journal of medicine and
science in tennis
*OURNALOF34-3INCOOPERATIONWITH)4& s !40 s 74!
Over the last decade more interest has been devoted
to youth sport and the increased training and
competition. In the tennis community this has
certainly occurred and having a clear picture of the
injury trends in junior tennis players is important
from a research perspective, and also from a training
and competition perspective. e average young
tennis player experiences relatively few severe injuries.
However, overuse is a concern and some researchers
have stated that junior tennis players are at signiﬁcant
risk of injury,
yet these statements have been made
based on limited research. More research is needed to
better understand the type and amount of injuries and
also causes and better methods of preventing injuries
in tennis players.
Although limited research has been performed on
injuries in junior tennis players throughout training,
some good information has been obtained during
Very limited research is available on
injury rates over the course of a year and the inﬂuence
of training on injury rates, however, over a multiyear
period at a major junior national tennis tournament
Mark S. Kovacs, Todd S. Ellenbecker, W. Ben Kibler, E. Paul Roetert, Paul Lubbers
J Med Sci Tennis 2014;19(1): 19-23
Injury Trends in American
Competitive Junior Tennis
Understanding demographic data and potential trends from of national-level junior tennis players can assist
strength and conditioning professionals in comparing their individual athletes to tennis norms based on age and
gender. The purpose of this study was to analyze a series of demographic, technique, injury and training related
questions in competitive junior tennis players. The data was collected during a major, combined gender, national
team competition in the United States (age ranges from 10-17) a self-reported survey used and descriptive
statistics were used to analyze the results. 41% of all respondents reported at least one injury per year.
Approximately 1/3 of players injured once received a second injury that year. Females reported 57% of all injuries.
As junior players age they reported more injuries: 12 and under age group (11%); 14 and under age group (28%);
16 and under age group (36%). The most commonly injured areas in order are: 1) back, 2) shoulder, 3) ankle,
4) knee, 5) wrist, 6) other. The results highlight the need for more focus of training (both on and off-court) that
emphasis the back, shoulder, ankle, knee and wrist areas from an injury prevention perspective. The results from
this study provide some important information about the trends seen in national-level junior tennis players in the
United States. More injury data and further research is still needed in junior tennis players.
Keywords: tournament, injury, elite performance, specialization.
21% of participants sustained an injury.
the last few decades research has been inconsistent
about which part of the body sustains the majority of
tennis injuries. Earlier research showed that a large
percentage of injuries occurred in the lower body.
However, more recent research has showed that upper
body and core injuries are becoming more and more
Better understanding of injury data from large samples
of junior tennis players can assist coaches as well as
sport science/medicine staﬀ in developing tennis
speciﬁc training and injury prevention programs. e
purpose of this study was to deﬁne injury patterns by
anatomic location and to determine whether a link
with other variables exists (e.g. training volume, tennis
technique, court surface etc). ese data could then
be used to help promote future research into junior
tennis injury rates and also prevention. Unfortunately
a paucity of research exists in this area and much more
research is needed to help improve the understanding
of injury rates, causes, and potentially promote the
development of prevention strategies in the future.
reported three injuries per year, 36% reported a
Females reported 57% of all injuries and males
had 45% of all injuries. As junior players age they
reported more injuries: 12 and under age group
(11%); 14 and under age group (28%); 16 and under
age group (36%). e most commonly injured areas
are presented in Figure 8. Male and female junior
players use the following training components
respectively: 51% & 54% use free weights; 38% and
40% use machine based strength training; 36% &
49% use elastic tubing/bands; 43% and 58% use
medicine balls during training. 83% of players report
that they usually play on a hard court surface.
e survey instrument was developed by the United
States Tennis Association’s Sport Science Committee
which is comprised of experts in tennis medicine and
science including physical therapists, medical doctors,
athletic trainers, strength and conditioning professionals,
dietitians, sport psychologists and tennis coaches. is
group of experts then worked with statistical experts
to develop the survey instrument. e research project
was approved by the Institutional Review Board of the
University of Connecticut.
e survey was administered during the summer of
2008 at the largest combined gender, junior national
team competition in the United States (age ranges from
10-17). e survey was administered at 12 diﬀerent
locations throughout the country. See Table 1 for
e opportunity to participate in the survey was
provided to all participants and the self-reported
paper and pencil survey was returned by 861 junior
tennis players with a 97% completion rate [males-43%
(N=356); females-57% (n=476)]. Descriptive statistics
were used to analyze diﬀerences between age, gender
and injury rates.
