CONDITIONING, FITNESS & HEALTH page 1 of 3

*Adelsberg, S. "The tennis stroke: an EMG analysis of selected muscles with rackets of increasing grip size." American Journal of Sports Medicine 14.2 (1986):139 42.

The purpose of this study was to analyze the effect of different racket grip sizes on the muscle activity of the forearm and shoulder. Telemetry EMG was used to assess the muscle activity of the anterior deltoid and the forearm extensor muscles during the forehand and backhand strokes of tennis in a selected group of test subjects. The EMG activity of the subjects' anterior deltoid muscle and the forearm extensor muscle group was recorded with the subjects using racket grip sizes of 4 1/4, 4 1/2, 4 3/4 inches. A specific pattern of sequence phasing was seen in all subjects, and amplitude ratio between the muscles was constant. Changes in grip size demonstrated a change in amplitude of both the anterior deltoid and the forearm extensor muscle group.

*Armstrong, Larry. "Evaluation of fluid-electrolyte balance associated with tennis match play." USTA Research Grant, 1992. Information available from Dr. Larry Armstrong, Univ. of Connecticut, Storrs, CT 06268.

The author examined Division I male and female college tennis players for three days in a hot, humid environment to determine fluid-electrolyte loss and intake, rehydration requirements. Results include recommendations for planning training sessions and tournament play, and for reducing the risk of heat illness.

*Balduini, F.C. "Abdominal and groin injuries in tennis." Clinics in Sports Medicine 7.2 (1988):349 57.

Although abdominal and groin injuries are not unique to the game of tennis, the very mechanics of the ground stroke and overhead volley predispose participants in this sport to the chronic pain and frustration of these injuries. Careful consideration must be given not only to the muscular anatomy of the region but also to the visceral and neurologic anatomy. A patient, controlled program of rehabilitation, emphasizing flexibility and subsequent strengthening, must be stressed if recurrence is to be avoided.

*Bergeron, M.F., et al. "Tennis: a physiological profile during match play." International Journal of Sports Medicine 12.5 (1991):474 79.

Heart rate (HR), hematocrit, hemoglobin, blood glucose, and plasma concentrations of lactate, cortisol, and testosterone were monitored in 10 male subjects (Division I, 20.3 +/ 2.5 yrs, VO2max: 58.5 +/ 9.4 ml.kg 1.min 1) during singles tennis and a treadmill test. During the on court session, HR was 144.6 +/ 13.2 beats.min 1 for the 85 min of play. Plasma lactate rose 50% from a post warmup value of 1.6 +/ 0.6 mmol.l 1 to 2.3 +/ 1.2 mmol.l 1 during play (p greater than 0.05). Blood glucose slightly decreased (8%, p greater than 0.05) from a pre exercise value of 4.6 +/ 0.8 mmol.l 1 as a result of the 10 min warmup. This was followed by a 23% rise (p less than 0.05) from 4.2 +/ 1.0 mmol.l 1 to 5.2 +/ 0.6 mmol.l 1, measured after the first 30 min of play. Blood glucose subsequently remained steady at slightly above the pre exercise value. Plasma cortisol rose (9%, p greater than 0.05) during the warmup and subsequently decreased (p less than 0.05) from a post warmup value of 558.2 +/ 285.2 nmol.l 1 to 337.1 +/ 173.3 nmol.l 1 (a 40% decrease), and remained decreased during recovery. Plasma testosterone rose 22% (p less than 0.05) from pre exercise to recovery (13.5 +/ 3.8 nmol.l 1 and 16.5 +/ 2.6 nmol.l 1, respectively). Although tennis is characterized by periods of high intensity exercise, the overall metabolic response resembles prolonged moderate intensity exercise.

*Bigiliani, L.U., et al. "Repair of rotator cuff tears in tennis players." American Journal of Sports Medicine 20.2 (1992):112 17.

