody (1987) also         9 (30 ft.s-')

demonstrated through computer simulation that              18(60 f t d )                         20.0

success rate improved if the ball was hit with some        27 (90 ft.s-')                         8.0

forward rotation (usuallya combination of topspin                                                 5.8

and sidespin).                                                                                    4.0



                                                           Approximate values for a preimpact ball angle of 20" to the

                                                           racket direction at a speed of 18 m s-l (40 mphl.

                                                            BIOMECHANICS 7



region of the court, and if attempting a passing shot       falling 1.2 m. In this situation the player has to contact

always swing at the speed `grooved during practice'.        a target moving at approximately 5 m.s-l.

A lower speed (often mistakenly adopted to improve

accuracy) will increase the effect of any error in the      The swing to impact

angle the ball leaves the racket and often leads to the

ball landing out of court.                                  Although coaching books provide guidance, weight

                                                            distribution, along with the initial positioning of the

Stroke production                                           feet, tends to be modified by personal preference.

                                                            During the backswing the body weight initially moves

This section reviews the scientific literature with         back, then forwards such that at contact the vertical

reference to the key mechanical factors in effective        line from the centre of gravity (the hips) is approxim-

stroke production. The need to present general              ately 25 cm and 40 cm forwards of the front toe in the

mechanical principles to beginners (in an appropriate       flat and slice serves,respectively.

manner) and certainly to college-age students or

above, has been shown to be beneficial to learning.           What movements then drive the hitting shoulder

For a comprehensive understanding of stroke tech-           forwards and upwards for impact? Different serving

nique this section must be read in conjunction with         techniques, with reference to movement of the feet,

the coaching literature. Specific conclusions will be       produce different mechanical characteristics(Elliott

drawn from the literature where this is possible;           &Wood 1983).

however, coaching theory based on subjective opinion

will not be included.                                          The foot-up style: this technique produces greater

                                                            vertical forces over time, which results in a higher

The serve                                                   impact position and a better up-and-outracket

                                                            trajectory when compared to the foot-back style.

The service action is not only the most studied stroke

in tennis but is also the most strenuous, and as such a        The foot-back style: this technique produces larger

sound biomechanical basis is critical to performance.       horizontal forces during the drive phase than the

Coaches must pay specific attention to the physical         foot-up style and may thereforebe more conducive

characteristics of the player, along with the key           to rapid movement to the net, following the serve.

mechanical features needed to develop a rhythmic

action. Because of the complexity of the shot, the            Players may choose either style and then con-

key mechanical factors in the service action will be        centrate on eliminating weaknesses and enhancing

presented under separate headings.                          strengths of each technique. An efficient service action

                                                            was characterizedby negligible side-to-sideforces,

TPIe ball toss                                              and small forward forces during the preparatory

                                                            phase (vanGheluwe & Hebbelinck 1986).Vertical

The height the ball should be `pushed'using the             forces should be such that the body is `driven off the

`straight forwards and up' or the `rotary style' is the     ground' for impact (Elliott & Wood 1983;van Gheluwe

first service skill to be mastered. An analysis of players  & Hebbelinck 1986).This lower limb drive, together

at the Atlanta Olympics showed that the toss was            with trunk rotation (Fig. 1.5a-d), then produce a

positioned such that it was in front and marginally to      forward speed of the shoulder that represents

the left of the front foot at impact (Chow et d.1999).      approximately 10-20% of the racket speed at impact

High-speed photography has been used to show that           for high-performance players (Elliott et d.1986,1995;

many elite performers impact the ball after it has          van Gheluwe & Hebbelinck 1986).As the lower limb

begun to drop (2.5-20.0 cm). It has been calculated         action also drives the racket `downbehind the back'

that when impact occurs at the top of its flight, a         this movement together with trunk rotation (to drive

player has eight times the amount of time to contact        the racket away from the body) are key mechanical

the ball (stationaryball) than when the ball is hit after   characteristicsof the service action.



                                                              Research has very recently supported a commonly

                                                            held view by coaches on the role of trunk rotation in

                                                            the serve (Bahamonde2000). Trunk rotations in the

                                                            three planes are observed i n the period prior to impact.

- \-I  -



1-1



     Fig. 1.5 The service forwardswing to impact.



