Tennis injuries: occurrence, aetiology, and prevention

Tennis Injuries Among German League Players: Investigating Patterns and Epidemiology of Acute and Chronic Injuries

Purpose

While injuries among elite tennis athletes are extensively documented, a notable research gap exists regarding tennis injuries among club-level players. This study examines tennis injuries in German league players, with a particular emphasis on the impact of racquet properties and court surfaces, distinguishing between chronic and acute injuries.

Patients and Methods

Retrospectively analyzing data from 600 tennis players over a 1.5-year period, a standardized questionnaire covered anthropometrics, injury characteristics, equipment usage, and court surface conditions.

Results

The study identified 1012 tennis-related injuries, averaging 1.7 per player. Acute injuries predominantly affected the lower extremity (56%), with ankle injuries being the most prevalent, and ligaments were the most commonly affected structures (36.4%). Chronic complaints (reported by 364 athletes) focused on the upper extremity (63.2%), primarily tendon injuries (56.8%). Racket properties exhibited no significant impact on chronic upper extremity injuries.

Conclusion

This study highlights a high incidence of acute lower extremity injuries, especially ankle ligament injuries, among German league tennis players. It offers crucial insights for devising targeted injury prevention strategies applicable to amateur, semi-professional, and professional tennis players, despite finding no significant link between racquet material and chronic upper extremity injuries.

Retirements of professional tennis players in second- and third-tier tournaments on the ATP and WTA tours

The demands of professional tennis, including physical and psychological aspects, contribute to the frequency of retirements at elite levels of the sport. The aim of this study was to analyze epidemiological patterns and risk factors associated with retirements in previous ATP and WTA Tour tournaments. A retrospective cohort study was conducted. This study focused on previous ATP and WTA Tour tournaments. The ATP database encompassed 584,806 matches, while the WTA database included 267,380 matches. To assess retirements, potential risk factors such as playing surface, tournament category, match round, and player age were analyzed. Incidence rates were calculated for the period between 1978-2019 for men and 1994-2018 for women. The overall incidence rate was 1.56 (95%CI: 1.54, 1.59) and 1.36 (95%CI: 1.33, 1.39) retirements per 1000 games played in male and female competitions, respectively. Retirements increased over the years. Higher incidence rates were observed on hard (1.59 [95%CI: 1.56, 1.63] and 1.39 [95%CI: 1.34, 1.44]) and clay (1.60 [95%CI: 1.57, 1.63] and 1.36 [95%CI: 1.32, 1.41]) compared to grass courts (0.79 [95%CI: 0.65, 0.94] and 1.06 [95%CI: 0.88, 1.27]). Risk factors differed by gender, with tournament category significant in males (IRR: 1.23 [95%CI: 1.19, 1.28] in ITF vs ATP) and match round in females (IRR: 0.92 [95%CI: 0.88, 0.98] in preliminary vs final). This study provides valuable insights for coaches, players, support teams, and epidemiologists regarding retirements and associated risk factors in previous ATP and WTA Tour tournaments, contributing to injury prevention strategies.

Pickleball Primer: An Overview of Common Injuries, Treatment, and Optimization Strategies in Pickleball Athlete

Pickleball is one of the fastest growing sports in the United States with millions of players nationwide. It is a relatively appealing sport because of its ease of access, low impact, and highly social atmosphere, allowing players of all ages to participate. As the number of players continues its dramatic increase, player injuries are certain to increase in turn. There is little to no orthopaedic research on pickleball-related injuries and a paucity of data regarding treatment and prevention strategies. This summary was designed to familiarize orthopaedic surgeons with the basics of the sport and highlight potential pickleball-related injuries they may encounter in practice.

Osteochondritis Dissecans of the Elbow in Overhead Athletes: A Comprehensive Narrative Review

Osteochondritis dissecans (OCD) of the elbow mainly occurs in overhead athletes (OHAs). This narrative review aimed to comprehensively analyze the epidemiological data, etiological factors, clinical and imaging features, treatment options, and outcomes of OHAs with the diagnosis of elbow OCD. A literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science. Individuals with elbow OCD were usually 10-17 years of age with incidence and prevalence varying between studies, depending on the sport activity of the patients. The etiology of OCD lesions is multifactorial, and the main causes are believed to be repetitive trauma, the biomechanical disproportion of the articular surfaces, poor capitellar vascular supply, and inflammatory and genetic factors. Athletes usually presented with elbow pain and mechanical symptoms. The mainstay for the diagnosis of elbow OCD is MRI. The treatment of elbow OCD lesions should be conservative in cases of stable lesions, while various types of surgical treatment are suggested in unstable lesions, depending mainly on the size and localization of the lesion. The awareness of medical practitioners and the timely diagnosis of OCD lesions in OHAs are key to favorable outcomes.

Epidemiology of Musculoskeletal Injuries in Tennis Players During the French Open Grand Slam Tournament From 2011 to 2022

Background

The epidemiology of musculoskeletal injuries at the Australian Open, Wimbledon, and US Open tennis tournaments has been investigated in recent studies; however, there is no published literature on the incidence of musculoskeletal injuries at the French Open.

Purpose

To describe the incidence, location, and type of musculoskeletal injuries in tennis players during the French Open tournament from 2011 to 2022.

Study Design

Descriptive epidemiology study.

Methods

A review was performed of all injuries documented by a multidisciplinary medical team during the French Open from 2011 to 2022. All musculoskeletal injuries that occurred during the main draw of the female and male singles or doubles matches were included. Descriptive statistics were used to summarize the data. Injury locations were grouped into regions as well as into upper limb, trunk, and lower limb.

Results

In total, there were 750 injuries in 687 tennis players, resulting in a mean of 62.5 injuries per tournament; however, there were no obvious trends in injury incidence over the time frame evaluated. The number of injuries in female and male players was similar (392 vs 358, respectively). The most common injury regions were the thigh/hip/pelvis (n = 156), ankle/foot (n = 114), and spine (n = 103). The most common injury types were muscle-related (n = 244), tendon-related (n = 207), and joint-related (n = 163), and the most affected muscles were the adductors (n = 45), rectus abdominis (n = 38), and lumbar muscles (n = 25).

Conclusion

Over the 12-year period from 2011 to 2022 female and male players experienced similar numbers of musculoskeletal injuries, with most injuries occurring in the lower limbs compared with the upper limbs and trunk.

