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Playing for a Cure 08/28/2009 - 2:14 PM

Lauren Harvey Nine-year-old Lauren Harvey has been playing tennis since she was 4. She recently started playing in her first USTA junior tournaments, and she religiously checks her USTA ranking online each week. This weekend, she’s playing in a tournament at her home club, The Greens in Oklahoma City. But it’s not just any tournament, and tennis is more than just a childhood obsession for her. The tournament is to benefit the Cystic Fibrosis Foundation, and since Lauren has cystic fibrosis, playing tennis is helping to keep her healthy.

A genetic disease that changes the way secretions happen in the body, CF causes mucus to thicken and clog wherever it is in the body. For the lungs, that can mean clogged airways, which can lead to breathing difficulties and infection. Aerobic activity helps clear the lungs, so it’s absolutely necessary that those with cystic fibrosis lead active lifestyles.

“What happens is gradually over time you lose functioning in the lungs,” says Dr. Mark Harvey, M.D., father to Lauren and her brother, Will, 13, who also has CF and also plays tennis, though mostly as a way to stay in condition for his favorite sport, auto racing. “The goal is to make that happen as slowly as possible.”

What’s more, Harvey told me as he drove his daughter home, aerobic activity helps condition the entire body, which is extremely important when you have a chronic disease. “People who are better conditioned live longer lives with better quality,” he says. “If they get an infection, the better condition they’re in, the better they’ll be able to deal with it.”

In 1955, when the CF Foundation was founded, children with the disease weren’t expected to live through elementary school. But after strides in treatments and therapies, the median survival age today is 37. Dr. Harvey says there have been some major research developments recently, and he’s most excited about trials on therapies to correct the functioning of the defective protein created by the abnormal gene that causes CF. “There’s a good chance that those people who are alive right now with CF may have the chance to have normal life spans,” Harvey says.

The Harvey Family with The Greens tennis director Suzanne LaBelle The junior tournament this weekend, in its first year, is the latest of many CF fundraising activities for the Harvey family. They do a golf tournament that raised $200,000 this year, the Great Strides nationwide walk, galas to raise funds and an adult tennis tournament at The Greens in February that raised $15,000 this year.

Another reason Harvey and his wife, Diane, encourage their kids to be active? “When you’re dealing with chronic illness, staying active and engaged and thinking about the future is important,” he says. “Like with tennis, positive self-talk, visualizing success and goal making, those are the same things that are important.”

Let’s hope Lauren takes that positive attitude and determination to the court this weekend. 


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The Latest Tennis Elbow Cure 08/20/2009 - 11:11 AM

Attention tennis elbow sufferers: Could a short, twisty rubber bar be the solution to your painful elbow problems? That’s what a recent trial concluded. In an uncompleted study, two groups of tennis elbow victims, one doing exercises with dumbbells and the other using a rubber bar, were compared. The results were so drastically different, with the rubber bar group coming out ahead, that the study was aborted so everyone could use the rubber bar.

Thera-Band Flexbar So what is this magical tool, you ask, and what does it do? It’s a Thera-Band Flexbar hand exerciser, which you can twist and bend. According to Tim Tyler, a clinical research associate at Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York, who headed the study, it allows you to do “isolated eccentric” exercises, meaning that it provides resistance while the muscles lengthen. When I spoke to him, he likened the exercise to lowering the barbell while doing a chest press: As you slowly lower, you have to work to control the resistance of the weight, so your muscles lengthen as they contract. Here’s a link to a video of the exercise with the rubber bar.

Wouldn’t it be nice if this simple exercise was the answer? Since the study wasn’t completed, there isn't hard data to cite. But given the fact that many of the other solutions, things like cortisone shots, platelet replacement therapy, and surgery, are much more invasive, this at-home exercise might be worth a try. Tyler recommends three sets of 15 repetitions twice a day, though only after you’ve gotten the OK from your doctor or physical therapist.

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Mailbag: Fostering Flexibility 08/14/2009 - 3:19 PM

I’ve recently started to have knee pain after playing tennis. Are there any type of exercises to strengthen the knees? Second question, do you have any suggestions to improve mobility on the tennis court? I always seem to come to the ball late and never make a good shot.—T. Nguyen

Vera Zvonareva Knee problems are hugely common in a pounding sport like tennis. But that doesn’t meet that you can’t avoid it. An answer to both of these problems might be increased flexibility. Often times, knee pain comes when the tendons in your legs are too tight and rigid to withstand the stress you put on them with quick starts, stops and changes of direction in tennis. So to keep your knees ready to hit the court, warm up properly each time you play, doing a 5–10-minute jog followed by dynamic stretches. After you play, make sure to cool down properly with more dynamic stretches or some static stretches. Another great way to loosen up tight tendons and bands is to use a foam roller to massage your legs (learn how from Victoria Azarenka). But depending on the severity of the pain, it might be something more serious than tight tendons and bands, so you should have your knees checked out by a doctor.