---

[Cuối tài liệu]

                                                             I N D E X 313



    sweetspot 32                                                 modern testing techniques 35-6

    testing 131-4                                                moment of inertia 32-3,35

 practice                                                        node 29,30-1

    with distractions present 287

   fluid intake 70-1                                             power 32

   under pressure 283                                               longitudinal distribution 33

 prehabilitation 150,264                                            point of maximum 36

    shoulder 274

   young tennis players 142-5                                    role in tennis elbow 237-9

   see also rehabilitation                                       size, tennis elbow and 238

 preparation, early 2                                            speed

 pre-participation medical screening 297

 pre-participation profiling 124-38,150                            error margins and 6-7

   fitness-testing protocol 125-37

   goals 124-5                                                     generation 2-5

   for training programme design 137-8                           strings see strings

   young tennis players 142-3                                    swingweight 33

pre-patellar bursitis 201                                        weight 33

primary health care providers (PHCPs] 94, 296,297,298

   facilities and equipment 95,298                                 tennis elbow and 238

   injury evaluation 300-1                                       young tennis players 141

   player confidentiality 301                                 radial deviation exercise 122

   player treatment 298-300                                   radial nerve 233

   support function 301                                         compression 242

prone horizontal abduction exercise 118                      radiocarpal ligaments 223

proprioceptive feedback exercises 143,145                    radiographs

proprioceptive neuromuscular facilitation (PNF) 273,275         ankle injuries 166,174

protein                                                         hand and wrist injuries 224-5

   dietary intake 56,57                                         knee problems 195

   as energy source 56                                          shoulder injuries 251,255

   metabolism 48                                             Rafter, Patrick 278

   use, effects of training 56-7                             range of motion (ROM)exercises

pseudo-anaemia, dilutional 87-8                                 in knee rehabilitation 275, 276

pseudo-spondylolisthesis 213                                    in shoulder rehabilitation 272-3

psychological support 301                                    Reagan Shuck test 228,229

psychology 278-90                                            rebound coefficient 2

pump bump 155-6                                              records, medical 301

push-ups 135-6,142                                           rehabilitation 262-77

   wall 144                                                     acute phase 263-4

pyruvate 47,48                                                  closed-chain see closed-chain rehabilitation

                                                                functional phase 264

Qangle 195,196                                                  hip in leg injuries 266,267

quadriceps 104                                                  kinetic chain integration 264-5

                                                                in knee injuries 275-7

   isokinetic strength testing 137                              making diagnosis 262-3

  stork stretch exercise 104                                    phases 263-4

  strength training 195,196                                     plyometric exercises 269-71,272

  tendinopathy and tears 198-9                                  recovery phase 264

                                                                scapula in arm injuries 266

racket 29-38                                                    setting goals 262

  ball speed and see ball, speed                                in shoulder injuries 260,272-5

  centre of mass (CM)(balance point] 30, 32,33                  in tennis elbow 240

  centre of percussion (COP) 29,30,237                          see also prehabilitation

  coefficient of restitution see coefficient of restitution  relaxation 282

  errors and 36-7                                               on-court tips 282-3

  face angle 6,13                                               progressive 282

  frame 29                                                      response 282

     stiffness 35                                            relocation test 255

     vibrations 30-1,237-8,239-40                            repetition maximum (RM) 121-3

  head                                                       research 294-5

     additional weight at 33                                 resistance stress test 235

     impact locations 36-7                                   resistance training 116,117-18

     size 32,240                                                in rehabilitation 270-1

  materials 29                                               respiration, cellular 48

     tennis elbow and 238                                    respiratory disorders 82-5

                                                             respiratory exchange ratio (RER) 49

                                                             respiratory tract infections, viral upper 83-4

                                                             restringing, racket 35

                                                             retinal detachment 78

 314 I N D E X                                  serotonin 63

                                                serratus anterior muscle 122

 retrocalcaneal bursitis 155-6                  serve 7-10

 return of serve 10-11

 reverse medicine ball toss 132                    backswing 3 , 4

 rhinitis 82-3                                     ball toss 7,210-11

 RICE principle 166                                elbow hyperextension 244,245

 right ventricular dysplasia 82                    error margins 6

 Rh4 see repetition maximum                        follow-through 10

 roll moment of inertia 32-3                       lower extremity problems and 156, 176