Elbow, wrist kinematics and shock transmission of backhand stroke in wheelchair tennis players

The aim was to compare the differences in kinematics of elbow and wrist and shock transmission of the upper extremity in wheelchair tennis players and able-bodied players (in standing and sitting position) during backhand strokes. Fifteen wheelchair tennis and 15 able-bodied tennis players enrolled. Electromagnetic system and trial-axial accelerometers were used to measure the difference in the kinematic parameters of the upper extremity and the impact vibration transferred across the wrist joint. The results indicated that wheelchair players demonstrated unique elbow and wrist kinematics, especially shorter total swing time, greater elbow flexion at preparation, lower wrist extension acceleration before impact, and smaller racket vibration at impact. Comparing to able-bodied players in standing, wheelchair players and players in sitting demonstrated significantly greater elbow joint flexion/extension angle, angular velocity, angular acceleration during extension, and wrist joint flexion angle. Wheelchair players also differ significantly with the players in sitting regarding elbow joint angular velocity and acceleration, and wrist joint flexion velocity. These adaptations and adjustments can be attributed to the missing lower extremity function and deficient trunk kinetic chain. The differences between wheelchair tennis players and able-bodied players in sitting could represent the progress as the wheelchair players moving from novices to experts.

Influence of altered torsional stiffness through sole modification of air pressure shoes on lower extremity biomechanical behaviour during side-step cutting maneuvers

Directional changes in cutting maneuvers are critical in sports, where shoe torsional stiffness (STS) is an important factor. Shoes are designed based on different constructions and movement patterns. Hence, it is unclear how adjustable spacers into the sole constructions of air pressure chambers (APC) affect the STS in side-step cutting. Therefore, this study investigated the effects of altered STS through adjustable sole spacers on ground reaction force (GRF) and ankle and knee joint moments in side-step cutting. Seventeen healthy recreational athletes performed side-step cutting with experimental conditions including (i) barefoot (BF), (ii) unaltered shoes (UAS): soles consisting of APC, and (iii) altered shoes (AS): modified UAS by inserting elastomeric spacers into cavities formed by APC. Mechanical and biomechanical variables were measured. Significant differences were revealed across shoe conditions for impact peak (p = 0.009) and impulse (p = 0.018) in vertical GRF, time to achieve peak braking (p = 0.004), and peak propulsion (p = 0.025) for anterior-posterior GRF in ANOVA test. No significant differences were observed in GRF peaks and impulses between UAS and AS except for a trend of differences in impact peak (p = 0.087) for vertical GRF. At the ankle and knee joint, peak ankle power absorption (p = 0.019), peak knee internal rotation moment (p = 0.042), peak knee extension moment (p = 0.001), peak knee flexion moment (0.000), peak knee power absorption (p = 0.047) showed significant difference across three shoe conditions. However, no significant differences between the UAS and AS were noticed for peak joint moments and power. Altered shoe torsional stiffness did not significantly affect the peak forces and peak ankle and knee joint moments or powers; hence sole adjustment did not influence the cutting performance. This study might be insightful in sports footwear design, and adjusting shoe torsional stiffness by sole modification might be advantageous for athletes playing sports with cutting maneuvers to reduce the risk of injuries by controlling the twisting force at the ankle that frequently happens during cutting maneuvers.

Effects of Proprioceptive Insoles and Specific Core Training on Postural Stability for Preventing Injuries in Tennis

Tennis is a complex sport based on unpredictability that requires adequate physical and psychological preparation to prevent injuries. The aim of this study was to investigate the effects of 8-week specific core stability training on postural stability in competitive adolescent tennis players, aged between 14 and 19 years old. Sixty-one participants were randomly allocated into two groups: experimental (n = 32) and control (n = 29) groups. The first group wore proprioceptive insoles 8 h a day and performed a detailed training 3 times a week for 8 weeks; the second group only received proprioceptive insoles to wear 8 h a day for 8 weeks. The postural stability parameters (center-of-pressure length, center-of-pressure velocity, and 95% confidence ellipse sway area) included three assessment times: baseline (T0), intermediate test (T1), post-test (T2), and retention test (T3). Data analysis showed a significant improvement in the experimental group compared with the control group, indicating a large effect size in center-of-pressure length, ellipse sway area, and center-of-pressure velocity at T2 and T3 (p < 0.05). In conclusion, our results suggest that a specific and detailed core stability training plays a significant role in improving balance and postural stability in young tennis players, especially in terms of preventing the risk of injury.

Lower-Extremity Injuries Predominate in American High School Tennis Players

Purpose

To describe injury epidemiology in U.S. adolescent tennis players between 2014 and 2018 via the High School Reporting Information Online (HS RIO) database.

Methods

The HS RIO database was queried for injury data on high school tennis players as reported by athletic trainers between 2014 and 2018. Injuries were analyzed according to athlete demographics, injury type, location, and context. Variables of interest between male and female athletes were compared using Pearson χ2 test or Fisher exact test.

Results

In total, 176 injuries in high school tennis players between 2014 and 2018 were identified in the HS RIO database. Overall, 25.6% (45/176) occurred in the ankle, 12.5% (22/176) in the knee, and 9.7% (17/176) in the wrist. The most common types of injuries were ligament sprains and muscle strains at 35.2% (62/176) and 17.6% (31/176) of injuries, respectively. Although most injuries were unrelated to contact, such as overuse and heat exertion or stroke, 28.7% (47/176) of injuries were the result of rotation around a planted foot/inversion of the foot. We found no difference in injury patterns between male and female high school tennis athletes.

Conclusions

We found no difference in injury patterns between male and female U.S. high school tennis athletes. The ankles, knees, and wrists were the most commonly injured areas in this population. The most common types of injuries were ligament sprains and muscle strains. Although many injuries were new, athletes rarely required surgery and returned to play. Finally, we found no difference in injury patterns between male and female high school tennis athletes.

Clinical Relevance

The epidemiology of injuries among high school tennis players is poorly understood. The information from this study will help us to understand these injuries and how we may be able to better prevent them.

Characteristics and reported injuries of recreational and competitive archers

BACKGROUND

The aim of this cross-sectional study was to describe basic characteristics of archery athletes and examine injuries reported among archers of a variety of demographic and experience levels.

METHODS

Participants at various archery competitions were asked to complete a 27-item survey that included demographics, bow type, archery experience, archery training patterns and volume, and injury incidence and anatomical location.

RESULTS

Two hundred and thirty-four complete surveys were included in the analysis. No significant differences were noted between archery experience groups for age, height, weight, or draw length. A significant difference for draw weight was noted between beginners and advanced level (P=0.045) and between intermediate and advanced archers (P=0.013). Expert level archers reported participating in archery the most days per week (4.9±1.6) and months per year (11.6±0.9) out of all experience levels. Archers using recurve bow types reported more injuries (54 in total) than archers using compound bows (that were 47). The highest percentage of injuries due to archery was found at the expert/professional level with 50% of that group acquiring an injury. The shoulder was the most reported anatomical site of injury (with a total of 69 cases) followed by the back (30 cases) and elbow (19 in total).

CONCLUSIONS

Injury rates in archery are comparable to other sports such as golf and tennis, thus establishing archery as a sport with legitimate risks to athletes. Also, there are several factors within the sport that predispose participants to injury. It is crucial that participants are informed of these risks and that appropriate training and equipment decisions are made to optimize the reduction of injury prevalence.

