Guest Blog by Perry Nickelston DC, NKT, FMS, SFMA
Tennis is fun and exciting to play, but the potential for injury is high. In the thick of a good game, it’s easy to push harder, faster, stronger, longer and get hurt. There are a few tennis-related injuries that tend to arise more often than others, and they can be difficult to treat both quickly and comprehensively. Sometimes, these injuries require a different treatment approach – more than certain traditional treatment options, injections or medications can individually offer. Deep tissue laser therapy is one way to rapidly reduce pain and inflammation and get athletes back out on the court and playing the game they love.
Constant acceleration and deceleration in multiple planes of motion leads to inversion sprains of the ankle. The inability to decelerate is one of the highest risk factors for injury in sports. Mix that inability with high intensity play, forceful swings, and multiple matches, and injury is a high probability.
The choice of shoes makes a difference too. The traction provided by different shoes can affect movement unexpectedly, usually at the expense of an ankle. A twisted ankle causes damage to ligaments and other soft tissues around the ankle, which then causes bleeding within the tissues and swelling that can be extremely painful.
Laser therapy protocol for a sprained ankle:
Balance of the muscles that control the ankle joint is critical. If there is inhibition or weakness, the ankle is prone to injury. When applying laser, make sure to cover the following inversion and eversion muscles for best results: the tibialis anterior, tibialis posterior and fibularis.
Acute Case: For acute instances with bleeding, wait until bleeding subsides before applying laser. Once bleeding has subsided, apply laser twice daily if possible, but at least once per day. Use low dosage and low power (5-6 J/cm2 at 5-6 W) for an approximate total of 1,000 J over the ankle. Then laser the calf with higher dose and power (6-7 J/cm2 at 9-10 W) to deliver about 5,000 J to that area.
Subacute Case: Treat daily or every other day. Deliver a higher dose but use a lower power (7-8 J/cm2 at 6-7 W), for an approximate total of 1,500 J over the ankle. Then treat the calf and foot with a higher dose and power (6-7 J/cm2 at 9-10 W) to again deliver around 5,000 J to that area.
Otherwise known as lateral epicondylitis, this is a very common injury consisting of pain in the outside of the elbow. Tennis elbow is an inflammation of the muscles and tendons in the forearm where they attach to the humerus bone. The pain is exacerbated by gripping activities, and in some cases simple things like turning a door handle can cause intense pain. Extending the wrist backwards can also be difficult and painful. Because of forceful swinging of the racket, any weakness or tightness in the upper body can lead to overuse of the arm to generate power. Weakness is often found in the latissimus dorsi, while tightness is found in the thoracolumbar fascia and opposite side gluteus maximus.
Laser therapy protocol for tennis elbow:
Click here to download a study looking at the effectiveness of laser therapy for epicondylitis.
Acute Case: Treat entire area, from elbow to hand, daily. When treating directly over the elbow, use low dosage and low power (5-6 J/cm2 at 5-6 W) for a total between 600-700 J. Then, using the same dosage, increase power (10-12 W) and laser the forearm to fingers and upper arm to shoulder, delivering a total of 2,000 J below the elbow and 2,000 J above the elbow.
Chronic Case: Treat entire area, from elbow to hand, every other day. For the elbow, use a higher dose and a higher power than used when acute (8-10 J/cm2 at 8-10 W) for a total of 1,000 J. Then increase power again and deliver 2,000 J above the elbow and 2,000 J below the elbow.
In addition to treating the immediate and directly surrounding sites of pain, you may want to consider treating the thoracolumbar fascia, latissimus, and cervical spine. Increase the power to the maximum available on your laser (preferably 15 W or above) and treat the thoracolumbar fascia and latissimus of the painful arm using a dose of 8-10 J/cm2 (6,000 J total combined dose) with open cone or massage ball. Then, reduce dosage and power (5-6 J/cm2 at 7-8 W) and deliver 1,000 J directly to the nerve root of the cervical spine.
Swing something often enough and the shoulder is probably going to start hurting – even if it’s a lightweight racquet. Frequent overuse of the rotator cuff muscles can cause the bursa to become impinged, leading to impingement syndrome and bursitis. Tennis players who develop this often experience pain anytime the arm is raised and even when simply sleeping at night. Sharp pain with episodes of deep aching is common.
Overuse of the anterior chain muscles is also common in overhead athletes (pectoralis major/minor, anterior deltoid, bicep, and coracobrachialis are a few). It is not uncommon for the bicep tendon to pop out of the bicipital groove in the humerus, causing anterior shoulder pain and inflammation. Weakness in the latissismus dorsi, middle trapezius, and abdominals will also lead to overuse of other muscles in the swinging pattern.
Laser therapy protocol for shoulder pain:
To achieve the best outcomes, combine the laser therapy treatments with rehabilitation exercises, using laser therapy prior to exercise.
Acute Case: Treat daily directly over the painful area (7-8 J/cm2 at 7-8 W) and deliver a total of roughly 1,800 J.
Subacute Case: Treat directly over the painful area daily or every other (8-10 J/cm2 at 8-9 W) and deliver a rough total of 2,000 J.
Chronic Case: Treat directly over the painful area every other day (10-12 J/cm2 at 10-12 W) and deliver a rough total of 2,500 J.
In addition to treating the immediate site of pain, you should consider treating a couple additional areas (especially when the condition is subacute or chronic). Treat the cervical spine nerve root at C5-C6 (5-6 J/cm2 at 7-8 W) to deliver about 600 J. Then, increase laser to full power available on your unit (preferably 15 W or above) and treat the pectorals, humerus, mid back, latissimus and thoracolumbar fascia with a dose of 8-10 J/cm2 for a total delivery of 600 J per area.