 rooms, allocating 101                             mechanical model 25

 rotary torso machine exercise 1 1 1 , 1 1 2       racket trajectory prior/after impact 9-10

 rotator cuff                                      return of 10-11

                                                   routines 286-7

    assessment 251,255                             shoulder instability 254

    exercises 117,118,252,268                      speed, racket and 36

    injuries (tendinitis) 250-3                    spinal injury prevention 217

                                                   spinal strain 207,208,209-11

       evaluation 151                              summation of segment velocities 4

       pathophysiology 248-9                       swing to impact 7-9

       in senior players 260                       tennis elbow and 234,237

       surgical treatment 252-3,257,258            valgus stress on elbow 9, 242,243

      symptoms 250-1                               wrist movement 9,223

      tears 257, 258,259                        sesamoid dysfunction 161-2

      treatment 251-2                           sex differences

    surgical repair 253                            electrolyte losses 66

 routines, using 286-7                             spine injuries 213

 run, 1.5-mile(2.4-km) 127                         sweating rates 66

 runner's knee 201,202                             tennis elbow 236

 running                                           see also female tennis players

   biomechanics 41,42                           Sexias, Vic 282

   injury mechanisms 42                         `shin splints' 177, 179

                                                shirt, changing wet 71

 sacroiliac joints 206                          shoes 39-44

 salt intake 60,68-9, 72-3                         with flexible soles 176,177

                                                   hallux valgus and 162-3

   during play 71                                 high-topped 44

   postmatch 72                                   injury aspects 39-43, 176, 186

   prematch 70                                    inserts 156-7

   see nlso sodium                                modifications 43-4

 Sampras, Pete 278,289                            in nerve entrapments 161

Sanchez-Vicario, Arantxa 278                      performance aspects 43

Sanex WTA Tour 294                                poor fitting 155,164,176

   medical services 94-5,296-7                    posterior heel pain and 155,156

   pre-participation medical screening 297        with stiff soles 159,163

saphenous nerve entrapment 160                  shoulder

scapula                                           arthrokinematics 273

   exercises 117-20                               arthroplasty, total 260

                                                  capsularlaxity 258-9

      in rehabilitation 251-2, 266,268, 273       capsular tears 259-60

   function 266                                   capsulolabral reconstruction 258, 259

   position 117                                   extension exercise 118

   in rotator cuff injuries 251                   external rotators 116,118,119

scapular slide test, lateral 116                  injuries 248-60

Scheuermann's disease 220

Schmorl'snodes 216                                   in adolescent players 249

scoliosis 216,220                                    in adult players 249-60

scuba diving 99                                      pathophysiology 248-9

seated row exercise 117, 219                         postoperative management 260

seizures 76                                          rehabilitation 266,268-9, 272-5

selenium sulphide 91                                 in senior players 260

Seles, Monica 278,283                             instability 254-60

self-monitoring 288                                  in adolescent players 249

self-talk 287-90                                     conservative treatment 255-6

   effectiveness 28 7- 8                             indications for surgery 256

   methods of using 288                              physical examination 255

   negative and positive 289

  techniques for improving 288-90

semimembranosis bursa problems 202

senior tennis players see older tennis players

                                                          I N D E X 315



       postoperative management 260                        spastic colon 86

       surgical procedures 256-60                          specialist physicians 297

       type1 258                                           specificity principle 116

       type 11 258-60                                      spectacles 78

    internal impingement 254,257,258                       spectators 297

    internal rotation, limited 114,140, 251                speed

    internal rotators 116

    joint see glenohumeral joint                              ball see ball(s),speed

    movements                                                 testing 127-34

       approach shot 2 1                                      training 107-8,109

       backhand 14,18                                      spider test 130-1

       forehand 11,13                                      spin 6

       serve 9                                                see also backspin; topspin

       volley 19-20                                        spinal canal stenosis 213, 215

    muscular imbalances 115-16,140                         spinal twist stretch 114

    press exercise 120                                     spine

    range of motion, young tennis players 140,141             biomechanical strain 207-11

    rotation                                                 congenital malformation 220,221

      flexibility testing 126-7                              flexors and extensors 204,205

      isokinetic strength testing 137                        functional anatomy 204-7

   shrug exercise 119                                        functional unit 204

   strength and endurance exercises 117-18, 144              injuries 204-21

   stretch exercises 114-15

   `tennis' 117                                                 epidemiology 212-13

 shoulder blade see scapula                                     medical check-up 220-1

