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Fitness Mailbag: Stretch and Strengthen 09/23/2010 - 10:38 AM

We’ll answer your health, fitness and nutrition questions here each week. Click here to submit one of your own.

Maria Sharapova I’m looking for shoulder exercises. Can you help me? Thanks.—Jim Filippo

An injury to your shoulder can keep you off the court for months. Take Maria Sharapova: She was sidelined for nine months after having surgery on her rotator cuff in 2008, and she still hasn’t been able to climb back to the top. “The majority of upper body injuries in tennis players are shoulder-related,” says Dr. Mark Kovacs, manager of USTA Sport Science. “So spending time on rotator-cuff strengthening and shoulder flexibility, especially internal rotation of the shoulder, is really important.”

When you exercise your shoulders, you’re actually working the four muscles of the rotator cuff, which stabilize the joint. Resistance band exercises are great for the shoulders because the work you do to control the motion fine-tunes and strengthens those muscles. For more on keeping your shoulders healthy, read this article from TENNIS Magazine, and click here for some sample exercises.

I’m a 55-year-old male who plays four to five times a week. I’m looking for some stretching and strengthening exercises that will help me stay injury-free. The wear and tear on the hard courts is starting to be an issue with my kness, back and shoulder, and I’d also like to address my core. Thanks.—Frank Redman

It’s great that you’re seeking to strengthen and stretch, Frank. Both are essential if you want to prevent injury and stay fit, and adding strength is particularly important as you get older. “Strength training and especially power training as we age has been shown to be really beneficial,” Kovacs says. He recommends you consult a qualified strength and conditioning coach or a physical therapist to start a regimen.

Another option would be to check out a book like Complete Conditioning for Tennis by E. Paul Roetert and Todd S. Ellenbecker, which comes with a workout DVD. It gives you exercises and tips to help you gain flexibility and strength and prevent injury throughout the body. For a more bite-sized guide, check out our rules for keeping fit as you get older.

Also, it might be time to ditch the hard courts. More forgiving surfaces like clay or grass will limit the pounding on your body. And no matter what courts you play on, Kovacs says, watch what you wear on your feet: “Really make sure that the shoes and any inserts or orthotics are replaced regularly and are of high quality.”

What are the best exercises to improve the serve, especially for beginners? Do I need a strong core or shoulder?—Aris Morales

You definitely need a strong core and shoulders. “But for a beginner,” Kovacs says, “probably what will give you the biggest return is developing some lower-body power.” Kovacs recommends you do plyometrics to gain power. That’s “anything that’s explosive and requires the athlete to get off the ground,” Kovacs says. So if you’re new to tennis and want to beef up your serve, get moving with things like jump squats, high knees and figure-8s.

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Tennis Elbow? Try Botox 05/04/2010 - 5:37 PM

Botox isn't just for your face anymore For all you players with tennis elbow, here’s the good news: A new study shows that botulinum toxin can help reduce pain from tennis elbow. Yes, that’s right, Botox isn’t just for your face anymore. The most common use for Botox is, of course, cosmetic. Doctors inject it into patients’ faces to temporarily paralyze muscles (it usually lasts for three to six months) to prevent wrinkles from forming. But researchers at Imam Khomeini Hospital Complex at Tehran University in Iran found that, when injected at the proper spot, Botox eased arm pain in tennis-elbow patients. The study, which was published by the Canadian Medical Association Journal, tested 48 subjects who hadn’t had relief with other treatments. 

Now for the bad news: If you were planning on using that arm to, you know, play tennis, be warned. That paralyzing effect doesn’t just reduce pain, it also reduces strength, even making it difficult to fully extend the third and fourth fingers. Sounds like this remedy needs further study.

Ds In news from a former player who went the Juvéderm route, rather than the Botox route, to deal with wrinkles, Lindsay Davenport tweeted yesterday about the dangers of too much sun exposure: “At dermatologist getting something cut out of my lip...downside to career in the sun,” she wrote. “Wear sunscreen and get your skin checked regularly!” She speaks the truth. Especially as we head into the summer months, remember to slather on the sunscreen and wear protective gear when you hit the court. 