Another important factor to avoiding knee pain is, as you mention, building strength. You asked for exercises to strengthen the knees, but what’s really important is strengthening the muscles around the knees. When your quadriceps, hamstrings and calf muscles are strong, they offer support and keep the knee joint stable. Go here for a TENNIS article on knee health that includes strength exercises and a good stretch for flexibility.

As for mobility on court, you have it right that arriving at the ball in time to get in position is key to hitting consistent strokes. In addition to helping keep you be pain-free, flexibility also plays an important part in your movement. If you keep your muscles limber with regular stretching, both dynamic and static, your body will be more prepared to get moving. Other things factor in as well, like maintaining the proper weight (a few extra pounds can weigh you down on court) and leg strength (which can be increased with strength training and footwork drills). Check out the Health & Fitness section of the upcoming November/December issue of TENNIS for a flexibility workout geared toward improving movement around the court.

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Taking It Outside 08/07/2009 - 1:17 PM

Joggers Have you seen that New Balance commercial where the sheet tries to keep the woman from getting out of bed? While she’s lacing up her running shoes, the sheet slithers up behind her and wraps itself around her. That happens to me pretty much daily. Sometimes the workout wins, and I get out the door to go on a jog, and sometimes the bed wins.

But in the summer, getting up for a morning workout is better than the other option: exercising in the miserable afternoon heat and humidity of August in New York City. The air can be so thick that running through Prospect Park in Brooklyn feels like running through soup. While the visible haze that hangs over the park’s large grassy meadows and pond in the mornings can be disheartening—Why am I doing this? I could be home in bed with my AC blasting—it’s better than after it’s burned off and the sun is blaring down.

Aside from some rough conditions, I love working out outside when it’s warm. The nature and activity of the park beats the fluorescent lighting and mechanical hum of the gym. So try waking up for an outdoor workout. It’ll keep your evenings free for summer activities and give you a nature fix before a day in the office. If you have a hard time getting up, plan a tandem workout with a friend. The buddy system (though I often think of it more as peer pressure when I just wake up) makes you get out of bed—no one wants to stand someone up at 6:30 in the morning—and makes workouts a lot more fun.

As a friend of mine, who happens to be seriously fit, says, you’ll never regret working out, but you’ll probably regret skipping it.

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Health & Fitness Mailbag 07/30/2009 - 12:39 PM

Todd Ellenbecker

T
odd Ellenbecker, D.P.T., chairman of the USTA Sport Science Committee and co-author of Complete Conditioning for Tennis, answers your tennis health questions.



I’m 16 and about 5-foot-8. I eat healthily and have a light body frame. I have recently been considering taking protein supplements in order to gain some weight around my shoulders, would this work?—Conor Graham

Conor, this is a great question. By taking a supplement alone, this would not increase your strength in any specific area. In fact, supplements alone do not typically induce a strength improvement. Instead, they give you the energy you need to increase your training and perform strength-training exercises to increase your strength. So, to answer your question, I would consult a certified dietician who can do a profile on your current nutritional intake. It’s likely that you are eating correctly, but may simply need more calories or a more balanced food to optimize your energy level and training response. Then, by starting a specific strength and conditioning program for tennis players, that includes a program of shoulder and upper back exercises, you can improve your upper-body fitness.

It is important to note that you have to be very careful when adding upper-body exercises for the shoulder area. Training the chest and shoulders for a tennis player should be very different from training for a linebacker in football. Consult books like Complete Conditioning for Tennis, which I wrote with Paul Roetert or Tennis Training by Mark Kovacs, W. Britt Chandler and T. Jeff Chandler for direction on the proper rotator cuff and scapular exercises to give you great shoulder strength and stability.

My son and I are playing in a two-day tournament. What should we eat before, between and after matches to prepare and recover? We are NTRP 3.5, he is 19 and I am 53, if that makes any difference.—John Lott

Rafael NadalOne of the most important aspects of nutrition during a tournament is hydration. And one of the most often overlooked aspects of hydration is preparation. Studies have shown that players actually enter matches and practice sessions dehydrated before they even start. That puts you behind the eight ball, so to speak, and makes it hard to catch up by drinking during changeovers. So be sure you drink plenty of fluids the night before the match and the morning of. As a general guide, drink until your urine is clear. That means you are well hydrated. But note that if you take vitamin supplements, it may keep urine colored and alter this test.