As the goal of the study was to evaluate injury patterns
and trends a clear deﬁnition of injury was important.
e committee that created the instrument agreed on
the following deﬁnition of an injury: “An event that forces
a player to miss 3 or more consecutive days of tennis play,
either practice or competition, or that requires medical
attention from an athletic trainer, physical, therapist, or
Forty-one percent of all respondents reported at least
one injury per year (Table 2). One third (33%) of
players who reported one injury per year, also reported
a second injury that year. irteen percent of young
athletes reported two or more injuries per year. Of
those individuals that reported two injuries per year,
38% reported a third injury. Of those individuals that
12 and Under
14 and Under
16 and Under
At least one injury per year 41
2 injuries per year 12.9
3 injuries per year 5
4 injuries per year 2
Major ﬁndings from this study
was the most often injured area. However for the 16 and under age
group the back was the most commonly injured area.
and only 38% and 39% use machines.
Geographic locations of data collection
Overall percentage of injury occurrences
Major ﬁndings from all age groups
(12 and under, 14 and under, 16 and under)
Type of injury in the 12 and under age group
(male and female combined)
Type of injury in the 14 and Under Age Group
(Male and Female Combined)
Type of injury in the 14 and under age group
Type of injury in the 16 and under age group
(male and female combined)
Figure 4: Type of injury in the 12 and under age group
e information obtained from this data collection
is very important to coaches, athletic trainers, sports
medicine clinicians and tennis administrators. is is
one of the few studies that evaluated tennis injuries in
competitive junior tennis players throughout the United
States. is adds to the current body of literature that
has evaluated injuries in tennis players (both junior and
Once a player reports an injury, the likelihood of the
same player being injured a second time is 31%, or
nearly a third of those injured will incur a second injury
in the same year, and roughly a third of those will incur
a third injury that year and a third of those will incur
a 4th injury in the same year. As individuals age they
report more injuries: 12 and under age group 11%;
14 and under age group 28% and 16 and under age
group 36%. is increase in injury rates as athletes’ age
through the junior tennis career is rather interesting
when looked at in comparison to withdrawal rates
from junior tournaments. A similar trend of increased
medical withdrawal rates in junior tournaments are
seen as athletes age.
erefore, it would be prudent
for coaches, athletic trainers and administrators to
understand the increased risk of injury in the junior
tennis players as they go through the pubertal years and
appropriate training and education and research needs
to be focused on these important competitive years.
When combining all age groups the overall injury
prevalence reported was (Figure 8): 1) Back, 2)
Shoulder, 3) Ankle, 4) Knee, 5) Wrist, 6) Other.
Reece et al
in the 1980s reported 176 injuries at the
Australian Institute of Sport over a four year period.
e results showed that 59% of injuries occurred in
the lower limbs with other injuries equally distributed
between trunk and upper extremity.
In a prospective
study of 104 elite athletes injuries were 46% in the
upper extremity with 39% and 11% of injuries in the
lower extremities and back, respectively.
Pluim et al.
identiﬁed 28 epidemiological studies on injuries in
tennis published since 1966. 35% were prospective and
of the 19 studies published only three were performed
on junior tennis players. Although population groups
and methodological diﬀerences exist, the authors
concluded that most injuries occur in the lower
extremities (31-67% of all injuries), followed by the
upper extremities (20-49%) and the trunk (3-21%).
Hutchinson et al
found similar results. Kibler
and Safran also found similar values but a slightly
higher degree of trunk injuries (11-30% of all injuries).
In competitive juniors players in their study, the most
commonly injured body parts were reported to be the
thigh, ankle joint, shoulder and elbow joints as well as
the lumbar spine.
Rank order of injuries observed in junior tennis players
Relationship between days oﬀ per week and
percentage of all injuries
Type of injury in the 16 and under age group
In one of the most robust studies conducted
on junior tennis players, Hutchinson et al,
collected data at the biggest individual national
junior tournament in the United States for 16
and under and 18 and under male tennis players.
is study collected data over a six year period. In
this study 21% of participants sustained an injury
that involved them visiting the medical staﬀ at
e major ﬁndings from this
extensive study were that “overuse” appears to be
a primary factor associated with low back strains
and sprains in elite tennis athletes.
extremity injuries are twice as frequent as upper
extremity or central injuries in the young elite
Central injuries especially those
of the spine are common and similar in frequency
as upper extremity injuries.
As can be seen
from these previous studies, some variability in
injuries exists and much of this variability is due
to methodological diﬀerences in data collection,
and the population groups studied (i.e. adults vs.
youth, elite vs. recreational etc).
