Category: Tips and Tricks

Doctor’s Tips for Tennis Players: Achilles Tendon Injuries

There you are – out on the tennis court playing in a tough match to clinch your USTA League season and advance to Mid-Atlantic League Regionals. You’re playing tough and your opponent is starting to catch fire too. They hit a burner down the line and you lunge for the ball when – bang – out of nowhere you start experiencing searing pain in the back of the leg.

Greetings USTA Mid- Atlantic members. My name is Dr. Blake Moore with Atlantic Orthopaedic Specialists in Virginia Beach, VA. What I’ve just described is injuries to the Achilles tendon – everything from tendonitis to the dreaded Achilles tendon rupture.

bruno-nascimento-149663-unsplash-resize

Tennis players should be aware of Achilles tendon injury types and treatment options. Photo by Bruno Nascimento on Unsplash

Tendonitis is a term that indicates an overuse phenomenon where the tendon becomes inflamed and irritated in an attempt to heal itself. When this occurs in the Achilles tendon it can cause pain with every step and significantly restrict extracurricular activities. Some people will even go on to develop a form of Achilles tendonitis which appears as small amounts of bone growth in the Achilles tendon that can be seen on x-ray. This typically occurs following a long duration of these symptoms. The most extreme of Achilles injuries is those who report an Achilles tendon rupture. A rupture is where the tendon actually “pops” and fails. Following this type of explosive injury there is commonly a notable gap, often palpable, where there was once a strong connection from the calf muscle to the heel bone where the Achilles inserts.

Tendon disorders comprise 30 to 50 percent of all activity related injuries.1 Yet, Achilles tendinopathy affects athletes, recreational exercisers and even inactive people.  Current research suggests that there is a significant correlation between the prevalence of Achilles tendonitis and those who suffer from other diseases such as obesity, hypertension, and steroid use.2

Now, I mentioned Achilles tendon ruptures. The Achilles tendon is the largest, strongest tendon in the body and is critical for climbing, running and explosive movements which you often use on the tennis court. It’s necessary for anything from serving a tennis ball to carrying groceries up the stairs. The Achilles tendon can rupture for multiple reasons including injuries, medications, or biomechanical malalignment, and typically occurs when the Achilles tendon is stretched in a traumatic fashion. Patients frequently report a sudden “pop” and a sensation of someone kicking them in the back of the leg with no one there.

What can be done for Achilles Injury? 

Achilles tendon ruptures can be treated either operatively or non-operatively if caught early and treated appropriately following time of injury. Non-operative treatment typically includes casting and physical therapy whereas surgical treatment aims to reattach the tendon and restore function. Many people are shocked to hear that research shows outcomes are essentially the same regardless of treatment plan. Recovery after an Achilles tendon rupture is possible! A recent study revealed that 70% of NFL, MLB and NBA players returned to participation in the following season after surgical treatment.3

Achilles tendon rupture - Symptoms and causes - Mayo Clinic

Photo courtesy of the Mayo Clinic

Most patients see a dramatic decrease in their symptoms following the completion of a conservative care protocol – treatments that avoid invasive measures. Many who experience Achilles tendonitis related symptoms improve with a home stretching program and 6-8 weeks of physical therapy once their acute symptoms subside.

It is not uncommon when I see patients with debilitating/severe symptoms for me to place patients in a walking boot with a heel lift to immobilize, and minimize the tension on the Achilles tendon. This can often decrease pain and discomfort and get patients back to activity such as tennis quicker.

For those who do not feel significant symptomatic relief there is evidence to suggest benefits from platelet rich plasma injections and extracorporeal shockwave therapy which is a non-surgical and non-invasive treatment that uses shock wave outside the body to stimulate healing.

As a last result, if all conservative efforts fail, there is an operative procedure that can be performed. Naturally, as with any operation this requires significant time away from tennis and downtime during recovery so it is avoided at all costs.

If you or someone on your tennis team or at your tennis club is suffering from nagging ankle pain or suffers a sudden injury, we at Atlantic Orthopaedic Specialists are here for you. Please email my Athletic Trainer, Riley Fontaine, MSAT, ATC, OTC at FontaineR@atlanticortho.com and we will be glad to get you an appointment!

Blake_Moore_AOSDr. Blake Moore is an Orthopaedic surgeon who specializes in foot and ankle injuries. He is a physician with Atlantic Orthopaedic Specialists in Virginia Beach, Va. AOS provides Athletic Trainers for several USTA Mid-Atlantic Regional, Sectional and other tennis events.

