FROM THE EDITORS MESSAGE FROM THE PRESIDENT ISSN: 1567-2352 The Journal of Medicine and Science in Tennis (JMST) is produced by the Society for Tennis Medicine (STMS) in As the COVID-19 pandemic surges on, there have been no traditional co-operation with the ITF, the ATP, and the WTA, and is issued professional or collegiate tennis events to enjoy. Even local tennis has been three times a year. JMST is listed in Altis, Free Medical Journals, MedNets, NewJour, Sponet and SIRC Sports Discus. off-limits in many parts of the United States, with neighborhood courts often The International Board of the STMS closed-up and locked. Only recently have certain venues figured out how to President Walt Taylor, MD stage some exhibition-style tennis events for television viewers, with limited Vice-President Kathleen Stroia Outgoing President Neeru Jayanthi, MD or no local attendees, and strict adherence to “social distancing” protocols. Treasurer Paul Caldwell, MD Secretary & Chair/Editor Stephan Esser, MD Chief Journal Editor Michael J. Griesser, MD Entertaining and educational reading has become more important than ever Associate Journal Editor Natalie L. Myers PhD, ATC as many people are limiting their social outreach as much as possible, and Education Committee Co-Chair Karen Jordan Education Committee Co-Chair Richard Gayle, MD keeping tight to their homes in an effort to limit infection risk and spread Scientific/Research Committee Chair Caroline Martin, PhD of disease. Once again, we have attempted to provide some intriguing and Sports both recreationally and professionally are starting to resume slowly and with caution. Planning for resumption Website Committee Chair Paul Caldwell, MD of the WTA and ATP Tour, as well as, ITF Tournaments are underway. Several professional exhibition tournaments Social Media Committee Chair Melissa Baudo, DPT stimulating tennis-science articles for your enjoyment during this curious Tennis Committee Chair Mark Kovacs, Phd period in human history. have been conducted. A women’s exhibition tournament was successfully hosted in Charleston, South Carolina. International Tennis Federation Miguel Crespo, MD Kudos to the tournament director, Bob Moran as he worked extremely hard with tournament staff and local medical ATP Representative Gary Windler, MD WTA Representative Kathleen Stroia Please enjoy a discussion of “backhand wrist” by Epperson et al, a professionals to keep the players and staff as safe as possible by following strict COVID-19 prevention guidelines. This Membership Committee Co-Chair Todd Ellenbecker, DPT Membership Committee Co-Chair Elaine Brady, PT comparison of general health outcomes in recreational tennis players by tournament has set the standard for future professional tournaments as competition resumes. World Team Tennis in Tishelman et al, and a technique of tactical tennis learning presented by JMST Peer Review Staff the United States has also had a successful restart. We all look forward to witnessing incredible tournament play from Deb Skinstad, Aylin Seyalioglu, Jonathan Fraser, Alaoui et al. Hopefully these unique articles provide some distraction from amazing professional tennis athletes again in 2020. However, we are living in a different world and players and those Deena Casiero, Jason Vescovi, Caroline Martin our current collective health crisis, and provide a basis for some stimulating running tournaments must make sure they attempt to minimize the risk to all involved of COVID-19. Subscriptions and Membership discussion amongst tennis and science professionals. Todd S. Ellenbecker, DPT E-mail: [email protected] Recreational tennis is felt to be a low risk sport, but those playing must still be careful and follow guidelines such as The Journal of Medicine and Science in Tennis (JMST) is a those recommended by the USTA. Many recreational players are back to play which will hopefully improve their membership benefit of the Society for Tennis Medicine and health and overall wellbeing. Science (STMS). Annual Subscription fees due 1st January Physicians and STMS Fellows $195 US With respect to future STMS meetings, we may need to look to having virtual educational meetings over the next Physiotherapists, Athletic Trainers $95 US year or two, depending on the progression of COVID-19 and a potential vaccine for this illness. I hope all of you are Coaches, Tennis Enthusiasts $30 (online access only) healthy and staying safe. Design Rebeca Anaya www.rebecaanaya.com Respectfully, Photography Walter Taylor, MD. Jeff and Manuela Davies, Orlando, FL, USA www.doubleXposure.com Circulation 1,000 Website www.tennismedicine.org Michael J. Griesser Natalie Myers, PhD, ATC Disclaimer Editor-in-Chief, JMST Associate Editor This journal is published by