During the match, be sure to have several swallows of fluid on every changeover. Don’t skip just because you’re not thirsty, as thirst is a poor indicator of fluid need. Also, if you are used to a drink like Gatorade or Powerade, those contain important electrolytes that you lose when you play. These are recommended, but never try something new on a match or tournament day. Some may upset your stomach or give you diarrhea.

Finally, after your match it’s a good idea to replace not only fluid and electrolytes but also replenish your glycogen stores. This should be done in the first 30–60 minutes after you play. If you enjoy energy bars, these can be very easily ingested and can help you recover for your next match (assuming the next match doesn’t start soon after). For more tips on nutrition and hydration, go to the USTA Sport Science Committee’s website.

I came back to the game last summer after six or seven years of not playing. I am 6 feet, weigh 200 pounds, and live in Panama. I am 38 years old and consider myself to be in fairly good shape. I’ve been playing three to four times per week, not less than two hours per session, mostly singles, and mostly on hard courts. I don’t know if it's important, but I use Adidas Barricade V tennis shoes. I understand these are good shoes, but are they known for giving people aches in their feet? For the past couple of months I’ve been getting pain on the bottom of my feet, which tends to go away about 18 to 24 hours after I play. It is as if my feet are getting hurt from the pounding. Is it normal? What I can do to prevent it? Thanks in advance for your help.—Douglas Webster

Douglas, the Adidas Barricade shoe is one of the most popular shoes in junior tennis and worn by many professional players. They are well constructed and typically provide excellent cushioning and support for the feet. However, since everyone has so many specific nuances to their feet, you may need additional support when you play, and it sounds like you play quite a bit. I would recommend first going to the sporting goods store or pharmacy in Panama to get some Dr. Scholl’s-type inserts that will give you greater support in the arch. In the United States, these cost about $25. If you notice an immediate improvement, that may be a necessary addition to your shoes to give you added support when you play. If, however, they help a little, but do not completely alleviate your problem, you may need a more customized insert called an orthotic (in Panama they’re likely called a plantia.) These are made by therapists and podiatrists by making a mold of the foot and provide you with very specific support. If the temporary insert does not help, see an orthopaedic doctor or podiatrist to be sure that you don’t have any other issues with your foot that would explain the soreness from tennis. From the sounds of it, however, the addition of either the simple insert or a customized insert will really improve the way your feet feel after playing tennis. As a side note, most of the top professional players use orthotics (plantias) to increase the support for their feet during competition and training.

I have been an athlete most of my life and played quite a bit of tennis 25 to 30 years ago. I want to get back into tennis in the fall and need a few suggestions as far as a workout that would benefit me. I’m 51, in good health, 5-foot-6 and 185 pounds, so I’m around 40 pounds overweight. I walk my dog 40–60 minutes a day and belong to a local gym, but haven’t gone for a couple of months. I would like to be able to enjoy my time on the court in the spring without feeling like I’m sucking wind or completely out of shape. I know weights or some type of resistance training would be good as well. Any suggestions for a workout that would benefit me would be greatly appreciated.—Judy Smith

Your decision to return to tennis is a great one, but unlike what we used to do in the old days—play tennis to get in shape—we now recommend getting in shape to play tennis. It sounds like you have a very good walking program, but since you say you would like to lose a few pounds and get in better shape before returning to tennis, here are a few suggestions: 

First, add to your program. Maybe try biking for 30 minutes three times a week, keeping your heart rate in your target zone.

To prepare your body for the stresses of tennis, try a basic resistance exercise program even two times a week for a few weeks, prior to your return to tennis. Be sure to included exercises like the seated row, leg press, lateral band walks, shoulder external rotation and lunges (don’t bend the knee more than 60 or so degrees at first), doing three sets of 10–15 repetitions to prepare your muscles for the return to tennis. 

Finally, since it has been some time since you’ve played, consider taking a lesson a week for a few weeks to be sure your technique is at its best before you get back to playing with friends or join a league. These tips will prepare you for the return tennis with greater endurance and prepared muscles, which should help you maximize your performance and enjoyment.