The expert eye? An inter-rater comparison of elite tennis serve kinematics and performance

This study examined the reliability of expert tennis coaches/biomechanists to qualitatively assess selected features of the serve with the aid of two-dimensional (2D) video replays. Two expert high-performance coaches rated the serves of 150 male and 150 female players across three different age groups from two different camera viewing angles. Serve performance was rated across 13 variables that represented commonly investigated and coached (serve) mechanics using a 1-7 Likert rating scale. A total of 7800 ratings were performed. The reliability of the experts' ratings was assessed using a Krippendorffs alpha. Strong agreement was shown across all age groups and genders when the experts rated the overall serve score (0.727-0.924), power or speed of the serve (0.720-0.907), rhythm (0.744-0.944), quality of the trunk action (0.775-1.000), leg drive (0.731-0.959) and the likelihood of back injury (0.703-0.934). They encountered greater difficulty in consistently rating shoulder internal rotation speed (0.688-0.717). In high-performance settings, the desire for highly precise measurement and large data sets powered by new technologies, is commonplace but this study revealed that tennis experts, through the use of 2D video, can reliably rate important mechanical features of the game's most important shot, the serve.

Well-being as a performance pillar: a holistic approach for monitoring tennis players

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.

Effects of physical training programs on female tennis players' performance: a systematic review and meta-analysis

Background: Tennis is among the world's most popular and well-studied sports. Physical training has commonly been used as an intervention among athletes. However, a comprehensive review of the literature on the effects of physical training programs on female tennis players' performance is lacking. Therefore, this systematic review and meta-analysis aimed to determine the effects of physical training on performance outcomes in female tennis players. Methods: A comprehensive search was conducted on Web of Science, PubMed, SPORTDicus, Scopus, and CNKI from inception until July 2023 to select relevant articles from the accessible literature. Only controlled trials were included if they examined the effects of physical training on at least one measure of tennis-specific performance in female tennis players. The Cochrane RoB tool was employed to assess the risk of bias. The CERT scale was used to examine the quality of program information. The GRADE approach was adopted to evaluate the overall quality of the evidence. The Comprehensive Meta-Analysis software was used for the meta-analysis. Results: Nine studies were selected for the systematic review and seven for the meta-analysis, totaling 222 individuals. The study's exercise programs lasted 6-36 weeks, with training sessions ranging from 30 to 80 min, conducted one to five times per week. Muscle power (ES = 0.72; p = 0.003), muscle strength (ES = 0.65; p = 0.002), agility (ES = 0.69; p = 0.002), serve velocity (ES = 0.72; p = 0.013), and serve accuracy (ES = 1.14; p = 0.002) demonstrated significant improvement following physical training, while no notable changes in linear sprint speed (ES = 0.63; p = 0.07) were detected. Conclusion: Although research on physical training in sports is diversified, studies on training interventions among female tennis players are scarce. This review found that existing training programs yield some favorable outcomes for female tennis players. However, further research with high methodological quality is warranted on the tailoring of specific training programs for female tennis players. There should be more consistent measuring and reporting of data to facilitate meaningful data pooling for future meta-analyses.

Preseason shoulder screening in volleyball players: is there any change during season?

Background

Volleyball players sollicit their shoulder with high velocity and high ranges of motion. Musculoskeletal adaptations have been described after some years of practice but have not been explored after some months of practice. The objective of this study was to analyze the short-term evolution of shoulder clinical measures and functional performance in youth competitive volleyball players.

Methods

Sixty-one volleyball players were assessed twice, at preseason and at midseason. Shoulder internal and external rotation range of motion as well as forward shoulder posture and scapular upward rotation were measured in all players. Two functional tests were also performed: the upper quarter Y-balance test and the Single-arm medicine ball throw. The results obtained at midseason were compared to those measured at preseason.

Results

Compared to preseason, an increase in absolute value of shoulder external rotation, total rotation range of motion and forward shoulder posture were observed at midseason (P < .001). An increase in side-to-side difference for shoulder internal rotation range of motion was also observed during the season. As for scapular kinematics, scapular upward rotation was significantly decreased at 45° and increased at 120° of abduction at midseason. Concerning functional tests, an increase in throwing distance in the single-arm medicine ball throw was observed at midseason while no change was noted for the upper quarter Y-balance test.

Conclusion

Significant changes in clinical measures and functional performance were observed after some months of practice. Since some variables have been suggested to be correlated to a higher risk of shoulder injuries, the current study emphasizes the importance of regular screening in order to highlight injury risk profiles throughout the season.

Incidence, prevalence and nature of injuries in padel: a systematic review

Objective

It is unclear what the incidence, prevalence and nature of injuries are that can occur during playing padel. This study aimed to systematically review the incidence, prevalence and nature of injuries in padel.

Method

A literature search was performed up to December 2022 through MEDLINE Ovid, PubMed, Cochrane Library, SportsDiscus and CINAHL. Following database search, article retrieval and title and abstract screening, articles were assessed for eligibility against predefined criteria. Studies were assessed for methodological quality. Data on injuries' prevalence, incidence and nature of injuries were extracted, analysed and described in a descriptive statistical manner which did not include a pooling strategy as part of a formal meta-analysis.

Results

Eight studies with 2022 participants were included (range of mean age: 31-57). The incidence rate was 3 injuries per 1000 hours of padel training and 8 injuries per 1000 matches of padel practice. The overall prevalence range was 40%-95%. The elbow was the most common anatomical site of injury, followed by the knee, shoulder and lower back. Tendinous and muscular injuries were the most reported injury types.

Conclusion

Injuries are common among padel players, with an incidence rate of 3 per 1000 hours of padel training and 8 per 1000 matches of padel practice-as based on limited literature. The overall prevalence range was 40%-95%. The elbow was the most frequently reported anatomical region concerning location injury distribution, and injuries were mainly of tendinous or muscular origin.

Case report: Self-performed orthopedic exams in telehealth treatment of a youth athlete with acute rotator cuff strain

Background

Sports-related rotator cuff muscle injury is one of the most prevalent pathologies affecting overhead sports athletes. Since the COVID-19 pandemic and its subsequent stay-at-home protocols, physical therapy has transited into a new realm of telehealth. Current evidence regarding examining and managing RTC strain in telehealth physical therapy is minimal.

Case presentation

A self-referred 14-year-old female Chinese semi-professional tennis player presented with an acute right RTC strain. The mechanism of injury involved forehand strokes with left trunk rotation. No ligamentous or labral damage was observed on Magnetic Resonance Imagining. The individualized care plan included virtual partner-assisted assessment, online instructions on therapeutic exercises, and education with psychosocial considerations.

Outcome and follow-up

After a 6-week intervention, the patient demonstrated complete shoulder range of motion, full muscle strength, complete return-to-practice, 0% Quick DASH disability index, and 6/68 on the Tampa Scale for kinesiophobia.

