by Oliver Stephens, CTPS, MTPS
“Tennis Elbow” is an expression that we as tennis coaches and trainers hear on a regular basis.  There is a lot of information on this subject online and in some great books such as Tennis Anatomy (Roetert and Kovacs), Fit To Play Tennis (Peterson and Nittinger) and Tennis Training (Kovacs, Chandler and Chandler).

In fact, there may be so much DETAILED information available to us, that it may seem challenging to find a simple answer to the following questions:

1.      What exactly is Tennis Elbow?

2.      What makes it occur?

3.      How do we treat it?

So, here are the answers in a very simple form:

1.      What exactly is Tennis Elbow?  Tennis Elbow is sometimes called Lateral Epicondylitis.  It is pain on the outside area of the elbow.  Pain on the inside part of the area may be Medial Epicondylitis, or golfer's elbow.  Tennis Elbow is typically degeneration of the tendons that connect to certain muscles in the area (the muscle usually involved in this condition is the  extensor carpi radialis brevis).   {Remember, a tendon’s main purpose is to connect muscles to bone}.  When the tendons degenerate enough, this causes acute pain, particularly at the moment when someone is making contact with the ball, this is Tennis Elbow. 

2.      What makes tennis elbow occur?   Firstly, understand that tennis elbow is a long-term injury.  Younger players rarely have tennis elbow as it usually takes years to develop (at least 10 years).  The main culprit is incorrect technique on a one-handed backhand.  When recreational players “lead with the elbow” on the backhand for a number of years, then Lateral Epicondylitis occurs.  For this reason, you do not hear of high-level players with tennis elbow as they are all technically sound. 

3.      How do we treat Tennis Elbow?  The first way to treat any injury is of course, rest.  Taking a month or two away from tennis may have a big effect on pain levels and allow the tendons time to recover.  Also, making sure that the bio-mechanics of the backhand are correct will also have a positive effect.  Another commonly used method is to Strengthen the flexors and extensors of the forearms using light weights and to Stretch these same muscles on a regular basis.  I have also had students who have drastically reduced the string tension on their rackets and this has absorbed more of the vibration of the ball and has helped alleviate pain. 

This article is not intended to be a medical diagnosis or replace a visit to a P.T. or a Doctor.  However, I hope it can give you a simple understanding of what tennis elbow is and some of the common ways we can help our clients if they have this common affliction. 

By LaRue E. Cook
Certified Tennis Performance Specialist
Certified Strength and Conditioning Specialist
As I constantly remind ALL of my clients - whether they are tennis athletes wanting to improve their performance, or general fitness clients needing to improve their general health and fitness - “nothing in sports performance or general health and fitness is a straight-line progression!”  What I mean by this is that as humans, we might see great progress in what we do one day, and then see it all seemingly come crashing down the next.  Whether it’s in practice on the court, or training in the gym, each day is different, and poses a challenge even to elite athletes; it’s what being human is all about.  In tennis, this concept often smacks us right in the face as the shots we or our athletes made last week or even yesterday, seem elusive today.  The key to developing a player who can handle these ups and downs is to practice how we, as the player’s support system, also handle these swings in performance.  Here’s what I mean.

Whether it’s perfecting a player’s technical tennis skills, or improving their fitness and conditioning, there will always be peaks and valleys on the road to progress. This is something that coaches, trainers and parents should be aware of, accept, and learn how to use to affect a positive attitude in their tennis athlete.

Coaches, Trainers, and Parents of tennis athletes, have a very important role as that athlete’s support system and in how our athletes react to the ups and downs of tennis performance.  How we react to the ups and downs of tennis, and more importantly how we teach our athletes to deal with them, can make all the difference between ‘success’ and failure.

Staying positive and focusing on what’s going ‘right’ rather than always focusing on what needs improvement, what went wrong or what is missing, is vitally important to building an athlete’s confidence and encouraging them to strive for better.

