BLISTERS

• Ensure that shoes fit correctly.
• Protect the potential 'hot spots' by applying a second skin and / or taping. Click here for details of how to tape the foot.
• If you wear boots such as those required for mountain walking ensure all seams are flat inside the boot. Take care of the boots, do not leave them on radiators or near heaters. This may cause the leather to shrink and seams protrude.
• Keep feet as dry as possible. Wet shoes, boots and socks will cause blisters far quicker than dry ones.
• Wherever possible change socks regularly and use foot powder to help keep them dry.

• The first sign of blisters will be redness over the skin, possibly at the back of the heel, the instep or toes.
• Apply a second skin dressing or blister plaster and tape the effected area.
• Ensure the feet are dry and change socks (unless you are in the middle of a race).
• A highly effective but short term measure is cover the foot and effected area in petroleum jelly. This should provide instant relief from pain but as the heat from the foot melts the petroleum jelly it will run away and be ineffective.

• If the blister has not burst then it may be necessary to make a small hole at the edge with a serialized pin or needle, particularly if the blister is on a weight bearing surface. A pin can be sterilized by passing it through a flame.
• Do not drain a blood filled blister.
• Drain the fluid but leave as much of the skin as possible covering the wound. This is an important protective layer for the underlying skin and will help to prevent infection.
• Clean the blister with a sterilizing wipe. Cover the wound with a second skin or blister plaster - take the time to apply it correctly.
• For additional security apply tape over top.

HYDRATION

Staying hydrated – What are the key points?
(This article has been reprinted from the USTA High Performance Coaching Newsletter, Vol. 2, No. 2/2000)



By Michael F. Bergeron, Ph.D., FACSM

The three primary nutritional factors, related to keeping hydrated, are Water, Electrolytes, and Carbohydrates.
These are also the nutrients that have the most immediate effect on performance – positive or negative, depending if their intakes are managed well or not.

Water

Facts:



• Many players begin play dehydrated.
• On-court sweat losses can be extensive – 1-2.5 liters (~35-88 ounces) per hour is typical.
• Any water deficit can have a negative effect on a player’s performance and well being. The effects of a progressive water deficit due to inadequate fluid intake and/or excessive sweat losses include
• Increased cardiovascular strain – your heart has to work harder.
• Decreased capacity for temperature regulation – you heat up more.
• Decreased strength, endurance, and mental capacity – your intensity is lower, you tend to lose control, and you make inappropriate shot selections.
• Increased rate of carbohydrate metabolism – you fatigue faster.
• Many players to not adequately rehydrate after play.
What you can do:
• Drink plenty of fluids (water, juice, milk, sport drinks) throughout the day.
• Don’t forget to drink regularly during all practice and warm-up sessions.
• Have another 12-16 ounces about 1 hour before you play.
• Drink at each changeover – typically, older adolescents and adults can comfortably drink up to 48 ounces or so per hour. This rate of fluid intake can prevent large fluid deficits from developing for most players.
• After play, drink about 150% of any fluid deficit that still remains. For example, if your weight is down 1 pound at the end of play, you still need to drink another 24 ounces.

Electrolytes



Facts:
• Players lose far more sodium and chloride (salt) from sweating than any other electrolyte.
• Sodium and chloride losses are greater with higher sweating rates.
• Sodium and chloride losses tend to be less with players who are used to (acclimatized to) the heat.
• Sodium deficits can lead to incomplete rehydration and muscle cramps.
• If you don’t replace the salt, you can’t completely rehydrate.
• Excessive water consumption, combined with a large sweat-induced sodium deficit, can lead to severe hyponatremia (low blood sodium) – a very dangerous situation. Even mild hyponatremia can give a player a sense of fatigue, apathy, nausea, or a headache.