I practice tennis every day, so when the weekend comes I need to rest. But if I don’t practice Saturday and Sunday, on Monday I am breathless, and if I practice Saturday or Sunday, I’m fatigued on Monday! What should I do?—Pedro Kern

Pedro, you need a periodized training program. In general, days off from playing tennis can help you, but they need to be interspersed so that you don’t lose your fitness or timing on court. By alternating your workouts and doing different workouts on specific days, you can keep your edge and fight fatigue. For example, by hitting and doing on-court drills five or six days a week with one day off in between, and altering the amount of time you play each day based on the rest of your training, you may keep your energy level up. Having one day where you do very little training or tennis is great, but it doesn’t mean you have to sit in front of the TV and each chips. You can do other things you enjoy, like playing a bit of soccer or cycling for fun, which will help your endurance but keep you from being burned out. A strength and conditioning specialist can help you put together a specific periodized training program to facilitate your development that will alternate the workouts and allow the rest needed for recovery.

What recommendations do you have for plantar fasciitis and tennis elbow for tennis players?—J.P.

J.P., prevention is the key. For plantar fasciitis, be sure to keep your calf muscles stretched out, and also use proper shoes and change them frequently to help support your foot and ankle. You may also need orthotics to give you greater support if you have flat feet or a high arch, which can make you more prone to plantar fasciitis (your doctor or a therapist can help to determine what type of foot type you have). If you already have plantar fasciitis, have your foot formally evaluated by a physician, podiatrist or physical therapist. They can provide treatment that will decrease the pain and inflammation in the foot, and also make footwear and orthotic recommendations to help your condition.

For tennis elbow, using proper technique is by far the best prevention. So often, players use techniques that lead to elbow pain, and the best treatment and prevention is a tennis lesson with a certified professional. In the early stages of tennis elbow, treatment to decrease the pain can be given by a physical therapist, along with exercises to increase the strength and endurance of the muscles from the shoulder blade to the tips of your fingers. Exercises to prevent tennis elbow can be performed several times a week using a light weight and doing wrist curls with the palm up and down. Doing these if you have acute symptoms of tennis elbow, however, may make the condition worse. 

Shoulder problems seem to be common among pro tennis players. Is the cause the new lighter racquets, more tournaments, string choice? What are some preventative measures for shoulder problems? How big a factor is flexibility?—Dave Ferguson

Dave, there are many causes. Some of the lighter, stiffer racquet frames may subject the arm to increased stress, especially when coupled with improper technique. Increasing your rotator cuff strength protects shoulder ligaments by providing extra stability. Rotator cuff exercises are performed often by professional tennis players as well as baseball pitchers to protect the shoulder. Shoulder exercise programs for tennis players can be found in Complete Conditioning for Tennis, which I wrote with Paul Roetert, or Tennis Training by Mark Kovacs, W. Britt Chandler and T. Jeff Chandler. Most preventative exercises for the shoulder involve using very light weights (1–2 pounds to start) and performing external rotation while lying on your side. Rowing and exercises are also great for preventing shoulder injury.

For flexibility, players can perform a cross arm stretch before and after play to stretch out the back of the shoulder. Simply bring your playing arm across your body at shoulder level and using your other arm to give slight pressure for a stretch. Hold for 15–20 seconds and do two sets. But, while important, flexibility is also commonly the cause of shoulder problems. Some players’ shoulders are actually too flexible, jeopardizing the stability of the shoulder.

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Match Woes 05/08/2009 - 3:01 PM

A recently released study shows that the more matches a junior plays in a tournament, the more likely it is that he or she will have to pull out with an injury. How’s that for obvious? While it is intuitive, it’s the first time there’s been hard data on medical withdrawals for juniors. The study, which is based on findings from the four USTA national junior tournaments in 2005, found that after four matches, young players are twice as likely to withdraw for medical reasons.

The simple fact is that high-level tennis necessitates a high level of effort, and it can take a toll on the body. It’s the same in the pro game. After the grueling early part of the season, the pros always start to seem exhausted, like they’re collectively dragging themselves toward the off-season finish line. Most juniors don't play quite as much as professionals, but those who are very serious about tennis get close when you include the hours they spend training. Plus, at junior tournaments, breaks between matches can be much shorter, and many juniors play multiple matches in the same day.

6a00d83451599e69e201156f82add8970c-800wiSo what does this mean for junior tennis? For the individual, it all comes down to taking care of yourself. Proper rest, nutrition and training are all key to making it through a tournament. In interviews with experts who train tennis players, there’s one thing they always seem to emphasize when it comes to preventing injury: “prehabbing.” It may be a made up word, but it’s important. As opposed to rehabilitation, where you do therapies and exercises to help heal an injury, prehabilitation is about preventing injuries. Prehab exercises usually involve working on flexibility or strengthening muscles surrounding and supporting a joint with very small weights or resistance bands. In a recent conversation with JohnMark Jenkins, who works with juniors as the strength and conditioning coach at Evert Academy in Boca Raton, Fla., he especially stressed prehabbing the rotator cuff (like in the exercise at right) to reduce risk of injury to your shoulder area. For a description of the exercise and a couple more anti-injury moves, click here.

