Tennis Racquets

Summer's here which in Australia means cricket, swimming and tennis.  Some useful info below about tennis racquets.  More to come next week on tennis injuries.

LB

 

Anatomy of a Racquet

The terminology used to describe a tennis racquet is pretty straightforward (see below).  A player tries to hit the ball with the sweet spot as this spot results in decreased vibration and increased force production.

Picture from: https://www.asme.org/engineering-topics/articles/design/a-racket-for-engineers

Great website for basics of tennis: http://www.tennis101.com/anatomyofthetennisracquet.htm

More detailed description of racquet. Picture from: http://blog.activepepper.com/finding-the-perfect-tennis-racquet/

Racquet Variables
There are many factors to consider when choosing a tennis racquet.  These include:

o   Length

o   Children play with small racquets

o   Adult racquets are approximately 27 inches long

o   Material

o   Racquets weigh between 230g unstrung and 350g strung

o   Originally made from wood, then aluminium, racquets today are made of composite mixes such as carbon fibre (graphite) and boron and Kevlar.

o   Racquet head size

o   Children play with smaller, modified racquet heads

o   The larger the head the less stiff the strings are, increasing the speed of the ball

o   The small the head, the more control over the ball the player has

o   Strings

o   The lower the string tension the more flexibility/less stiffness the racquet has, this increases the speed of the ball, but decreases control of the ball

o   The higher the string tension, the less flexibility/more stiffness the racquet will have, resulting in more control over the ball, but the ball tends to skim lower and slower over the net

o   The pattern of the strings can also affect the string tension

o   Tension on the strings varies between players; males average 230N and females 180N. 

o   Vibration dampners

o   These are used reduced vibration when the ball hits the racquet

o   Somewhat controversial, may reduce ‘feel’ of the ball as it hits the racquet

o   Grip size  

o   Influences grip strength on the racquet

o   The handle is octagonal to improve grip and comfort in the player’s hand

 

How to Hold A Racquet

The three most common grips are continential, eastern and western.  A player may change grips several times within a match depending on what shot they are hitting.  Best not to follow Jimmy Connors’ example below:

Picture from: http://www.theguardian.com/books/2013/jun/28/critical-eye-books-review-roundup

Below is an illustration of 6 different grips.

http://www.theguardian.com/lifeandstyle/2009/jun/28/tennis-learn-grips

Link to further explanation on each grip http://en.wikipedia.org/wiki/Grip_(tennis)

Subacromial Bursitis

Shoulder Bursitis

The shoulder is a ball and socket joint formed by the upper arm bone (humerus), shoulder blade (scapula) and the collar bone (clavicle).  These 3 bones are connected with a series of muscles, tendons and ligaments.  This allows a large range of movement, but at the expense of stability. 

 

Picture from: http://morphopedics.wikidot.com/shoulder-joint-instability-syndromes  

 

The shoulder moves in many directions:

·         forwards and backwards (flexion and extension)
·         towards and away from the body (adduction and abduction)
·         rotation (internal and external rotation) and
·         across the body and behind the body (horizontal adduction and abduction)

The main shoulder joint in the glenohumeral joint formed by the shoulder blade and arm bone, but it is important to assess the acromioclavicular joint and scapulothoracic joint in a person with shoulder pain.

Stability in the shoulder (glenohumeral joint) comes from muscular control, pressure within the joint and the labrum (lining) of the joint.  The rotator cuff muscles, infraspinatus, teres minor, supraspinatus and subscapularis, are the primary muscle stabilisers.  They help to hold the ball (head of humerus) in the socket (scapula), and also rotate the arm. 

 The shoulder joint also has a number of bursa – small fluid filled sacs designed to minimise friction between surfaces.  The subacromial bursa sits underneath the acromion of the scapula and above the tendon of supraspinatus.   

Bursitis is a painful inflammation of the bursa.  Subacromial bursitis is reported in up to 2% of upper limb pain in the general population[1].   Because the shoulder joint is already a small, confined space, any extra fluid such as swelling in this space often leads to impingement – when you lift your arm the bursa is pinched or impinged between the acromion (scapula) and the arm bone (humerus).  The supraspinatus tendon is also often irritated. 

There are many causes of bursitis, and often a multi-faceted treatment approach is needed.  The aims of treatment should be to improve shoulder posture and manage load on the shoulder to reduce pain and inflammation; and to optimise flexibility, control and strength for best biomechanics.