What you can do:
• When you play in a hot environment (or any time you sweat a lot), add some salt to your diet (or eat certain high-salt foods) before and after you play. Good sodium and chloride sources include
• salt: ¼ teaspoon (or 1.5 grams) has 590 mg of sodium
• salted pretzels
• many types of soups
• cheese
• salted sport drinks (or Pedialyte)
• tomato sauce (pizza!)
• tomato juice

Carbohydrates



Facts:
• Adequate carbohydrate intake is crucial to optimal tennis performance.
• Consuming carbohydrates before and after exercise can help restore some of your body water reserves.
• Playing tennis in the heat causes the body to use carbohydrates faster. So, even if you eat well prior to playing, after 60 to 90 minutes of intense singles, chances are you’ll need some supplemental carbohydrate to continue playing your best.
• Ingesting too much carbohydrate or too much of an inappropriate carbohydrate (e.g., fructose) can delay carbohydrate and fluid absorption and may cause gastrointestinal distress.
What you can do:
• Generally, 7-10 grams of carbohydrate per kilogram of body weight (~500-700 grams per day for a 155-lb player) is recommended for periods of intense training or competition.
• During play, 30-60 grams per hour is most effective. Choose a sport drink whose primary carbohydrate is sucrose, glucose, or a glucose polymer (e.g., maltodextrin).

Adequate and well-timed water, electrolyte, and carbohydrate intake should be priorities for any player looking to play well and safely. Yet their importance is still often overlooked or underestimated.

DON’T GET BURNT

Sun protection
To protect yourself from the sun's UV rays, cover up with shade, hats, clothing, sunscreen and sunglasses.

Why sun protection is important
Australia has the highest rate of skin cancer in the world, mostly caused by over exposure to UV radiation.  Around 380,000 people are treated for skin cancer and 1,600 people die from the disease every year.

When to use sun protection in Victoria
Whenever ultraviolet (UV) radiation levels reach 3 (moderate) and above, sun protection is required. At that level UV radiation can damage your skin and eyes and lead to skin cancer.  In Victoria from September to April, UV radiation levels are usually 3 and above for most of the day. Particular care should be taken between 10am - 2pm (11am - 3pm daylight saving time) when UV levels reach their peak.
From May to August, average UV Index levels are usually low (below 3). Therefore, sun protection measures are not necessary during these months unless you are in alpine regions, or near highly reflective surfaces like snow or water.

Don't just use sunscreen
Clothing, hats and shade are the best ways to protect skin from ultraviolet (UV) radiation. Use sunscreen on any skin that can't be covered by clothing.
Don't use sunscreen as your only form of sun protection. No sunscreen offers 100% protection from UV radiation.

How sunscreen works
Sunscreen stops most UV radiation from reaching the skin. Ingredients in sunscreen can absorb UV radiation or reflect UV radiation away from the skin.

UVA radiation
UVA radiation goes deep into the skin, affecting the living skin cells that lie under the skin's surface. UVA causes long-term damage like wrinkles, blotchiness, sagging and discolouration, and also contributes to skin cancer.

UVB radiation
UVB radiation reaches the top layer of skin and is the main cause of skin tanning and sunburn, and also contributes to skin cancer.
Broad spectrum sunscreen helps protect skin from both UVA and UVB radiation.
All sunscreen products sold in Australia have been approved by the Therapeutic Goods Administration as safe and effective.

Sun Protection Factor (SPF)
The sun protection factor (SPF) rating tells you the level of protection. The highest SPF for sunscreen available in Australia is SPF30+. If used correctly, this can protect your skin from about 97% of UV radiation. No sunscreen blocks 100% of UV radiation.
Many people don't use enough sunscreen, and don't re-apply it every two hours. So they may not be getting the best level of protection from their sunscreen.

Choosing a sunscreen product
Choose broad spectrum SPF 30+ water resistant sunscreen.
All sunscreen sold in Australia must meet the Australian/New Zealand Standard for sunscreen products.
The price of sunscreen does not always match the quality.
All sunscreen products should have an expiry date. Most sunscreens will last 2-3 years if stored below 25°C. Don't use a sunscreen if it is out of date.
Try a toddler sunscreen or a sunscreen without a fragrance if you have sensitive skin.
Sunscreen can be bought as a cream, lotion, milk or gel. Choose the one that best suits your skin type and your type of activity.