Of course, there are things organizations like the USTA can do, too. The study’s lead author, Neeru A. Jayanthi, M.D., from Loyola University in Chicago, suggests that tournaments decrease the number of matches played each day for juniors. He also recommends an extended rest after a player’s fourth match. That would help juniors recover more fully and be ready to perform their best in the next round.

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Stressed? Play Tennis 04/17/2009 - 4:56 PM

Rafasmall Did you know that April is stress awareness month? I didn’t either. But apparently it has been for the past 17 years. This year, though, I would say the 30-day recognition of emotional strain is more justified than most. These are uncertain times, and with job security to worry about, free-falling savings balances, and the fact that even our banks are currently undergoing stress tests, anxiety levels are soaring. It would almost be better if April had 31 days.

A recent New York Times article offers some insight into the collective mind-set of Americans right now. A couple of tidbits: In a September American Psychological Association poll, significant economy-related stress was up 14 percent from the previous April. And the National Sleep Foundation found that 27 percent of people polled in the fall of 2008 had trouble sleeping because of anxiety related to the economy.

Sponsored by the Health Resource Network, a health education nonprofit, stress awareness month is dedicated to disseminating educational information about the affliction. Stress can definitely take a toll on your health, causing things like headaches, stomach issues, insomnia and depression. It can also lead to weight gain or loss depending on how your appetite sways when you’re under pressure.

The Substance Abuse and Mental Health Services Administration has started a website to help people sort through stress related to the economy. Under “Managing Stress” it recommends “strengthening connections with family and friends” and “engaging in activities such as physical exercise, sports or hobbies.”

This is where your tennis comes in. When you’re worried about financials, hitting the court may be the last thing on your to-do list. But you should give it higher priority. Physical exertion can significantly reduce stress, making you better able to deal with your problems. And while doing something like going on a run can relax you, I think the release of whacking a tennis ball is an even better stress-reliever. 

The fact that tennis is a social sport is also great for your health. In times where it’s every man for himself when it comes to financial stability, socializing on a court can help you balance the bad with some good.

So take some time be aware of your stress this month, and to play some tennis.

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Give Yourself the Pro Treatment 03/27/2009 - 1:06 PM

RecGirlIn the May issue of TENNIS we have an article called “The Pro Treatment” about the different health professionals who help keep the pros in playing shape. But what about rec players? What can the health pros do for your game? While some of the services they provide may seem a bit indulgent, especially in this economy (a session with a sports psychologist, for example, starts at around $150 an hour), they do work wonders for the pros. Here’s a look at what they can do for you.

Trainer

If you have a hard time motivating to work out off the court, a personal trainer can help. While it may be hard find a trainer who’s an expert in tennis, sessions with any strength and conditioning specialist should improve your overall fitness. And the more fit you are, the better you’ll feel and perform on court. “A trainer who’s played tennis would be very helpful, so they know what type of muscles they should work on,” says Jeff Michaud, owner of Fitness by Jeff in Atlanta, where he coaches tennis and does personal training. If you can’t find someone who plays tennis, tell a regular trainer that you need total-body strengthening, with specific attention paid to your core, shoulders, upper back and legs. “For weights I’d recommend anywhere from 20 and about 35 reps,” Michaud says. “You want to do more reps, less weight. You’re not playing football. You want to build endurance and lean muscle mass.”

Physical Therapist

A lot of us have gone to a physical therapist to get treatment for injuries, but many don’t realize the other purpose of P.T.: injury prevention. “Before you’re injured, a physical therapist can provide a preventative evaluation and do things to screen flexibility, strength and balance,” says Todd Ellenbecker, M.S., D.P.T., the ATP tour’s director of sports medicine and the chairman of the USTA Sport Science Committee. If they find a problem, like a muscle imbalance or a weak rotator cuff, they can design a “prehab” program to prevent an injury. So if you’re getting back in the game after time off or if you let yourself get out of shape over the winter, a P.T. evaluation could keep you from getting injured and spending more time away from the court. If you are injured, a physical therapist can perform in-clinic treatments for rehabilitation and prescribe exercises to help you heal and strengthen the injured area.

