MEDICINE IN TENNIS

Sports medicine is vital to tennis players, taking into consideration the mounting likelihood of injury in today’s fast-paced competition. Firstly, if athletes are to benefit from sports medicine, they must be able to identify whether they have been struck by injury. Regardless of this, the best way for athletes to avoid serious injury is to know how to train properly and to rest when needed. However, injuries are not uncommon amongst athletes from all sports. The R.I.C.E. treatment is a standard procedure to treat an injury.

In addition to treating athletic injury, the sports world also conducts medical research on performance enhancing substances. Medical research in performance enhancers provides more accurate information that would be beneficial to athletes and event organizers. The athletes would benefit, as they would be better educated in regards to the side effects of performance enhancers. Event organizers would benefit, as they would devise more effective and less expensive means of testing athletes for doping. Especially with the next Olympic Games creeping up ever so quickly, medical research in performance enhancers is undoubtedly imperative.

[Identification of Injury]
[Training and Injury]
[Treatment of Injuries with R.I.C.E. Formula]
[Tennis Elbow]
[Differences Amongst Genders]
[Performance Enhancement Drugs and Drug Testing]
[Gene Doping]

IDENTIFICATION OF INJURY

Most of the time, it is quite easy for an athlete to be able to identify the presence of an injury. There are many injuries that can be easily identified by the athlete, such as a nosebleed or broken bones. However, at some times, an athlete will have an ambiguous perception as to whether they have an injury or just feel fatigued. This can lead to the athlete sustaining a minor injury until it escalates to a worse situation. Therefore, it is important that athletes be able to identify injury, then to report the injury to qualified personnel. The following is a list of simple ways to identify injury.

1. Pain is sustained steadily and does not subside.
2. An extent of tightness can be felt that restricts full-range motion.
3. You feel light-headed or nauseous.
4. What initially appeared to be a minor injury does not heal promptly.

TRAINING AND INJURY

Highly motivated athletes always strive to push beyond their limits, especially in training. Unfortunately, if an athlete does not take sufficient rest when needed, their muscles can actually be injured, rather than become stronger. Such injuries include cramps, Osgood-Schlatter disease, contusion, sprains and strains.

When lifting weights in weight-training, the body’s natural response to the heavy weights is have microscopic tears in the muscles’ connective tissues. This explains the soreness that one would usually feel after each weight-training exercise. It is essential that an athlete to rest after weight-training. During the duration which the athlete rests, the microscopic tears are repaired. In the repair process, muscles become larger and stronger. However, if an athlete fails to obtain adequate rest after weight-training, the repair process may be delayed or a true injury may result. This is because if the athlete continues to strenuously use the muscles without allowing rest for repair, the microscopic tears may become larger tears.

Another reason why an athlete’s body would feel sore during training would be the athlete’s natural processes of the production of certain acids. These acids may cause pain during repetitive muscle contractions. Included in the series of acids is lactic acid. In this situation, there is no true injury, as this is only a natural response of the body to strenuous muscular activity.

If an athlete refuses to train in a proper manner or rest after weight-training, there are several injuries that they are prone to.

• Cramps- Muscles become excessively tight in contractions. This happens the most often in the leg muscles in endurance and high-exertion sports. The specific cause of this injury is an excessive loss of fluids.
• Osgood-Schlatter disease- This happens specifically in growing athletes. Males are more prone to this injury. Repetitive strain of the lower leg muscles is the specific cause of this injury. The result is inflammation and pain in the knee tendon. There is enlargement and swelling just below the kneecap. This should be treated with rest, ice and stretching.
• Contusion- Internal bleeding, swelling, pain and stiffness are caused by a serious bruise.
• Sprain- A ligament has been overstretched and torn.
• Strain- A muscle or tendon attachment has been over-stretched or torn.

TREATMENT OF INJURIES WITH R.I.C.E. FORMULA

To treat most injuries, qualified personnel will often use the simple R.I.C.E. formula.

• Rest- Immediately stop the usage of the injured body part.
• Ice- Apply ice to the injured area in a plastic bag. Separate the ice from the skin with a towel. Ice is to be applied at 2-hour intervals for 24 hours.
• Compression- Wrap an elastic bandage over the joint to compress it. This is done to reduce swelling.
• Elevation- The injured area needs to be raised in order to prevent the fluid from pooling at the injury and provoking swelling.

TENNIS ELBOW

Figure 2 depicts the ligaments in an uninjured elbow. Accompanying the anatomy is a description of each ligament.

