A biomechanical evaluation of the lower quarter (foot/ankle, knee, hip, and pelvis) by a skilled Physical Therapist can reveal functional deficits that maybe be contributing to traditionally diagnosed orthopedic problems in tennis players. Looking at the kinetic chain as a complex system of codependent joints, muscles, and ligaments can help to identify the factors that may be causing pain and inflammation that often present as chronic tennis injuries. If a particular structure is overloaded because of muscle weakness or joint instability than the tennis player is susceptible to injury and re-injury when performing sports.
One of the most common is collapse of the knee, secondary to either “flat feet” (over pronation) or hip instability (Trendelenberg position of the pelvis). A key factor in the lower-quarter kinetic-chain problem is gluteus medius weakness. Ireland, et al., have shown gluteus medius weakness is common in patients with knee pain. Additionally, a flat foot puts undue stress on the knee joint. Both of these examples demonstrate how other joints can affect another joint in the kinetic chain and lead to problems.
The female tennis player is at greater risk than the male for serious knee injuries (i.e. anterior cruciate ligament-ACL) because of the increased “L” shaped angle (valgus) at the knee and shorter duration of contraction of the gluteus medius during weight bearing and load-absorbing during a cutting maneuver.
Since biomechanical overload of the knee is so common, prevention is an important when initiating tennis.
Most Gluteus Medius weakness results from a mechanical lower back problem at L4-L5 or L5-S1, thus suggesting a link between back pain and knee/hip problems. When the Gluteus Medius is not performing properly other muscle compensate to allow for motion. These muscles include the Quadratus Lumborum which is located in the lower back and Iliotibial band which is located on the outside of the thigh. Both become tight and overactive which can lead to pain and trigger points in the muscle.
Over pronation or flat feet change the biomechanics of the lower quarter and can cause abnormal weight bearing at the knees, hips, and pelvis.
Manual corrections of the mechanical issues driving the muscle weakness is paramount to further strengthening and pain free exercising or participation in tennis. This should be done by a skilled clinician that has experience with manual therapy. Orthotic splinting may be necessary to correct foot overpronation.
When the body is biomechanically sound muscle strengthening and stretching can be initiated with the goal of symmetrical motion from side to side. Symmetrical motion and balance will allow the player to perform tennis at the most optimal level with less risk for injury.
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