Twenty three tennis players with a symptomatic full thickness rotator cuff tear underwent anterior acromioplasty and rotator cuff repair. There were 8 small tears (less than 1 cm), 5 moderate tears (1 to 3 cm), 2 large tears (3 to 5 cm), and 8 massive tears (greater than 5 cm). The dominant shoulder was involved in all patients and all were unable to play tennis before surgery. Eleven patients experienced a traumatic event that caused an injury, 6 while playing tennis, and 12 patients had a gradual onset of symptoms. At average follow up of 42 months, 19 patients (83%) achieved a good result, were pain free, and were able to play tennis at their presymptomatic competitive level. Three patients (13%), all with massive tears, had a satisfactory result and were able to play tennis, although at a lower competitive level secondary to weakness. One patient (4%), who also had a massive tear, had an unsatisfactory result and was unable to play tennis.

*Blackwell, John Royse. "Grip pressure, wrist kinematics and forearm electromyograms of expert and novice tennis players performing the backhand stroke." PhD Diss. Univ. of Iowa, 1991. Ann Arbor: UMI, 1992. Order No. 9212854.

Humeral epicondylitis, often referred to as tennis elbow (TE), is a soft tissue injury with pain at the humeral epicondyles. Mechanisms related to TE development are unclear. However, it is generally accepted that lateral TE is due to overload of the extensor carpi radialis brevis muscle. The incidence of lateral TE is greater in unskilled than skilled players, and due to previous qualitative reports, differences in the behavior patterns of these groups were hypothesized. The purposes of this project were to investigate whether grip pressure, wrist angular motion, and forearm electromyograms (EMG) differentiate skilled and unskilled players, and to discuss these differences in relation to tennis elbow development. Skilled and unskilled tennis players performed the backhand groundstroke. Measured variables included: (i) grip pressure integral values, (ii) wrist angular kinematic trajectories, and (iii) wrist flexor and extensor EMG.

Results showed no group difference in grip pressure integral values. However, skilled subjects tended to increase their grip rapidly prior to ball racket impact, whereas unskilled subjects tended to use a more static grip. Skilled players showed greater wrist extensor EMG after impact than the unskilled group and both groups showed greater wrist extensor EMG than flexor EMG overall. Unskilled subjects were in wrist flexion and ulnar deviation (adduction) while flexing and adducting the wrist at ball racket impact. Skilled subjects were in wrist extension and radial deviation (abduction) while extending and adducting at impact. Unskilled subjects exhibited rapid wrist flexion due to ball racket impact whereas skilled subjects exhibited wrist extension. These data imply that unskilled subjects may be more susceptible to injuries of the wrist extensor muscles because these muscles are at long lengths and lengthening at impact. These conditions place relatively greater loads on the musculo tendinous units and subject the wrist extensor muscles to potentially damaging eccentric contractions. Implications for tennis instruction aimed at reducing the incidence of tennis elbow were discussed.

*Blackwell, John Royse, and K.J. Cole. "Wrist kinematics differ in expert and novice tennis players performing the backhand stroke: implications for tennis elbow." Journal of Biomechanics 27.5 (1994): 509 16.

Investigators have suggested that the greater prevalence of lateral humeral epicondylitis (tennis elbow, TE) in novice tennis players compared to expert players may reflect the novice players' use of faulty mechanics for the backhand stroke. We investigated the wrist kinematics (flexion/extension), grip pressures, and wrist muscle electromyographic activity in novice (N = 8) and expert (N = 8) tennis players performing the backhand stroke. Experts performed the backhand stroke with the wrist extended (re: neutral alignment of the forearm and hand dorsum). Collision of the ball and racket occurred with the wrist extended on average of 0.41 rad (about 23 degrees from neutral alignment) in the expert players; moreover, their wrists were moving further into extension at impact. In contrast, novice subjects struck the ball with the wrist flexed 0.22 rad (about 13 degrees) while moving their wrists further into flexion. Wrist extensor EMGs showed similar levels of activity during the 500 ms interval before ball racket impact, whereas expert subjects displayed greater EMG levels after contact, consistent with the accompanying wrist extension. The wrist kinematic and EMG data together show that the novice subjects eccentrically contracted their wrist extensor muscles throughout the stroke. We argue that conditions exist for novice subjects that assist stretch of wrist extensor muscles upon collision of the ball and racket. The resulting eccentric contraction of wrist extensor muscles may contribute to lateral TE in novice players, given previous research indicating that eccentric muscle contraction facilitates muscle fiber injury.