Nutritionist

Let’s face it: Many of us pack a few extra pounds. But moving around court is much easier if you’re not overweight, and that’s where a nutritionist comes in. The most obvious role of a nutritionist for someone who’s not an elite athlete is to design you an eating plan to help you reach and maintain the proper weight. Dietitians can also counsel you on the proper fueling and hydration for the best performance on court and detect and help you correct any deficiencies in your diet.

Sports Psychologist

Say a certain opponent has you spooked or you just can’t get your forehand to land in. It may not be that your opponent is better than you or that your forehand needs to be reworked; it might be mental. And sometimes mental blocks are the most difficult to break down. You may need help from an expert. “I think it’s an illusion that sports psychology is only for elite athletes,” says Dr. Alan Goldberg, Ph.D. “Pro and rec athletes have the same kinds of issues.” The Massachusetts-based Goldberg does his work primarily over the phone with athletes all over the country, hearing the history of their performance troubles and helping them work through them. “If I’m doing my job well, I’m going to be able to teach them to self-correct,” he says. “I teach them to identify when they’re beginning to make those mistakes on the court and teach them some skills to deal with it.”

Massage Therapist

Anyone who’s ever had sports massage knows it’s not a relaxing experience. The deep pressure can be downright painful. But from tight muscles and bands to scar-tissue buildup, massage therapists can push all the right buttons on your body to prevent injury and help you recover faster. For a full report on how sports massage can help you, check out this TENNIS article. This doesn’t mean that regular spa massages don’t have benefits for your tennis. Like yoga, massage can relax both your muscles and your mind and be almost meditative, which can lead to better concentration on court.

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Blood Sport 03/11/2009 - 4:40 PM

BloodTennis elbow: It’s a nagging injury that makes even the most casual play painful. It can linger so long that many sufferers resort to surgery. But there’s a new treatment for tendinitis of the elbow that’s less invasive than surgery and more long-term than the anti-inflammatory cortisone. It’s called platelet-rich plasma therapy, and, according to Dr. Allan Mishra, an assistant professor of orthopedic medicine at Stanford and one of the method’s pioneers, it’s one of the only truly biological treatments in use today. It works by enhancing the healing powers of your body, and more specifically, your blood.

That may sound like science fiction, but the process is pretty simple. It goes like this: Doctors take about 30 cubic centimeters of your blood (roughly 1/16 of what you would give when donating blood) and put it in a centrifuge to separate the red blood cells from the white blood cells and platelets. After it’s done processing, about 20 to 30 minutes later, they numb the injured area and inject the plasma containing the platelets and white blood cells into the frayed and degenerated tendon. Then your natural healers—growth factors or proteins within platelets—get to work.

And based on Mishra’s research, they really do work. In 2006, he published a study in the American Journal of Sports Medicine on PRP’s efficacy in treating tennis elbow. He took 20 patients with tendinitis so bad that they were considering surgery (“these were the worst of the worst cases,” Mishra says), and gave 15 of them PRP therapy and the other five an anesthetic. After two months, there was 60 percent improvement in the PRP group and only 16 percent in the control group. Two years later, Mishra says, after that single procedure, over 90 percent of the PRP group were better.

After his patients have the procedure, Mishra advises that they start a gentle stretching program within a few days and then gradually work back to their activities. “The significant majority of patients are going to get better when properly selected,” Mishra says. He advises that patients get checked out before getting the treatment to make sure their elbow soreness isn’t referred pain from a pinched nerve in their neck or a rotator cuff injury. In those cases, a shot of PRP to their elbow won’t solve the problem.

The therapy isn’t just for tennis elbow, though. It was created about eight years ago, and is becoming more common for use with a variety of injuries. Professional athletes have tried it, too. Pittsburgh Steelers receiver Hines Ward had the therapy on his injured knee so he could be in playing shape in time for his team to win the Super Bowl. His teammate Troy Polamalu had it, too.

But is this akin to that backroom, mad-scientist procedure known as blood doping where you give blood, store it, then inject it back in before the big match so you feel like Superman? There are similarities, but also definite differences. The World Anti-Doping Agency’s website says they classify as blood doping techniques that increase your red blood cell count, allowing your body to get more oxygen to your muscles. If anything, Mishra says, PRP decreases your red count because the red cells that are separated out in the centrifuge are discarded. A New York Times story discussing platelet-rich plasma and blood doping brought up the fact that WADA bans a certain growth factor contained in platelet-rich plasma, but the agency declined to comment on whether PRP was a violation of their code.

