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Injury Trends in American Competitive Junior Tennis Players

  • Rehab Plus Sports Therapy Scottsdale & Vice President Medical Services ATP World Tour
  • United States Tennis Association
journal of medicine and
science in tennis
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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
Original Research
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
fourth injury.
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 Associations 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
Age Division
14 and Under
Age Division
16 and Under
Age Division
Virginia Beach,
St. Louis,
Salt Lake,
Salem, North
Waco, Texas
Percentage (%)
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.
Table 1
Geographic locations of data collection
Table 2
Overall percentage of injury occurrences
Table 3
Major findings from all age groups
(12 and under, 14 and under, 16 and under)
Figure 1
Type of injury in the 12 and under age group
(male and female combined)
Figure 2
Type of injury in the 14 and Under Age Group
(Male and Female Combined)
Figure 5
Type of injury in the 14 and under age group
(gender comparisons)
Figure 3
Type of injury in the 16 and under age group
(male and female combined)
Figure 4
Figure 4: Type of injury in the 12 and under age group
(gender comparisons)
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.
Figure 8
Rank order of injuries observed in junior tennis players
Figure 7
Relationship between days off per week and
percentage of all injuries
Figure 6
Type of injury in the 16 and under age group
(gender comparisons)
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
the tournament.
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
tennis athlete.
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
survey development.
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
Paul Lubbers
United States Tennis Association
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Reece LA, Fricker PA, Maguire KF. Injuries to elite young tennis 3.
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Winge S, Jorgenson U, Nielson L. Epidemiology of injuries in 4.
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Jayanthi NA, O’Boyle J, Durazo-Arvizu RA. Risk factors for 5.
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Champaign, IL: Human Kinetics, 2007.
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... This result does not come as a surprise because elite tennis players are occupied with competitions at various tournaments throughout the year, with a tremendous increase in the playing hours. According to the survey conducted in previous research, elite junior players recorded a high incidence of injury over the year, with 41% of the players reporting at least one injury in the preceding year, while 38% were reported to have sustained a second injury within the year (2). Similarly, the authors further reported an association between injury occurrences and the age of tennis players, with older players dominating the chart. ...
... Tennis, as opposed to other sports such as soccer, is characterized by sprinting and gliding, where loading primarily affects the lower extremities (57). In addition, tennis does not have a certain fixed duration and hence matches often last numerous hours with many shorts and bursts of energy (2,3). This unique nature of tennis fosters the occurrence of injuries in the lower, trunk, and upper body regions that are regarded to be greater than in other non-contact sports (58). ...
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... Several studies were conducted to investigate tennis-related injuries with different designs and populations (e.g. Gescheit, Cormack, Duffield, Kovalchik, Wood, Omizzolo, & Reid, 2017;Hjelm, Werner, and Renstrom, 2010;Kaiser et al., 2021;Kovacs, Ellenbecker, Kibler, Roetert, & Lubbers, 2014;Kühne, Zettl, & Nast-Kolb, 2004;Lynall, Kerr, Djoko, Pluim, Hainline, & Dompier, 2015;Maquirriain & Baglione, 2016;Pluim et al., 2016;Sell, Hainline, Yorio, and Kovacs, 2014). Most of these studies reported that tennis-related injuries occurred in the lower extremity, followed by the upper extremity and the trunk (e.g. ...
... Dines et al., 2015;Fu et al., 2018;Kühne et al., 2004;Pluim & Windler, 2018;Verhagen, Clarsen, Capel-Davies, Collins, Derman, de Winter,... & Pluim, 2021). Specifically, the most affected locations include the knee, ankle, shoulder, wrist, back, foot, hip, and low back pain (Ellenbecker, Pluim, Vivier, & Sniteman, 2009;Fu et al., 2018;Hjelm et al., 2021;Kaiser et al., 2021;Kovacs et al., 2014;Pluim & Windler, 2018;Sell et al., 2014). According to Pluim and Windler (2018), the knee is a frequently injured joint in tennis because the location "is typically related to repetitive eccentric overload" (p. ...