 sidelying external rotation exercise 118                       pathology 213-16

side-shuffle movement                                           prevention 110-14,216-17

   biomechanics 41,42,176                                       rehabilitation 216-17

   injury mechanisms 42,43                                      treatment 217-20

sideways shuffle test 130                                    manipulation 217-19

sinusitis 83, 99                                             mobility 205-6, 207

sinus tarsi syndrome 1 7 2 , 1 7 4                           tennis 213-16

sit and reach test 125-6                                  splinting

sit-ups 135                                                  night 156

skill acquisition, young tennis players 141-2                wrist 232

skin                                                      spondylolisthesis 215-16

   bloodflow 67                                           spondylolysis 215-16

   cancer 90                                              spondylosis,lumbar 213-15

   disorders 88-90                                        sport bars 58,60

   fungal infections 91,98-9                              sports anaemia 87-8

   premature ageing 90                                    sports drinks

SLAP (superior labmm anterior-posterior) lesions 257,258     carbohydrate-electrolyte see carbohydrate-electrolyte

sleep 98,100,101

sleeping tablets 100,101                                          drinks

sleep-wake cycle 9 7 , ~                                     postmatch 60

sliding, surfaces permitting 43,44

slow down, between points 282                                prematch 70

smash, overhead 24                                        sports medicine trainers (SMTs) 94, 297,298

smog 84

smoking 100                                                  equipment and facilities 95,298

snacks                                                       injury evaluation 300-1

   during play 60                                            player confidentiality 301

   prematch 58, 70                                           player treatment 298-300

Society of Tennis Medicine and Science 294                   support function 301

sodium (Na'] 63,66                                        sprains 40

   deficit (hyponatraemia) 72-3                           squats 106,143

  foods containing 70                                     stance, one-legged 266, 267

  heat cramps and 68                                      staphylococcal skin infections 91

  intake see salt intake                                  steroids see corticosteroids

  losses in sweat 66                                      stitch in side 86

sodium bicarbonate 62                                     straight leg raise 275

                                                          strapping 299

sole heel pain (plantar fasciitis) 156-8                  strength

soleus muscle strain 179-80                                 isokinetic, testing 136-7

somersault service action 9                                 muscle



                                                               in stroke production 4-5

                                                               tennis elbow and 237

                                                               testing 134-6

                                                               young tennis players 140,141-2

 316 INDEX                                   subtalar joint

                                                chronic instability 172,173-4

 strength (continued)                           fusion 175

    training                                    sinus tarsi syndrome 174

       defined 104                              sprains 173

       in knee rehabilitation 276

       lower back and trunk 110- 4.23        subungual haematomas (tennistoe) 89,164

         218                                 sudden cardiac death 79,81,82

       lower body 104-6                      sugars 55

       physiological effects 52

       in rotator cuff injuries 252             metabolism 47

       in shoulder rehabilitation 273, 274      see also glucose

      in tennis elbow 240                    sulcus sign 255

      upper extremity 116-17                 summation of segment velocities (speed) 4 , s

      young tennis players 143               sun-related disorders 90,99

                                             sunscreens/sunblocks 90,91,99

 stress fractures 42                         superficial peroneal nerve entrapment 160

