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Common Injuries of Collegiate Tennis Players


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The purpose of this study is to determine the common injuries of Filipino collegiate tennis players; 110 varsity tennis players with a mean of 20 years old (SD ± 1.7) with an average playing experience of 12 years participated in the study. There was a 100% occurrence of at least one injury with an average rate of 5.98 injuries per person. The authors observed that the most commonly injured anatomical region is the lower extremity; ankles were recorded as the most commonly injured part. Other commonly injured areas included the shoulders and lower back. Furthermore, the most common injury type is tendinitis, sprains, and strains. The recorded injuries were mostly associated with overuse injuries, and the findings were similar to those of most other studies on tennis injuries. A larger sample size may provide more conclusive findings on tennis injuries, particularly in different levels of competition, such as recreational or professional athletes.
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Monten. J. Sports Sci. Med. 6 (2017) 2: 43–47 | UDC 796.342(599) 43
Common Injuries of Collegiate Tennis Players
Christian Wisdom Magtajas Valleser1 and Ken Ewing L. Narvasa1
Affiliations: 1University of the Philippines Diliman, Department of Sports Science, College of Human Kinetics, Quezon
City, Philippines
Correspondence: Christian Wisdom Magtajas Valleser, University of the Philippines Diliman, Department of Sports
Science, College of Human Kinetics, Don Mariano Marcos Avenue, Diliman, Quezon City, Philippines, 1101. E-mail:
ABSTRACT e purpose of this study is to determine the common injuries of Filipino collegiate tennis
players; 110 varsity tennis players with a mean of 20 years old (SD ± 1.7) with an average playing experience
of 12 years participated in the study.  ere was a 100% occurrence of at least one injury with an average rate
of 5.98 injuries per person.  e authors observed that the most commonly injured anatomical region is the
lower extremity; ankles were recorded as the most commonly injured part. Other commonly injured areas
included the shoulders and lower back. Furthermore, the most common injury type is tendinitis, sprains, and
strains.  e recorded injuries were mostly associated with overuse injuries, and the  ndings were similar to
those of most other studies on tennis injuries. A larger sample size may provide more conclusive  ndings on
tennis injuries, particularly in di erent levels of competition, such as recreational or professional athletes.
KEY WORDS Injuries, Collegiate, Tennis, Student-athletes.
It is widely accepted that while engaging in sports and physical activities reduces the risk of certain diseases,
it also entails a noticeable risk of injury among all levels of participation (Bahr & Krosshaug, 2005). Although
there is no universally accepted de nition, this study de nes sports injury as a physical condition incurred as a
result of sport participation, which requires medical attention and restriction of participation or performance
(Hootman, Dick & Agel, 2007).  e general objective of this study is to identify the common injuries
incurred by collegiate tennis players using student athletes from participant schools of the University Athletic
Association of the Philippines (UAAP). Speci cally, this research aims to identify the common type of injuries
and most commonly injured anatomical regions.
Tennis is a sport widely participated in by the more than 200 countries a liated with the International Tennis
Federation. Along with its popularity are the various national and international tournaments organized
throughout the year, many of which feature large prizes (Pluim, Staal, Windler & Jayanthi, 2006).  ere
is increasing research on the epidemiology of tennis and other sport injuries, which further promotes the
awareness of injury tendencies and the development of prevention strategies (Rechel, Yard & Comstock, 2008;
Hootman et al., 2007).
On the international level, tennis is featured in the Olympics and most notably in major tournaments, such
as the Australian Open, Wimbledon Championships, French Open, and US Open. In the Philippines, there
are various professional and amateur tennis tournaments; most notably, on the amateur level, the UAAP
typically features the best collegiate tennis players in the country. Collegiate players in the UAAP normally
take up the sport at a young age, typically no later than ten years old.  e risk of early introduction and
regular participation in sports is that players starting young could acquire chronic injuries, especially when
trained with techniques that are not compatible with what their bodies can tolerate (Reid & Schneiker, 2007).