In the early stages hot or cold packs can help reduce pain as can resting from aggravating activities.  Massage and soft tissue treatment (trigger pointing, myofascial release, dry needling etc) are useful to improve flexibility around the shoulder joint and reduce impingement.  Patients should discuss pain relief (analgesia) and anti-inflammatories with their doctor or pharmacist.    

As pain settles, rehab increases with techniques (e.g. taping) and exercises focussed on:

·         improving range of movement

·         controlling the shoulder blade during posture and arm movement

·         restoring spinal flexibility

·         strengthening the rotator cuff

·         complex shoulder movements and tasks

·         returning to sport and/or work

Exercises should always be prescribed by a qualified physiotherapist.  You will find a range of exercises on the internet, but you need an individualised and progressive program to ensure a safe and successful recovery. 

Corticosteroid injections (CSI) can also be used if physiotherapy is not completely successful in reducing pain.  I personally think that CSI should be ultrasound guided to ensure accurate placement – see this link for a recent study that supports this http://europepmc.org/abstract/MED/23698243 .  Clinically patients often feel worse for a couple of days after the injection, possibly due to the increase in fluid volume in the area.  Rehab is essential after CSI to ensure the shoulder returns to full function and to prevent recurrence.   Bursitis usually responds to conservative management, although surgery can be performed to remove the bursa in chronic cases. 

 

References:

1.            Walker-Bone, K., et al., Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Care & Research, 2004. 51(4): p. 642-651.

 

Home-made Gadgets

Lately I've been reading Eric Orton's latest book - The Cool Impossible (TCI).  Eric rose to international fame after the release of the book Born to Run by Christopher McDougall.  Eric coached Chris to his first 50 mile ultramarathon after the author had given up hope of running again after numerous injuries.  More on that another time though... 

In TCI, Eric describes exercises using a stability disk or balance board and a slant board or wedge board.  http://www.runningwitheric.com/page/strength-equipment Both are designed to improve balance, coordination and leg strength. 

I've been wanting to make my own wedge board or decline board for a while, because it's such a great way to stretch calf muscles.  So with some very basic pictures from Eric's website and book and the decline board I had at work, I recruited my Dad's help to build my own balance board, slant board and decline board.

The boards are made from 16mm MDF (leftover from my brother's new kitchen, but available from most hardware shops).  The ball for the balance board is made from cutting a fence cap in half.  All boards are stuck together (very technical!) with wood glue and 20-30mm screws.  A few hours later and this is what you get:     

 
Slant Board
12.5cm x12.5cm square (5inch x 5 inch)
4.5cm (1.75inches) high

Balance Board
16cm (6.5inches) diameter
5cm (2 inches) high ball

Decline Board
Angle: 30deg
38cm (15inches) wide
33cm (13 inches) long
16cm (6 inches) high
Non slip mat for extra grip

Now to put them into practice.  Eric Orton has a range of suggested exercises. 
If you've got some spare time this holidays, why not have a go. 

LB



Disclaimer: These boards are not laboratory tested.  They are designed for home use only and for balance exercises or calf stretches.  Create and use at your own risk.  LucyBeumerSportsPhysiotherapy will not be held liable for any injury occurred during the making or use of such boards.   

 

M Phty (Sports) 2013

On Saturday I graduated with my Masters of Physiotherapy in the field of sport!  This year I went back to uni and studied my post-graduate Masters of Physiotherapy at the University of Queensland (UQ) because since I was about 13 all I've wanted to do was be a Sports Physio.  I chose to study full time and work part time so I could complete this course in 1 year.  Previously you have been able to complete the course part-time over 2 years.  Below is a recap of the year. 

 

The questions a lot of people have asked me are what does that mean and where does that get you.

Firstly I want to explain that completing your Masters in Physiotherapy (majoring in sport, or musculoskeletal physiotherapy) is completely different to studying a Masters of Physiotherapy Studies. 

Post Grad Masters in Physiotherapy Studies (MPhtySt): http://www.uq.edu.au/study/program.html?acad_prog=5267

A Masters in Physiotherapy Studies is essentially an accelerated Bachelor of Physiotherapy (B Phty) degree and to be honest I think it’s confusing to the general population and somewhat offensive to Masters of Physiotherapy graduates, to call this a Master’s degree.  To be accepted into this program, a student must have completed an approved bachelor degree or equivalent (other than physiotherapy) such as human movement studies, with a minimum GPA (varies year to year).  Prerequisite courses in human anatomy, human physiology, psychology and statistics are also required.  Over 2 years (6 semesters) the M PhtySt student learns the same as a B Phty student, with the addition of a larger research project.    

