Roetert E P, Brody H, Dillman C J, Groppel J L, Schultheis J M
United States Tennis Association, Key Biscayne, Florida, USA.
Clin Sports Med. 1995 Jan;14(1):47-57.
Tennis elbow afflicts 40% to 50% of the average, recreational tennis players; most of these players more than 30 years of age. Tennis elbow is thought to be the result of microtrauma, the overuse and inflammation at the origin of the ECRB as a result of repeated large impact forces created when the ball hits the racket in the backhand stroke. Several authors have found that EMG activity in the ECRB, the muscle and tendon complex afflicted in tennis elbow, is high during the acceleration and early follow-through phases of the groundstrokes and during the cocking phase of the serve. Unfortunately, none of the authors gave evidence to support the claim that muscle activity in the ECRB at ball contact is high. In the one-handed backhand, the torques at impact (17-24 nm) will be absorbed by the tendons of the elbow. Giangarra and his colleagues observed that the two-handed backhand "allows the forces at ball impact to be transmitted through the elbow rather than absorbed by the tissues at the elbow." Other authors have reported that players using a two-handed backhand will rarely develop lateral epicondylitis, because the helping arm appears to absorb more energy and changes the mechanics of the swing. As seen by Morris and colleagues, Giangarra and associates, and Leach and colleagues, players who utilize the two-handed backhand have a very low incidence of tennis elbow. These three studies conclude that the two-handed backhand stroke is probably the most effective backhand stroke to prevent lateral tennis elbow. Studies show that wrist extensors are highly involved in all strokes (serve, forehand, and both one- and two-handed backhand strokes). This relatively high involvement (40%-70% MVC) throughout play may result in overload of this muscular group. Thus, tennis elbow may be caused simply by continued use of this muscular system in all strokes, and not just because of the high forces absorbed at impact. Another theory concerning impact states that if the extensor group is already at near maximum contraction, vibrations and twisting movements are transferred directly through the muscle (muscle stiffness at this point would be great) to the tendinous insertion, causing repeated microtrauma. If the muscle is the stiffest element in the system, the force will be transferred to the tendon. It is evident that a need exists for specific study of muscular response during impact. More microanalysis of the impact phase needs to be conducted specifically for the one-handed backhand groundstroke.
网球肘困扰着40%至50%的普通休闲网球运动员；这些运动员大多超过30岁。网球肘被认为是微创伤的结果，即由于在反手击球时球击中球拍产生反复的巨大冲击力，导致桡侧腕短伸肌起点处过度使用和发炎。几位作者发现，在底线击球的加速阶段和早期随挥阶段以及发球的引拍阶段，桡侧腕短伸肌（网球肘所累及的肌肉和肌腱复合体）的肌电图活动很高。不幸的是，没有一位作者提供证据支持在球接触时桡侧腕短伸肌的肌肉活动很高这一说法。在单手反手中，击球时的扭矩（17 - 24牛米）将由肘部的肌腱吸收。詹加拉及其同事观察到，双手反手“使球撞击时的力通过肘部传递，而不是由肘部的组织吸收”。其他作者报告称，使用双手反手的球员很少患外侧上髁炎，因为辅助手臂似乎吸收了更多能量并改变了挥拍的力学原理。正如莫里斯及其同事、詹加拉及其同事以及利奇及其同事所观察到的，使用双手反手的球员患网球肘的发生率非常低。这三项研究得出结论，双手反手击球可能是预防外侧网球肘最有效的反手击球方式。研究表明，腕伸肌在所有击球动作（发球、正手击球以及单手和双手反手击球）中都高度参与。在整个击球过程中这种相对较高的参与度（40% - 70%最大自主收缩）可能导致该肌肉群过载。因此，网球肘可能仅仅是由于在所有击球动作中持续使用这个肌肉系统造成的，而不仅仅是因为击球时吸收了巨大的力量。另一种关于撞击的理论指出，如果伸肌组已经接近最大收缩，振动和扭转运动将直接通过肌肉（此时肌肉的僵硬度会很大）传递到肌腱附着点，导致反复的微创伤。如果肌肉是系统中最僵硬的元素，力将传递到肌腱。显然，需要对撞击过程中的肌肉反应进行专门研究。需要针对单手反手底线击球对撞击阶段进行更多微观分析。