Mishra makes the case that PRP is a treatment for injury, not for enhancing performance. “All we’re doing is concentrating what you already have in your blood and putting it in a tendon where the blood supply is poor,” he says. “We’re not storing it and reintroducing it at a different time. And probably most importantly, I haven’t heard of anybody who is some phenomenally better person for it.”

But recreational athletes typically don’t have to worry about doping code violations. And for those who have suffered with tennis elbow and tried everything from time off to cortisone, and even considered surgery, platelet-rich plasma might be something else to consider.

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Health & Fitness Mailbag 02/11/2009 - 11:51 AM

Todd Ellenbecker, D.P.T., chairman of the USTA Sport Science Committee and co-author of Complete Conditioning for Tennis, answers your tennis health questions.

CrampsmallI have often experienced painful cramps in my legs, mostly the calf area, while playing. This normally happens during a tournament after three or so matches in the heat. I know that it could be caused by heat and excess sweating, but I drink plenty of Gatorade and water. Is there anything you know about this as far as supplements, stretches and training?—Hassan Rashid

Cramping as you describe it is likely due to an electrolyte imbalance and improper hydration practices. Even though you are drinking Gatorade and water, you may be starting matches dehydrated and not able to keep up with the fluid loss while you’re playing despite your efforts. Some players sweat excessively and really lose a lot of fluid and electrolytes while playing (especially sodium). A physiologist can evaluate you for this to determine if you need to take extra steps to combat this problem.

Some things I would recommend include weighing yourself before and after play in the heat. This will allow you to know how much fluid loss you have encountered while playing and also ensure that you drink enough to regain your pre-match weight ensuring that you replace the fluid you lost before you play the next day. Also, research has shown that many players are dehydrated before they even step out on the court. Monitoring the color of your urine can help as well. If it is yellow or dark colored, you are still dehydrated and need to keep drinking fluids (though if you take supplements, it may never be clear). Gatorade allows you to get extra electrolytes by adding the contents of electrolyte packages to your drink. Stretching is always a good idea but likely will not help if you are cramping due to a fluid imbalance.

What is the best way to build stamina for tennis?—Nicole Ross

By studying physiology in tennis, scientists have shown us that fitness in tennis requires bursts of activity known as anaerobic fitness, as well as aerobic fitness due to the long matches and the repetitive nature of the game. Given that, players need both explosive power and aerobic endurance to be successful. So, for the stamina aspect, you should try to supplement your training with some aerobic training. Research has shown that players with higher levels of aerobic fitness recover better between points. To build your aerobic fitness level, the American College of Sports Medicine recommends you perform steady exercise for periods of 20–30 minutes at least three to four times per week at an intensity of 60–80 percent of your maximum heart rate. To do this you could use a stationary bike, elliptical trainer or Stairmaster and use your heart rate as a guide to get optimal benefit out of our workout. Go here to learn to calculate your target heart rate.

Since you love tennis, you could also try enrolling in a cardio tennis program—any type of sustained exercise as mentioned above would be a great choice. If you have had any types of knee or leg issues, running would be my last choice since the pounding of tennis along with the pounding of running may be an overload in your training.

I partially tore my ACL in February 2008. I’ve seen a couple of ortho docs and some physical therapists and I’m really confused. My knee feels OK now, but it starts to hurt after an hour or so, especially when I serve. But I can still play and move. If I elect to have surgery, which is better for a tennis player? One doctor wants to do a hamstring autograft and the other doctor wants to do a cadaver/allograft. One P.T. I saw said I shouldn't get the surgery because it gives you arthritis in 10 years! He said just play with a brace. So, I’m really confused. Help!—Joe Polito

Injury to the ACL in a tennis player is a significant functional problem. With the weight-bearing, loading and twisting that occurs when you play tennis, not having the surgery in a knee that is unstable can lead to arthritis due to increased translation between the femur bone and tibia. You have done the right thing in consulting with numerous orthopedic surgeons and physical therapists as they can give you the specifics of the surgery and rehabilitation following the procedure.

Recent research following patients for as long as 10 years after surgery has not shown a superior graft choice. Patients using their own tissue (autograft) as well as a cadaver graft (allograft) both can return to function following reconstruction. Failure to have the ACL reconstructed can lead to continued meniscal (cartilage) tears which can lead to accelerated rates of arthritis in the knee.

Regardless of the graft and procedure chosen, a steady course of rehabilitation is required following surgery to retrain the muscles in the lower extremity and core to allow for an optimal result. Unfortunately, there is no best surgery, but by consulting the top sports-medicine physicians in your area and asking them the key questions you have outlined will likely guide you to the best procedure for your specific knee injury. Either way, making sure you regain the strength in your quads and hamstrings will help to stabilize the knee, no matter what you decide.