Post-Grad Masters in Physiotherapy (MPhty(sports)):  http://www.uq.edu.au/study/program.html?acad_prog=5221

At UQ you can choose to study a post-grad Masters in Physiotherapy in Sport or Musculoskeletal Physiotherapy.  The Sports program aims to provide advanced, specialised training in sports physiotherapy.  To qualify for this program the candidate must have a 4 year degree in physiotherapy (or equivalent), have at least 2 years full time clinical experience and submit a written application.

As I said earlier you can complete this course over 1 or 2 years (soon to be changing to a partly online course).  Australian students are also eligible for Commonwealth funded positions with HECS-HELP also available.  Once you have completed this course you are eligible to apply for the title of Sports Physiotherapist.  The Australian Physiotherapy Association (APA) use “titling” to recognise members with advanced expertise and experience in their relevant area of practice.  APA Titled physiotherapists are highly qualified physiotherapists with expert knowledge and skills in their area of practice. They undergo a rigorous selection process to ensure that they achieve and maintain exceptional standards of clinical experience and knowledge.  The APA Title serves as a professional mark of distinction.  Students who study a Masters of Physiotherapy Studies are not eligible for a title.   

      
Each semester has 3 subjects, see below:

PHTY 7101 - Advanced Studies in the Basic, Behavioural & Medical Sciences A
PHTY 7103 - Theory & Practice of Musculoskeletal Physiotherapy A
PHTY 7111 - The Scientific Basis of Advanced Therapeutic Exercise
PHTY 7018 – Directed Research Project
PHTY 7303 - Theory & Practice of Sports Physiotherapy
PHTY 7305 - Advanced Studies in Sports Science for Sports Physiotherapy

All subjects in first semester are shared between Musculoskeletal (Muskies) and Sports (Sporties) students.  Anatomy dissection (PHTY 7101) was definitely a highlight of semester 1.  Body donation is an extraordinary gift that allows many students at UQ the chance to learn anatomy and knowledge of the human body.  http://www.uq.edu.au/sbms/body-donor-program .  There is nothing like learning from the real thing and having the opportunity to work with the cadavers at UQ was an amazing experience and much more insightful then a textbook. 

Second semester sees two smaller groups form – Muskies and Sporties - and subjects become more specific and I enjoyed semester 2 much more because of this.  A lot of work is self-directed in this course which is both positive and negative.  It certainly teaches you to be motivated and organised, but there were times were some direction would have helped make an easier or smoother road to travel.    

2013 Sporties

 

Second semester also involves a group research project.  I was fortunate to be supervised by Associate Professor Kay Crossley and work with two other dedicated Masters students, Paul and Jennie.  We’re currently working on finalising our research paper “Exercise and Manual Therapy for Hip Osteoarthritis: A Systematic Review and Meta-Analysis” and hope to have this published next year.  Kay's guidance and encouragement made this seemingly unachievable and unending project possible and enjoyable.  I certainly have a better understanding of Level 1 evidence and the work that goes into preparing this.        

Jennie, me, Kay, Paul

This year I have grown as a person and as a physiotherapist.  Juggling full time study with part time work was certainly challenging.  You’ve got to be organised to attempt something like this.  For me that meant 2012 was a year of saving and planning.  This enabled me to focus on study this year.  I managed to work about 8 hours a week (Saturdays and Thursday nights) each semester and extra during the uni holidays.  Thanks to my boss Julie for being so flexible and allowing me to essentially take a year off!  There wasn’t much time for anything other than work, sleep, eat and study. 

While all adventures we attempt in life come with ups and downs, highlights and lowlights, overall, completing my Masters in Sports Physiotherapy was well and truly worth all the lack of sleep, disappointment, feelings of uselessness and self-doubt, tears, frustration and stress.  I don’t think anyone would say that this year has been easy.  I couldn’t have made it through each day at uni without Kylie and Jen – thanks for your support, friendship and teamwork this year.  I’ve made lifelong friends and can’t wait to see where this road takes us.

And finally as this starts to sound like an Oscar’s award speech, thanks to my family for your never-ending love and support (and all the editing of my assignments, being guinea pigs for my practice and sending me home with leftovers so I didn’t have to cook!)

Dad, me, Mum

 

Next year I’ll be working at Revive Ashgrove and Back2Balance Physiotherapy.  I’m looking forward to a new challenge at B2B and continuing my current work at Revive.  Having my Masters now opens doors to working at the Commonwealth and Olympic Games, with one of my goals being to get to the Gold Coast Comm Games in 2018.  It also means that I can follow an academic pathway (i.e. PhD) if I want to. 