Discussion

This case report demonstrated that telehealth is an accessible and cost-effective option for youth tennis athletes with RTC strain. This unique case showed a detailed roadmap from examination to discharge of this plan of care. There are also barriers including test and measure validity, and communication difficulties to be considered. Despite the challenges, this case was a good example of telehealth being an effective, repeatable, and cost-efficient option for patients with poor healthcare access.

Medical withdrawals in elite tennis in reference to playing standards, court surfaces and genders

OBJECTIVES

To examine the relationships between medical withdrawals, playing standards, court surfaces and genders in tennis players participating in all elite tours.

DESIGN

Descriptive epidemiology study.

METHODS

Medical withdrawals of men and women tennis players from Association of Tennis Professionals, Women Tennis Association, Challengers and International Tennis Federation Futures tours' matches have been identified considering the court surfaces (fast vs. slow). Proportion comparison and the binomial regression model were used to determine the influence of playing standards, court surfaces and genders on tennis players' likelihoods to withdraw.

RESULTS

A higher proportion of withdrawals was found for men in Challengers and Futures vs. Association of Tennis Professionals (4.8 %, 5.9 % vs 3.4 %; p < 0.001), but without difference between court surfaces (0.1 %, p > 0.05) whatever the playing standards. Women reported higher proportion of medical withdrawals sustained on slow surfaces (0.4 %, p < 0.001), but without different withdrawal rates between playing standards (3.9 %, p > 0.05). After adjustment, the odds of medical withdrawals were higher for Challengers (1.18, p < 0.001) and Futures (1.34, p < 0.001), with a higher likelihood to withdraw (1.04, p < 0.001) when playing on slow surfaces and with a gender-dependent effect indicating higher odds (1.29, p < 0.001) to withdraw for medical reasons in men in reference to women.

CONCLUSIONS

These findings demonstrated a gender-dependent effect on medical withdrawals from an elite tennis tournament with higher likelihood for men participating in Challengers/Futures tours and for women playing on slow surfaces.

Injury Surveillance and Training Load Methods Used by Health Professionals in Tennis: An Online Multinational Survey

CONTEXT

Injury surveillance and training load monitoring are both essential for the development of preventative strategies for gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players on whether and how they monitor injuries and training load.

DESIGN

A cross-sectional multinational online open-survey.

METHODS

The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels, a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020 to April 2021.

RESULTS

72 health professionals from 27 different countries working with elite tennis players responded to the survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring are injury prevention (94%), training planning (81%), and player feedback (53%).

CONCLUSIONS

Despite a high percentage of health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers reported for adequately monitoring injuries.

The Association Between Chronological Age and Maturity Status on Lower Body Clinical Measurements and Asymmetries in Elite Youth Tennis Players

BACKGROUND

Tennis is one of the most popular sports among youths. At elite levels, a notable increase in injury incidence and a temporary decline in performance may occur when children progress through puberty. However, limited research has explored maturity-associated variations in clinical measurements suggested as predictors of injury and tennis performance in elite youth players. Therefore, the main purpose of this study was to analyze the association between chronological age and maturity status on several measures of neuromuscular capability and physical performance as well as bilateral (interlimb) asymmetries in elite youth tennis players.

HYPOTHESIS

Youth tennis players around peak height velocity (PHV) will show higher growth-related impairments or deficits in measures of neuromuscular capability and physical performance than their less (pre-PHV) and more (post-PHV) mature counterparts irrespective of sex.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 68 male (age, 13.7 ± 1.1 years; height, 162.4 ± 9.4 cm; body mass, 51.4 ± 10.3 kg [Mean values ± SD]) and 60 female (age, 13.6 ± 1.1 years; height, 162.8 ± 7.2 cm; body mass, 52.7 ± 7.5 kg [Mean values ± SD]) elite youth tennis players from 2 different age groups (under 13 [U13] and under 15 [U15]) and maturity status (pre-PHV, around PHV, and post-PHV), were tested during national training camps. Tests included the Y Balance Test, isometric hip abduction and adduction strength, hip ranges of motion (ROMs), and countermovement jump (CMJ) height. Bayesian analysis was used to establish any significant between-group differences.

RESULTS

Only dynamic balance (in boys; Bayesian factor [BF₁₀] = 88.2) and jump height (in both boys and girls; BF₁₀ >100) were significatively associated with chronological age, whereby the U15 group showed lower Y Balance Test reach distances (-6%; standardized effect size δ = 0.62) but higher CMJ height scores (+18%; δ = 0.73) than the U13 group. Although boys jump higher (+11%; δ = 0.62) and were stronger in isometric hip adduction strength (+14%; δ = 0.92) than girls, the latter had greater hip internal ROM values (+15%; δ = 0.75). Furthermore, relevant maturity-associated effects (BF₁₀ = 34.6) were solely observed for the CMJ test in boys, with the most mature players demonstrating higher jump height scores (+12%; δ = 0.93). Finally, a significant percentage (>25%) of tennis players, independent of sex, demonstrated bilateral asymmetries in hip ROM, hip strength, and jump height values.

CONCLUSION

The findings of this study show that in U13 and U15 male and female tennis players, there were neither positive nor negative maturity-associated variations in the clinical measurements analyzed (with the exception of jump height in male players). The high proportion of tennis players showing bilateral asymmetries in dynamic balance, hip ROM, and strength and jump performance highlight the need of future studies to analyze these factors in relation to unilateral tennis-specific adaptations in the musculoskeletal and sensorimotor systems.

CLINICAL RELEVANCE

These results may help to better understand how different clinical measurements are associated with the process of growth and maturation in elite youth tennis players and may aid in the design of specific training interventions during these stages of development.

Comparison of scapular position in elite tennis players with and without shoulder impingement: A case-control study

BACKGROUND

To maximize the ball velocity in the tennis sever, the shoulder plays a key role in the kinetic chain. But shoulder inefficiency leads to shoulder injuries such as shoulder impingement syndrome (SIS). Thus, to verify the scapular movements during the tennis serve could help prevent shoulder injury in tennis players.

OBJECTIVE

This case-control study aimed to verify the scapular movements during flat first serve for elite tennis players with shoulder impingement syndrome compared to those without it.

METHODS

Eight elite tennis players (4 males and 4 females) with SIS and 8 elite healthy players (4 males and 4 females) performed flat first serves, and the three-dimensional scapular kinematic data was recorded using the Qualisys motion capture system through spherical reflective markers including the acromion marker cluster.

RESULTS

The scapula was more internally rotated (median difference: 10.40∘) in the male players with SIS than in those without it at the maximally externally rotated humerothoracic joint during flat first serve, and female players with SIS (median difference: 7.16∘ and 11.28∘, respectively) had more internally rotated scapula at the maximally externally rotated humerothoracic joint and ball impact.