Here’s one example of what I mean:  During a tennis match your player hits a deep approach shot, adeptly moves into the court positioning herself for a volley, anticipates her opponent’s passing shot attempt, and then badly misses the volley.  What do you see, and more importantly what do you react to?  Do you see, and focus on the great tactical play she made to put herself in position to make the volley?  Or, do you focus on, and react to, the missed volley?

Coaches, Trainers and Parents are teachers, motivators and leaders.  Your athlete picks-up on many of cues that they get from you, spoken or unspoken.  Slumped shoulders, that unmistakable look to the heavens, or a grimace can all signal ‘failure’ to a sensitive athlete, and can diminish their desire to take such ‘chances’ or employ such tactics in the future.

So, the next time you watch your athlete during play or training, try to see what went right.  Of course this doesn’t mean that you need to ignore the mistake, but instead that you use any setback as a learning experience, not as a source of negativity.  You will be amazed at how this simple change in focus and attitude will have a positive impact on your athlete, and spur them on to want to improve, and to take tactical chances in performance when they present themselves. So remember, teaching our athletes to be unafraid to take tactical risks and to focus more on the process rather than the results has a lot to do with our Reaction!

About the Author:  LaRue is a CTPS, CSCS and also holds specialty certifications as a Youth Conditioning Specialist. LaRue travels the US providing specialty training and programming to Country Clubs and other organizations, working with tennis players and other athletes providing one-on-one and team Strength and Conditioning and Post-Rehab training. LaRue also serves on the Board of Examiners for the National Board of Fitness Examiners.

Compiled by Alvaro Lopez Samanes, CTPS
Compiled by Oliver Statham CTPS
Compiled by Oliver Statham, CTPS
Information compiled by Oliver Statham, CTPS
by LaRue Cook, CTPS, Certified Strength and Conditioning Specialist

The tennis wall or backboard is an unbeatable opponent and tireless hitting ‘partner.’ In fact, when we compete against human opponents who get ball after ball back, we say that it was like hitting against a ‘human backboard!’

So, rather than dreading the thought of hitting against the wall - human or otherwise - you can actually use the wall to not only improve your game and hone your strokes, but also to improve your conditioning and your ability to outlast those ‘human walls.’ With the proper motivation, attitude and training, you can make this unbeatable foe a wonderful tennis conditioning buddy.  Here’s how I train my tennis fitness training clients using the wall.

Of course, first things first!  Always start with a proper warm-up (e.g. dynamic warm-up and a few easy strokes against the wall to warm-up).  Now you’re ready to PLAY!

Simulated Match Play

Start by playing out a tennis point against the wall.  Simulate a 20 - 30 second point by trying to keep a single ball in play for that entire time (hitting forehands and backhands).  Keep a few extra tennis balls in your pocket so that if you cannot keep the single ball in play for the designated time, you can take one out of your pocket and continue with minimal delay.  After hitting for the designated time, take a short break - simulating the time between points (e.g. 20 seconds or so), then begin again.  Continue this process for several points, alternating your hitting time from between 15-45 seconds, and your ‘rest’ time between points to anywhere from 5-20 seconds.  By using this type of ‘interval’ tennis conditioning session, you would begin to notice improved tennis-specific cardiovascular conditioning and be better prepared to meet, and beat, those human-wall opponents that seem to give us all a problem.

Let’s Bump-Up the Intensity

If you find that you want to up the intensity of your ‘wall workout’ session, you can do so by using a rubber medicine ball that bounces.  Use a ball weight between 2-8 pounds and throw it against the wall, alternating between forehands and backhands.  Stand close enough to the wall so that you can catch the ball on one bounce and don’t forget to move your feet as you alternate ‘strokes!”  Use both arms to throw and catch the ball. 

Because this is a much higher intensity exercise, limit your points to between 10-15 seconds until your conditioning and strength improves.  Also. as with any type of training, I highly recommend that you check with your physician to ensure that this type of training is appropriate for you before starting.

About the Author:  LaRue is a CTPS, CSCS and also holds specialty certifications as a Youth Conditioning Specialist. LaRue travels the US providing specialty training and programming to Country Clubs and other organizations, working with tennis players and other athletes providing one-on-one and team Strength and Conditioning and Post-Rehab training. LaRue also serves on the Board of Examiners for the National Board of Fitness Examiners.