*Bollen, S.R., et al. "Stress fractures of the ulna in tennis players using a double handed backhand stroke." American Journal of Sports Medicine 21.5 (1993):751 2.

*Booth, A., et al. "Testosterone, and winning and losing in human competition." Hormones and Behavior 23.4 (1989):556 71.

Testosterone and cortisol were measured in six university tennis players across six matches during their varsity season. Testosterone rose just before most matches, and players with the highest prematch testosterone had the most positive improvement in mood before their matches. After matches, mean testosterone rose for winners relative to losers, especially for winners with very positive moods after their victories and who evaluated their own performance highly. Winners with rising testosterone had higher testosterone before their next match, in contrast to losers with falling testosterone, who had lower testosterone before their next match. Cortisol was not related to winning or losing, but it was related to seed (top players having low cortisol), and cortisol generally declined as the season progressed. These results are consistent with a biosocial theory of status.

*Bracker, Mark, et al. "Low back pain in a tennis player." Physician and Sportsmedicine 16.4 (1988): 75-79+.

A case in which a middle-aged tennis player suffering from low back pain was discussed by a group of physicians. The diagnosis, treatment, and management of the case are presented in this report.

*Buckley, J.P., and D.G. Kerwin. "The role of the biceps and triceps brachii during tennis serving." Ergonomics 31.11 (1988):1621 29.

*Butch, C.A. "The incidence of injuries in intercollegiate tennis players." MS Thesis. Northeastern Univ., 1983. Available from Northeastern Univ., Boston, MA 02115

The incidence of injuries sustained by men and women tennis players in the Northeastern U.S. during 2 years was studied. The incidence of injury at the intercollegiate level, the types of injuries, and the classification of information according to body parts was investigated. The source used to collect data included a Tennis Injury Report Form for every injury relating to tennis. Results showed that the most common injuries were sprains and strains which occurred in the ankle, shoulder, and knee joints. Data also provided information on the high reoccurrence rate of ankle, shoulder, and knee injuries, which suggested that treatment and rehabilitation of injuries may not have been fully completed before the players resumed practice or a match.

*Capek, P., and J. Holcroft. "Traumatic ischemia of the hand in a tennis player: successful treatment with urokinase." Journal of Vascular and Interventional Radiology 4.2 (1993):279 81.

*Chandler, T.J., et al. "Flexibility comparisons of junior elite tennis players to other athletes." American Journal of Sports Medicine 18.2 (1990):134 36.

Flexibility measurements were obtained in 86 junior elite tennis players and compared to the flexibility measurements of 139 athletes involved in other sports. The measurements obtained included sit and reach flexibility, quadricep flexibility, hamstring flexibility, gastrocnemius flexibility, shoulder internal rotation, and shoulder external rotation. All measurements except sit and reach flexibility were obtained goniometrically. Tennis players were significantly tighter in sit and reach flexibility, dominant shoulder internal rotation, and nondominant shoulder internal rotation. They were significantly more flexible in dominant shoulder external rotation and nondominant shoulder external rotation. The flexibility differences found in tennis players suggest adaptations to the musculoskeletal demands of their sport. These results suggest that a sport specific flexibility program may be necessary for junior elite tennis players in order to promote maximum performance and help prevent flexibility related injuries.

*Chandler, T.J., et al. "Shoulder strength, power, and endurance in college tennis players." American Journal of Sports Medicine 20.4 (1992):455 58.