Finally, is anyone else happy to see Dinara Safina back on court? She may have lost her first match in Rome to Romania’s Alexandra Dulgheru, but she reached the quarterfinals in Stuttgart last week. Her steps back on court may be tentative, but she’s happy to be taking them. She had two stress fractures on a disk and a muscle rupture in her back that went undiagnosed last summer that have really derailed her ever since. It’s hard to imagine a doctor not taking the greatest care with a professional athlete of Safina’s stature. Surely, she could pay for the best possible treatment, but from Safina’s telling, the doctor said she was fine and pushed her to practice. Now, she says, if she reinjures it, “that might be it for my professional career altogether.” For now she’s taking it easy and enjoying being on court. And her fans are enjoying seeing her play again.

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The Hip Option 04/26/2010 - 11:53 AM

In the May issue of TENNIS we have an article about a player who successfully came back to the court after traditional hip replacement. Frank Trulaske, a 61-year-old tennis lover, returned to his regular game nine months after his surgery, and two years later he’s still playing. It doesn’t go that well for everyone. With heavy use, traditional artificial hips can dislocate or wear out. That doesn’t bode well for patients in their 40s who need a solution for bad hips. 

Mike Schnably  “It used to be that the people coming in for joint replacements were all in their 60s and 70s, but now with the baby boomers coming of age, we’re seeing a lot of younger people who’ve played a lot more sports and pounded their bodies a lot more,” says Dr. Chet Simmons, an orthopaedic surgeon at Chester County Orthopaedic Associates in West Chester, Pa. “They’re wearing out their joints sooner and sooner, so we’re seeing some people who need a replacement of some sort in their 40s sometimes.”

One solution for younger people with chronic hip pain is hip resurfacing, which is fairly new to the United States, but is popular in Europe. Instead of removing the ball of the joint and replacing it with a prosthesis, like in traditional hip replacement, a metal cap is put over the ball on top of the femur, which fits into a metal socket that’s placed in the pelvis. It’s usually only done in those who are younger because the patient needs strong bones to support it. “It has to sit on top of healthy bone or it can come loose or fracture,” Simmons says. “Older people typically have weaker bone and it may not support that structurally.” Simmons says there’s also concern about doing the procedure in women because of the prevalence of osteoporosis as they get older.

Hip resurfacing is the option Simmons’ patient Mike Schnably, a 45-year-old competitive tennis player, decided on. A Division II All-American for West Chester University, Schnably gave up playing competitively for about 20 years after college, but he took it up again in his 40s as a way to stay in shape and have fun. He rose quickly to No. 39 in the nation in the 40-and-over division, only to be brought down by chronic hip pain. At first he thought it was just a pulled muscle or a bruise, but it got progressively worse. “Eventually, end of the year 2008, it was baaad,” Schnably says. “I couldn’t even keep up with people playing golf. I couldn’t do anything. I mean, I could walk with a limp, but there was pain.” An X-ray revealed that he had no cartilage left in his hip. Bone was rubbing against bone.

X-ray of Schnably's hip  Schnably wanted the pain to go away, but he didn’t want to give up his lifestyle. As a young, active guy, he feared that a traditional hip replacement wouldn’t keep up with him and that it would wear down too quickly or dislocate. “Intense play would probably shorten the life of a traditional hip replacement significantly,” Simmons says. “There are lots of folks that will play kind of low-intensity tennis, and they can do that pretty well because they don’t have to run long distances or dig into the corner for a ball.”

A little less than a year ago, Schnably had a hip resurfacing with a product made of magnesium cobalt alloy. Six months after the surgery, he was back on court. Now, he’s ranked No. 5 nationally in the 45s and he has won three tournaments so far this year. 