    female tennisplayers 93, 94, 159, 178    superman exercise 110

    foot and ankle 159-60                    suprachiasmatic nuclei 97

    hand and wrist 226,231                   suprascapularneuropathy 251,253-4

    lowerleg 178                             supraspinatus exercise 118

                                             supraspinatus tendon 250

 stretching 298, 300                           tears 257

    in Achilles tendinopathy 184            sural nerve entrapment 160

   lower body 103-4,202                      surfaces,playing 39-44,301

   in plantar fasciitis 156                    injury aspects 39-43, 176, 186

    in tennis elbow 240                        modifications 43-4

   trunk and lower back 114                    performance aspects 43

   upper extremity 114-15,231-2                tennis elbow and 239

                                            surgery, flying after 99

 stretch-shorten cycle 2-3                  sweating 65

 strings 33-5                                  electrolyte losses 66

                                               excessive 89

   ball dwell (contact) time 34                rates 65-6, 71

   elasticity 35                               salt intake and 60

   gut 34,35,239                            sweet spot 29,237

   plane stiffness (deformation) 34            power 32

   replacement frequency 35                    see olso centre of percussion

   synthetic 34,35,239                      swingweight 33

   tennis elbow and 238,239                 sympathetic activity 49

   tension 34-5                             syncope 80

                                            synovial plica syndrome 191-2

      tennis elbow and 238,239              synovitis 192

   vibrations 31,35

stroke production 1-26                      talus

   analysis 24-6                               fractures 168

                                               osteochondritis dissecans 171-2

      objective methods 26

      predictive methods 26                 taping 298

      subjective methods 24-6               tarsal tunnel syndrome 160-1

   approach shot 21-4                       technology 294

   backhand 14-19                           television monitors 298

   forehand 11-14                           temperature, body

   general mechanical factors 1-7

      generation of racket speed 2-5           diurnal variation 96-7

      grip firmness 2                          regulation see thermoregulation

      margin for error and rally speed      tendinitis 183,235

                                            tendinopathy 151,152,183,234-6

         5-7                                tendinosis 183

      time of ball contact 1                   angiofibroblastic 148

   return of serve 10-11                    tendon injuries

   serve 7-10                                  lower leg 179-85

   smash 24                                    mechanisms 42

   volley 19-21                                pathology 148-9

stroke technique                               terminology 183, 235

   changing 301                                wrist and hand 225-6

   choosing 1                               tennis elbow see lateral elbow tendinopathy and olso medial

   faulty, causing tennis elbow 234

subacromial bursa 252-3,258                         elbow tendinopathy

subacromial decompression 252-3, 258,259

subacromial impingement 253,258,259,262

subscapularis tendon 250,257

subscapular nerve 250

 tennis leg 152,179-80                                                                              INDEX 317

 tennis shoulder 117

 tennis spine 213-16                               young tennis players 143-5,293

 tennis toe 89,164                                 see also prehabilitation; rehabilitation; specific exercises

 tensile loading 264

 tension headache 75                                    and types of training

 teres minor tendon 116, 250                    travel 96-101

 testosterone, plasma 50                        traveller's diarrhoea 85,98

 thermoregulation 65                            Travelling Sports Medicine Fellow 297, 300

                                                treatment 298-300

    age effects 67-8

    heat acclimatization and 70                    on-court 299

    in hypohydration 67                            postmatch 300

 thirst 71                                         prematch 298-9

 Thompson's squeeze test 181, 182                  tables 298

 thoracic spine 207                             Trendelenburg posture 266,267

   injuries 213                                 triangular fibrocartilage complex (TFCC)injuries

   mobility 205,206

 thought stopping 288-9                                 228

 thrombosis, venous 99                          triceps 233

thrower's elbow see medial elbow tendinopathy

 tibia, stress fractures 178                       curl exercise 120

 tibial nerve entrapment 160-1                     tendinosis 245

tibial tubercle transfer 195,196                triglycerides 55

tibiotalar joint, chronic instability 1 7 2        medium-chain (MCTs) 61-2

time zones                                      triquetral hamate impingement 226

   acclimatization to changes 97-8              triquetrolunate ligament tears 228-9

   crossing 96-101                              trunk

tinea pedis 91                                    flexion and extension 109-10

tinnitus 76                                       injury prevention 110-14

toe                                               isokinetic strength testing 137

                                                  machine exercises 111,112

   hammer 164                                     movements, approach shot 22

   problems 161-4                                 muscles

   tennis 89,164

toenails                                             kinetic link 109

   fungal infection 91                               training 108-14

   ingrown 89                                     pain, evaluation 152

toilet break rules 293                            rotation 110

tooth care 99                                        backhand 14,17

topspin 6,36                                         forehand 11-12,13

   approach shot 21-2,234                            serve 7-9

   backhand 14-15                                 young tennis players 140

   forehand 11-12,13                           tryptophan 63

tournament physicians 94,296,297-8             tuhcups 157

   equipment and facilities 95, 298            20-yard (18-m)dash 1 2 8

   injury evaluation 300-1                     2.4-km (1.5-mile)run 127

   ITF policy 292, 293

   patient confidentiality 301                 ulnar artery, repetitive injury 230-1