LB

Melbourne Cricket Ground

The Melbourne Cricket Ground (MCG)

On Sunday (17/11/2013) I had the opportunity to attend Open Day at the MCG which was celebrating 175 years of the Melbourne Cricket Club (MCC).  The MCC was founded on 15^th November 1838 when five men agreed to form a cricket club in Melbourne.  The MCG itself was built 15 years later in 1853 and is colloquially known as the ‘G.  Over the last 160 years the MCG has hosted numerous sporting events, including cricket and Australian football (AFL), but also the Melbourne Olympics (1956) and Commonwealth Games (2006). 

With a capacity of 100,024 seats the atmosphere created in this stadium is intense, spine-tingling, dramatic, emotional, just ‘marvellous’ as Richie Benaud would say.  Being based in Brisbane I have only been to the MCG a handful of times, but it is always a memorable experience.  My favourite memory would have to be the finish of the women’s marathon in the 2006 Commonwealth Games when the late Australian Kerryn McCann entered the ‘G and  won against Kenyan Hellen Koskei  in a sprint finish in front of 90,000 cheering fans. 

So after a miserable week of cold, wet and windy weather, the weather and sporting gods brought out an almost perfect, sunny, 23 degree day for Open Day.  Guided tours of the MCG can be taken throughout the week, but  Open Day allowed the general public FREE access to a self-guided tour of one of the best sporting stadiums in the world.  Visitors were able to wander through the Long Room (normally limited to members) and the Committee Room, view the Cricket Nets, sit in the Cricket Viewing Rooms (very comfortable!), inspect the change rooms, medical facilities and press room, enjoy the view from the media centre and press box (one of the best seats in the house) and probably the highlight for many; walk or kick the footy on the hallowed MCG grass!

Open Day was certainly a popular event (thousands attended), and at times it felt a bit like you were in a cattle yard.  I would recommended the guided tour for those interested in seeing the MCG as the MCC guides are a wealth of knowledge and you are able to spend much more time in each area of the stadium.  The only thing you would miss out on is being able to walk on the field.      

The next big event at the MCG will be the Boxing Day Ashes Test match between Australia and England.  Hopefully by this time, the Aussies will be leading the series! 

Below are some photos from the day. 

LB

 

 

View of Melbourne’s sporting precinct from the Eureka Skydeck – 88 floors up.

 

View from the members dining room.

 

Just a few people on the field.

 

Bill Lawry Cricket Nets. 

 

Medical Rooms next to Players Change Rooms.

 

Statue of Australian sprinter Betty Cuthbert outside the MCG.

 

 

Injury Prevention

ANKLE SPRAINS

Ankle injuries are one of the most common injuries seen at sports medicine clinics.  Ankle sprains are the most common type of ankle injury, with injury predominantly involving the lateral ankle ligaments following a plantar flexion - inversion stress.   Ankle sprains are particularly prevalent in the sports of Australian Rules Football (AFL), basketball, soccer and netball (1).  Health care and socioeconomic costs associated with ankle sprains are significant both during initial management and post-injury.  Many people who have ankle sprains suffer from residual problems such as instability, weakness, activity restriction and osteoarthritis (2).    Injury prevention is thus pertinent to the athlete and society. 

RISK FACTORS

Risk factors can be classified as intrinsic or extrinsic.  Intrinsic factors are inherent to the athlete and can be modifiable (e.g. strength, flexibility, skill level) or non-modifiable (age, gender, genetics).  Extrinsic factors are not inherent to the athlete and include training load, equipment and the environment. 

Previous ankle injury has been shown, by a number of studies, to be a significant risk factor for recurrent ankle injuries (3).  A recent review of risk factors by Noronha et al., (2006) suggested that preliminary evidence shows reduced ankle dorsiflexion range of motion may increase the risk of ankle sprains.  This is supported by the research findings of Willems et al., (2005).

The literature is divided on other proposed risk factors including athlete height and weight, limb dominance, joint laxity, muscle strength, reaction times and postural sway (3). 

A small study by Beynnon (2001) found that women with increased tibial varum and calcaneal eversion range of motion are at greater risk of suffering ankle ligament injury, while men with talar tilt are at greater risk. 