Of course, not everyone has as much success as Schnably. A recent article in the New York Times questions the safety of metal-on-metal hip products. The concern is that the metal rubbing together releases tiny particles that can cause soft-tissue damage or even get into the blood stream, especially in poorly installed resurfacings. Only a small percentage of people have had problems like these, but they’re certainly a concern. “That’s a problem with any new surgery because you don’t have long-term follow-up yet,” Simmons says. The majority of people who’ve had this are doing well like Mike. But it’s something we always discuss.”

Now pain-free and playing as well as he was before, Schnably has been satisfied with his decision. “You can’t tell it’s there except when you go through the airport,” he says.

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A New Fight 04/09/2010 - 4:43 PM

Martina Navratilova A week ago our photo editor, David Rosenberg, had some gossip. But it wasn’t the good kind. He had come across a photo of Martina Navratilova in a swimsuit with a large bandage underneath her arm. That got the speculation started around the office, and it was unhappily confirmed this week when Navratilova, 53, announced that she has ductal carcinoma in situ, a form of breast cancer. That’s the bad news. The good news is the cancer has not spread and her outlook is “excellent.” 

Though she was shocked when she found out (“I was devastated, physically, I couldn’t think, I couldn’t move, I was useless,” she said on Good Morning America on Wednesday), Navratilova went on the offensive. She had a lumpectomy in February and will undergo six weeks of radiation starting in May. The 59-time Grand Slam winner (in singles, doubles and mixed doubles) has now gone on an offensive of another kind: a crusade for awareness.

Surprisingly for such a supremely fit, multitasking go-getter, Navratilova put off getting a mammogram for four years because she moved and changed doctors. And that was after her mother and sister both had benign calcifications in their breasts. Navratilova doesn’t want other women to make the same mistake. She’s now telling her story and advocating for women to schedule their yearly check-ups. As for the controversial new recommendations that say most women should wait until they’re 50, instead of 40, to start getting regular mammograms, Navratilova said sarcastically on GMA, “The cancer knows that you’re not 50 yet, so it’s going to wait. I don’t know who came up with these recommendations.”

Ever the model for the active lifestyle, Navratilova has no plans to slow down. Her radiation is scheduled for during the French Open, but she still hopes to commentate for Tennis Channel. She has kept up her health and fitness regimen, as well. She played in the Hit for Haiti in Indian Wells between her biopsy and lumpectomy and has continued to play hockey and bicycle. "I gravitated towards yoga these last few months and find it extremely relaxing and calming, so I expect I will be doing that as much as possible," she wrote in an e-chat to answer questions on the website of the AARP, where she's the health and fitness ambassador. 

She also chatted about the outpouring of support she’s received: “My tennis friend Jim Courier sent me a sweet e-mail yesterday saying he felt sorry for the cancer because I was going to kick its ass,” she wrote. “I said thank you so much, Jim. Don’t feel sorry for the cancer—but yes, I will kick its ass.” I have no doubt that she will.

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Ditching Plastics 04/01/2010 - 5:19 PM

Roger Federer Today at lunchtime I stumbled across this article. Between taking bites of salad out of a Tupperware container and plucking grapes out of a Ziploc bag, I started thinking that it’s time for some new lunch packaging.

The article, titled “The Perils of Plastic,” brings up lots of questions about the possibly harmful chemicals in many plastics. When ingested, some may have unintended effects on the endocrine system, especially when absorbed during developmental stages. They may also be linked to obesity, autism and behavioral problems in children. I write “possibly” and “may” because none of this has been proven. There hasn’t been enough study on many of the chemicals to determine if they have negative effects. I found this quote from Richard Wiles of the Environmental Working Group, a nonprofit, especially eye-opening: “Chemicals are deemed safe until the EPA can prove that they are dangerous. It’s completely backward.”

Two stats in the piece, both from CDC studies, also caught my attention: First, researchers found bisphenol-A, chemical found in many plastics that some believe to be harmful, in the urine of 93 percent of Americans surveyed over age 6. And second, in a separate study, researchers found traces of 212 environmental chemicals in those tested.