Twenty four college tennis players were tested for bilateral shoulder internal/external rotation strength on a Cybex 340 isokinetic dynamometer; hey were positioned supine with the glenohumeral joint abducted to 90 degrees. Subjects produced significantly (P less than 0.01) more torque in internal rotation at 60 and 300 deg/sec in the dominant arm compared to the nondominant arm. Subjects also produced significantly more power in internal rotation at 60 deg/sec in the dominant arm. No significant differences between the dominant and nondominant arms were seen in internal rotation power at 300 deg/sec or in the internal rotation endurance ratio. No significant differences were seen in external rotation on any measurement. By significantly increasing the strength of the dominant shoulder in internal rotation without subsequent strengthening of the external rotators, muscle imbalances may be created in the dominant arm that could possibly affect the tennis player's predisposition to injuries caused by overloading of the shoulder joint. This study suggests that external rotation strengthening exercises should be implemented in tennis conditioning programs to maintain muscle strength balance, and possibly reduce the chance of overload injury.

*Crews, Debra. "Physiological, psychological and perceptual characteristics of junior tennis players." USTA Research Grant, 1990. Information available from Dr. Debra Crews, Univ. of North Carolina, Greensboro, NC 27412.

The author studied the characteristics which are most closely associated with the best performance among young tennis players in order to develop appropriate training programs for athletes of this age.

*Dalziel, R., and P. Dixon. "Tennis injuries." Australian Family Physician 20.7 (1991):931+.

An unfit tennis player is more likely to suffer an injury. The tennis player should be well prepared physically and possess a sound technique. Attention should be paid to playing gear to minimize the possibility of injury.

*Deutsch, E., S.L. Deutsch, and P.S. Douglas. "Exercise training for competitive tennis." Clinics in Sports Medicine 7.2 (1988):417 27.

This article reviews the muscle physiology underlying various forms of activity, as well as the adaptive responses induced by specific forms of training, and thus provides a rational basis for the design of a training program for competitive tennis.

*Dunlap, Patricia. "Addressing competitive stress in junior tennis players." Journal of Physical Education, Recreation and Dance 62.1 (1991): 59-63.

A PRECEDE (Predisposing, Reinforcing, and Enabling Causes In Education Diagnosis And Evaluation) model was used in assessing the health needs of nationally ranked junior tennis players. The objective of this study was to reduce stress illness in high-level competition.

*Dwyer, Colleen Marie. "A comparison of an isotonic and an isokinetic weight training program on performance of the tennis serve." MA Thesis. Univ. of North Carolina, 1983. Available from Microform Publications, 1243 Univ. of Oregon, Eugene, OR 97403. Order No. PE2657f.

*Edinger, J.D., et al. "Daytime functioning and nighttime sleep before, during, and after a 146 hour tennis match." Sleep 13.6 (1990):526 32.

Two adult males (ages 31 and 35 years) were studied while they participated in a week long marathon tennis match under conditions of extreme sleep restriction (4 5 h reductions per night). Polysomnographic monitoring was conducted on the two nights prior to the marathon, continuously throughout the match, and on two recovery nights. In addition, measures of daytime sleepiness, mood state, and cognitive performance were obtained during the course of the study. Despite undergoing marked sleep restriction, both players continued to obtain their usual (baseline) amounts of slow wave sleep throughout the marathon. Both players showed a gradually increasing tendency toward daytime dozing across the first few days of the marathon. This tendency decreased on the fifth day but increased again on the sixth day of the match. Also, both players showed a pre to postmatch decline on some cognitive measures. However, the players differed markedly in their ratings of sleepiness, mood ratings, recovery sleep patterns, and endurance with respect to the demands of the match. Results appear to be consistent with previous laboratory studies in documenting the primacy of the "slow wave sleep drive." Given the marked differences observed between the players, research designed to identify factors that predict response to sleep loss seems to be warranted.