CONCLUSION

Increased scapular internal rotation may be something that affects shoulder injuries in the overhead sports, and it may help to prevent and rehabilitate overhead injuries including SIS.

The Effects of a Compensatory Training Program Adding an Isoinertial Device in the Shoulder Function on Young Tennis Players

ABSTRACT

Fernandez-Fernandez, J, Moreno-Perez, V, Cools, A, Nakamura, FY, Teixeira, AS, Ellenbecker, T, Johansson, F, and Sanz-Rivas, D. The effects of a compensatory training program adding an isoinertial device in the shoulder function on young tennis players. J Strength Cond Res 37(5): 1096-1103, 2023-The aim of this study was to analyze whether a compensatory training program, including isoinertial flywheel training, could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, 26 young tennis players were assigned to either a supervised flywheel training group (FTG, n = 13) or a control group (CG, n = 13). Shoulder passive internal (IR) and external rotation (ER) range of motion (ROM) as well as shoulder IR and ER maximal isometric strength were measured before and after a 12-week training intervention, performed 3 times per week. After the intervention, results showed significant changes for IR ( p < 0.001, effect size [ES] = 1.83) and ER ( p < 0.001, ES = 1.77) on the dominant (D) side, and IR on the nondominant (ND) side ( p < 0.001, ES = 2.24) in the FTG compared with the CG. Regarding the ROM values, results showed that the FTG achieved significantly greater increases for the IR ROM ( p < 0.001, ES = 3.32) and total ROM (TROM) ( p = 0.004, ES = 1.39) on the D and ND sides (IR ROM: p = 0.002, ES = 1.53; TROM: p < 0.001, ES = 2.35) than the CG. Moreover, the CG displayed larger decrements in ER ROM ( p = 0.016, ES = 1.12) on the ND side after the training period than the FTG. The conducted compensatory training program was effective to increase the ER strength and IR mobility of the FTG players, which led to a reduction in the glenohumeral imbalances.

The short-term effectiveness of scapular focused taping on scapular movement in tennis players with shoulder pain: A within-subject comparison

This study aimed to investigate the short-term effectiveness of scapular focused taping (SFT) on scapular position and kinematics during the tennis serve among professional players with and without shoulder pain. The cohort included 7 players who had no history of non-shoulder pain (NSP) and 6 players with shoulder pain (SP). All participants performed tennis flat serves while the Qualisys motion capture system recorded three-dimensional scapular kinematic data according to the International Society of Biomechanics recommendations. SFT was applied to the participants' torso aligned with the lower trapezius, and the same movements were repeated. In the SP group, the scapula was tilted more posteriorly after the application of SFT as compared to before at ball release and maximally externally rotated humerothoracic joint during tennis serve (t = -5.081, P = .004 and t = -2.623, P = .047, respectively). In the NSP group, the scapula was tilted more posteriorly with SFT as compared to without at first 75% timing of the cocking phase and maximally externally rotated humerothoracic joint (t = -3.733, P = .010 and t = -2.510, P = .046, respectively). And the SP group exhibited a more rotated scapula externally after the application of SFT as compared to before at Ball impact (t = 5.283, P = .003). SFT had a positive immediate effect on the scapular posterior tilting and external rotation during certain phases of the tennis serve among tennis athletes with and without shoulder pain. These findings may help clinicians and sports practitioners to prevent and rehabilitate shoulder injuries for overhead athletes. Level of evidence: Level III; Case-Control Design; Comparative Study.

Epidemiology of United States tennis-related ocular injuries from 2000 to 2019

PURPOSE

To characterize trends in ocular tennis injuries over the last 20 years.

METHODS

The National Electronic Injury Surveillance System was utilized to characterize tennis-related eye injuries in a nationally representative sample of emergency department visits. Data were divided into 5 age groups, and various demographic information was obtained.

RESULTS

Approximately 16,000 tennis-related ocular injuries were identified with males being affected nearly 2:1 compared to females. The youngest age group (0-20) had the greatest proportion of injuries, with most injuries in boys 11-15 years old. Injuries occurred most often during the spring season. Most patients were treated and released from the ED. Of those patients who were hospitalized, one-third had an open globe injury.

CONCLUSIONS

The overall number of injuries trended downward during the timespan of the study. Although most patients did not experience serious visual consequences, the greatest proportion of ocular tennis injuries occurred in the pediatric age group in whom the risk of amblyopia is high. Primary care providers and tennis regulatory bodies should consider recommending eye safety sports goggles in children to mitigate the potential for significant visual morbidity.

A longitudinal analysis of injury characteristics among elite and amateur tennis players at different tournaments from electronic newspaper reports

The non-complexity of tennis, coupled with its health benefits, renders it appealing and encourages varying competitions at different levels of age, gender, and expertise. However, the rapid increase in the participation rates witnesses a surge in injury occurrences, prompting the need for in-depth analysis to facilitate immediate intervention. We employed a media content analysis technique in which tennis-associated articles published in the last 5 years were examined. A total of 207 news reports were gathered and screened for analysis. Subsequently, 71 articles were excluded from the study due to content duplications or summary updates of existing news articles, while 23 news articles were also excluded from the study due to inappropriateness. Finally, 113 news reports directly related to injury in tennis were coded and analyzed. We examined various types of injuries reported from the screened articles with respect to their status (fresh, recurrent, and recovery) across expertise levels i.e., elite, or amateur. Similarly, the incidence of injury occurrences based on the types of tournaments the players engage in was also investigated. A chi-square analysis was employed to achieve the objectives of the study. Occurrences of tennis-associated injuries are disseminated across expertise levels [χ ( 18 ) 2 = 16.542; p = 0.555], with knee, hip, elbow, and shoulder injuries being highly prevalent in both elite and amateur players. Nevertheless, it was noted that elite players suffered a staggering 72.60% of injury-related problems, while amateur players sustained 27.40% of injuries. Moreover, the status of injury spreads based on types of tournaments [χ ( 4 ) 2 = 3.374; p = 0.497], with higher occurrences of fresh and recurrent injuries, while low recovery rates were observed. The findings further demonstrated that injuries are sustained regardless of tournament types [χ ( 36 ) 2 = 39.393; p = 0.321]. However, most of the injuries occurred at international tournaments (85%). Whereas, only 5.30% of the injuries occurred at national/regional tournaments while 9.70% were unidentified. It could be deduced from the findings of this investigation that elite players are more prone to injuries compared with amateur players. Furthermore, the most common tennis-related injuries affect the lower, trunk, and upper regions of the body, respectively. A large number of the reported tennis injuries are fresh and recurrent, with a few recoveries. The international tennis tournaments are highly attributed to injury occurrences as opposed to the national/regional tournaments. The application of the media-based data mining technique is non-trivial in projecting injury-related problems that could be used to facilitate the development of an injury index peculiar to the tennis sport for prompt intervention.