Furthermore, long-term sport participation can cause chronic and acute injuries in the developing bodies of
child- and adolescent-aged athletes (DiFiori et al., 2014).
Safran, Zachazewski, Benedetti, Bartolozzi III and Mendelbaum (1999) reported that many athletes have
Accepted a er revision: March 29 2017 | First published online: September 01 2017
© 2017 by the author(s). License MSA, Podgorica, Montenegro.  is article is an open access article distributed under the
terms and conditions of the Creative Commons Attribution (CC BY).
Con ict of interest: None declared.
44 UDC 796.342(599)
claimed that they played or competed through these discomforts.  ey further noted that low back pain was
common in elite junior players. Hellstrom, Jacobsson, Sward and Peterson (1990) also made this observation
in elite adult players. Lower-back pain from tennis comes from a wide variety of sources but is mainly due to
high demands placed on the lower back and trunk combined with low  exibility resulting in frequent overuse-
type injuries. Kibler and Safran (2005) observed that ankle sprains were the most common microtrauma
injury in tennis due to the frequent running, pivoting, sudden stopping, acceleration, jumping, and lunging
movements in tennis play. Furthermore, lateral epicondylitis (tennis elbow) and medial epicondylitis chronic
repetitive motion through  rm gripping of the handle of the racket and impact of the ball were common.
Generally, hand and wrist complaints are observed, speci cally tendinitis. It is o en common to have a
two-handed backhand stroke in which the non-dominant wrist receives stress through overuse during the
backswing phase of the stroke. Strains in the adductor muscles and hamstring are also common, primarily
due to sudden changes in direction or slipping on clay courts resulting in splits.
It was also reported by Ireland and Hutchinson (1995) that stress fractures of the ulna of the non-dominant
forearm, as well as distal radius and ulna fractures of the dominant wrist, were reported in players with
forearm and wrist pain. Renstrom (1995) indicated that 19% of all tennis-related injuries are knee injuries,
70% being acute and 30% overuse.
Most sports injuries, tennis included, occur in the lower extremities particularly the knee and ankles (Pluim
et al. 2006; Hootman et al. 2007; Rechel et al., 2008; Abrams, Safran & Renstrom, 2012) while injuries in the
trunk were the least common (Rechel et al., 2008; Chard & Lachman, 1987). In the study by Hjelm, Werner,
and Renstrom (2010) on the injury pro le of junior tennis players, the lumbar spine was the most commonly
injured body part. In contrast, Pluim et al. (2006) stated that the most commonly injured anatomical region
is the upper extremities followed by the lower extremities and the least injured part was the trunk. In the
summary by Kibler and Safran (2005), the most injured region is the lower extremities accounting for 39-59%
of reported injuries followed by the upper extremities with 20-45%, and lastly the central core with 11-30% of
the total injuries reported. Speci cally, the ankles and the thighs showed the highest frequency in the lower
extremities, the shoulders and elbows in the upper extremities, and the lower back in the central core.
Concerning practice and tournament injury rates, Hootman et al. (2007) observed that in-season
tournaments produced the highest injury rates followed by pre-season practices and in-season practice
among student-athletes. Meanwhile, post-season practice accounted for the lowest injury rates. Rechel et
al. (2008) also observed that as the level of competition increases so do injury rates and that most injuries
occur in competition as opposed to in practice. A variety of reasons that may explain why injury rates are
higher during preseason practice than during in-season or post-season practice have been suggested such as
coming to pre-season practice poorly conditioned, the duration of pre-season practices being longer than
other sport seasons, less-skilled athletes trying to improve technique and becoming injured, and pre-season
competitiveness in which players battle for starting positions.
is study is descriptive research design to identify the common injuries of collegiate tennis players,
speci cally, the most common types of injury and the anatomical regions at risk.
e criteria for the selection of research participants were as follows: (1) a current varsity player of a UAAP
school for at least one year and (2) must have played in at least one UAAP season; 110 (60 male, 50 female)
collegiate student-athletes (Mage 20 ± 1.7 yrs.) representing 100% of all UAAP tennis players in a speci c
season participated in the study.  e subjects had an average playing experience of 12 (SD + 2.4) years.