... The previous studies have focused on injury analysis at different levels of tennis, including elite professional tennis (Gescheit et al, 2017;Maquirriain & Baglione, 2016;McCurdie et al., 2017;Sell et al., 2014) and junior tennis (Hjelm et al., Kovacs et al., 2014;Pluim et al., 2016). Although tennis-related injuries have been reported throughout body regions (Ellenbecker et al., 2009), some studies highlighted that elite professional tennis is more injurious compared with other categories of tennis (Gescheit et al., 2017;Maquirriain & Baglione, 2016). ...
Full-text available
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... Les blessures des joueurs et des joueuses élites concernent prioritairement les membres inférieurs (de 33 à 61 %), puis les membres supérieurs (de 20 à 46 %) et le tronc (de 8 à 27 %) (Tableau 2.5 et Tableau 2.6). Plus précisément, la blessure au dos est souvent citée comme l'atteinte la plus fréquente et l'épaule représente l'articulation la plus touchée des membres supérieurs (Fu et al., 2018;Gescheit et al., 2018;Kovacs et al., 2014;McCurdie et al., 2017;Montalvan et al., 2004;Okholm Kryger et al., 2015). Selon les études, les poignets, les genoux ou les chevilles sont aussi des articulations régulièrement blessées (Baxter-Jones et al., 1993;Fu et al., 2018;Gescheit et al., 2017;McCurdie et al., 2017;Pluim et al., 2016;Sell et al., 2014). ...
... Une comparaison des données épidémiologiques en fonction de l'âge a été présentée dans cette revue de littérature, suggérant que les jeunes joueurs et joueuses de tennis élites constituent une population à risque concernant les blessures (DiFiori et al., 2014;Kibler et Safran, 2005). Lorsque l'intérêt se porte spécifiquement sur les enfants et les adolescents, plusieurs études ont souligné une augmentation de l'incidence des blessures entre l'âge de 12 -13 ans et l'âge de 18 ans (Gescheit et al., 2018;Jayanthi et al., 2009;Kovacs et al., 2014;Silva et al., 2003). Par exemple, lors d'un suivi épidémiologique de 861 joueurs et joueuses élites, le pourcentage de joueurs et de joueuses ayant contracté au moins une blessure dans l'année de l'étude était de 11 % pour les U12, 28 % pour les U14 et 36 % pour les U16 . ...
... En outre, la répartition anatomique des blessures est sensiblement différente en fonction de l'âge des joueurs et des joueuses. Plusieurs études ont montré que l'épaule et le genou sont les deux articulations les plus souvent atteintes entre 11 et 14 ans, alors que le dos est la région anatomique la plus fréquemment et la plus sévèrement touchée par les blessures à partir de 14 ans (Gescheit et al., 2018;Kovacs et al., 2014;Pluim et al., 2016). L'utilisation du service lifté constitue une hypothèse pour expliquer l'augmentation du nombre de blessures au dos avec l'âge. ...
Pour les joueurs de tennis professionnels, le service est considéré comme le coup le plus important pour gagner un match. De plus, il est décrit comme un coup traumatisant qui occasionne de nombreuses blessures chroniques du membre supérieur et du tronc. Dans une logique de formation vers le haut niveau, les jeunes joueurs doivent alors acquérir le plus tôt possible une technique de service efficiente pour produire une vitesse de balle élevée tout en limitant le risque de blessures. La réalisation de ces deux objectifs représente une réelle problématique au regard de la complexité gestuelle du service et des erreurs techniques qui en découlent. Dans ce cadre, cette thèse ambitionne de répondre aux questions suivantes : comment évolue la technique de service des joueurs élites entre 12 ans et l’âge adulte ? Quels sont les critères de performance et les facteurs de risques de blessures au service chez les jeunes joueurs ? À partir de captures de mouvement en 3D, la première étude explore l’influence de l’âge et du sexe sur les variables cinématiques et dynamiques du membre supérieur dominant au cours du service. Les études 2 et 3 s’intéressent respectivement au type d’appuis et à la trajectoire de la raquette en « plateau » pour comprendre leur effet sur la performance et le risque de blessures au service. L’ensemble de ce travail fournit aux entraîneurs des recommandations concrètes sur le service pour faciliter la détection des meilleurs espoirs, individualiser les contenus d’entraînement en fonction de l’âge et du sexe, et améliorer la formation technique des jeunes joueurs pour augmenter la vitesse de balle et diminuer le risque de blessures chroniques.