tournaments 296                                ulnar carpal impingement 227-8

   injury evaluation 300-1                     ulnar deviation 223

  ITF involvement 291-4

  medical services 94-5, 297-8                    exercise 122

   player treatment 298-300                    u h a r nerve 233

  psychological support 301

traction apophysitis 139-40                       compression at elbow 244-5

training 103-23                                   compression at wrist 230

  effects on nutrient use 56-7                 ulnar neuritis 244-5

  frequency, young tennis players 140          ulnar shaft stress fractures 231

  kit 298                                      ulnar styloid carpal impingement 227-8

  lower body 103-8                             u h a r variance, positive 227, 228

  mid-section 108-14                           ulnar wrist pain 226

  physiological effects 51-2                   ultrasound therapy 217

  programme design 137-8                       United States Food Guide Pyramid 54

  spinal injury prevention 108,110-14, 217     United States Tennis Association (USTA)fitness testing

  upper body 114-23

                                                       protocol 124,125-37

                                               unweighting 3

                                               upperback exercises 116,117-20

                                               upper extremity



                                                 injuries

                                                    epidemiology 223

                                                    prevention 114-23

                                                    rehabilitation 266,268-9

318 INDEX                                              intoxication 72-3

                                                      see also fluid

upper extremity (continued)                         weights 270-1

   movements                                        wheelchair tennis 294

      approach shot 21                              Williams, Venus 278

      backhand 14,18                                Wolff-Parkinson-White syndrome 82

      forehand 13,14                                women's tennis 293

      serve 9,lO                                      see also female tennis players; Sanex WTA Tour: sex

   muscular imbalances 115-16

   training 114-23                                          differences

   see also elbow: forearm: hand; shoulder: wrist  wrist



upright row exercise 119                              anatomy and biomechanics 223-4

urine production 70                                   brace 224,231

                                                      curl extension exercise 120,121,122

vaccinations 98                                       curl flexion exercise 120,121,122

valgus stress overload syndrome 242-5                 dorsiflexion test 235

varicose veins 99                                     injuries 223-32

vasovagal reaction 80

vastus medialis, electrical stimulation 195              epidemiology 223

venous thrombosis 99                                     evaluation 224-5

ventilation, maximal voluntary 51                        neurovascular 230-1

vertebrae 204                                            return to play 231-2

                                                         tendon 225-6

   compression fractures 215                          movements 223

vertebral ring apophyses, abnormal 216                   approach shot 23

vertical jump 134                                        backhand 14,18,223

vibrations                                               forehand 11-12,13,223

                                                         serve 9,223

   dampeners 35,240                                      volley 20-1,223

   racket frame 30-1,237-8,239-40                     pain, ulnar 226

   role in tennis elbow 239-40                        strength and endurance exercises 117,119-20

   strings 31, 35                                     stress fractures 231

video photography 26                                  stretches 115, 231-2

viral gastroenteritis 85, 98                          ulnar deviation 223

viral upper respiratory tract infections 83-4      `writer's cramp' 233

vital capacity 51                                  WTA Tour see Sanex WTA Tour

vitamin C 63,64

                                                   X-rays see radiographs

vitamin E 63,64

                                                   young tennis players 139-45

vitamins 63-4                                         age eligibility rules 92,293

  B-complex 63                                        biomechanics and skill acquisition 141-2

                                                      burnout 92,293

vitreous, blood in 77-8                               fluid and electrolyte balance 66,69

VO,,,x 47, 50-1,52,82                                 heat tolerance 67-8

volley 19-21                                          injuries 139-40

                                                         causation 139

  backswing 19                                          epidemiology 139

   follow-through 2 1                                   treatment 140

   forwardswing to impact 19-21                       knee problems 194,200

  split step 19                                       lower extremity injuries 40,41

  wrist movement 20-1,223                             maladaptations 140-1

                                                      prehabilitation 142-5

warm-up exercise                                      shoulder injuries 249

  food and fluid intake 58, 70-1                      spine injuries 213

  injury prevention aspects 202,217

                                                   Zeifgebers 96

warts 92                                           zinc 63,66

`washerwoman's elbow' 233                          `zone,playing in the' 278, 279-80

wasp stings 89-90

water



  body, deficit 66-7,71

  intake



     duringplay 58-60, 71

     postmatch 72

     prematch 70