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Improperly-Sized Tennis Racket Grip Doesn't Cause Tennis Elbow
Article Date: 02 Dec 2006 - 0:00am (PST)
Researchers apparently have "gotten a grip" on the relationship between the development of tennis elbow (tendonitis) and the size of the grip on the racket a player uses.
A grip that is either too big or too small for the player's hand is not a factor in whether or not a player may develop tennis elbow, according to a study published in the December issue of The American Journal of Sports Medicine. "An optimal grip size may influence the force with which a player hits the ball, but variations in grip size are unlikely to be contributing factors in overuse injuries such as tennis elbow," concludes George F. Hatch III, MD, currently of the Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, and colleagues. (Dr. Hatch conducted the study while in training at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles.)
"Clinicians who treat patients with tennis elbow often tell them to try a different size grip in order to alleviate muscle fatigue," says Dr. Hatch. "Our study demonstrates that those recommendations have no scientific basis. Therefore, it is reasonable to recommend whatever grip size feels most comfortable for them."
Tennis elbow (lateral epicondylitis) is the most common upper extremity complaint among recreational players, accounting for 75% to 85% of elbow injuries. Researchers believe it results from repetitive impacts between the ball and racket coupled with poor wrist stability especially during the backhand swing. The backhand stroke seems to be the culprit because it results in overexertion and micro-tearing within two primary muscles inside the forearm.
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Hatch and coauthors at Kerlan-Jobe Orthopaedic Clinic studied 16 NCAA Division I and II tennis players (10 men, 6 women) with no prior history of elbow problems. Twelve players were right-handed; four left-handed. All players were proficient at using a one-handed backhand. Players' "recommended" grip size was determined using an industry standard: measuring the distance from the bottom lengthwise crease in the palm to the tip of the ring finger with a ruler.
The researchers inserted electrodes into five different muscles in each player's dominant arm to measure the firing pattern of their muscles (electromyogram, EMG). After a warm-up period, players then performed three single-handed backhand strokes using identical model rackets with three different grip sizes: the "recommended" grip size, a "small" grip size (1/4 inch smaller than recommended), and a "large" grip size (1/4 inch larger than recommended). One-quarter inch size variations were chosen because most commercially available adult-sized rackets have grip sizes ranging from 4 inches to 4 5/8 inches. A ball machine set at a constant speed and angle provided consistent ball delivery. Each player's strokes were captured on high speed video which was then synchronized with the corresponding EMG.
Of the five forearm muscles studied, none showed significant variations in firing patterns during three phases of the backhand stroke: accelerated forward motion of the racket, ball impact, and early follow-through. Close attention was paid to two specific muscles, the extensor carpi radialis brevis (ECRB) and the extensor digitorium communis (EDC), which are located beside each other in the forearm and originate from the bony prominence on the outside of the elbow. Overuse, microtrauma, and failed healing in both of these muscles can result in tendonitis. Yet larger and smaller grip sizes did not affect the activity of these two muscles, the authors found.
"Based on our data, we recommend recreational tennis players use the currently accepted grip size measurement technique as a starting point in when picking a grip size," says Dr. Hatch. "However, the player should feel free to increase or decrease the size of the grip based upon what feels most comfortable. Previous studies have shown that improper form is one of the biggest risk factors for the development of tendonitis."
The American Journal of Sports Medicine is the monthly peer-reviewed scientific journal of the American Orthopaedic Society for Sports Medicine (AOSSM). AOSSM is a world leader in sports medicine education, research, communication, and fellowship. The Society works closely with many sports medicine specialists and clinicians to improve the identification, prevention, treatment, and rehabilitation of sports injuries. Please visit http://www.sportsmed.org.
Can a toothbrush help clean out your heart? Surprisingly, yes. Brushing your teeth has been shown to be the first step in preventing periodontal disease that can lead to heart disease, stroke, and diabetes complications.
Dr. Chris Kammer of the Center for Cosmetic Dentistry says that 80% of adults have periodontal disease and most cases go undetected. The disease raises the level of harmful bacteria in the mouth, which travels through the bloodstream to other organs in the body, and can lead to a plaque buildup in arteries surrounding the heart.
"Most people don't think of their dentist when it comes to health problems that are not found in one's mouth," says Dr. Kammer. "But a dentist can actually be the first line of defense in reducing the risk for many of the most deadly diseases."
Brushing and flossing are effective means of preventing periodontal disease, but diabetes can counteract these efforts. Diabetes, which kills more people annually than breast cancer and AIDS, can weaken your mouth's ability to fight germs, increase blood sugar levels, and make periodontal disease more difficult to control. Your dentist may suspect diabetes if you brush and floss regularly and still have symptoms of periodontal disease. Nearly 21 million children and adults in the U.S. have diabetes, yet one-third of them are not aware they have the disease. Regular gum disease therapy and treatments can help avoid diabetes complications as serious as death.
As periodontal disease worsens, surgery may be needed to save your teeth. The more teeth a person has lost, the greater the risk for cardiovascular problems such as heart disease. Bleeding gums is just one of many symptoms of periodontal disease. New studies published in the Journal of Periodontology are linking periodontal disease to diabetes and heart disease. And the American Association for Cancer Research has even found that diseased gums raise the risk of pancreatic cancer.
In fact, men with a history of gum disease had a 63 percent higher risk of developing pancreatic cancer relative to men without periodontal disease after factoring out smoking, diabetes, obesity, and other potentially confounding factors. Pancreatic cancer is the fourth leading cause of death from cancer death in the U.S.
Dr. Kammer adds, "If you washed your hands and they started to bleed, you would be alarmed, right? Then how come the majority of people are not alarmed when they brush their teeth and their gums bleed?"
According to Dr. Kammer, periodontal disease works to destroy gums and is the leading cause of tooth loss in adults. It is now known that patients with a 20 percent increase of periodontal bone loss have a 40 percent increase in developing chronic heart disease. The process begins when the plaque that settles around your gum lines fails to be removed by daily brushing and flossing. When plaque stays on your teeth, it turns into tartar, and only your dentist can remove tartar. The plaque and the tartar are irritants that house the bacteria that cause the gums to become infected.
It was found by researchers that diseased gums released higher levels of bacterial pro-inflammatory components into the bloodstream. These bacterial agents could travel to other organs in the body and cause damage.
Tips for preventing periodontal disease that could lead to diabetes and heart disease:
-- Every Day: Be knowledgeable about how gum problems start and look for early signs.
-- Twice a Day: Brush your teeth. Also remember to brush your tongue and the roof of your mouth.
-- Once a Day: Floss your teeth and use an irrigator like a Waterpick or Hydrofloss for even deeper cleaning of the gum pockets.
-- 2 to 4 times a year: Visit your dentist for a cleaning (50% of patients must go to the dentist more than twice a year to maintain gum wellness). Up to 70% of people have gum disease, so more frequent visits will be required until the disease is under control.
Be Proactive: Visit your dentist if you have any of these symptoms -- warning signs of periodontal disease:
- Bleeding gums when brushing or flossing
- Red, swollen, or tender gums
- Gums that have pulled away from teeth
- Bad breath
Dr. Chris Kammer has been an expert for USA Today, Reader's Digest, Fox News and CNN. He is available to provide more information at 608-827-6453, or visit the Center for Cosmetic Dentistry online at http://www.thesmileexperts.com.
