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Back Pain in Tennis Players: A Link with Lumbar Serve Kinematics and Range of Motion


Medicine & Science in Sports & Exercise: February 2014 - Volume 46 - Issue 2 - p 351–357
doi: 10.1249/MSS.0b013e3182a45cca
Applied Sciences

Purpose This study compared regional lumbar (upper and lower), pelvis, trunk, and lower limb kinematics between elite male adolescent players with and without a history of low back pain (LBP) during the kick and flat serves as well as regional lumbar mobility and serving kinematics relative to the end of range.

Methods Seven players with a history of LBP and confirmed L4/L5 injury and 13 controls matched for age, height, mass, and performance underwent a three-dimensional motion analysis during serving trials and lumbar mobility assessments. Regional lumbar, pelvis, trunk, and lower limb kinematics were compared between pain/no pain and kick/flat serves using a series of 2 × 2 mixed-model ANOVA, with independent samples t-tests used to compare regional lumbar mobility between pain/no pain.

Results The pain group had significantly reduced lower lumbar mobility in every plane of motion than the no pain group. The pain group demonstrated less right lower lumbar and pelvis/shoulder rotation, greater right pelvic tilt, earlier peak right knee extension velocity during the drive phase of the tennis serves, and greater lower lumbar and pelvis left rotation, upper lumbar left lateral flexion, and anterior pelvis tilt during the forward-swing phase. All players approached their lumbar end of range during the serve.

Conclusions The results of this investigation suggest that a multidimensional LBP management and prevention strategy is required, including the assessment of regional spinal mobility, the lower limb and upper limb and spinal kinematics, and the integrated work between clinicians and coaches to adapt adverse technique.

1School of Physiotherapy and Curtin Health Innovation Research, Curtin University, Perth, AUSTRALIA; 2School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, AUSTRALIA; and 3Sport Science and Medicine Unit, Tennis Australia, Melbourne, AUSTRALIA

Address for correspondence: Amity Campbell, School of Physiotherapy and Curtin Health Innovation Research, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; E-mail:

Submitted for publication April 2013.

Accepted for publication July 2013.

© 2014 American College of Sports Medicine