A simple measure of training volume in this study
was to determine how many days per week each
athlete trained/competed. e Individuals that
trained/competed 6 days per week had more
than 50% of all the injuries reported (Figure 7).
Whereas individuals that had 2 days rest per
week (i.e. training/competing 5 days per week)
had 50% fewer injuries than the individuals that
only had one day of rest per week (Figure 7).
e ﬁndings from this study show a
predominance of overuse injuries occurring in
elite junior tennis players. is points to the
important role of strength and conditionings and
prevention programs play in the development of
elite junior tennis player. Reed and Schneiker
have provided an extensive review of the
importance of sports speciﬁc strength and
conditioning programs for elite level tennis
players, with several other reports speciﬁcally
targeting shoulder and scapular stabilization and
hip and core strengthening as areas of emphasis in
elite tennis players.
e limitations of a self-reported survey must
be acknowledged and the data is based upon
recollections of young athletes. However, due
to the rather large sample size, it does provide a
robust overall picture of junior tennis injuries.
Hopefully this study will encourage more
research in the area of junior tennis injuries with
a speciﬁc emphasis on prospective studies as well
as longitudinal studies looking at injury rates
and possible links with training, equipment and
e results from this study provide important
information about the injury trends seen in
competitive junior tennis players in the United
States. e shoulder and the back were identiﬁed
as the two major areas that need a greater focus
in training and injury prevention programs
based on the high number of injuries reported
by competitive elite junior players in this study.
e increase in injuries as athletes age through
their junior career is also something that should
be of major interest to coaches, sports medicine
professionals, and administrators. More research
and education is needed to ensure that appropriate
understanding of volume and injury prevention
programs are implemented to help reduce the
likelihood of injuries in junior tennis players.
e authors would like to acknowledge the work
of the entire USTA Sport Science Committee
who served during the 2007-2008 and 2009-2010
terms. e authors would also like to acknowledge
Scott Riewald for his work as the Administrator
of Sport Science for the USTA at the time of the
Conﬂicts of Interest: none declared.
About the authors
Mark Kovacs, PhD, CTPS, MTPS
Dr. Kovacs is a co-founder of the
International Tennis Performance
Association (iTPA) He formally
directed the Sport Science and Coaching
Education departments for the USTA.
He currently chairs the ITF Health
Benefits of Tennis Taskforce and the
PTR Sport Science Committee.
Todd S. Ellenbecker
Physiotherapy Associates Scottsdale
Sports Clinic - ATP World Tour
W. Ben Kibler
Lexington Sports Medicine Center
E. Paul Roetert
American Alliance of Health Physical
Education, Recreation & Dance
United States Tennis Association
Kibler WB, Safran M. Tennis Injuries. In: Caine D, Maﬀuli N 1.
(editors). Epidemiology of Pediatric Sports Injuries. Basel: Karger,
Hutchinson MR, Laprade RF, Burnett QM, Moss R, Terpstra J. 2.
Injury surveillance at the USTA boys’ tennis championships: a
6-yr study. Med Sci Sports Excerc 1995;27: 826-830.
Reece LA, Fricker PA, Maguire KF. Injuries to elite young tennis 3.
players at the Australian Institute of Sport. Aust J Sci Med Sports
Winge S, Jorgenson U, Nielson L. Epidemiology of injuries in 4.
Danish championship tennis. Int J Sports Med 1989;10: 368-371.
Jayanthi NA, O’Boyle J, Durazo-Arvizu RA. Risk factors for 5.
medical withdrawals in United States Tennis Association junior
national tennis tournaments: a descriptive epidemiologic study.
Sports Health 2009;1:231-235.
Pluim BM, Staal JB, Windler GE, Jayanthi N. Tenis injuries: 6.
occurence, aetiology, and prevention. Br J Sports Med 2006; 40:
Ellenbecker TS, Pluim B, Vivier S, Sniteman C. Common injuries 7.
in tennis players: exercises to address muscular imbalances and
reduce injury risk. Strength Cond J 2009;31: 50-58.
Kovacs M, Chandler WB, Chandler TJ. 8. Tennis training: enhancing
on-court performance. Vista, CA: Racquet Tech Publishing, 2007.
Kovacs MS, Roetert EP, Ellenbecker TS. Eﬃcient deceleration: 9.
the forgotten factor in tennis-speciﬁc training. Strength Cond J
Roetert EP, Ellenbecker TS. 10. Complete conditioning for Tennis.
Champaign, IL: Human Kinetics, 2007.