... Of particular interest to coaches is the reported increase in injury prevalence with chronological age (13-18 years) from 2.0 ± 0.2 to 2.9 ± 0.1 injuries per 1000 exposure hours (Gescheit et al., 2019). In adolescents 14 years and under the shoulder was the most dominant injury location, followed by the hip/groin (Gescheit et al., 2019;Kovacs et al., 2014). The knee was particularly prevalent in the under-16 category (Kovacs et al., 2014). ...
... In adolescents 14 years and under the shoulder was the most dominant injury location, followed by the hip/groin (Gescheit et al., 2019;Kovacs et al., 2014). The knee was particularly prevalent in the under-16 category (Kovacs et al., 2014). However, a consistent observation between 14-18 years of age was the high prevalence lumbar spine injuries (Gescheit et al., 2019). ...
Full-text available
This literature review aimed to identify injury prevalence in adolescent female tennis players, and was conducted in accordance to the PRISMA guidelines (Shamseer et al., 2015). The lower extremity encountered the greatest number of injuries and musculotendinous injuries were the most common injury type. Injury prevalence and the anatomical location of injuries changed with chronological age. Acknowledging the results can help tailor strength and conditioning programmes to target the most prevalent injuries within each age group.
... In addition, injuries are common in elite adolescent tennis players, where injury rates of 1.2-2.8 injuries per 1,000 h played have been reported (Pluim et al., 2016;Gescheit et al., 2019;Moreno-Perez et al., 2019) with an overall yearly injury prevalence of 41% (Kovacs et al., 2014). Moreover, once the first injury has occurred, the likelihood of a second injury is as high as 31% (Kovacs et al., 2014). ...
... injuries per 1,000 h played have been reported (Pluim et al., 2016;Gescheit et al., 2019;Moreno-Perez et al., 2019) with an overall yearly injury prevalence of 41% (Kovacs et al., 2014). Moreover, once the first injury has occurred, the likelihood of a second injury is as high as 31% (Kovacs et al., 2014). Overuse injuries are particularly troublesome, as they are the most frequently reported health complaint among adolescent tennis players, with a weekly prevalence of 12.1% (Pluim et al., 2016). ...
Full-text available
Objectives: Our primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume. Methods: A cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS). Results: The adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36-2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74-8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training. Conclusions: Our results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.
... According to Fu et al. (2018), acute injuries tended to be more likely in the lower body, but upper body suffered more by chronic overuse injuries (referred to 47% of junior tennis players problems in the study of Pluim, Loeffen, Clarsen, Bahr, and Verhagen (2016) and in Colberg, Aune, Choi, and Fleisig (2015) even 67%). Kovacs, Ellenbecker, Kibler, Roetert, and Lubbers (2014) examined 861 elite junior tennis players in their study, and they came with the result that injury rates were 11% in the 12 and underage group, 28% in the 14 and underage group, and 36% in the 16 and underage group. McCurdie, Smith, Bell, and Batt (2017) found a higher injury rate among female players compared to men. ...
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The term laterality refers to the preference or dominance of the lateral asymmetry of the human body. The prevalence of left-handedness is reported to be 10–13%, but in some sports (e.g. boxing, ice hockey, tennis), the proportion of left-handers is higher. The left-handedness is considered an advantage in tennis; however, the one-sided load can cause muscular dysbalances leading to injuries. The research aim was to assess bilateral differences in handgrip strength in top Czech female tennis players U12 as to injury prevention. The participants were tennis players (n = 165) aged 11.0–12.9 years taking part in the regular testing by the Czech Tennis Association using the TENDIAG1 test battery between 2000 and 2018. 87.3% of all players were right-handed (RH) and only 12.7% left-handed (LH). Bilateral differences between the right- and left-hand strength of all players were medium significant in favor of the right hand. The assessment of differences between RH and LH players showed only small differences in favor of LH players. There was a medium significant difference between RH and LH players in favor of the dominant hand (DH) over the non-dominant one (NDH). As to injury prevention, it is surprising that a difference between DH and NDH strength >15% was found in 40.91% of RH players and even in 40.06% of LH players. This predicts an increased risk of injury, so it is desirable to pay attention to both sides of the training load and to include compensatory or strengthening exercises.