That’s a lot of chemicals. Plastic is abundant in most parts of life (I’m typing on a plastic keyboard right now, the phone I just picked up is made of plastic, etc.), and that includes tennis. From food you bring for snacks at tournaments to the sports drinks or water you sip on court, most of it is probably contained in plastic. 

So what’s a tennis player to do to avoid chemicals? Many recommend stainless steel reusable bottles like Klean Kanteen or ThinkSport for exercise. I'm thinking of purchasing some new lunch containers like those from the brand Sanctus Mundo. 

What types of containers do you use? Have you shied away from plastic at all, or are you waiting for more information?

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This Week in Research 03/26/2010 - 2:55 PM

Is it just me, or has the health news this week been pretty wild? From how much women need to work out to maintain their weight to the ballooning portions on the table for the Last Supper, here’s a look at the research that’s come out this week.

New research shows women need 420 minutes of moderate exercise every week. Get to Work, Ladies
A new study shows that women need to do moderate exercise for 60 minutes every day to prevent weight gain as they get older. That’s 420 minutes a week of activities like brisk walking, leisurely bicycling and golfing. However, if you do more intense activities, like running or lap swimming, you only need to do 30 minutes a day, or 210 minutes a week. Compared to the current federal guidelines of 150 minutes per week, that’s a lot. I always thought I was pretty health conscious, but I’d say I average only about 180 minutes a week working out. Uh oh. Time to form some new habits. 

Supersized Last Supper
Researchers have discovered that over the past millennium the amount of food depicted in paintings of the Last Supper has ballooned. By comparing the ratios of portion sizes relative to the attendees’ head sizes in paintings over the last 1,000 years, they found the meal to be like a story getting exaggerated the more you tell it: First it was just a nice dinner, then it was a feast, now it’s a full-on smorgasbord. The researchers have deduced that “art imitates life,” and think humans have slowly been evolving toward our supersized portions—and bodies—of today. 

Keep Smiling
Apparently, people with bigger smiles live longer. How can you tell this? From looking at old photos of baseball players. Does this seem a little crazy to anyone else?

Andy Roddick Roddick's Personal Massage Parlor
In tennis health/gossip news, Andy Roddick had to do some heavy lifting in order to set up a physical therapy table in his hotel room in Miami. He asked to have one of the hotel’s tables removed to make space for his PT equipment and the hotel wanted to charge him $150. What did he do? He tweeted about his dilemma and, on the advice of his followers, moved the table into the hall himself. Hey, a pro has to do what he has to do for the sake of his body. Side note: Roddick’s still the No. 1 American in men’s tennis, right? Whatever happened to the star treatment?

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Mailbag: Making the Switch 03/18/2010 - 4:00 PM

Roger Federer I've been playing tennis for about six years. I have a two-handed backhand that I've developed well, but I want to switch to a one-hander. What exercises should I do to strengthen up to hit a one-handed backhand for full matches and long hours of practice?—Alex Layfield

While the two-handed backhand revolutionized the game in the late ’70s and has been the stroke taught to most Americans ever since, there’s something very appealing about the one-handed backhand. The two most prominent players with one-handers on tour today, Roger Federer and Justine Henin, have two the most beautiful, stylish games in the history of the sport. My two-hander is my best stroke, but I have to admit that I still covet the fluid, sweeping motion of the one-hander. Whenever I try to hit one, though, it feels as awkward as trying to write with my left hand. 

If you can get over that awkward feeling and want to make the switch, preparation is essential to avoid injury. Two-handers and one-handers may accomplish the same thing on court, but they’re very different strokes that involve different muscles. I spoke to Mark Kovacs, Ph.D., senior manager of strength and conditioning and sport science for USTA player development, to find out the basics to prevent injury when swapping out a two-hander with a one-hander. 

Technique: Kovacs recommends some time with a teaching pro to make sure you’re hitting the one-hander the right way. “Good technique is first and foremost,” Kovacs says. “Injuries are going to come if you don’t have proper technique.” 

