Reach out to the author: contact and available social following information is listed in the top-right of all news releases. Welcome back to the new series of articles about physiotherapy and common injuries and pathologies seen by physiotherapists. The elbow is an amazing piece of biomechanical design and is comprised of 3 bones – the humerus which is the upper arm bone and two bones in the forearm called the radius and ulna.
Now as we are looking at tennis elbow we are not going to look or worry too much about the actual elbow joint itself except to say that it has two ways of movement – flexion and extension (basically straightening and bending) and pronation and supination (pronation is rotating the hand palm down and supination palm up). The key part of the elbow in tennis elbow that we really need to examine is the lateral epicondyle – this is the point where all of the wrist extensors and finger extensors start from and is the point at which pain is felt in tennis elbow, it is also called the common extensor origin (for reasons which will become apparent soon) and is the site of attachment for the common extensor tendon. Running from the lateral epicondyle and the common extensor origin are all of the muscles that extend the wrist and the fingers – extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis and extensor digiti minimi. Before moving on it is worth considering the actions of a couple of these muscles in more detail extensor carpi radialis brevis and extensor carpi ulnaris have an important synergistic role in stabilising the wrist – they both act at the same time in concert with their flexor brothers (flexor carpi ulnaris and flexor carpi radialis) to prevent side to side movement at the wrist (ulnar and radial deviation). So hopefully from the above brief anatomy lesson we can now see that any extension or even flexion of the wrist is going to put a large amount of stress through the common extensor tendon and in turn if this tendon receives any injury we are likely to feel pain at the lateral epicondyle – which is where patients with tennis elbow will normally describe to their physiotherapist that they feel pain when they pick things up. The next article will look at the physiology and some of the reasons why tendons get injured and why tennis elbow can often become chronic and last for a long time. As we watch the US Open on TV or live in person, we can continue to marvel at the grace and elegance of Roger Federer’s forehand. Roger Federer’s forehand is a shot that has won him many Grand Slams, and at this year’s US Open, it might prove to be another victorious occasion for the master.
Federer’s forehand is a step above the rest on the ATP tour, but few commentators understand why. Most are quick to point out his mental toughness, but few notice that his forehand technique is actually mostly responsible for his dominance in the world of tennis. Roger Federer is able to combine the right technical elements based on a solid foundation of world class principles to produce a modern forehand that is unmatched by his competitors.
Federer uses a modified eastern grip, slightly between the classic old school eastern grip and the standard semi-western grip. In many ways, his grip is considered more conservative than others like Novak Djokovic or Andy Roddick. Another element of Roger Federer’s forehand is the coiling during the preparation phase that brings his racket back and coils his upper body at the same time.
This is a clear indication of the great amount of coil he achieves on his forehand, and unsurprisingly this element contributes a large amount of power once he swings forwards to the ball.
One thing that sets Federer’s forehand apart from many of the WTA players and almost all club players is that he achieves a greater body coil than the rest. There has been great debate in the world of tennis on the subject of Federer’s forehand and his contact point.

The follow through is important because it shapes the arc and path of the ball once the ball leaves the racket. This type of follow through increases the rotation and spin of the shot, because the ball is virtually being “peeled” from low to high in a rapid succession using a high level of racket head speed, when compared to the classic over the shoulder follow through. There are many more technical elements that make up the Federer forehand, but the basics have been covered. Great demonstration of Federer’s  forehand but no mention of the rotation of the hips.
Free red and yellow tennis racket graphics in a fully editable Photoshop image file download.
First, fans around the world can enjoy the different competitions that are a part of the Summer Olympic Games in London. Each year, the US Open is traditionally the last of these tournaments, following the Australian Open, French Open and Wimbledon. Last time we took a brief look at one of the most common musculo-skeletal conditions that a physiotherapist will encounter – tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). The radius runs from the elbow to the thumb and the ulna starts at the bony prominence on the back of your elbow (olecranon process) and runs down to the wrist. It may seem strange that in a condition called tennis elbow we will be ignoring the elbow joint itself but hopefully the reason why will become clear soon.
The two extensors also act together at the same time you grip an object to hold the wrist in extension a bit and prevent the finger flexors from flexing the wrist. The few of us who have the opportunity to watch the pros practice in person at the US Open is up for a rare treat of the impeccability, fluidity and overwhelming power that Roger Federer’s forehand is known for.
What separates Federer’s forehand from the rest of the pack is his impeccable timing and technique. This modified grip allows Federer to drive through the ball more and take more shots on the rise when compared to his more extreme “Western” counterparts.
In a modern forehand, players are now utilizing more angular momentum on their shots with added upper body rotation. The unit turn is a move where the upper and lower body turn sideways simultaneously around 45 degrees with the hips turning toward the direction of the incoming ball.
In addition, at the peak of the preparation, Federer’s racket is prepared in a way that allows him to lower the racket below the level of the ball via the help of gravity. In slow motion video, Federer sometimes uses a straight arm forehand where the racket and arm is virtually straight on contact. If a proper swing occurred up this point, the contact point should naturally come in place. In the modern forehand, a relatively new follow through called the “windshield wiper” forehand follow through is now popular amongst pros and many high level players alike.

Even though many players won’t have a chance of hitting their forehand exactly like Federer, there are still important fundamental commonalities behind his shot that can be modeled by players at all levels. After the Olympics are over, fans can look forward to one of the best tennis tournaments in the world: the US Open.
Although the exact dates of the US Open vary from year to year, it always takes place during the weeks before and following Labor Day weekend. This article will now look at the anatomy of the elbow and the muscles connected to it in detail so that we can have a good idea of what is hurting or being injured in tennis elbow and can maybe start to have an idea of what causes it. To make it easy to remember which bone is which, when I was a student I used to repeat “the ulna is underneath the radius”. All of these muscles merge together here to form what is known as the common extensor tendon which then attaches to the lateral epicondyle. In fact studies have shown that extensor carpi radialis brevis is the tendon most commonly injured in tennis elbow and the most common point that it is injured at is the common extensor tendon.
It is important to analyze his forehand to determine what elements players at all other levels of the game can emulate in order to improve their own forehand.
In order to accomplish this, pro players are increasing the amount of body turn during the preparation. This follow through is one where the racket swings across the body on the “same side” like the blades of a windshield wiper inside a car. Simple I know but effective nonetheless when you are a physio student desperately trying to cram in your anatomical knowledge. So it is fairly obvious that this common extensor origin is an important point in wrist and finger extension and may well be a likely site of injury that physiotherapists will need to examine.
At 65 I broke the handle on a graphite racket returning an ex tour player’s first serve. The 2012 US Open will be held at the United States Tennis Association's Billie Jean King National Tennis Center. The importance of loading the big muscles by rotation is too often ignored by tennis coaches.
Mind you, if you overload the big muscles, as Becker did with his service motion, the body can rebel. The company offers an impressive variety of US Open Tennis tickets for sale in all price ranges.

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