Figure 2; Anatomy of Elbow Muscles

In more medical terms, tennis elbow is referred to as lateral epicondylitis or lateral elbow tendinosus. The people who are most prone to suffering from tennis elbow are those who are aged 35-50 years and play tennis for more than 30 minutes per session, for 3 sessions or more per week. This is mainly due to their inadequate fitness levels in enduring demanding techniques. It is most likely that their forearm muscle does not have the strength to endure these techniques. In other words, there is an overuse of tennis elbow sufferers’ elbow muscles. In order to force him or herself to endure the techniques, a player with inadequate forearm muscle strength excessively increases the flexing of the wrist. In addition, in specific with tennis technique, 40% of tennis elbow sufferers who play tennis suffer from tennis elbow as a result of a faulty backhand combined with muscle weakness. This places a stress on those who want to learn how to play tennis to learn proper technique. People of an older age are more likely to suffer from tennis elbow. Women are also more likely to suffer from tennis elbow.

In the formation of tennis elbow, there are actually microscopic tears that result from the overuse of the elbow muscles. These tears occur around a muscle known as the epicondylus lateralis humeri. However, these microscopic tears often go unnoticed until they multiply and expand. In spite of microscopic tears being unnoticed, there are several ways of diagnosing tennis elbow before muscle damage occurs. An unusual feeling of pain and weakness at the lateral part o the elbow is a very easily identified symptom of tennis elbow. Another way of diagnosing tennis elbow is the “coffee cup test”. The “coffee cup test” is simply picking up a filled coffee cup with the hand of the arm suspected to have tennis elbow. If a tennis player experiences pain at the epicondylar lateralis humeri area, there is a high likelihood that they have a case of tennis elbow. Another simple test that can be done to diagnose tennis elbow involves wiggling the middle finger of the arm suspected to have tennis elbow. The middle finger is connected to a muscle known as the extensor digitorum. The extensor digitorum muscle is connected to the epicondylus lateralis humeri muscle. If there is an unusual sensation of pain at the epicondylus lateralis humeri muscle while wiggling the middle finger, a tennis player is likely to be suffering from tennis elbow. There are also more advanced tests that are conducted by physicians to diagnose tennis elbow.

Pathology is the study of the course of deterioration of the body from disease. The following includes the stages of the deterioration of the arm according to a pathological analysis published by R. Nirschl.

1. Temporary inflammation can be felt at the elbow.
2. Permanent tendinosis affects less than half of the tendon, if examined through a side-view.
3. Permanent tendinosis affects more than half of the tendon, if examined through a side-view.
4. Fractional or entire rupture has occurred at the tendon.

R. Nirschl also proposed a series of seven stages that can be used in the classification of pain felt by tennis elbow sufferers.

1. There is a minute amount of pain felt after exercising that disappears within 24 hours.
2. Pain is felt after exercising that does not disappear within 48 hours. However, the pain disappears after warm-up activity.
3. Pain is felt during exercising that does not hinder the person’s ability to participate in the activity.
4. Pain is felt during exercising that does hinder the person’s ability to participate in the activity.
5. Pain is felt during daily activities that require substantial power from the muscles.
6. Pain is felt during daily activities that require very little power from the muscles. Some pain can be felt during rest, but is not enough to disrupt sleep.
7. The pain felt is so immense that the sufferer cannot sleep soundly.

Fortunately, there is a systematic method of healing tennis elbow. The three steps in the process include:

1. Acute inflammatory phase- The R.I.C.E. formula is used to alleviate pain.
2. Collagen and Grouund substance production phase- The sufferer should exercise to stimulate substance production. The wrist should be stretched lightly several times each day. Arm strength can be increased though lifting light weights with the wrists.
3. Maturation and remodeling phase- A brace is worn to put pressure on the appropriate muscle group to prevent rubbing and rolling of the bones. This is done in combination with application of heat to provoke faster healing. If pain is felt during exercising that hinders the sufferer’s ability to participate in the activity for over one year, healing is considered to have failed. The sufferer, then, undergoes surgery. In surgery, the damaged tissue is removed. This is known as resection. After the surgery, the elbow must be maintained at a right angle for one week. Three weeks after the surgery, the sufferer begins strength and endurance exercises. Six weeks after the surgery, the sufferer may begin to play tennis with modified technique. According to past statistics, 85% of sufferers who undergo this program of recovery reach full recovery of strength and experience no more pain.

DIFFERNECES AMONGST GENDERS

Injury rates for both genders are relatively equal. However, differences in the physical build of the genders makes each gender more susceptible to certain injuries. For example, the physical build of female athletes increases their tendency to suffer from anterior cruciate ligament (ACL) tearing.

Anterior cruciate ligament tearing
The anterior cruiciate ligament is located near the knee and controls the movement of the knee. The tearing of the anterior cruciate ligament is most common in ports that present many stops and starts, and pivoting, such as tennis. According to past data, females are six times more prone to suffering from anterior cruciate ligament tearing than males (figure 3). Sports physicians have explained females’ high likelihood of suffering from anterior cruciate ligament tearing through females’ wider pelvis compared to males. The wider pelvis creates additional strain on the knee joint because of its greater mass. The widening of the pelvis during puberty also slightly alters the angle of the knees.