Shoulder strength: To condition your body for the one-hander, the first thing you should work is your shoulder strength. “You’re going to need to get all your power from your dominant shoulder, whereas before you had some help from the non-dominant arm,” Kovacs says. To strengthen your shoulder and rotator cuff for the one-hander, Kovacs recommends securing one end of a resistance band or tube at shoulder height and pulling the other end across your body with your arm straight. Next, step on one end of the band and pull the other end diagonally low to high across your body to mimic the motion of a one-hander (like in this floor-to-ceiling lift).   

Elbow and forearm strength: As with the shoulder, your non-dominant arm won’t be there to support the rest of your arm, either, so you must strengthen your elbow and forearm. One of the best moves, according to Kovacs, is with a heavy hammer or another object that is head heavy. Hold the handle, rest your arm on a bench or the seat of a chair, and rotate your forearm side to side. 

Core stability: The core is important for all tennis strokes, but it’s especially key to the one-hander. “On the one-handed backhand you should be trying to rotate more than on a two-hander,” Kovacs says. He recommends “feet-on-the-ground exercises” to mimic the motion of the backhand. One exercise: Stand facing a wall holding a medicine ball in both hands, and, alternating sides, take the ball back like you’re starting a stroke and follow through by throwing the ball against the wall.

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Forced Break 03/05/2010 - 2:14 PM

Dinara Safina The women’s tour can be an emotional roller coaster, particularly when Dinara Safina is playing. During her matches you can bet you’ll see her berate herself in her native Russian, lock eyes with her coach in search of answers, or dissove in tears (and sometimes all three). But lately it hasn’t been her mental game that’s been holding her back. Now it’s her physical game. This week she announced that she won’t be able to play Indian Wells, which starts next Wednesday, due to a recurring back injury.  

The world No. 2 first sustained the injury in mid-2009, and she was forced to pull out of the season-ending championships in Doha in October. Then, after spending the off-season rehabbing and recuperating, she was back to telling the chair umpire midmatch that she couldn’t go on at the Australian Open. 

What now for Safina? More rehab. And to be honest, I can’t help but think that that may be a good thing. While Safina has had a couple of great seasons on tour, her success has been a mixed bag. Yes, she reached three Grand Slam finals, but she also fell apart in all of them. Yes, she reached No. 1, but she spent press conference after press conference defending that ranking. A forced break might do her good both physically and mentally. Maybe she could even be next in line for an extended layoff, like the ones Kim Clijsters and Justine Henin took. In the April issue of TENNIS, Chris Evert makes “The Case for the Hiatus,” saying that players should be allowed to take time off without having to officially retire.

Clijsters’ main reason for calling it quits, aside from the decision to have a family, was a laundry list of injuries (wrist, back, hip) that made it hard for her to show up on court prepared. “The constant injuries and continual rehabilitation…it makes it all even more difficult to go on,” she said when she retired.

As for Henin, her decision was seen as more emotional and due to burnout. Weeks before she was to defend her French Open title, which she had won the previous three years, she lost the last match of her first career to Safina in Berlin. A week later she announced her retirement, saying, “I really fought these last few months to try for a miracle and to get back this desire and flame I had in me. But I finished thinking it through after Berlin. At the end of last week, I realized I was at the end of my road.”

It’s been almost two years since that breakout match for Safina, and now I find myself thinking Safina’s woes are similar to both the Belgians’. Her struggles are with both her body and her emotions. But then again, her career doesn’t exactly rival Clijsters' and especially Henin’s first careers. Here’s hoping her injury layoff will be enough to get her back to the top of her game and give her a mental break so she can enjoy herself on court. 

If her attitude in the off-season says anything, she’s going to fight to get back to the tour as soon as possible: “I’m trying to recover and get fit for 2010, so I can hopefully show you all some good tennis again!” she wrote to fans on her website. “Don’t give up on me. I’ll do my best!” We’ll see if she’s ready to do her best in Miami, or if this will be a more extended break. 

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Fitness Mailbag: Stretch and Strengthen
Tennis Elbow? Try Botox
The Hip Option
A New Fight
Ditching Plastics
This Week in Research
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