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Treating Rafa's Abdominal Strain

Injury Management

Rafael Nadal© Getty ImagesATP World Tour physio Michal Novotny treats Rafael Nadal during the 2009 US Open.

What was that tape ATP physiotherapist Michal Novotny applied to Rafael Nadal's stomach during the US Open and what are its benefits?

Strains and overload of the abdominal muscles are very common tennis injuries. Many times this injury can be seen at the beginning of the season or after a long period without playing. We also can see this injury when changing surface from hard to clay.
 
When playing on clay, players normally have more rotation during the serve to produce topspin and kick effects. This over rotation of the torso or trunk is often the reason for the muscle strain or tear. 

Another possible external factor for this injury is windy weather. The worst is when the player is serving against the wind. First, the player tries to hit the ball harder than he normally would as he is playing against the wind and second, the wind moves the ball backwards during the serve which results in the player needing to overstretch or extend more to hit the ball correctly.

Compeed

Right-handed players during the serve overstretch the left side of the abdominal muscle, as from this maximum tension the player generates an explosive contraction to hit the ball with adequate velocity. When the muscle is not ready or prepared for this contraction in an overstretched position, the muscle can tear.

This tear is normally measured by ecography or ultrasound, where we can see how much liquid (blood) is around the tear. Depending how much liquid is present, we can give a prognosis or estimate how long the injury will take to heal.

Normally, when a small tear is seen on ultrasound or ecography, 2-3 days is needed to heal and resume tennis training. This recovery can be shortened by different physiotherapy techniques to heal 1mm per day. With this injury the player can often continue playing normally except for serving and smashing. The worst movement for the player is the serve during the hyperextension portion where the abdominal muscle is lengthened.

The prevention strategies for an abdominal injury would be doing abdominal exercises on a Swiss ball instead on the floor. The advantage of using the Swiss ball is that the contraction of the abdominals can be performed in a more extended position to more specifically train the abdominal muscles in the position in which they are stressed during play (i.e. generating the abdominal contraction from the extension instead of from neutral position). This is many times the mistake players make by doing a lot of abdominal training on the floor which is not applicable or specific to the service motion.

On-court Treatment
The treatment on the court for this injury consists of strapping or supporting the abdominal muscles by approximating or shortening the muscles’ origin and insertion closer to each other. This can be done by using several types of taping techniques.

One of these techniques is using a product called kinesiotape. This type of tape has similar tension as human skin. If the tape is applied with all the tension in the muscle during a contraction then we limit the muscle from the stretching position where the pain appears and where the injury could be aggravated.

One of the problems with tape techniques is that most of the time in the middle of the match the skin is sweating and the tape doesn't stick enough to continue to limit range of motion and protect the player. To address this issue, we use different steps before we apply this type of tape.

These steps include: First, clean the skin. Second, apply a sticky liquid on the skin, then adhesive spray. Third, apply a sticky layer of tape called hypafix. And finally, apply the kinesiotape on top of it. This last step you will see applied is some baby powder for the humidity, and the player is ready to continue.

After the match, the taping technique is different: We are looking to relax the muscle. For this we use the original kinesiotaping technique which consists of applying the tape without any tension or stretch in the muscle. With this technique we can leave the tape on the skin for 3-4 days or until the next match, when we need to change it, replacing it with the technique we use for play on the court.

These steps help to support the player’s abdominal muscles while on court and help to speed recovery. The key, however, is for the player to prevent abdominal injury by applying the appropriate prevention strategies like training the abdominal muscles to improve their strength and endurance.


 

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