Epidemiology of racket and paddle sports-related injuries treated in the United States emergency departments, 2007-2016

OBJECTIVE

Racket and paddle sports are popular worldwide. Although there are several epidemiologic studies on tennis, there are limited epidemiologic studies on injuries in badminton, squash, racquetball, table tennis, pickleball and other racket and paddle sports. We aimed to analyze acute racket and paddle sports injuries that presented to emergency departments.

DESIGN

Descriptive epidemiologic study; level of evidence 3.

SETTING

United States emergency departments (USEDs).

METHODS

Data from National Electronic Injury Surveillance System (NEISS) were queried to characterize racket and paddle sports-related (RPSR) injuries that presented to USEDs over a 10-year period.

RESULTS

From 2007 to 2016, there were 7,723 cases of racket and paddle sports-related (RPSR) injuries that presented to USEDs. This data provides a weighted estimate of 301,038 RPSR injuries in USEDs over the 10-year study period. The majority (60.3) of these injuries were in men. Men had a higher percentage of injuries of most body parts except the lower arm, wrist, and ankle. The mean age at the time of injury was 37 years. The highest percentage of sprains, strains, and lower extremity injuries occurred in athletes between ages 18-40 years. Between sports, table tennis had highest percentage of skin and internal organ injuries while badminton had the highest percentage of sprains, strains, fractures, and dislocations.

CONCLUSION

This study is the largest nationally representative study of RPSR injuries to date. RPSR injuries are varied in their presentation based on age, sex, body location, and type of injury.

CLINICAL RELEVANCE

This study determined common RPSR injuries presenting to USEDs, their patterns, and severity over a 10-year period. Researchers and clinicians can begin to use this data for future research studies and may consider this early data in management decisions.

An Analysis of Biomechanical Parameters in OTP Police Physical Intervention Techniques for Occupational Risk Prevention

(1) Background: a set of ergonomic parameters that are relevant for risk assessment methods for the prevention of occupational risks, such as REBA or NIOSH, have been measured by means of inertial sensors that allow capturing the movements of the human body. These methods base their assessment on a number of postural and dynamic parameters. In the case of police physical intervention techniques, trunk, legs, arms, forearms and wrists angles, joint contact force and sheer force at the L5-Pelvic junction, asymmetry (angle and factor), and muscle power are the more relevant parameters to be considered. (2) Method: The data have been collected by means of a motion capture suit equipped with 19 inertial sensors. The large amount of data and the 3-dimensional plots have been managed by a powerful software package specific for ergonomic analysis. The police physical intervention technique used was OTP. (3) Results: Five ergonomic parameters in a traditional police physical intervention technique have been analyzed. REBA scores and ergonomic metrics have been recorded and discussed with some prevention risk limits from the literature. (4) Conclusions: the usage of inertial sensors to capture the movements in OTPs provides a new and quite an efficient viewpoint for occupational risk research studies.

Upper Extremity Kinematics and Electromyographic Activity in Uninjured Tennis Players

There has been an increase in ulnar-sided wrist pain among tennis players. The purpose of this study was to establish a normative dataset of kinematic and electromyography (EMG) data during the forehand and two-handed backhand groundstrokes. In total, 20 adolescent United States Tennis Association (USTA) ranked tennis players (11/20 Male, Age = 15.0 ± 1.8 years, Height = 1.7 ± 1.1 m, BMI = 21.3 ± 3.4 kg/m2, 18/20 right-arm dominant) participated in this study. Kinematics (range of motion and angular velocity) and EMG data were simultaneously acquired during the forehand and two-handed backhand groundstrokes. Minimal differences were found between groupings of age, sex, and USTA ranking. The two-handed backhand groundstroke is characterized by bilaterally flexed elbows and ulnarly deviated wrists, with a flexed wrist and pronated forearm on the non-dominant side and an extended wrist and supinated forearm on the dominant side. EMG activation occurs bilaterally by peak backswing. The forehand groundstroke is characterized by a flexed elbow, pronated forearm, and ulnarly deviated and extended wrist. The wrist is at maximum ulnar deviation at ball impact. This study established an initial foundation for normative data for the forehand and two-handed backhand groundstrokes, which can be used for injury detection, rehabilitation, prevention, and ultimately performance improvement of tennis athletes.

Descriptive Epidemiology of Injuries in Professional Speedball Athletes

CONTEXT

Speedball is an increasingly popular racquet sport played in more than 25 countries. Our objective was to describe injury incidence and patterns among Egyptian national-level speedball athletes.

DESIGN

Descriptive epidemiological.

METHODS

We conducted a survey of athletes who were registered with the Egyptian Speedball Federation during the 2018-2019 professional season. The survey inquired about injury types and athlete exposures (AEs). The response rate was 63% (100/160 athletes). Respondent ages ranged from 18 to 41 years. We analyzed demographic characteristics; number, location, and mechanism of injuries; treatment; and speedball participation time lost because of injury.

RESULTS

Of 100 respondents, 65 reported having sustained at least one injury during the season for a total of 90 injuries and a rate of 4.7 injuries per 1000 AEs (95% confidence interval, 3.7 to 5.7). More injuries occurred during practice (77%) than during competition (23%). Thirty percent of respondents reported having missed a competition because of injury. The most frequent anatomic locations of injury were the shoulder (50%; 2.4/1000 AEs), elbow (14%; 0.68/1000 AEs), and low back (9%; 0.4/1000 AEs). The most frequently cited causes of injury were increased intensity of training (40%) and lack of warming up (18%). Seventy-seven percent of injured respondents underwent treatment by a health care professional, and 9% of these respondents underwent surgery.

CONCLUSION

The shoulder was the most common anatomic location for injuries in speedball athletes. Our results suggest that attention should be directed toward sport-specific injury prevention and intervention strategies because speedball is a fast-growing sport in several countries.

Validating an algorithm from a trunk-mounted wearable sensor for detecting stroke events in tennis

This study analysed the accuracy of a prototype algorithm for tennis stroke detection from wearable technology. Strokes from junior-elite tennis players over 10 matches were analysed. Players wore a GPS unit containing an accelerometer, gyroscope and magnetometer. Manufacturer-developed algorithms determined stoke type and count (forehands, backhands, serves and other). Matches were video recorded to manually code ball contacts and shadow swing events for forehands, backhands and serves and further by stroke classifications (i.e., drive, volley, slice, end-range). Comparisons between algorithm and coding were analysed via ANOVA and Bland-Altman plots at the match-level and error rates for specific stroke-types. No significant differences existed for stroke count between the algorithm and manual coding (p > 0.05). Significant (p < 0.0001) overestimation of "Other" strokes were observed from the algorithm, with no difference in groundstrokes and serves (p > 0.05). Serves had the highest accuracy of all stroke types (≥98%). Forehand and backhand "drives" were the most accurate (>86%), with volleys mostly undetected (58-60%) and slices and end-range strokes likely misclassified (49-51%). The prototype algorithm accurately quantifies serves and forehand and backhand "drives" and serves. However, underestimations of shadow swings and overestimations of "other" strokes suggests strokes with reduced trunk rotation have poorer detection accuracy.

Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players

The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.

Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players

BACKGROUND

Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population.

HYPOTHESIS

Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM.

RESULTS

A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides.

CONCLUSION

Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments.

CLINICAL RELEVANCE

Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.

Surveillance of Injury Types, Locations, and Intensities in Male and Female Tennis Players: A Content Analysis of Online Newspaper Reports

The popularity of modern tennis has contributed to the increasing number of participants at both recreational and competitive levels. The influx of numerous tennis participants has resulted in a wave of injury occurrences of different types and magnitudes across both male and female players. Since tennis injury harms both players' economic and career development, a better understanding of its epidemiology could potentially curtail its prevalence and occurrences. We used online-based tennis-related injury reports to study the prevalence, location types, and injury intensities in both male and female tennis players for the past five years. It is demonstrated from the chi-square analysis that injury occurrences are significantly associated with a specific gender (χ2(18) = 50.773; p = 0.001), with male players having a higher risk of injury manifestation (68.10%) as compared with female players (31.90%). Nonetheless, knee, hip, ankle, and shoulder injuries are highly prevalent in both male and female players. Moreover, the injury intensities are distributed across gender (χ2(2) = 0.398; p = 0.820), with major injuries being dominant, followed by minor injuries, whilst a few cases of career-threatening injuries were also reported. It was similarly observed that male players recorded a higher degree of both major, minor, and career-threatening injuries than female players. In addition, male players sustained more elbow, hip, knee, shoulder, and thigh injuries than female players. Whereas, female players mostly suffered from Achilles and back injuries, ankle and hamstring injuries affected both genders. The usage of online newspaper reports is pivotal in characterizing the epidemiology of tennis-related injuries based on locations and gender to better understand the pattern and localization of injuries, which could be used to address the problem of modern tennis-related injuries.

Epidemiology of Injuries in Elite Badminton Players: A Prospective Study

OBJECTIVE

To determine the incidence and characteristics of injuries in elite badminton players over a competitive season.

DESIGN

Prospective cohort study.

SETTING

The French National Institute of Sport, Expertise, and Performance (INSEP).

PARTICIPANTS

Twenty international elite badminton players.

INDEPENDENT VARIABLES

The type, the location, the occurrence of the injury (match or training), the footwork type, the type of shot, and the perceived fatigue were collected.

MAIN OUTCOME MEASURES

Injury incidence rates were calculated per 1000 hours of play (Hop).

RESULTS

Thirty-five injuries were collected over 10 210 hours of player exposure with an overall incidence rate of 3.4 injuries per 1000 Hop, with higher incidence during matches than training (11.6 vs 2.08; P < 0.05). Lower-limb injuries (LLI) were the most frequent (54.3%) especially on the foot (22.9%), and upper-limb injury rate (37.1%) was higher compared with previous studies. The most common type was musculotendinous injuries (51.4%). The smash and the lunge were the most frequent causes of upper-limb injury and LLI, respectively. Injuries occurred mostly during the first third of play (46.2%).

CONCLUSIONS

This is the first prospective study to investigate badminton injuries among international badminton players. Further studies are needed to confirm our results on larger samples.

Sensors for Wheelchair Tennis: Measuring Trunk and Shoulder Biomechanics and Upper Extremity Vibration during Backhand Stroke

This study was the first to compare the differences in trunk/shoulder kinematics and impact vibration of the upper extremity during backhand strokes in wheelchair tennis players and the able-bodied players relative to standing and sitting positions, adopting an electromagnetic system along with wearable tri-axial accelerometers upon target body segments. A total of 15 wheelchair tennis players and 15 able-bodied tennis players enrolled. Compared to players in standing positions, wheelchair players demonstrated significant larger forward trunk rotation in the pre-preparation, acceleration, and deceleration phase. Significant higher trunk angular velocity/acceleration and shoulder flexion/internal rotation angular velocity/acceleration were also found. When able-bodied players changed from standing to sitting positions, significant changes were observed in the degree of forward rotation of the trunk and shoulder external rotation. These indicated that when the functions of the lower limbs and trunk are lacking or cannot be used effectively, “biomechanical solutions” such as considerable reinforcing movements need to be made before the hitting movement. The differences between wheelchair tennis players and able-bodied players in sitting positions could represent the progress made as the wheelchair players evolve from novices to experts. Knowledge about how sport biomechanics change regarding specific disabilities can facilitate safe and inclusive participation in disability sports such as wheelchair tennis.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Tennis: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored men's tennis programs since 1982. The popularity of tennis has grown, as has sponsorship of men's tennis within NCAA institutions.

BACKGROUND

Continued monitoring of athletic injuries is important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 4.41 per 1000 athlete-exposures. Lateral ligament complex tears of the ankle (8.5%) were the most reported injury. Trunk (15.1%) and shoulder (13.2%) injuries accounted for the largest proportions of all injuries. Noncontact and overuse were the most common mechanisms of injury among all reported injuries, together accounting for 69.4% of all injuries.

CONCLUSIONS

Findings of this study differed slightly from previous studies, most notably in specific injuries reported. Continued monitoring of specific injury incidence as well as greater participation in injury surveillance is needed to inform the development of nuanced injury prevention strategies for this population.

Incidence Rate of Musculoskeletal Injuries among Professional Tennis Players during 2019 International Tournaments in Indonesia

Several studies have indicated that musculoskeletal injuries are common during a professional tennis competition. However, data from a tropical country like Indonesia is lacking. This study aimed to obtain the incidence rate and injury characteristics and identify risk factors of musculoskeletal injuries among professional tennis players competing in Indonesia under the International Tennis Federation (ITF). The study was a prospective cohort during professional tennis tournaments in Jakarta, Indonesia in 2019, consisting of the ITF Women's Circuit Indonesia (two weeks) and ITF Men's Future Indonesia (three weeks). All athletes were enrolled in this study. Injuries were assessed based on the ITF Consensus Statement. Incidence rate was the number of injuries per 1000 player hours (i.e., the total duration from before the match starts to completion of the match after the final point). The magnitude of risk was expressed as a relative risk (RR) and its 95% confidence interval (CI). Independent risk factors were identified using multivariate analyses. A total of 161 tennis players were enrolled; 71 (44.1%) were men. Their mean age was 22 years old. The incidence rate of musculoskeletal injuries was 30.8 injuries per 1000 player hours (95% CI: 28.2-33.5). The most common onset was acute injuries (61.1%), while the most common location and type of injury was the trunk (38.9%) and muscle strain (61.1%). Risk factors associated with musculoskeletal injury were higher body height, skill level, history of previous injury, and wet bulb globe temperature (WBGT) zone. There was no injury during the doubles matches. Previous injury was an independent risk factor (adjusted RR: 48.1 (95% CI: 11.3-155.0; p < 0.001). The incidence of musculoskeletal injuries among professional tennis player is considerably high. Factors associated with injury are body height, skill level, previous injury, and WBGT zone. Future injury prevention programmes should incorporate the management of previous injuries and take into account the effect of environmental temperature.

