פציעות טניס — שיקום השרשרת הקינטית, לא רק הנקודה הכואבת

WHAT IT IS: Tennis is a high-load racket sport with a distinct injury profile. Pluim BM et al. (British Journal of Sports Medicine, 2006, DOI:10.1136/bjsm.2005.023184) systematically reviewed 119 studies and found most injuries occur in the lower extremity, followed by upper extremity, then trunk. Abrams GD et al. (BJSM, 2012, DOI:10.1136/bjsports-2012-091164) further characterised acute lower-extremity injuries (ankle sprains) versus chronic upper-extremity overuse (lateral epicondylitis in recreational players, shoulder pain in elite players). Dines JS et al. (J Am Acad Orthop Surg, 2015, DOI:10.5435/JAAOS-D-13-00148) introduced the kinetic chain framework: tennis transmits supraphysiologic forces to shoulder and elbow hundreds of times per match; weakness anywhere in the chain (foot/ankle, hip, core, scapula, shoulder, wrist) produces compensatory overload above.

WHO IT AFFECTS: Recreational players: lateral epicondylitis is the dominant overuse injury; ankle sprains the dominant acute injury. Intermediate players: shoulder impingement and rotator cuff tendinopathy increase. Elite players: shoulder pain (rotator cuff, internal impingement, GIRD) becomes most common; SLAP tears, stress fractures appear. Risk modulators: age, sex, weekly volume, skill level, racket and string properties, grip size, and playing surface (clay vs hard).

HOW WE TREAT IT: Phase 1 (visits 1–2): full kinetic chain mapping — not just the painful site. Rotator cuff strength, scapular stability, core (Plank, Pallof Press, Bird Dog), hip ROM and abduction strength, ankle stability, biomechanical analysis of serve and forehand. Identification of the weak link. Phase 2 (weeks 1–3): relative load reduction (50–70% volume, not full rest), manual therapy, dry needling, TECAR, daily isometric loading on the affected tendon (Heavy Slow Resistance principles), maintain cardio via swimming or cycling. Phase 3 (weeks 3–8): progressive strengthening of every weak link — core, hip rotators, scapular stabilisers (Y-T-W, Wall Slides, Push-Up Plus), rotator cuff (External Rotation, Empty Can 1–3 kg), wrist extensors (Reverse Wrist Curl, Tyler Twist). 5–10% load progression weekly. Phase 4 (weeks 6–12): graded return — shadow swings, ball at 50%, mini-tennis, full play. Return-to-sport criteria: cuff strength 65–75% of healthy side, ROM symmetry ≥90%, 60-second Plank with leg lift, 2 weeks at full intensity without symptoms.

TIMELINE: Grade I–II ankle sprain 3–6 weeks. Mild–moderate lateral epicondylitis 6–12 weeks. Shoulder tendinopathy 8–16 weeks. Acute lower back strain 2–4 weeks. The decisive factor is rebuilding capacity, not biological healing time. Premature return is the leading cause of recurrence.

RED FLAGS: Sudden hand weakness after serve (full rotator cuff tear); audible "pop" with inability to bear weight (Achilles, ACL); numbness extending from neck to hand (cervical radiculopathy); chest pain or dyspnoea during play (cardiovascular); concussion after fall or impact.

CLINIC: Recovery TLV — private 1:1 physiotherapy, Yaakov Apter 9, Tel Aviv. Alejandro Zubrisky BPT, 20+ years specialising in racket sport injuries. ₪400 per session, 50–60 min, no referral required. Hours: Sunday–Thursday 07:00–22:00, Friday 07:00–14:00, Saturday closed.