Data were collected through a survey questionnaire and guided interview using a sports injury questionnaire
adapted from Duco (2005) and Reyes (2005).  e injury inventory is divided into 20 anatomical regions
and identi es nine (9) types of injuries. Certain additions were also gathered to meet the speci c objectives
of this study, including (1) the message in the project information box, (2) details in the demographic
information (3) addition of other types of injuries, (4) the de nition of speci c types of injury, (5) a more
detailed enumeration of musculoskeletal regions and (6) a speci ed area for other injuries that may not have
been covered in the questionnaire such as other anatomical areas or multiple injuries in the same anatomical
region.  e survey questionnaire has been reviewed by a medical professional in a sports physical therapy unit
and veri ed to meet the speci c objectives of the study.
Responses were gathered at the respondents’ playing venue. Letters of request were  rst sent to the coaches,
a er which, upon being given permission to have access to their players, informed consents were handed out
to the players. A brief overview of the objectives and procedure was given to all participants prior to the data
Statistical Analysis
Subjects’ responses were interpreted via descriptive statistics and presented in frequency and percentage
UDC 796.342(599) 45
distribution tables. Graphs are also used to display the  ndings and provide an overview of common injury
trends in collegiate tennis players.
A total of 658 injuries were reported.  ere was a 100% incidence of at least one injury among the athletes
with an average of close to 6 injuries per person.  e data showed that the following are the most frequently
reported injury types: tendinitis (39%), sprains (32%) and strains (22%). All other injuries were reported at an
occurrence of 4% or lesser. Table 1 below summarizes the frequency and percentage distribution of reported
Of all reported injuries, the most common are tendinitis; of these, most were in the shoulders, elbows, knees
and wrist (30%, 27%, 20%, and 9% of all reported injuries, respectively). Below, Table 2 presents the percentage
distribution of the occurrence of tendinitis.
e second most common injury were sprains, accounting for 32% of all reported injuries. Sprains were mostly
reported in the ankles (94%) and some on the wrists (5%).  e percentage distribution of the occurrence of
sprains can be seen below in Table 3.
e third most common injury, representing 22% of all reported injuries, were strains. Strains were most likely
to be in the lower back (45%) followed by the shoulders (19%) and thighs (17%). Table 4 below illustrates the
reported occurrence of strains.
TABLE 1 Frequency and percentage distribution of type of injury.
Type of injury Frequency %
Tendinitis 254 39
Sprain 211 32
Strain 148 22
In ammation 24 4
Abrasion 12 2
Stress Fracture 6 <1
Dislocation 2 <1
Fracture 1 <1
TOTAL 658 100%
TABLE 2 Percentage distribution of the occurrence of tendinitis.
Anatomical region %
Shoulders 30
Elbows 27
Knees 20
Wrists 14
Others 9
TOTAL 100%
TABLE 3 Percentage distribution of the occurrence of sprains.
Anatomical region %
Ankles 94
Wrists 5
Others 1
TOTAL 100%
TABLE 4 Percentage distribution of the occurrence of strains.
Anatomical region %
Lower back 45
Shoulders 19
Thighs 17
Others 19
TOTAL 100%
46 UDC 796.342(599)
Anatomical Region
Regarding the anatomical regions at risk, injuries commonly occurred in the ankles (30%), shoulders (16%),
lower back (12%), knees (11%) and elbows (10%). All other injury sites were reported to be injured at a rate
of seven percent or less. Table 5 below summarizes the frequency and percentage distribution of injuries by
anatomical region.