Baumhauer et al., (1995) reported college athletes with greater plantar flexion strength and smaller dorsiflexor to plantar flexor strength ratios had an increased number of inversion ankle sprains.  The 2006 review by Noronha et al., suggested postural sway and proprioception may be predictors of ankle sprain, however the quality of the studies reviewed makes it difficult to draw conclusions. 

There is no evidence to suggest shoe type affects ankle injury rates in basketball.  However, in soccer there appears to be a relationship between cleats and playing surface, but this requires further research (4).

PREVENTATIVE STRATEGIES

The last Cochrane review of preventative measures against ankle sprains was published by Handoll et al., in 2001.  A number of studies had and have since investigated prophylactic ankle bracing or strapping and balance or proprioceptive training programs as preventive measures.  

There is now extensive evidence that both bracing and strapping decrease the incidence of ankle sprains.  These interventions appear most effective in those who have previously sprained an ankle and are important in preventing recurrent ankle sprains (5).  The financial and time costs of bracing versus strapping must be considered.   In the long term bracing is more economical than strapping (6)

There is strong evidence that balance training is effective in reducing the risk of ankle sprain.  Again this appears to be more effective in those with previous ankle sprains (7).  Typically balance training programs have focussed on single leg stance activities as well as utilising balance boards, foam pads, hopping and jumping tasks and technical training (McKeon & Mattacola, 2008). Balance programs have varied between studies and were implemented for between four weeks and two years.   There is no consensus on optimal length of training or the optimal time to implement a training program. 

A recent review by (8) suggests shoe type does not play an important role in injury prevention. 

PREVENTION PROGRAM

My recommendations are:

1)   For athletes who have never sprained an ankle, it would be the athlete’s choice to use an external ankle support. There is no harm in the athlete wearing a brace or strapping, so it may be beneficial to do so prophylactically.  For example, a club may implement compulsory bracing in an attempt to minimise time and money lost to injury. 

2)  All athletes who have had an ankle sprain within the last 2 years should use ankle strapping or bracing.  Two years after injury, injury risk appears to be similar to those who have never had a previous ankle sprain (7, 9) so after this time it would return to being the athlete’s choice. 

3)  Teams should implement a neuromuscular and balance program which would include education about injury mechanisms and technique, single leg stance tasks, balance board exercises and sports specific drills (10-12).   This would begin as an extensive training program during the pre-season.  It would then be reduced, but still continued during the competition season and could easily be directed within a standard training session. 

4)    All previous ankle sprains should be identified and treated as an important part of preventing recurrent ankle sprains.  Treatment should target the active stabilising system, which emphasis on sensorimotor control as well as dorsiflexion range of motion. 

LB REFERENCES

1. Fong D, Hong Y, Chan L. A systematic review on ankle injury and ankle sprain in sports. Sports Medicine. 2007;37(1).

2. Braun B. Effects of ankle sprain in a general clinic population 6 to 18 months after medical evaluation. Archives of Family Medicine. 1999;8.

3. Beynnon B, Murphy D, Alosa D. Predictive factors for lateral ankle sprains: a literature reviewq. Journal of Athletic Training 2002;37(4).

4. O'Connor AM, James IT. Association of lower limb injury with boot cleat design and playing surface in elite soccer. Foot and ankle clinics. 2013 06/;18(2):369-80.

5. McKeon P, Mattacola C. Interventions for the prevention of first time and recurrent ankle sprains. Clinics in Sports Medicine. 2008.

6. Chung-Wei C, Kimi U, Veerle M, Kerkhoffs G, van Tulder M. Economic evaluations of diagnostic tests, treatment and prevention for lateral ankle sprains: a systematic review. British Journal of Sports Medicine. 2012.

7. Bahr R, Lian Ø, Bahr IA. A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Scandinavian Journal of Medicine & Science in Sports. 1997;7(3):172-7.

8.Verhagen E, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. British Journal of Sports Medicine. 2010;44.

9. Beynnon B, Renstrom P, Alosa D, Baumhauer J, Vacek P. Ankle ligament injury risk factors: a prospective study of college athletes. Journal of Orthopaedic Research. 2001;19.

10. Petersen W, Braun C, Bock W, Schmidt K, Weimann A, Drescher W, et al. A controlled prospetive case control study of a prevention training program in female handball players: the German experience. Arch Orthop Trauma Surg. 2005;125.

11. Verhagan E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains. The American Journal of Sports Medicine. 2004;32(6).

12.Thacker A, Stroup D, Branche C, Gilchrist J, Goodman R, Weitman E. The prevention of ankle sprain in sports - a systematic review of the literature. The American Journal of Sports Medicine. 1999;27(6).