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5
24th Year, Issue 70, December 2016
INTRODUCTION
Concussion in sport is a rapidly growing issue world-wide, not only
in contact sports where concussion is now a major issue, but also in
non-contact sports such as tennis. In contact sports, investigation
of concussion has focussed on the long-term consequences of
repeated head injuries during a professional athlete’s career (Pearce
et al., 2014). Concern has also been raised about players continuing
or returning to play following impact to the head where the likelihood
of further injury is signicantly increased (Nordström et al., 2014).
Concussion and tennis are not normally words that would be used
within the same sentence. Concussion rates in tennis are statistically
negligible (Pluim et al., 2006). Recently however, several highly
ranked players have been public with their struggles recovering from
this injury, that we thought it was prudent to discuss concussion in
tennis, particularly with regards to understanding what a concussion
is, how to recognise the signs of concussion on the tennis court,
when is a player ready to return to training and playing, and nally
understand the issue of post-concussion syndrome.
Recognising the signs of concussion
Sports-related concussion constitutes approximately 20% of
mild traumatic brain injury cases, which itself makes up nearly
80-90% of all traumatic brain injuries (Langlois et al., 2006). The
consensus statement following the 4th International Conference on
Concussion in Sport dened concussion as a brain injury involving
pathophysiological processes induced by biomechanical forces
(McCrory, Meeuwisse, Aubry, Cantu, Dvoák, et al., 2013). Table 1
illustrates key causes and warning signs of concussion.
Causes of concussion Onset of symptoms Noticeable symptoms
Direct impact to head
(i.e. from tennis ball)
Immediate Loss of consciousness only in
5-20% of cases (Finch et al.,
2013; Meehan et al., 2010).
Head hitting hard surface
(i.e. tripping during warm up
or play)
Delayed – by minutes or
sometimes by hours or days.
Headache; nausea, blurred
vision, fatigue.
Indirect force to upper
body causing whiplash
action
Cognitive signs: loss in
memory; confusion; ability to
think; inability to focus.
Motor signs: slowness in
reaction; slurred speech;
impaired balance.
Descriptions: “…not quite
right”, “ …having my bell
rung”, or “I couldn’t see
anything for a couple of
seconds” (Ropper, 2008)
Table 1. Causes and noticeable signs of concussion (McCrory et al,
2013).
Alan J Pearce (AUS) and Janet A Young (AUS)
ITF Coaching and Sport Science Review 2016; 70 (24): 5 - 7
ABSTRACT
Concussions in tennis are rare, but they do occur. As recent case reports have highlighted, players who sustain concussions
in tennis can be affected for much longer than expected. This article, written for the coach, outlines the signs of concussion,
concussion awareness in tennis, and the coach’s role in mitigating risk and managing concussions in their players.
Key words: Concussion, Injury, Post concussion syndrome Article received: 24 June 2016
Corresponding author: janet_young7@yahoo.es.au Article accepted: 27 July 2016
Hard knocks: Concussion injuries in tennis
CONCUSSION IN TENNIS
Although rare, concussions in tennis players have occurred. Reports
of players sustaining concussions indicate these are the result of
falls, which is the most common reason for concussion injuries
(Ropper, 2008). For example, Victoria Azarenka suffered concussion
at the 2010 US Open when warming up and catching her foot at the
bottom of her sweatpants. Azarenka went onto play her match but
collapsed on court 30 minutes into the match. In the same year,
British player Sarah Borwell was playing a doubles match when one
of her opponents hit a smash impacting directly into Borwell’s head
(Myles, 2015). Feeling ne, Borwell continued to play, winning the
match. However following the game symptoms appeared:
As soon as the adrenaline wore off I was a mess. I was feeling sick.
I was dizzy, and my face swelled up on the left hand side…They
monitored me for the evening, kept checking every hour and the next
day, I had an MRI in San Francisco and they saw a bruise on my brain
(Myles, 2015).
Despite the MRI ndings, Borwell was told that she would be
ne within seven days. Still feeling the effects of concussion
(fatigued, photophobic and unsteady) Borwell continued to the next
tournament and given a clearance that she could play. However,
Borwell could not actually undertake any physical activity, nding
difculty in simple motor tasks such as walking straight and keeping
her balance (Myles, 2015). It took nearly one year for Borwell’s
symptoms to dissipate. More recently Eugene Bouchard and Casey
Dellacqua showed ongoing symptoms following their concussions
after falls. Bouchard, falling in a change room accident, took over
three months to recover from concussion (Henley, 2015). In October
2015 Dellacqua, falling on the court during a match in Bejing, missed
the 2016 Australian summer season (Henley, 2015).
Importance of concussion awareness in tennis
In the USA, it is estimated that there are, per year, 1.6-3.8 million
hospitalisations for sports- and recreation-related head injuries
(Langlois et al., 2006). However, it is well known that sports