As the most injured anatomical region, all reported injuries in the ankles were sprains, suggesting the
vulnerability of the ankles to sprains. As such, all 198 incidences were ankle sprains. In contrast, injuries in
the shoulders were mostly in the form of tendinitis, observed to be accountable for 70% of all injuries in the
shoulders, followed by strains (26%). Below, Table 6 summarizes the reported shoulder injuries.
e lower back was reported to be the third most frequently injured anatomical region. Of all injuries in the
lower back, the clear majority were strains (86%), suggesting the susceptibility of the lower back to strains
among tennis players, while the rest were in ammation (14%) or swelling characterized by tenderness and
pain which may or may not be related to strains.
Meanwhile, the fourth most injured region were the knees, mostly in the form of tendinitis (69%) with a few
strains (18%) and abrasions (11%). Table 7 below shows the summary of reported knee injuries.
e elbows were the location for 10% of all injuries, the  h most injured anatomical region. All injuries
in the elbow were reported to be tendinitis, most probably lateral epicondylitis or “tennis elbow”. All other
TABLE 5 Frequency and percentage distribution of injuries by anatomical region.
Anatomical region Frequency %
Ankles 198 30
Shoulders 106 16
Lower back 82 12
Knees 71 11
Elbows 68 10
Wrists 45 7
Thighs 26 4
Lower leg 17 3
Forearms 12 2
Arms 7 1
Upper back 6 1
Feet 6 <1%
Groin 6 <1%
Head 4 <1%
Hands 2 <1%
Abdomen 2 <1%
TOTAL 658 100%
TABLE 6 Percentage distribution of shoulder injuries.
Injury %
Tendinitis 70
Strain 26
Dislocation 2
Others 2
TABLE 7 Percentage distribution of knee injuries.
Injury %
Tendinitis 69
Strain 18
Abrasion 11
Sprain 2
UDC 796.342(599) 47
anatomical regions were reported to be injured less frequently and represent a smaller proportion of all
injured anatomical regions.
Tendinitis, sprains, and strains were clearly the most common types of injury, as observed in the data.
is observation is similar to that of Kibler and Safran (2005), and they postulate that these are mostly
microtrauma-related overuse injuries. It may be inferred that most injuries recorded in this study were due to
overuse rather than acutely incurred injuries.  e ndings are also consistent with the conclusions of Lanese,
Strauss, Leizman, and Rotondi (1990) and Rechel et al. (2008).
Tennis injuries may occur in many musculoskeletal areas but will most likely be in the ankles, shoulders
and lower back. Ankle sprains are perhaps the most common injury in tennis as well as in many sports. In
contrast, tendinitis was mostly found in the elbow or shoulders, presumably due to repeated stress, which
gives credence to the previous speculation that most injuries will be caused by chronic overuse.  ese ndings
were also previously observed by numerous studies (Kibler & Safran, 2005); Pluim et al., 2006; Hootman et
al., 2007; Rechel et al., 2008).
Tennis injury studies mostly concur with each other, which suggests the proclivity of tennis to certain
injuries. According to the  ndings of this study, overuse injuries in the form of tendinitis, sprains, and strains
were found to be most common especially in the upper extremities. Overall, however, the upper and lower
extremities seem to be most susceptible to injuries, primarily due to overuse and may be chronic if not
properly addressed.
To further minimize the risk of injury, strength and conditioning programs are recommended to focus on
strengthening the upper and lower extremities, speci cally the ankles and shoulders. As injuries in tennis may
be unavoidable, coaches and team physicians are advised to be prepared for recurring injuries in the upper
and lower extremities. Despite the relatively high number of injuries reported, the fact that all these players
still have active collegiate careers suggests that returning to play is still very possible. As such, tennis can be
safe with an inherent risk of injury, just like many other sports.