*Edwards, Jeffrey E. "Quantification and fractionation of oxygen consumption during tennis match play using a miniaturized oxygen uptake telemetry system." USTA Research Grant, 1990. Information available from Dr. Jeffrey Edwards, c/o USTA, 7310 Crandon Blvd., Key Biscayne, FL 33149.

The author studied the oxygen consumption of a tennis match to determine the appropriate level of aerobic fitness for tennis. The study was conducted without interfering with the players' on-court tennis activities so as to obtain truly tennis-specific data.

*Edwards, Ronald Frank. "The effect of two resistance training programs on cross-court forehand groundstroke skill in tennis." MS Thesis. California State University, Fullerton, 1989. Ann Arbor: UMI, 1990. Order No. MA1336941.

The effects of two circuit weight training programs on performance of the cross-court forehand groundstroke in tennis were compared. Forty-five male and female student volunteers age 18-48y, from beginning and intermediate tennis classes, participated in the study. Subjects were randomly assigned to 3 groups of 15 subjects: a control group, a lower/mid body or a total body circuit weight training program. Exercises were performed on an isotonic Centurion Multi-Station machine manufactured by Universal Gym, Inc. 3 times a week over a 9 week period. The intensities (60-90%) in both exercise programs were cycled identically throughout the week, and gradually increased throughout the training period. All subjects were pre-tested and post-tested for speed and accuracy of the forehand groundstroke using a modified Hewitt's Tennis Achievement Test and Avery-Richardson Tennis Service Test. An analysis of covariance between the pre-test and post-test mean difference scores reveals no significant difference between the treatment groups and the control group or between treatment groups in skill performance.

*Ellenbecker, T.S., G.J Davies, and M.J. Rowinski. "Concentric versus eccentric isokinetic strengthening of the rotator cuff. Objective data versus functional test." American Journal of Sports Medicine 16.1 (1988):64 69.

Twenty two male and female college varsity tennis players trained for 6 weeks, one group using eccentric isokinetic internal and external shoulder rotation, and the second group using concentric isokinetic internal and external shoulder rotation. Subjects pretested and posttested both concentrically and eccentrically, so that training overflow and specificity could be examined. Three maximally hit tennis serves made before and after training, which were analyzed by high speed cinematography to obtain ball velocity, served as a functional performance measurement. Statistical analysis of peak torque (newton meters) and peak torque to body weight ratio have revealed significant concentric strength gains (P less than 0.005) in the concentric as well as the eccentric training groups. Eccentric strength gains were demonstrated by the concentric training group at selected speeds (P less than 0.05 and P less than 0.005) but were not generated in the eccentric group at the P less than 0.05 significance level. Functional test analysis shows an increase in maximal serve velocity at a significance level of P less than 0.005 in the concentric training group, with no significant (P greater than 0.01) increases in the eccentric group.

*Elliott, B.C. "Biomechanics of the serve in tennis. A biomedical perspective." Sports Medicine 6.5 (1988):285 94.

Epidemiological studies have indicated that the serve, arguably the most important facet of the game of tennis, is also the most likely stroke to cause injury, particularly to the elbow and back. A review of the kinematic and kinetic studies on the service action fails to clearly identify the reason(s) for these injuries. Data from these studies does, however, allow possible causes of injury to be postulated. Electromyographic data from the prime mover muscles involved in the serve have shown that muscle action was greater for beginners, whose muscles were active for longer periods than those of advanced players. Ground reaction forces associated with different serving techniques were small compared to those recorded from activities involving running or jumping. The potential to cause injury seems to be related to high internal forces (combination of muscle and joint reaction forces), particularly where these forces are associated with poor technique and high segment accelerations. These situations occur when the racket moves behind the body and the vertebral column is laterally flexed and hyperextended. The pronation of the forearm and the forces associated with the swing to the ball, the impact and the early follow through are also factors that have the potential to cause injury. The action of serving induces strains and pressures upon the body. A sensible approach to the number of serves, particularly when practising (overuse), appropriate physical preparation and a technique that does not introduce excessive forces to selected body parts (misuse) will greatly reduce the potential for injury from this activity.