Applying sunscreen
For best protection:
Apply sunscreen 20 minutes before you go outside.
Use a generous amount of sunscreen. The average-sized adult should apply at least a teaspoon of sunscreen to each arm, leg, front of body and back of body and at least ½ a teaspoon to the face (including the ears and neck). That is, 35 ml of sunscreen for one full body application.
No matter what the sunscreen directions say, always reapply sunscreen every two hours when you are outdoors. Sunscreen can be easily wiped or perspired off and you need to keep putting sunscreen on to get the best protection.

Sunscreen and babies
It is always best to keep babies and toddlers out of the sun or well-protected using clothing, hats and shade. Only use sunscreen on skin that can't be covered by other methods.
Many brands of sunscreen have special baby or toddler sunscreens, which are much gentler on the skin.
Test the sunscreen on a small area of the baby or toddler's skin before using it to make sure there won't be any reaction.


Why use shade
Shade alone can reduce overall exposure to the sun's harmful ultraviolet (UV) radiation by about 75%.
A well designed and correctly positioned shade device or shade tree planting will cast shade where and when it is most needed.
Maximum UV protection can be achieved by using shade in conjunction with sun protective clothing, hats and sunscreen.

Planning effective shade
Good planning ensures effective shade. Whatever the scale of the project, planning should include:
•    Identifying where and when shade is needed
•    Understanding your shade options

Buying Tennis Shoes

There are few sports that rival tennis for the speed, agility and endurance required of players- and their equipment. You can have an excellent serve and a great backhand but without the proper footwear you are working from a deficit from the start. A good tennis shoe can handle the constant movement, the back and forth to the net, side-to-side court coverage, running, jumping, lunging and the quick pivots that come in a tennis match.
 
Tennis shoes are designed with extra lateral support to endure the rigors of the game's frequent lateral movements and quick stops and starts. Finding the right shoe can be difficult given the wide selection available. One should consider the style of tennis that you play, the type of court that you usually use and what your foot type is before you make your final shoe selection.
 
Many people want to wear their regular running shoes to play tennis, but there are many good reasons that athletes should wear proper tennis shoes. Running shoes are specially designed for the forward motion that comes of running or walking for fitness. They have thick, soft heels that increase the cushioning and lessen the impact that comes with running. However, runners do not turn quickly or make rapid lateral movements so the shoes are not built to support player's feet during a tennis game or practice. Tennis shoes provide stability for side-to-side movement, built of heavier and stiffer materials than other athletic shoes, their flat, durable soles are designed to prevent stumbling or sliding and the toes are reinforced for stop and go action.
 
Fit
How do you know what kind of tennis shoe you need? The type of foot that you have, the way that you walk and stand, has an enormous impact on the way that shoes fit, feel and perform for you. Every foot is different but there are some general 'types' into which most people fall:
 
•    Pronated
•    Supinated
•    Ideal
•    So which one are you? A great way to learn about your feet is to check the wear on your shoes. Take a look at a pair of shoes you wear frequently and see which areas of sustained the must wear over time. If your shoes show a lot of wear on the inside of the sole and around the ball of your foot then you have a Pronated foot.
•    The Pronated foot is the type most commonly associated with injury. You should be extra careful about the shoes that you select and choose a tennis shoe with lots of support and cushioning.
•    If your shoe shows a lot of wear along the outside of the heel then you have a Supinated foot. Players with a Supinated foot tend to wear shoes out faster than other players. In such a case an extra durable sole would be the best choice. If when you look at your shoes it seems that there is even wear all around then you are one of the rare Ideal types.
•    Players with Ideal foot types have the flexibility to choose any kind of shoe as long as it is comfortable, and they might want to prioritize their shoe based on the surface on which they play ( e.g., grass, concrete).