Information Compiled by By Alvaro Lopez Samanes, CTPS
Information Compiled by Alvaro Lopez Samanes, CTPS
By Oliver Statham, CTPS,  iTPA Staff

Tennis is one of the most popular sports in the world with participation in more than 200 countries affiliated with the International Tennis Federation. Like many other sports, playing tennis places participants at risk of injury, and although many injuries that occur in tennis are common to other sports, tennis does have a unique profile of injuries. For example, there is no time limit in tennis, and so the players can be battling out on court for hours, producing hundreds of short, explosive bursts of energy. The aerobic and anaerobic requirements, combined with the variety of strokes and movements, induce a unique profile of injuries (figure 1). For the professional tennis player, the consequence of injury results in a lack of income and missed opportunities to gain and sometimes protect precious world ranking points in order to compete at the highest level. If the injury isn’t managed right, it may increase the servility of the injury or cause physiological changes from time off training that can take quite some time to regain (figure 2). On the other hand, a good rehabilitation presents a rear opportunity to review, recondition, and improve athleticism and general robustness. Treating injury as an opportunity is often a helpful mind-set to offer injured athletes as coaches navigate them through a difficult and uncertain period.

To begin the process of recovery, this article will firstly highlight the importance of an integrated approach to injury management for all support staff to ensure the best possible outcome is achieved, and then go on to provide some management strategies that should be incorporated during the design and progression stages of a rehabilitation program.

Planning the Process

When a player gets injured, it is of little use for him/her to start thinking about injury management because it will only lead to precious time lost and mistakes made through inadequate preparation. What is important at this time is the player's confidence in the plan of care as well as the performance team that puts the player at the heart of the rehabilitation process. This may involve:

·         Coach

·         Physician

·         Strength and Conditioner

·         Psychologist

·         Nutritionist

·         Physiotherapist, Chiropractor, Athletic trainer

Unless the player is a world-class professional or on a prestigious college tennis team, most players usually involve a few individuals; however, the one person who does not vary and should remain at the forefront of the management process is the player. Regardless of whom is involved as a member of the performance team, it is vital that the roles and responsibilities of each member are clarified and that they combine as a unified interdisciplinary team, not just a multidisciplinary team! This will prevent confusion from many separate opinions and outcomes, because many aspects of rehabilitation are interrelated and consequently there will be elements of crossover in terms of input at any given time. An interdisciplinary approach will ensure that there is no uncertainty among the performance team and promote the philosophy of a "One Athlete-One Program”.

Managing the diagnosis

Injures present a time of uncertainty and can be very disheartening. It is little wonder the first question usually asked by the player is 'how long until I can get back on court?' or 'do you think I'll be ready to play the ___ tournament?' At this point, the appointed health professional should manage the player's expectations while providing an accurate, realistic, positive answer. In which case the player should receive the following.

1.      A judgment that is not influenced by the pressures of those who stand to gain e.g. contracted practitioner’s attachment to the player’s on-court success.

2.      A correct diagnosis with discussions involving other practitioners in the team before providing narrow time lines to return to play.

3.      A best and worst case scenario along with a detailed explanation on what is involved before returning to court or competition.

4.      Be provided with a clear, criteria-driven program that includes input from all relevant members and accounts for external life priorities and pressures, and athletic capabilities that need to be developed.

But there is little point of the player knowing all this if he/she is not mentally ready to commit to the rehabilitation process. The next stage is for the player to gain a level of acceptance and desire to move forward. Usually the player's major barrier and source of anxiety is uncertainty, particularly in the diagnosis. It is therefore critical the explanation of the injury is explained fully and is understood by the athlete. This may involve multiple explanations to best suit the players learning style and for the information to be accepted. Adequate time needs to be given as well as opportunity for the player to ask questions.

