The physical therapist's role in the rehabilitation of tennis injuries is to evaluate and determine the nature and extent of the injury. The physical therapist then develops a treatment plan consisting of therapeutic modalities (such as hot and cold packs, ultrasound, and whirlpool) and exercise with the ultimate goal of returning the athlete to a level of conditioning at or above that which he or she had before the injury. To reach that goal, the following steps should be taken with the guidance of your physician and your physical therapist.

 

Protect the injured area

 

Avoid activities that aggravate the condition; use a cane or crutches when advised. Certain rehabilitative devices, such as braces, splints, corsets, slings, orthotics, and wraps, can reduce impact stress, provide compression and warmth, and support soft tissue structures (skin, ligaments, tendons, and muscles).

 

Decrease swelling, pain, and inflammation

 

Excessive swelling can slow down the healing process. Therapeutic methods consist of ice with compression, electrical stimulation, and massage with elevation and isometric contraction exercises. All of these create a muscle-pumping effect on the capillary system to move fluid away from the injury site. Pain and inflammation can be treated with ultrasound, heat, ice, and electrical stimulation. When resting, be sure to elevate the injured part and apply ice or heat and compression wraps as instructed.

 

Maintain and improve movement

 

Early movement of an injured part will help maintain the health of the cartilage within the joint. If the athlete cannot perform the movement because of pain, the physical therapist can assist by passively moving the joint (Fig. 1). It is also crucial to maintain overall flexibility, which can be achieved with a stretching program.

 

Increase muscular strength

 

This goal can be achieved only through active exercise; thus, the movement is performed by the athlete. There are several categories of active exercises and training programs. The physical therapist will choose the most effective program to build strength, power, and endurance, while keeping in mind the inherent demands of tennis.

 

Maintain cardiovascular endurance

 

Cardiovascular exercises, such as biking, walking, and stair climbing, can be incorporated to maintain cardiovascular endurance. Researchers have found that an athlete can improve physical conditioning daily by about 1%, but total inactivity causes a loss of 3% to 7% daily. Therefore, the longer the athlete remains inactive, the longer it will take to complete the rehabilitation program.

 

Improve balance

 

All injuries to the lower extremities (knee, leg, ankle, foot) result in some change in the body's ability to detect and control where the injured part is in space. Immobilization and not bearing weight normally on the injured part will also affect this ability, which is known as proprioception. Exercises that will improve balance and proprioception are standing on the injured leg only, walking a straight line, and balancing on a balance board.

 

Ensure progressive return to tennis

 

A gradual return is advised. Initially, that could include only hitting to half of the length of the court, simulating strokes without ball contact, and hitting a foam ball. The athlete can advance when he or she is able to perform each activity quickly, frequently, and without pain and swelling. A tennis professional can advise the athlete regarding technical changes to decrease stress to the injured area.

 

The rehabilitation program can be endless and must be tailored to the athlete's needs. Correcting any biomechanical errors could be what will prevent the athlete from returning with the same injury.

 

Elaine Ryan, P.T.

 

Hilton Head, South Carolina