So you have figured out what kind of feet you have and what kind of support levels are best, what else should you consider? Playing surface is the next key element for any player. Tennis matches can be held on concrete, grass or clay and each are very different surfaces of play. Clay courts allow a natural 'slide' as the player moves so you can have slightly lighter lateral support, but the fine grains of dirt can be bothersome to feet, so be sure that you have a solid upper of leather or synthetic material. Grass courts give players the most natural cushioning which means that you can forgo some cushioning in preference to more lateral support. Concrete is the most common playing surface and can be the most challenging for player's feet. The hard surface is unforgiving demanding as much cushioning as is comfortable. Lateral support is also key as player's stops and starts are particularly sharp on the firm concrete surface.
 
The type of foot you have, the surface on which you play are important considerations when selecting your tennis shoe, but another factor is body type. Tennis players who are larger and heavier would want to consider heavier, more stable shoes that provide the extra support you need. On the other hand, smaller players should consider a lightweight shoe that is more manageable over long periods of physical exertion.
 
The last step to achieving the best fit possible in your tennis shoe is selecting a cushioning sock and lacing up properly. Tennis shoes have developed good lacing systems designed to hold your foot snugly in place and to not loosen or come undone under the strenuous demands of tennis. If you are prone to rolling your ankle you might want to consider a higher cut shoe that can give you more support, particularly when laced up properly.
 
Surface, Style of Play and Materials
The way that you play tennis can also dictate what tennis shoe is best suited to your needs. If you are a baseline player, one who plays the back line of the court for most of the game, you will need a shoe with extra lateral support. This style of play uses the most side-to-side action and requires the most support for lateral movements and ankle stability. Your tennis shoes will need the highest amount of cushioning and shock absorption to ensure your feet are comfortable during play. This is particularly true if you play the majority of your matches or practices on hard courts.
 
If instead your method of play features the serve and volley with frequent charges to the net you should invest in a tennis shoe with a toecap that gives extra protection to the front of your foot. This method of play is especially hard on the toe and sole of the shoe, so consider an extra durable sole that will withstand your style of play. Many tennis players drag their toe while serving and on forehand groundstrokes, this is particularly true of right-handed tennis players.
 
It is crucial that right-handed players have an extra durable sole design in the inside toe area of their right tennis shoe to prevent premature wear. It is important to remember, however, that increased durability often means increased weight in the shoe, so be sure to consider carefully what your requirements are before selecting a tennis shoe.
 
Knowing what tennis players need, the major companies have created cushioning systems that are lighter, more comfortable and better at removing moisture away from feet. Polyurethane is a dense and durable material used for cushioning and it also increases the stability of the shoe. The drawback to polyurethane is that it is a heavier material and can make shoes more heavy than you like. The newest cushioning material, EVA, offers excellent cushioning but not as much stability or durability as some other materials. All of the newest cushioning materials have incorporated moisture management to wick moisture away from feet leaving them dry and comfortable.
 
The materials that are used to construct the upper part of the tennis shoe varies and each of the materials has benefits to players.
•    Canvas will stay the coolest and breathes the best allowing air to flow in and out of the shoe, but offers very little support, particularly for lateral movements.
•    Leather provides the best support and will keep your feet dry in damp conditions, but will be the most expensive.
•    Vinyl can provide support similar to leather and resists moisture the best, but can be the least breathable and can cause feet to overheat.
Many tennis shoes combine the best of both worlds by pairing leather or vinyl with a durable mesh that allows air to circulate through the shoe, cooling your feet and allowing moisture to evaporate. By keeping your feet cooler you resist fatigue and you can play better for longer periods of time. Because most of the impact is taken by the sole of the tennis shoe the durability of the upper portion is less important and can be a secondary consideration.  
The kind of tennis court on which you play the majority of your practices and matches will also impact the kind of tennis shoe that you need. Tennis shoes for hard, concrete courts usually offer an extremely durable outsole, a leather or vinyl upper for strength and support and are designed for the most stability and support for lateral movement. Continued play on hard court surfaces will wear the tread of the soles which can lead to loss of traction and increased slipping, so be sure to check your soles frequently for wear and be ready to replace your shoes when needed.
 