*Feit, E.M., and R. Berenter. "Lower extremity tennis injuries. Prevalence, etiology, and mechanism." Journal of the American Podiatric Medical Association 83.9 (1993):509 14.

A retrospective investigation was undertaken to determine the prevalence of tennis related lower extremity injuries in the San Francisco Bay area. A total of 376 participants at various Bay area tennis clubs completed a questionnaire before registering for tournament play. The results obtained from the survey indicate that 91.2% of this population had an injury to the lower extremity. A discussion of the etiology and mechanism of the various lower extremity injuries is presented.

*Gecha, S.R., and E. Torg. "Knee injuries in tennis." Clinics in Sports Medicine 7.2 (1988):435 52.

Racquet sports involve sharp, side to side movements and impose significant valgus and rotatory stresses on the knee. Most knee injuries are indirect as a result of these acute stresses and overuse. Some of the more common racquet sport injuries include tennis leg, jumper's knee, patello femoral pain, meniscal injuries, bursitis, and tendinitis.

*Gregg, J.R., and E. Torg. "Upper extremity injuries in adolescent tennis players." Clinics in Sports Medicine 7.2 (1988):371 85.

The majority of adolescent tennis players will have their playing temporarily interrupted by an injury, with lower extremity problems predominating. Although upper extremity injuries occur less frequently, they tend to be more troublesome. Injuries discussed in this article include "King Kong arm," slipped capital humeral epiphysis, "Osgood Schlatter disease" of the shoulder, tennis elbow, stress synovitis and elbow flexion contracture, and friction burns and collagen stress fractures of the rotator cuff.

*Groppel, Jack L., and R.P Nirschl. "A mechanical and electromyographical analysis of the effects of various joint counterforce braces on the tennis player." American Journal of Sports Medicine 14.3 (1986):195 200.

Biomechanical data on most bracing and protective equipment systems is lacking. To better understand the clinical success of counterforce bracing, a biomechanical analysis of braced and unbraced tennis players (serve and backhand strokes) was undertaken. Three dimensional cinematography and electromyographic techniques were used. Three commonly used counterforce braces (lateral elbow, medial elbow, and radial ulnar wrist) were compared with the unbraced condition. The overall results basically reveal positive biomechanical alterations in forearm muscle activity and angular joint acceleration dependent upon the brace and joint area analyzed.

*Groppel, Jack L., and E. Paul Roetert. "Applied physiology of tennis." Sports Medicine 14.4 (1992):260 8.

Studies in anthropometry showed that more research is needed in the area of physical development and its relationship to playing tennis. Muscle activity patterns have been studied for the different strokes, although more data are available relative to the service. During the service, skilled tennis players were found to display more consistent muscular activity with shorter periods of activation, implying a higher level of coordination than less skilled players. In profiling players, positive correlations were found between tournament play and a number of fitness parameters. More research is needed to develop assessment measures that are tennis specific. Also, longitudinal studies will provide greater insight into player profiles. The general consensus on fitness development was that tennis players should incorporate flexibility, strength and endurance training in their programmes to minimise asymmetry and injuries, while simultaneously enhancing performance. Tennis was found to have both aerobic and anaerobic components, with the predominant energy supply coming from phosphagen energy system. These findings suggest training programmes should be designed specific to the actual energy and muscular demands of the game. The need for further research in all areas certainly still exists in order to gain a better understanding of the game.

*Hageman, C.E., and R.C. Lehman. "Stretching, strengthening, and conditioning for the competitive tennis player." Clinics in Sports Medicine 7.2 (1988):211 28.

