BRIDGING THE GAP
RESEARCH and PRACTICALITY
Do Injuries Ever Fully Recover – A Study on Tennis Rehab Suggests No
All sports place our bodies under stress, however, most sport-related injuries come from repetitive use trauma. Tennis players stress their shoulders and arms, placing their joints under high loads and strain repeatedly striking the ball – over and over, and over, again - at high speeds. Excessive stress can cause injuries, most commonly in the player’s arms. The most common injury in all tennis players is lateral epicondylitis or “tennis elbow.” Tennis elbow is a condition in which the outermost area of the elbow becomes sore and tender at the lateral epicondyle. Tennis elbow is often treated without surgery with initially RICE treatment, and, if necessary physical therapy. If adhered to there is a high recovery rate - at least in terms of sensation of pain. However, a study by Alizadehkhaiyat and colleagues provide doubt whether a full, functional recovery in the musculotendinous injury and impacted muscles of tennis elbow can be achieved (1).
Their study compared healthy, injured, and post-recovery tennis players muscle strength and electromyographic (EMG) muscle activity. The testing included muscular strength, fatigability, and EMG activity in athletes who currently are injured with or who had undergone full tennis elbow PT. Strength measurements of wrist, metacarpophalangeal (MCP), and shoulder musculature along with isometric grip strength, and EMG activity for wrist extensors and flexors were taken between a control group (eight females tennis players who had no history of musculoskeletal problems), a group of injured athletes (seven females who had a minimum of 3 months’ history of localized lateral elbow pain, lateral epicondylar tenderness and pain with resisted wrist and middle finger extension); and a group of formerly injured athletes who had undergone a full course of physical therapy for their tennis elbow (six females who had been asymptomatic for at least six months).
The results found that except for MCP extension strength, all strength levels in the control group (those who had never experience an elbow injury) were significantly higher than both experimental groups. MCP extension strength was significantly higher in the recovered group than the tennis elbow group. The EMG results revealed an increase in activity of extensor carpi radialis in the recovered group and decreased in the tennis elbow group, in comparison to the control.
Overall, the study indicates that once an athlete experiences a tennis elbow injury - whether from overuse or acute trauma - complete recovery to pre-injury levels is not attainable. An incomplete functional recovery in strength levels of a person who has undergone PT and been asymptomatic for over six months remains with lower strength levels than a person who has not had tennis elbow. Being the most common tennis injury, tennis elbow needs to be researched into more to see if there is an effective way to prevent it in the first place.
Written by Ethan Andales with Eric Sternlicht, Ph.D., Chapman University, Orange CA.