the Society of Tennis Medicine and The Journal of Medicine and Science The Journal of Medicine and Science Science for general information only. Publication of information in the journal does not constitute a representation or warranty in Tennis in Tennis that the information has been approved or tested by the STMS [email protected] [email protected] or that it is suitable for general or particular use. Readers should not relay on any information in the journal and competent advice should be obtained about its suitability for any particular application. © 2020 Society of Tennis Medicine and Science. All rights reserved. No part of this publication may be reproduced in any form without prior written permission of the copyright holder. Opinions and research expressed in this journal are not necessarily those of the STMS. 2 · JULY 2020 · JOURNAL OF MEDICINE AND SCIENCE IN TENNIS JOURNAL OF MEDICINE AND SCIENCE IN TENNIS · JULY 2020 · 3 TABLE OF CONTENTS JULY 2020, VOLUME 26, NUMBER 2 Backhand Wrist: 6 A New Tennis-Specific Diagnosis By Kayla Fujimoto Epperson, Neeru Jayanthi, Gary Lourie, Michael Gottschalk Improved General Health Outcomes in US Recreational 20 Tennis Players By Jared Tishelman, Daniel Bu, James Gladstone, Alexis Colvin, Outcome of the Teaching Games for Understanding (TGFU) approach when applied to tactical understanding of 32 strategy and tactics in the game of tennis for young people. By Mustapha Alaoui, Georges Kpazaï, Michel Portmann, Alain Steve Comtois, 4 · JULY 2020 · JOURNAL OF MEDICINE AND SCIENCE IN TENNIS JOURNAL OF MEDICINE AND SCIENCE IN TENNIS · JULY 2020 · 5 TENNIS SPORT SCIENCE REVIEW KEY RESULTS Backhand Wrist is caused by repetitive, high-energy axial loading with rapid forearm rotation causing degenerative changes and/or poor force transmission throughout the ulnar quadrant. Excessive wrist extension, ulnar deviation, and supination during a two-handed backhand can Backhand Wrist: lead to the development of extensor carpi ulnaris pathology, triangular fibrocartilage complex pathology, distal radioulnar joint instability, and/or A New Tennis-Specific ulnocarpal impaction syndrome. Players with inefficient stroke mechanics may be at increased risk for developing Backhand Wrist. Diagnosis KEY WORDS: Kayla Fujimoto Neeru Gary Michael Wrist, TFCC, injury, rehabilitation Epperson*,DPT,1 Jayanthi,MD,2 Lourie,MD,3 Gottschalk,MD,4 Former President STMS CATEGORY: Institution Affiliation Hand and Wrist 1. Physical Therapist The Athlete Connection 2. Director Emory Tennis Medicine, President Society for Tennis Medicine Science (STMS) 3. Head Team Physician Atlanta Braves, Head Orthopedic Physician Georgia Institute of Technology Baseball 4. Director of Clinical Research Emory Healthcare INTRODUCTION * [email protected] Chronic overuse injuries are prevalent in tennis players due to the repetitive encountered stresses during strokes and on-court movement patterns.1 Epidemiological studies of injuries in professional tennis players note an increased prevalence of acute injuries occurring in the lower extremity and chronic overuse injuries occurring in the upper extremity.1,2 Injury incidence BACKGROUND data from the Australian Open revealed a 2.4 times increase in in-event treatment for upper extremity injuries in both male and female players.2 Moreover, the Ulnar-sided wrist pain is the most common complaint amongst athletic women’s side reported a 2.2 times increase in wrist injuries over the same time wrist injuries, especially in sports like tennis that involve high-impact, period.2 Similar results of increased incidence of wrist injuries are reported in repetitive forces and axial loading of the wrist. the US Open and Wimbledon in which the wrist accounts for a high percentage of all upper extremity injuries compared to other body areas.3,4 Injury incidence data collected from the US Open reported that wrist injuries accounted for CLINICAL QUESTION 13.6% of all injuries in female players followed by the shoulder/clavicle (11.8%), elbow (4.9%), and lumbar/pelvic/sacrum (4.9%).3 Epidemiological data from The primary purpose of this clinical commentary is to introduce Backhand Wimbledon reported that wrist injuries accounted for 12% of all injuries, which Wrist as a new condition related exclusively to non-dominant, ulnar wrist is only second to the knee (13%). Wrist injuries were the highest in the upper pain in elite level tennis players. By being able to clinically define Backhand extremity, followed by the shoulder (10%) and elbow (6%).4 Wrist in tennis players, will this improve diagnosis, clinical decision- making, treatment, and return to play outcomes in tennis athletes with ulnar wrist pain? In addition to reviewing and describing the relevant anatomy and risk