Resources
1. Nicola Maffulli, MS, MS, PhD, FRCS(orth), et al (2003). Types and epidemiology of Tendiopathy. Clin. Sports Med, 22, 675-692. 

2. Robert J. de Vos, MD (2010, January 13). Platelet-Rich plasma injection for chronic Achilles Tendinopathy. JAMA, volume 303, 142-149.

3. Trofa, David P., et al. “Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.” The American Journal of Sports Medicine (2017): 0363546517713001.)

Doctor’s Tips: Tennis Elbow

1 Comment

Hello USTA Mid-Atlantic Section members, Dr. Brad Carofino here from Atlantic Orthopaedic Specialists in Virginia Beach, VA! Today I wanted to take the opportunity to discuss something that could be all too common for some of you…Tennis Elbow! However, I also want to review treatment options for it that could speed up your recovery and return to play.

Tennis elbow, or Lateral Epicondylitis, in general terms, is a chronic degenerative overuse pathology that causes pain on the outside portion of the elbow. The muscles that extend the wrist, such as in hitting a backhand volley in tennis, can lead to a degenerative weakening or micro-tearing process of the tendon. The tendon becomes necrotic (dying) over extended periods of overuse…just like during long tournament weekends.

 
Best Treatment for Elbow pain: Tennis elbow Creekside Chiropractic

Photo courtesy of Creekside Performance Center

This overuse injury can snow-ball if athletes and patients don’t take proper
measures to stop the process and continue to overuse these wrist extensor muscles leading to further tendon injury.

A research article looked at a 13-year period of patient data and determined that the highest incidence of Tennis Elbow was among individuals aged 40 to 49 years, with 7.8 per 1,000 in male patients and 10.2 per 1,000 in female patients. The second highest incidence was from ages 50 to 59 years, with 7.0 per 1,000 in male patients and 6.7 per 1,000 in female patients.¹

Another interesting article noted that in regards to playing tennis, level of play, hours per day, and weight of racquets were directly related to ones’ possibility of acquiring tennis elbow. Also, athletes who were 40+ years of age and older who used a grip size of 4 3/8” or greater had a significantly greater chance of acquiring tennis elbow.²

When athletes or patients come to see me regarding tennis elbow I typically advise them of a few treatment options.

How to treat Tennis Elbow:

Above most, appropriate rest and recovery is the best thing someone can do as Tennis Elbow is an overuse injury. During a rest and recovery phase it is wise to perform Tennis Elbow stretches, wear a Tennis Elbow strap, and take oral over-the-counter anti-inflammatories for a brief stint.

If things still aren’t improving, I typically suggest seeing a Physical Therapist or Athletic Trainer to perform soft tissue therapies like massage, tool assisted soft tissue mobilization, ultrasound therapy, and even dry-needling.

If things still don’t turn around you could consider a cortisone injection. This option overall is a treatment that will eliminate pain, but is not shown to actually heal what is causing you pain.

If your elbow is still not responding to those treatment options, then some could consider performing surgery to debride the tendon of the necrotic tissue. As you can see, Tennis Elbow can linger for some time without resolution. The treatment algorithm is vast and sometimes cyclical. If you are having trouble with managing acute or chronic overuse Tennis Elbow, please call my Athletic Trainer, Brice Snyder, MSAT, ATC, OTC at 757-679-3407 to schedule an appointment.

 

Dr. Brad Carofino is an orthopaedic surgeon who specializes in shoulder, elbow and hand injuries. He is a physician with the Atlantic Orthopaedic Specialists in Virginia Beach, Va. AOS provides Athletic Trainers for several USTA Mid-Atlantic Regional, Sectional and other tennis events.

Resources
1. Sanders, T., Maradit Kremers, H., Bryan , A., Ransom, J., Smith, J., & Morrey , B. (2015, July). The Epidemiology and Health Care Burden of Tennis Elbow: A Population-Based Study. Am J Sports Med, 43(5), 1066-1071.

2. H. William Gruchow, P. D. (1979, July 1). An epidemiologic study of tennis elbow: Incidence, recurrence, and effectiveness of prevention strategies . The American Journal of Sports Medicine, 7(4), 234-238

A Coach’s Secret to Keeping New Players in the Game

By: Jeremy Carl

What is the easiest way to get any player new to tennis to keep playing?  Whether it’s beginner adults or 10 and under junior players, the ROGY Progression is without a doubt the best way.