Thinking in terms of abilities, not disabilities

A good rehabilitation program is drawn from an in-depth understanding of what body parts can be pushed, for how long, and why. This highlights the importance of developing a interdisciplinary approach as opposed to the traditional medial approach. The focus should not just be on what the player cannot do at this time; instead, emphasis should be placed on what the player can do. It is this approach that unites the coaching staff, athlete and strength and conditioner with the medical team so that the player can gain more out of the recovery stage.

Injury as an opportunity

Injury can offer an opportunity to review the player's capabilities as a whole, without merely focusing on the injury. A holistic approach at this time provides the opportunity to improve

·         Physical capacities (e.g. upper body strength, aerobic power)

·         Tactical awareness

·         Emotional and psychological resiliency

·         Movement efficiency

·         Injury profile

For these elements to be improved requires close communication between all involved in the interdisciplinary team on all components to meet the player’s needs without compromising rehabilitation outcomes.
Design and delivery

All of the above amounts to nothing if the practical elements (that is, the delivery of the rehabilitation program), lacks precision and effectiveness. All members involved in the performance team have essential roles and responsibilities in the planning and delivery of the rehabilitation process. The stages of rehabilitation are divided into staged phases of escalating demand (such as acute, low load, moderate load, high load and return to tennis sections). in conjunction with consideration to pre-habilitation once the athlete has returned to full function. The program format should be clear to all members involved with a structured pathway demonstrating where the player stands currently in the program and where he/she needs to be in order to move to the next stage. The progress stages of the program should also be manageable stepping-stones that ensure the player has a series of win. In order for a successful progression there needs to be close networking between the athlete and support team to determine what tennis-specific exercises concern the player.
Importance of periodising rehabilitation

Adaptation to an imposed demand requires both stimulus and recovery. We know and apply this principle when designing periodised training programs, and this should be the same for periodising rehabilitation, yet this is not always the case. For example, a player might be assigned a daily upper-body strength program in order to not load an injured knee, or extra running if the player has a shoulder injury. This type of approach that has not strategic, long-term view of loading may overwork the player and cause him or her to become stale when they return from injury. To avoid these types of continuously dreary and ineffective programs, start by estimating the return to play date and then work backwards, incorporating low-, medium-, and heavy- load weeks. This will ensure all bases are covered and before competition prevent the player from losing his competitive edge.

Importance of exit criteria

The progression stages of the rehabilitation program should be judged on achievement formulated, objective exit criteria. This will provide a clear direction of player’s recovery status and minimize the likelihood of inappropriate rehabilitation drills, sequencing, volume and loads. Doing so requires a good understanding of how the tissues functions and become stressed, and players technical and technical requirements. Developing a clear road map to recovery with definitive exit points allows the performance team to be more aggressive with the program, while having the confidence to know where the boundaries lie, and therefore reducing the risk to the athlete.

Another important point to note is that the rehabilitation stages should not be based on time, but rather achievement of functional competencies. Although there are certain healing times for particular injuries, the performance team should stay focusing on the achievement of functional goals rather than passing time. For example, the right-handed player may take 10 days to recover from a minor right ankle sprain, but he/she can't demonstrate competency in decelerating when recovering from an on the run forehand. It is much better to develop a return to play criteria for the athlete to satisfy rather than cross days off on a calendar. Lets say the player with the minor ankle sprain can start with drills that involve change of direction. Speed should only be incorporated once the player can do the drills slowly; the player can perform the drills slowly once he/she can decelerate; the player can decelerate once he or she can run; the player can run once he or she can hop; and so on. This competency-based approach to the rehabilitation stages ensures a logical and methodical flow to tissue loading to make sure the body is ready to handle the stresses of match play once returning to competition.

In summary:

1.      Teach players to have a perspective that injury is an opportunity to build on what they can do, not what they cant, which will improve recovery times and provide the opportunity to review and develop the player.

2.      The rehabilitation process must be carefully constructed with clear exit criteria at each stage to ensure a timely, holistic, and safe progression.

3.      A “champion team” will always beat a “team of champions”. The rehabilitation process should include input from the whole performance team and be delivered as one plane to the athlete, demonstrating unity, a clear direction, and purpose.