Players who conduct most of their play on soft court surfaces such as clay or grass should select tennis shoes that provide good traction. Durability is less of an issue for players who use soft surfaces. It is, however, vital that the tennis shoe has a smooth, flat sole because the knobs and bumps found in other athletic shoes can damage clay and grass court surfaces. Most tennis clubs will now allow players to wear street or running shoes while playing but instead require proper tennis shoes.
 
When Should You Replace Your Tennis Shoes?
The rule of thumb is that you should replace your tennis shoes after 500 miles of wear. Trying to estimate when you may have managed to travel 500 miles in your tennis shoes would be very difficult, however there are signs of wear that can be seen when shoes are failing. If you notice the tread pattern on the sole has become less distinct especially if there are smooth spots emerging, you risk slipping and possible injury on court.
 
Depending on the style of play, and surface that they use, some players may not see much change in their tread wear, however after a year of regular play a tennis shoe has lost enough of its lateral support and cushioning to justify replacement. Many players drag the toe of their shoe forward as they serve and handle forehand groundstrokes, which causes rapid wear of the tennis shoe. In that case, you will need to replace your shoes more frequently than once a year.

Ankle Sprain

Diagnosis
A sprained or twisted ankle is the most common tennis injury. In most cases, the injury is caused by landing on the outside of the foot, with the foot turning too far inwards. The relatively weak lateral ankle ligaments are then injured (Figure 1). An injury of the much stronger ligament on the inside of the ankle (medial ankle ligament) is far less common (5-10% of cases). Depending on the severity of the injury, the ligaments may be overstretched or torn, resulting in instability of the ankle. The symptoms are pain and swelling around the ankle, mainly on the outside, later followed by discoloration of the skin.

First Aid                    
  Perform the following as quickly as possible, during the first 48 hours:
• Rest (immobilization). Do not play tennis and do not lean on the ankle.
• Cool the painful area directly with ice, a cold pack or cold running water for 10 to 15 minutes. Repeat this several times a day (aim for 20 minutes every 2 hours). Do not place the ice directly on the bare skin, but cover the ice or cold pack with a towel.
• Apply a compressive bandage immediately. This is even more important than cooling with ice, as it will stop the bleeding and prevent severe swelling of the ankle due to an accumulation of blood. The ankle cannot be taped until the swelling subsides.
• Elevate the lower leg and the ankle above the heart whenever possible (i.e. lie on the floor and place the entire leg on several pillows to decrease swelling).
Immediate and adequate first aid is important to ensure fast healing. In more serious cases, a visit to the doctor is recommended to rule out a fracture and to determine whether crutches or a boot are necessary. The doctor may refer the patient for physiotherapy.

How to Ensure the Best Recovery

Rehabilitation can begin when most of the pain and swelling have disappeared (after 2 to 5 days). During the build-up phase, pain is a signal to rest. Do not cross the pain threshold, as this will slow down the healing process.
The build-up of the training load takes place in three stages, as described below, together with some practical tips.
Stage 1. Improvement of Normal Function
• As much as the pain allows, you may stand on the foot. Crutches can be used to support the ankle/foot during the first week, but try to walk normally, from heel to toe.
• Sit down in a chair. Lift the injured foot and circle the ankle 10 to 20 times. Make the circles slow and wide, first with a clockwise set, then an anti-clockwise set.
• Sit on a smooth surface. Lay a towel on the floor in front of you. Put the injured foot on the towel, with both the heel and the toes touching it (Figure 2). Move the feet with the towel alternately forwards (extend the knees) and back (bend the knees). Both the heels and the toes should stay in touch with the ground.
• Stand straight and walk on your heels. The forefoot and mid-foot must not touch the ground. Take small steps. Then walk on your toes. Finally, walk on the inside of your feet, pressing the big toe firmly into the ground.
• Stand on the injured foot, with arms spread to keep your balance (Figure 3). Shut your eyes and try to still keep your balance.
• Sit on a chair with your feet on the floor (Figure 4). Tie one end of an elastic tube to the chair. Wrap the other end of the tube under the middle of the injured foot. Bend the knees 90 degrees. Move the foot against the resistance of the elastic tubing outwards and try to keep the outer side of the foot facing up. Repeat 10 to 20 times. Try to hold the knee and upper leg stable.
• Swim or cycle for 15-30 minutes each day to preserve overall physical fitness.