For an athlete to be competitive at the highest levels of tennis, he or she must possess an optimal level of flexibility, strength, and cardiovascular conditioning. He or she also must be at a maximum level in areas including upper and lower extremity selective endurance, isolated muscular strength patterns of repetitive activities, and agility. To achieve this, a great deal of time and effort must be spent off the tennis court strengthening the appropriate muscle groups and improving overall agility and pattern responses. It is hoped that these programs will allow the American junior tennis player to return to a level competitive with the rest of the world.

*Hatze, H. "The effectiveness of grip bands in reducing racquet vibration transfer and slipping." Medicine and Science in Sports and Exercise 24.2 (1992):226 30.

The effectiveness of cushion grip bands in reducing impact shock and vibration transfer, and slipping in tennis racquets has been investigated. The results also apply, in principle, to badminton and squash racquets, and to golf clubs. An artificial arm (manusimulator) replicating the structure and all the important properties of the real human arm (shoulder, upper and forearm, hand, soft tissue and muscle simulators, etc.) was used together with a standard tennis racquet for the investigation. Laser beams were employed for precision adjustment of the spatial racquet position and the ball impact location. The impact velocity was standardized at 20 m.s 1 +/ 1.2%, while the impact point was located 32.5 +/ 2 mm distal to the sweet spot (the nodal point of the fundamental transverse vibration mode) on the racquet long axis. The grip circumference for the 26 different grip bands tested was controlled at 116 +/ 1 mm (grip size 5), and the adjustable manusimulator grip pressure was kept at preset values. Impact shock and post impact racquet vibrations were determined by manusimulator accelerometry, while slipping resistance was measured by friction methods. The major finding was that cushion grip bands do statistically significant (at P = 0.05) reduce impact shock and vibration transfer in tennis racquets, albeit to varying degrees depending on the brand. At present, there is no clear indication whether these reductions are, in fact, biologically relevant. Very large differences were found to exist between the various grip band types as regards the reduction of slipping.

*Ishikawa, H., et al. "Osteochondritis dissecans of the shoulder in a tennis player." American Journal of Sports Medicine 16.5 (1988):547 50.

*Jette, M., et al. "Ambulatory blood pressure and Holter monitoring during tennis play." Canadian Journal of Sport Sciences 16.1 (1991):40 44.

The effect of tennis play on blood pressure, heart rate response, and rhythm disturbances was evaluated in 21 men 39 to 61 years of age (M = 49.5 +/ 6.7 yrs). A Holter monitor was utilized for continuous ECG recording during tennis play and a portable ambulatory blood pressure recorder (Spacelabs) was used to measure blood pressures and heart rates periodically during tennis matches. The results indicated that blood pressure response to tennis (singles), although an activity of moderate aerobic intensity, can exert significant increases in systolic and diastolic blood pressure even in those persons who are normotensive at rest. Excessive body weight, and particularly abdominal deposition, appears associated with an increase in diastolic blood pressure to exercise. Few heart rhythm disturbances of consequence were uncovered. A simple submaximal step test such as the Canadian Aerobic Fitness Test, with ECG monitoring, could assist in detecting those individuals susceptible to an exaggerated blood pressure response and to heart rhythm disturbances at exercise.

*Kamien, M. "A rational management of tennis elbow." Sports Medicine 9.3 (1990):173 91.

Tennis elbow is due to a torque injury or sudden overstretching of tendons which insert into the epicondyles of the humerus. The predominant lesion is an enthesopathy a pathological lesion at the insertion of tendon into bone. The most common site is at the lateral epicondyle and this is 3 times as frequent as at the medial epicondyle. Approximately 50% of tennis players can expect to get a tennis elbow at some time during their playing lifetime. In one third of the players this will be severe enough to interfere with their tasks of daily living. The major unresolved question about the aetiology of tennis elbow is why it has its peak incidence between the ages of 40 and 50 years and why 90% of players then have no further recurrence. Making sense of the literature on the treatment of tennis elbow is difficult because there are few studies that have used the acceptable epidemiological techniques of the prospective randomised controlled trial or case controlled study.


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