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Recovering From a Tennis Injury: Realistic Expectations

February 17, 2006 11:39 AM

By Jim Brown, Ph.D., Executive Editor, Sports Performance Journal, Author, Tennis: Steps to Success

Arthroscopic surgery has spoiled us. Athletes want to believe that they can return to full participation in a matter of weeks — maybe even days — after an operation on the knee or shoulder.

"Be realistic about recovering from an operation," warns Atlanta physical therapist Don Van Volkenburg. "That knee or shoulder will not be exactly the same as it was before an injury or before surgery. The goal is always a 100 percent recovery, but there are many times when a full recovery is simply not possible."

Allow for Setbacks
Ask about a time range for your return to sports. Although statistics indicate that you should be able to resume full participation in four weeks, for example, there are too many variables for a precise projection. "We don’t treat statistics; we treat people," explains Van Volkenburg. "Anticipating a return in 4-8 or 4-12 weeks allows both the patient and the therapist or trainer to contend with things that might go wrong."

One of the most common rehabilitation problems is the aggressive athlete who pushes too hard or who tries to come back too soon. But there are potential problems at each stage of rehabilitation. During the first couple of weeks, the goal is to reduce or eliminate pain, tenderness to touch, and swelling. Those problems should be controlled by ice, elevation, and compression. If they are not, a change in the rehabilitation strategy is necessary. A word of caution: Expect more pain if bone tissue is involved in arthroscopic surgery (such as shaving a bone spur) than if the procedure involves muscle tissue only.

Increasing Range of Motion
The second phase of recovery involves increasing the range of motion. If you start to lose the ability to move the joint or get stuck at a certain position, that is a red flag that something is not going well. Passive range of motion exercises, active assisted exercises, or active range of motion exercises should be altered to deal with the problem.

At the same time, a person may have to re-establish neuromuscular control. The interaction between nerves and muscles may be lost. You may not even be able to activate a muscle group. Isometric exercises or electrical stimulation may be necessary for a jump-start.

Regaining strength carries a certain risk. Loads that are too heavy or repetitions that are excessive can cause a step backward. One guideline for appropriate intensity and volume is the level of discomfort following strength training. Pain that lasts longer than an hour after an exercise period and symptoms that linger the following morning are not normal.

Functional Progression
Regaining strength does not necessarily mean readiness for full participation. Strength has to be transferred into the movements specific to a sport. This final test of rehabilitation is called functional progression. It is an ordered sequence of sport-specific activities that enables you to reacquire the physical tools necessary for a safe and effective return to full-scale participation.

Following is an example of a functional progression plan for tennis that could be adapted to several other sports following a knee injury. It was developed by John Darmelio, A.T.C., at the Methodist Sports Medicine Clinic in Indianapolis. Consult a sports medicine physician, physical therapist, or trainer before beginning this or any other program.

  1. Complete ten heel raises on the injured leg.
  2. Walk the length of the court at a fast speed.
  3. Jump on both legs 10 times.
  4. Jump on the injured leg ten times.
  5. Jog the length of the court in a straight line.
  6. Jog two laps around the court (running in a straight line and in a curve).
  7. Sprint the length of the court at 1/2, 3/4, and full speed.
  8. Run a figure 8 using the baseline to service line area at 1/2, 3/4, and full speed.
  9. Sprint from the baseline to the service line; run backward to the baseline; shuffle step along the baseline to the right singles sideline, then to the left sideline.
  10. Use the carioca step (running sideways with a crossover step) along the baseline of one court at 1/2, 3/4, and full speed.
  11. Run the length of the court cutting at side-to-side angles at 1/2, 3/4, and full speed.

© 2005 HMS Publishing, Inc.
Jim Brown will be contributing new content to this site on a monthly basis. If you have a question for Dr. Brown please feel free to email him at
sportsmed@mindspring.com.

 

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