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This perspective article aims to discuss the usefulness of tools that can assist tennis professionals effectively manage the well-being of their players. This includes identifying and monitoring meaningful metrics (i.e., training load, training intensity, heart rate variability), as well as careful planning of training and competition schedules with appropriate recovery periods. The use of innovative training methods (i.e., repeated-sprint training in hypoxia and heat training), and proper dietary practices, along with biometric assessment for young players, represents should be considered. Adopting a holistic approach to decision-making about training and competition, balancing both health and performance considerations, is crucial for tennis players and their support teams. More research is needed to refine best practices for enhancing tennis performance while prioritizing the well-being of players.
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The aim of this study is to examine the relationship between injury risk profile and injury awareness, as well as the level of injury knowledge and the incidence of injuries among adolescent tennis players. Material and Methods: One hundred seventy-nine adolescent tennis players (n: 98 females and 81 males, age: 13.9±1.6 years), who had a history of at least one sports injury were included in the study. A questionnaire was designed by sport experts that questioned about the tennis injuries and awareness of tennis injuries. Results: The most injured area was the shoulder (22%). It was followed by elbow (19%), ankle (17%), wrist (16%), and the knee (12%). Experiencing more sport injuries (more than twice) increased 5.7 times (p<0.01) if they had medium knowledge level, and increased 22.4 times if they had low knowledge level (p<0.001). Conclusion: Upper extremity injuries are more common in adolescent tennis players comparing with lower extremity injuries. In addition, the number of previous tennis injuries was related to training load and the athletes' awareness of tennis injuries. Therefore, optimizing tennis training load and increasing the level of injury awareness in adolescent tennis players may be important in preventing future sports injuries.
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Tennis players' joints are subjected to enormous loads, with supraphysiological stresses generated at the shoulder and elbow hundreds of times per match. Chronic injuries typically concern the upper extremity while acute injuries typically affect the lower extremities. The type and frequency of injuries have also changed as a result of advancements in equipment and playing surfaces. Top athletes and coaches need some understanding of how the playing surface affects tennis performance. Thus, the purpose of this review is to provide an overview of the most recent research on injuries and playing surface effects in tennis. The main aim of this study was to ascertain whether there is a difference in the incidence of tennis injuries between the four most popular court surfaces, including clay, hard, grass and concrete. Tennis court surfaces have been identified as a factor that influences the occurrence of injuries. The evidence strongly suggests that the surface is a significant component in injury causation and varying surfaces have been found to have considerably different injury rates. A systematic search of published reports was conducted in four electronic databases from 2010 to discover relevant articles relating to tennis injuries and surfaces.
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There have been no large-scale epidemiologic studies designed to determine the risk factors related to medical withdrawal in United States Tennis Association junior national tennis tournaments. Risk of medical withdrawal will increase on the basis of cumulative match volume within a tournament. A retrospective, cross-sectional analysis was performed of data collected for every match of all 4 United States Tennis Association supernational tournaments (spring, summer, fall, winter) for the boys and girls divisions and for all age divisions (12, 14, 16, 18) during a single year (2005). Logistic regression analysis was performed to determine relative risk of all risk factors. Additional analysis was performed to determine the threshold (ie, match number) at which a player would substantially increase his or her risk of medical withdrawal. A total of 28336 match exposures were analyzed, with an even distribution with respect to sex and age. The total medical withdrawal rate was 15.6 per 1000 match exposures. Every factor of interest was highly significant in predicting a higher rate of medical withdrawal per 1000 match exposures. The medical withdrawal rate was significantly higher in the fifth match or greater (26.3/1000) versus the first 4 matches (12.7/1000; P < .0001), even when analyzing main draw and singles matches. In United States Tennis Association national junior tennis tournaments, there is a significant increase in risk of medical withdrawals directly related to older age divisions, boys, singles matches, and main draw matches. Specifically, there is a significant increase in medical withdrawal rate beyond the fourth match in the tournament regardless of whether it is a main draw, consolation, or singles match. Recommendations can be made to exercise caution in tournaments that involve boys, older age divisions, and singles. In addition, there may be sufficient evidence to suggest intervention within a tournament when players play beyond their fourth match.