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DiFiori, J., Benjamin, H., Brenner, J., Gregory, A., Jayanthi, N., Landry, G., & Luke, A. (2014). Overuse
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Lanese, R., Strauss, R., Leizman, D. & Rotondi, A.M. (1990). Injury and disability in matched mens and
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The aim of this study was to prospectively make a survey of injuries in junior players from a Swedish local tennis club during a 2-year period in relation to gender, anatomic location, month of the year when injured, injury type and injury severity. All 12-18 years old members in a tennis club playing more than twice weekly were asked to participate. Fifty-five junior tennis players, 35 boys and 20 girls accepted to participate. All tennis-related injuries were prospectively registered and evaluated. Time of exposure for playing tennis was recorded. Thirty-nine players sustained 100 injuries, 73 in boys and 27 in girls. Injury incidence for boys was 1.7 injuries/1000 h of tennis playing time and for girls 0.6 injuries/1000 h. Ankle sprains, low back pain and knee injuries were the most common ones. Sixty-five percent were new injuries, and the majority of these injuries were located at the knee joint followed by the ankle joint, while most of the recurrent injuries were found in the lumbar spine. Boys suffered mainly from low back pain and ankle injuries and girls from low back pain and knee injuries. Forty-three percent of the injuries caused absence from tennis for more than 4 weeks and 31% more than 1 week.
Eight matched men's and women's intercollegiate varsity teams were studied prospectively for one academic year to determine the incidence of athletic injury and resulting disability. Sports in which both men and women participated in a comparable manner were chosen: basketball, fencing, gymnastics, swimming, tennis, indoor track, outdoor track, and volleyball. Men (232) and women (150) were injured at comparable rates, 42 percent versus 39 percent. When adjusted for exposure time, seven of the eight sports continued to show similar injury rates. Women gymnasts, however, experienced .82 injuries per 100 person-hours of exposure as compared to .21 injuries for the men (p = .0001). Disability was greater in women gymnasts, 7.44 days per 100 person-hours versus 1.15 days for men (p = .0004). Percent of season lost to injury was also greater for women gymnasts. Types and sites of injury were similar for men and women, with sprains and strains accounting for over half of all injuries. We found no evidence for gender differences in matched sports except for gymnastics, in which technically diverse events may have accounted for the differences observed.
In an 8-year retrospective study, 631 injuries due to the racquet sports of squash (59%), tennis (21%) and badminton (20%) were seen in a sports injury clinic, males predominating (58 to 66%). The proportion of squash injuries was higher than expected and probably relates to higher physical stress and risk of contact in this sport. Also they occurred mainly in persons over 25 years (59%) i.e. the reverse for sport in general. Acute traumatic injuries were seen especially in squash players, a majority affecting the knee, lumbar region, muscles and ankle. Tennis injuries differed most with lateral epicondylitis, patello-femoral pain and lumbar disc prolapse being relatively common. The badminton injury pattern overlapped the others. Lower limb injuries predominated in all three. Detailed assessment of 106 cases showed many to be new, infrequent, social players. Poor warm-up was a common factor in new and established players. The importance of these findings is discussed.
With the knowledge base of normal anatomy, development, biomechanics, and differential diagnosis, the sports medicine professional can treat injured young athletes with greater efficiency. In addition, microtraumatic injuries may be prevented by emphasizing safe parameters of participation, proper throwing techniques, and careful monitoring of the amount of practice time and intensity. Gymnasts using apparatus should always have spotters. The height of towers and basket tosses by cheerleaders should be limited by age and ability. Proper pitching techniques, not the fastest pitch or youngest curve, should be taught to baseball players. "Play it safe" should be the rule. Finally, by establishing an early and precise diagnosis, potential complications from injuries can be lessened.
Knee injuries are relatively common in tennis, comprising about one fifth of all tennis injuries. The most common injuries are meniscus injuries and degenerative cartilage problems in middle aged and elderly recreational players. In younger individuals, patellofemoral pain syndromes are the most frequent and intriguing problems. Knee overuse syndromes occur more commonly on surfaces such as all weather concrete because they are more fatiguing and have higher friction than clay surfaces do.
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.