Stage 2. Build Up

As soon as the player can perform the above exercises well and can walk without pain, he/she can start building up strength for a return to sport.
• Slowly rise onto your toes and hold this position for 10 to 20 seconds. Return to the starting position. Perform this exercise with first with both feet together, then using the injured leg only.
• Stand on the injured leg. Bounce a tennis ball against a wall or on the floor and catch it again without losing your balance. Try to vary the point of the bounce as much as possible. A variation on this exercise is to stand on one leg and try to juggle with one, two, three or even more balls.
• Take quick, small steps, alternating the injured and uninjured legs.
• A very good exercise for the muscles around the ankle and foot is skipping. This should be done with care, however. It is important to build up this exercise gradually, from one minute a day to 10-15 minutes daily. Use a soft surface, such as grass or carpet, and wear either tennis or running shoes.
• If this goes well, you can start jogging. Start with an easy warm up, then progress to straight running, followed by the introduction of starts and stops into your running exercises.
• Finally, include sprints and jumping exercises.

Stage 3. Return to Play

Now you are ready to go back on court again. Initially, the ankle should be taped or lace-up brace should be used, to help prevent re-injury of the ankle ligaments.
• Start against the practise wall or with mini-tennis (playing within the service lines). Gradually increase the area of play and move back towards the baseline. Make sure you use small steps to position yourself correctly for the ball.
• This can be followed by volley exercises.
• After 1-2 weeks, you can start including exercises in which you run longer distances to the ball (tennis drills, from side to side).
• Include low volleys, followed by the serve and overhead.
• As soon as you can hit a jump smash without problems, you can start playing practice matches.
• Take care with explosive or unexpected movements, or strokes in which your foot is perpendicular to the running direction, such as wide backhands.
• In this phase, it is important to increase the loading capacity of the ankle, to regain your rhythm and to win confidence.
• Once you have been able to play practice matches for two successive weeks without problems, you will be ready for match play again.

Preventing Re-injury

It is not always possible to prevent an ankle sprain, but the risk can be reduced by paying attention to the following:
• Perform a complete warm-up before each practice or match, and a cool-down afterwards, both lasting 10-15 minutes. Pay attention to the correct performance of stretching exercises. Stretching exercises for the calf muscles are especially important.
• Ensure a gradual build-up of training, so the body can get used to the extra load.
• Wear firm, stable, well-fitting tennis shoes and pay attention to how the shoelaces should be tied. An ideal tennis shoe should have good shock absorption, sideways stability, feeling with the surface (grip) and optimal comfort.
• Remove all the balls from the tennis courts, to avoid tripping over them.
• Improve your physical condition with regular jogging or cycling. Most injuries tend to occur towards the end of the match or at the end of the day, when you are getting tired. The better your physical condition, the lower the risk of injury.
• Improve proprioception and strength of the muscles around the ankle with co-ordination and balance exercises. Standing on one leg is a particularly useful exercise. The exercises can be made more difficult by using a wobble board.
• A tape, brace or high shoe will help protect the ankle ligaments, especially during the first three months after the injury, and have been shown to reduce the risk of re-injury. Contrary to common belief, this does not weaken the ankle.