There are two sorts of muscular injuries – structural and functional. Structural refers to when muscle fibres are damaged. Functional injuries differ as no physical damage has occurred. Delayed onset muscle soreness, which can still be quite painful, is an example.
Muscles are made up of tiny bundled fibres wrapped in fascia to hold it together. Theoretically an injury can occur anywhere along the muscle-tendon-bone chain, but most happen at the junction between muscle and tendon as this is the weakest point. A structural muscle strain is when any number of these fibres tear, this could result in a partial tear where a small percentage of fibres are damaged, or a complete tear where the whole muscle ruptures. They most commonly occur in muscles that cross over two joints, such as hamstrings which connect hips and knees, as they are longer and generate more force.
Muscular injuries in tennis
An abdominal strain derailed the beginning of Svetlana Kuznetsova’s clay court season, forcing her to withdraw injured from her Prague semifinal against Sam Stosur. This is a common muscular injury for an elite player.
The rectus abdominus, more commonly referred to as the ‘six-pack’ muscle, is used heavily in the tennis service action, both to stop the trunk going backwards but also to accelerate the trunk into flexion.
A calf tear is a more common injury for social players, particularly those in the over 35 age group. As the body ages and generally becomes less active, calf muscles lose condition. That’s when putting a rapid burst of strain on the muscle becomes dangerous, especially if it’s a sudden movement like sprinting for a drop shot.
Maintaining muscular system strength and conditioning is imperative to prevent injury. Training should cover all aspects of what is expected from muscles, including lower intensity endurance as well as power, speed and coordination. This helps prevent both structural and functional injuries.
Strengthening abdominal muscles needs to focus on the specific demands of tennis. Doing sit-ups and crunches is not adequate, as they only involve the trunk moving to a flexed position. Exercises need to also focus on the decelerate motion the trunk makes during a service action.
Warming-up muscles before exercise also reduces injury risk.
Research is unclear on the best form of warm up. Static stretching is important for improving flexibility, even if it has not proven to prevent injuries. Recent research suggests a dynamic warm up, which includes lower intensity variations of the movements muscles are put through in a match situation, is a more beneficial option. Lower body exercises that enhance balance and landing techniques are also regarded as good prevention routines.
Road to recovery
The body needs to go through set stages to heal a muscular injury.
Recovery: step one
Immediately after an injury occurs, the body starts the healing process with inflammation to help clean up the debris and bring all the ‘good’ cells to the area to start the repair. There is debate whether icing in this early stage is actually beneficial, as inflammation is a crucial component of setting up the repair of a muscle injury. As icing reduces inflammation, this can impact the quality of the healing. Non-steroidal anti-inflammatory drugs should also be avoided for the same reason.
Complete rest and immobilisation is not recommended, as movement within pain limit assists the healing process. Gentle and pain-free muscle contractions help circulate fluid away from the injury site, removing the waste products caused by the inflammatory process. Elevation and compression is helpful.
Recovery: step two
When pain has settled and the injured muscle can contract against resistance, this means the muscle repair process has matured to a point where a strengthening program can be implemented. It typically takes between seven to 10 days to reach this stage.
Strengthening should not only focus on the injured muscle, but also address any weaknesses or imbalances that may have been a contributing factor. As healing continues, resistance can steadily increase towards endurance and faster movements.
Recovery: step three
Once full strength has been restored, it is time to return to court. This typically takes between four and six weeks. However MRI scans have taught us that the healing process does not actually conclude at this point, which means continued rehabilitation of the injured muscles is needed for several weeks after returning to competition to prevent reoccurrence.