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A systematic search of published reports was carried out in three electronic databases from 1966 on to identify relevant articles relating to tennis injuries. There were 39 case reports, 49 laboratory studies, 28 descriptive epidemiological studies, and three analytical epidemiological studies. The principal findings of the review were: first, there is a great variation in the reported incidence of tennis injuries; second, most injuries occur in the lower extremities, followed by the upper extremities and then the trunk; third, there have been very few longitudinal cohort studies that investigated the association between risk factors and the occurrence of tennis injuries (odds ratios, risk ratios, hazard ratios); and fourth, there were no randomised controlled trials investigating injury prevention measures in tennis. More methodologically sound studies are needed for a better understanding of risk factors, in order to design useful strategies to prevent tennis injuries.
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A retrospective analysis of injuries sustained by young male and female tennis players (aged 16-20 years) enrolled at the Australian Institute of Sport was conducted over a four-year period between 1982 and 1985. The dominance of lower limb injuries over those involving the trunk and upper limbs was evident in both sexes. Factors considered important in explaining this trend include lack of attention to lower limb fitness programs, constant playing on hard courts, and the use of improper footwear, It is recommended that the prevention and management of tennis injuries can be effected by comprehensive pre-participation conditioning of all regions of the body, recognition of the degree of stress imposed on the lower limbs by different courts surfaces and by the design of appropriate tennis footwear.
During the outdoor tennis season of 1984 a prospective injury registration was done in 104 randomly chosen elite tennis players, of whom 86% could be followed. We found 46 injuries: an incidence of 2.3 injuries/player/1000 tennis hours. Men were more frequently injured than women. The prevalence was 0.3 injury/player. Upper extremity injuries were most frequent - 45.7% (21/46). Shoulder injuries were the single most frequent injury - 17% (8/46). The pathophysiology was overuse in 67% (28/42), strains in 14% (6/42), sprains in 17% (7/42), fractures in 2% (1/42), and blisters in 5% (2/42). Players using conventional rackets had more injuries to the upper extremity compared with players using mid/oversized rackets, though the difference was nonsignificant. The importance of impact forces from the tennis stroke in the mechanism of upper extremity injuries is discussed.
Injuries that required physical or medical assistance were recorded for participants at the United States Tennis Association National Boys' Tennis Championships from 1986-1988, 1990-1992 (N = 1440, 240 athletes per year). Over the 6-yr period, a total of 304 athletes (or 21.1%) sustained new or recurrent injuries that required evaluation by the medical team. New injuries alone numbered 145 (incidence rate of 9.9 per 100 athletes). The analysis of injuries showed a higher rate of lower than upper extremity injuries. When evaluated by anatomic regions, back injuries were most common followed by thigh, shoulder, and ankle injuries, respectively. When evaluated by injury type, strains and sprains were most common (71% of all injuries) with fractures and dislocations being rare (1.3% of all injuries). The lower extremity provided the majority of sprain type injuries with 87.5% of ligament sprains coming from the knee and ankle. Injuries with tennis eponyms (i.e., tennis toe, tennis leg, tennis elbow, and tennis shoulder) were rare (0%-5% of all injuries). It would appear that these young elite athletes are at significant risk of injury.
The purpose of this chapter is to critically review the existing studies on the epidemiology of tennis injuries in pediatric athletes, present suggestions for the prevention of injury based on these studies, and present suggestions for future research. Data sources included published articles on pediatric tennis injuries, a previously published review by the authors, and unpublished data from one of the authors (MS). Most studies of tennis injuries show that they are of microtrauma origin, develop over time, and result in short times of absence from play. They involve all joints of the body, but have a higher incidence in the shoulder, back, and knee. Intrinsic and extrinsic risk factors may be related to the incidence of injury. These factors may be evaluated by a comprehensive pre-participation exam, and preventive strategies may be implemented. Most injury studies in pediatric tennis players vary in the population studied, methods of injury evaluation, and risk factors studied. Consequently, few specific conclusions can be derived about the causative factors. Further longitudinal prospective studies need to be done to completely discover all the factors involved in producing tennis injuries.
Tennis training: enhancing on-court performance
  • M Kovacs
  • W B Chandler
  • T J Chandler
Kovacs M, Chandler WB, Chandler TJ. 8. Tennis training: enhancing on-court performance. Vista, CA: Racquet Tech Publishing, 2007.