How can I avoid a bruise on the heel of my hand where the racquet rests? I use a [K] Three Wilson raquet.—Sharon Ortega

This problem is most likely not due to the racquet but rather how you grip it. Each racquet has an enlarged end (butt cap) to keep the hand from sliding downward on the racquet when playing. Having your grip and hand position checked by certified teaching professional is likely the best line of defense for this issue, as your hand might be too far down on the racquet. Additionally, if you have your hand positioned in a grip so increased loads are transmitted to certain parts of the hand, like the bones in your wrist, this may cause more discomfort. Sometimes an overgrip can give additional cushioning to your hand, but I would first consult the teaching professional to be sure your grip is proper and best suited for your game.

I am 53 years old and starting to develop knee pain after playing for 30 minutes, is there a certain type of knee support that would offset the discomfort. I really don’t want to give up tennis, I use it as an encouragement to keep getting in better shape.—Jim Cielma

Without examining your knee is difficult to determine what is best for you as there are many options. Knee supports can consist of simple sleeves with a cut-out around the knee cap to support the kneecap when you play. These can be particularly effective if you don’t have really good quadriceps strength and need that support. If your knee pain is caused by an alignment issue (such as if you are bow-legged), then there are specific braces that can be used to unload your knee and relieve compressive type pain in the knee from early arthritis. The best advice for making sure you have the correct support and exercise program for you ailing knee is to see an orthopaedist to examine the knee and determine the source of the discomfort, then perhaps a physical therapist to get the right exercises. The combination of the right brace and exercise regimen will hopefully keep you out on the courts for a long time to come.

I’m trying to train my sister and get her as fit as possible. I want to do some stuff but I’m not sure if they’re a little bit too extreme for her since she’s only 9. Can you please give me some advice on what things she could do?—Erik Angamarca

At that age, working on basic athletic skills is very helpful. Lifting weights and other typical training methods are not as effective and could be dangerous without the supervision of a trained professional. However, doing general calisthenics and body-weight exercises like squat and lunges, sit-ups and push-ups can be used to tone the muscles and gain coordination. Often, exercises that promote body awareness and balance, such as agility drills and kicking (soccer) can be very helpful for general coordination. Many tennis drills can be used or altered for young players to keep it fun and promote overall athletic fitness at that early age, which can go a long way in a player’s development.

I’m 21 years old, and I haven’t played tennis for six or seven years. I started playing again, but now when I play I feel some pain in my wrist. What kinds of exercises can I do to prevent the pain and to strengthen my wrist?—José Dias

Great question. Since you have taken some time off from tennis, you may not have as much strength in your forearms and wrist as you once had when you were playing more regularly. I would recommend doing some wrist exercises to increase your strength to get you back in playing shape. These would involve using 3–5 pounds (I don’t know how large you are, how strong you are etc, so starting out with just a few pounds would likely be the best choice) and doing wrist curls both with your palm facing upward (flexion curls) as well as palm facing downward (extension curls).

In addition to the curls, you can squeeze a ball, holding for five seconds and repeating 10–15 times per session. The curls can be done moving the weight slowly in an upward and downward direction for 3 sets of 15–20 repetitions. These exercises should not be done right before playing or practicing as it will tire out your muscles before you play. Do these several times a week and in 4–6 weeks your wrists will be stronger.

I am 55 years old and play mostly men’s doubles at a 4.5 level. I have a ruptured disc in the lower lumbar spine area. The pain dictates when I can play and for how long. Should I stop doing what I love, consider surgery or try and live with the pain? I have had decent results with Z-pak steroids (a small dose for 6 days straight). Would this be OK to help me keep playing?—Ron Eddy

Injuries to the spine are common in tennis players of all ages and ability levels. Typically the best treatment for tennis players with back problems is to improve their core stability. The core consists of the muscles of the lower back, abdomen and hips. All players need to have a strong core to perform the rotational movements required in tennis. There are many ways to strengthen the core, and for tennis players, exercises with rotation are most specific to the movements you do in tennis. Using a physio ball adds a lot to the exercise by providing an unstable base, which works muscles of the core even more. Doing sit-ups with rotation, as well as exercises for the lower back such as the superman and pointer exercise can be especially helpful as research has shown that elite tennis players actually have fairly strong abdominal muscles, but have relatively weak low back muscles. Injections and surgery should be resorted to after physical therapy and exercise have not remedied the problem. Go here for a core workout from TENNIS. Adopting a comprehensive core training program would be a great step to playing with greater core strength.

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