For those unfamiliar, ROGY stands for Red, Orange, Green, Yellow – the color of the balls that can be used to teach kids and adult beginners in a more effective way. Red balls are the lowest compression and larger than the traditional yellow ball, meaning they don’t bounce as high and are easier to control. Orange balls have slightly higher compression than red balls and are the same size as yellow balls. The last step before traditional yellow balls is the green ball, which is similar to playing with a yellow ball but slows down the game and helps lengthen rallies through its lower compression.

I have really seen and experienced the benefits of using this progression in two ways:

Jeremy Carl

Jeremy Carl with his daughter accepting his USPTA Mid-Atlantic Pro of the Year Award in 2016. Photo: Mount Vernon Athletic Club

  1. My own seven-year-old daughter grew up using red balls since age three and half and is now loving playing orange ball level USTA tournaments
  2. Adults in beginner group classes learn how to
    rally from their first-ever tennis class by using red or orange balls from the get go

Here are the top reasons I’ve seen that make the USTA’s ROGY progression is so effective:

  • Helps Incorporate Fun Right Away – More than anything, my daughter loves playing the sport. A big reason for that is by using the ROGY progression throughout her learning process, she learned the sport through a game-based approach. She is not a fan of “drills.” (What kid is?) The only time she does like them is if she comes up with one herself.  Using red and orange balls have allowed her to rally and play games from an early age.
  • Helps Players Learn Situations in Tennis – Tennis is an open sport, and points develop in unexpected ways. However, sometimes lessons are too dependent on hitting in a closed environment, repeatedly hitting a forehand down the line for example.  Every world-class tennis player has learned how to play tennis as a game of situations, not as a game of perfection. Repetition is important but learning how to navigate points is also an extremely important skill to nurture. For example, you can coach players on ball recognition and making contact in the strike zone.

One game to develop these skills can be done by having an orange ball player at one baseline and a partner standing at the other baseline with a ball. The player with the ball tosses it to the other side of the court. Once the ball crosses the net, the player receiving the ball immediately calls out either “Defend,” “Hold,” or “Attack” and catches the ball between their waist and shoulder, slightly out in front of their body. If a player calls out the correct ball recognition and catches it in the strike zone, they get two points.  If a player just does one of the two, they get one point.  You can do this yourself when you go on court with a friend or if you are a coach, have teams compete against each other in class. Once they understand those two principles, you have the basis for learning about offensive, defensive and neutral court positioning.

  • Allows them to Practice Playing Front Court at an Early Age – One of the biggest coaching benefits of using the ROGY progression is that kids feel confident playing in the front court from an early age. They know the ball doesn’t hurt them even if it hits them, and it’s much easier to learn the correct footwork and volley form with the appropriate ball and court size. In the first TennisBASH my daughter played in, one of the first winning shots she hit in her doubles match was a volley winner at the net as the server’s partner. She did it with all the confidence in the world and with a split step before hitting the volley.
  • Helps Adults Enjoy Rallying Right Away – One of biggest themes I learned from completing the Adult Development PTR certification was that using orange or red balls are critical for early success of adults who are learning the game. It allows them to play a variety of rally games, learn footwork, contact point, ball recognition and other items through playing the game from the beginning, which they actually enjoy!

If you’re just starting out, ask about learning on red or orange balls. You won’t be disappointed.

  • Allows players to practice hitting shots with a purpose – Whether it be live ball drill, racket fed or hand toss drill, the balls allow kids to hit to a certain part of the court. Since the ball bounces at the appropriate height for their age, the ball can come to their optimal strike zone more easily, and therefore they can practice hitting down the line or crosscourt with correct swing path. This was one of the key principles I learned from being involved in the USTA Player Development National Early Development Camps.
  • Makes it Easier to Develop Proper Service Motion Early – One of the most important fundamentals on serve is swinging the racquet up toward the ball with full extension and rotating, regardless of a flat serve or spin serve.  When juniors use the appropriate color ball for their age, it gives them the confidence to hit through the ball since the balls actually weigh less.  This has made huge difference in my daughter learning the building blocks of the serve that allow her to play in USTA tournaments with confidence on her serve motion.
  • Helps Players Learn Proper Footwork – Studies have shown that players learning with this ball progression develop similar court footwork fundamentals to the pros. The appropriate size court helps build a foundation of footwork movement that they can develop as they grow bigger and taller.  It also helps them enjoy the movement of tennis because they’ll be able to reach more balls during a rally.