Figure 3; Anterior Cruciate Ligament Tearing in Females
Females have a higher probability of suffering from anterior cruciate ligament tearing because of the greater pelvis mass put on their knees.

PERFORMANCE ENHANCEMENT DRUGS AND DRUG TESTING

Although the organizers of the Olympic Games consistently demonstrate their opposition of drug use in competition through their rules and drug testing, there are always gold medallists who are stripped of their title because they had hoped that they would receive a “free ride” without being caught. Some of the commonly used drugs amongst athletes include steroids, the human growth hormone, erythorpoietin and nandrolone. Intake of these substances appear to give an athlete advantages in their performance. However, obvious side effects are often apparent.

Steroids are taken to increase muscle growth. If a female injected a steroid that stimulated male hormones, they would obtain masculine muscular growth to aid their performance. However, a female athlete who used a steroid with male hormones will deepen their voices and grow facial hair.

The human growth hormone diminishes body fat, increases muscle mass and slows down aging. It is actually naturally produced by the body’s pituitary gland. The pituitary gland is a part of the body that is located near the brain that secretes hormones into the rest of the body to promote growth. Testing for the human growth hormone is quite difficult, as available methods of testing have proved to be unreliable. Fortunately, there have been incidents where athletes had been physically discovered to be carrying containers of the human growth hormone.

Erythropoietin is better known as EPO. Erythropoietin is actually also a hormone that is naturally produced by the body. The release of erythropoietin encourages rapid production of red blood cells. This would be beneficial to an athlete, as red blood cells transport the body’s oxygen and carbon dioxide. More red blood cells would allow the athlete’s muscles to respire at a faster rate. Testing for erythropoietin can be quite difficult. A major external factor that would make it appear that an athlete had taken erythropoietin would be the altitude at which the athlete trains. The body will naturally produce more erythropoietin from training at higher elevations because more red blood cells are needed to transport oxygen in “thinner air”. There has been a urine test developed in France. However it is too expensive and complicated for large-scale testing at events such as the Olympic Games. However, there has been a test that has been developed in Australia that is less expensive and is more reliable. It simply identifies the increased amount of recently produced red blood cells.

Nandrolone is an anabolic steroid. This means that it contains a male hormone that would provoke side effects in women such as facial hair growth. Testing for nandrolone can be done through urine sample testing. An athlete who has injected nandrolone will have unusually high levels of metabolites in their urine. However, this method of testing is somewhat questionable, as there has recently been evidence supporting those high levels of metabolites may be a result of strenuous training.

GENE DOPING

With the rapid advancements in genetic therapy meant to assist patients with severe medical conditions, there has been a concern by the Olympic Committee that athletes will abuse these therapies to enhance their performance. Through gene therapy, athletes may be able to cheat past the standard doping examinations. It may be harder for these doping examinations to detect gene doping because athletes have been modified at a genetic level. Some specialists panic that gene doping may appear as early as the Shanghai Olympic Games of 2008. The Olympic Committee has already identified three major types of gene therapy that will most likely be used in gene doping.

• Increase in erythropoietin production by inserting a gene into the individual’s bloodstream- Increasing erythropoietin production through gene therapy will actually benefit patients suffering from anemia, where they have a low supply of hemoglobin in their blood. Hemoglobin is essential to the transportation of oxygen throughout the body. By stimulating red blood cell production through increased erythropoietin secretion, patients of anemia will be able to increase their content of hemoglobin. Unfortunately, athletes may abuse this gene therapy to simply increase their muscles’ aerobic aptitude. This means that the muscles will be able to respire at a faster rate. This faster rate of gas exchange leads to higher levels of muscular endurance during competition. This type of gene therapy would affect the entire body.
• Strengthen muscles by inserting muscle-stimulating genes into muscle cells- Strengthening muscles through gene therapy would benefit patients suffering from muscle degeneration. However, athletes may abuse this to strengthen their muscles and increase their muscles’ capacity of recovery. This type of gene therapy is localized at specific muscles. For example, a tennis player would specifically ask for their shoulder muscles to be strengthened.
• New blood vessels are grown by inserting a gene into tissues- Inserting a gene into tissues to provoke new blood vessel growth would benefit the elderly who suffer from peripheral arterial disease. Peripheral arterial disease is where tissues of the body’s extremities, such as the fingers and the toes, die due to insufficient supply of oxygen transported by existing blood vessels. However, athletes may abuse this to improve their means of transportation of oxygen and nutrients throughout the body. This, similar to the erythropoietin gene therapy, would increase the athlete’s endurance, due to the increased efficiency of nutrient supply.