You want to get more people in the game of tennis? The answer is start off juniors or adults in the ROGY ball progression. Whether you’re a longtime coach or introducing the game to friends, or even getting yourself or your child in the game, using the proper ball can make a big difference in how much others enjoy playing tennis.

Look for red, orange and green balls in most places that sell tennis equipment. For more information on court sizes and ROGY progression in youth players, click here.

Jeremy Carl is a USPTA Elite Professional, PTR Professional and Safe Play-certified USTA High Performance Coach with Net Generation. He was named the 2016 USPTA Mid-Atlantic Pro of the Year and is currently coaching at Belle Haven Country Club after coaching at Mount Vernon Athletic Club in recent years.

Doctor Tips: Keeping Your Feet and Ankles Healthy

Hello USTA Mid-Atlantic! I’m Dr. Blake Moore at Atlantic Orthopaedic Specialists. I specialize in foot and ankle surgery for both acute injuries and chronic care. I work in Virginia Beach and see patients at both our Princess Anne and Camelot offices. My Athletic Trainer, Riley Fontaine, MSAT, ATC, OTC will be available at USTA MAS events across the greater Hampton Roads area for consultation and appointment scheduling if you experience an injury and need further care.

I wish to offer some advice to keep you in the game not only today, but for many years to come. There are a number of different structures in the foot and ankle that can lead to daily discomfort and even debilitating pain. For anyone who has experienced this type of pain you know that it can affect your daily life and extend to your game play as well. Among the various conditions that can affect one’s foot and ankle, tennis players are at an increased risk to sustain an ankle sprain due to the constant demands of the sport including lateral movement, cutting and twisting.

Recent sports literature suggests that ankle sprains are the most common injury suffered during sports participation. With appropriate treatment the vast majority of these injuries go on to heal themselves. If left untreated, and repeat incidents occur, some athletes go on to develop chronic ankle instability, where the ankle is no longer able to support the body as its virgin status once could. If you’ve experienced one of these injuries, here is what you should know.

Prevention of a primary incident or rehabilitation to prevent a secondary event is thought to be the key to decrease the rate of recurrence in most cases. Ankle sprain prevention programs that include proprioceptive exercises, isolated single leg strengthening and balance activities have been shown to decrease the risk of sustaining a repeat ankle sprain. An ankle sprain, regardless of severity, affects the ligaments that stabilize your ankle. Proper treatment and gradual/monitored return to sport, increase the chances of a long, healthy and successful career.

Click here to watch Dr. Moore demonstrate what severe ligament ankle damage looks like. 

With those tips in mind we hope you have a healthy and successful career. If you sustain an injury to the foot or ankle we would be happy to treat you and team up to safely return you to play. Please feel free to schedule an appointment by contacting Ceil Scarano at (757) 321-3307, or visit www.atlanticortho.com for more information.

Keeping your Knees Healthy

Hello USTA Mid-Atlantic! I’m Dr. Bradley Butkovich at Atlantic Orthopaedic Specialists. I specialize in Sports Medicine and Arthroscopy and see patients at our Kempsville and Depaul offices. I am the Team Physician for Old Dominion University and work with all athletes including ODU’s Men’s and Women’s Tennis Teams. My Athletic Trainer, Jonathan Hartman, MSAT, ATC will be available at USTA MAS events in the Virginia Beach area for consultation and appointment scheduling if you experience an injury on the court.

Today I wanted to discuss “knee health” and give you some tips to help keep you on the court! Tennis requires you to be quick on your feet to keep the ball in play. All of the constant back-and-forth, quick turns, and other moves mean that your knees are constantly being twisted, turned and pounded on.

As a tennis player it is very important to protect your knees and prevent knee pain and problems. Always warm up before a match, and cool down afterward. It is crucial to have a good stretching program to be performed before and after activity. Play within your limits, and ease back into play if you haven’t played in while. Strengthen the muscles around your knee and in your legs to offer better support and protection for your knees. Exercises that focus on quadriceps, hamstrings and core are all very important in injury prevention.

If you have an injury, take a break from tennis and allow the knee to heal. Ice the knee regularly to ease pain and inflammation, and keep the knee elevated to manage swelling. The use of a knee sleeve can help keep the knee warm and has proprioceptive properties that can help to support the knee. Anti-inflammatory medications such as Aleve, Advil or Ibuprofen, can help to manage your pain and swelling. If you are having persistent swelling, pain, locking, clicking or catching then you may have a more serious knee joint problem and you should come see us in the office. Please feel free to schedule an appointment by contacting Renee Hart at (757) 321-3311, or visit www.atlanticortho.com for more information.