Balance dynamics are related to age and levels of expertise. Application in young and adult tennis players

In tennis, coaches consider balance fundamental for the acquisition of skilled motor performance. However, the potential relationship between balance and tennis expertise and performance has not been explored yet. Therefore, this study assessed the relationship between balance and tennis performance using linear and non-linear parameters through 1) the comparison of tennis players of different ages and levels of expertise, and 2) analyzing the relationship between balance and tennis serving speed and accuracy. One hundred and six recreational and expert male tennis players took part in the study (age range 10-35 years old). Temporal dynamics of postural control during a balance task on an unstable surface were analyzed through the mean velocity and the detrended fluctuation analysis (DFAV) of center of pressure (COP). Tennis serve performance was quantified by measuring accuracy and speed. Traditional variables measuring balance performance only showed differences according to age but not to sport performance. COP showed a reduction of auto-correlated variability (reflected by DFAV) with age but mainly in expert players. COP dynamics was the only balance parameter discriminating sport expertise and it was related to age. Balance dynamics exhibited by expert tennis players DFAV results support the idea that, along the years, sport experience induces balance adaptations characterized by a higher ability to perform postural adjustments. These results also reinforce the use of non-linear analysis to reveal subtle balance adaptations produced by sport practice. Finally, the lack of correlations suggests that balance, measured with scattering variables, in a non-specific task is not a main determinant of sport performance in tennis serve.

Tennis-related adult maxillofacial trauma injuries

Objectives: Tennis participation continues to increase amongst adults across the United States. The purpose of this study was to analyze trends in adult tennis-related facial injury epidemiology, demographics, diagnoses, and locations of injury. Materials and methods: The National Electronic Injury Surveillance System was evaluated for tennis-related facial injuries in adults from 2009 through 2018. Number of injuries were extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and discharge disposition. Descriptive statistics were used to present and describe variables of interest. Chi-squared testing (χ2) was performed to compare categorical variables. Results: During the study period, 342 tennis-related facial trauma ED visits were analyzed. Lacerations were the most common injury (45%), followed by contusions or abrasions (33.3%), concussions (11.7%), and fractures (8.5%). The most common sites of injury were the face (47.4%) and head (27.2%) regions. Males accounted for 62.0% of injuries, while females accounted for the remaining 38.0%. Patients between 34-65 years-old accounted for 47.7% of all injuries, and athletes over 65 years-old had the highest rate of fractures (10.1%). Conclusions: Facial trauma incurred secondary to tennis may follow patient-specific patterns. The incidence of tennis-related facial trauma is smaller compared to other sports, but the severity of such injuries remain a danger. Facial protection and enforcement in tennis is virtually absent, and these findings strengthen the need to educate athletes, families, and physicians on injury awareness and prevention.

Injuries in Netball-A Systematic Review

BACKGROUND

Netball is estimated to be played by more than 20 million people worldwide, but there is evidence of high injury incidence. A thorough understanding of the types and rates of netball injuries is essential for effective injury management and prevention strategies to be developed and implemented. This systematic review summarises the published findings with respect to injury types, participant characteristics and any identified risk factors for netball injuries.

METHODS

A librarian-assisted computer search of seven scientific databases was conducted for studies reporting on netball injuries. Inclusion criteria were studies published in English, in peer-reviewed journals, which reported data on injuries and variables (e.g. age and competition level) that have been proposed as possibly associated with netball injury risk.

RESULTS

Forty-six studies (43.5% prospective, 37% hospital/insurance records, 19.5% retrospective) from 45 articles were included after screening. The majority of studies (74%) were conducted in Australia or New Zealand. There was little consistency in the definition of 'injury'. Elite or sub-elite level players were included in 69% of studies where the level of competition was reported. The duration of injury surveillance was generally related to the format of competition from which data were collected. Self-report questionnaires were used in 48% of studies and only 26% of studies used qualified health professionals to collect data courtside. Injuries to the ankle and knee were the most common (in 19 studies) although the incidence varied considerably across the studies (ankle 13-84% and knee 8-50% of injuries). Prevention of ankle and knee injuries should be a priority. Children sustained more upper limb injuries (e.g. fractures) compared with adults who sustained more lower limb injuries (e.g. ankle and knee sprains/strains). A large number of potential risk factors for injury in netball have been investigated in small numbers of studies. The main circumstances of injury are landings, collisions and falls.

CONCLUSION

Further studies should be directed towards recreational netball, reporting on injury incidence in players by age and utilising high-quality, standardised methods and criteria. Specific injury diagnosis and a better understanding of the circumstances and mechanisms of injury would provide more meaningful data for developing prevention strategies.

Acute Tennis Injuries in the Recreational Tennis Player

Background:

Epidemiological studies on tennis injuries are mainly conducted in either elite professional or junior players. Injury patterns might differ in the recreational tennis player.

Purpose:

To investigate acute injuries in the recreational tennis–playing population with an additional focus on acute injuries that require surgical treatment.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective data analysis was conducted among patients who sustained an acute tennis injury between January 2013 and December 2018 and who had treatment administered at a single university hospital. Demographic data, diagnosis, body region of the trauma, injury mechanism, and treatment methods were recorded. Data were evaluated using descriptive statistics.

Results:

A total of 449 patients sustained 467 injuries (148 female, 301 male; mean age, 43.6 years; range, 8.2-84.4 years). The injuries occurred throughout the year, with an increased prevalence in the summer months. Injuries occurred in the lower extremity in 59%, the upper extremity in 30%, and the head and trunk in 11%. The main reason for an injury was a twist of a specific joint (n = 194) or a fall (n = 102). Harmless contusion or strains were the most common injury (49%). Ankle sprains were the most common serious injury, occurring in 11% of patients. Fractures occurred in 54 cases (12%). Overall, 9% of patients were treated surgically (fractures, n = 13; meniscal tears, n = 8; Achilles tendon ruptures, n = 6), and surgery was advised to another 1% who did not receive surgery at the study hospital.

Conclusion:

Typical acute injuries in recreational tennis players differ from acute injuries in elite and junior players, with an increased fracture occurrence. The main causes of acute tennis injuries are falls and twists, with 10% of injuries needing surgical treatment, mainly for fractures, meniscal tears, and Achilles tendon ruptures.

Within-Session Sequence of the Tennis Serve Training in Youth Elite Players

The influence of muscular fatigue on tennis serve performance within regular training sessions is unclear. Therefore, the aim of the present study was to examine the within-session sequence of the tennis serve in youth tennis. Twenty-five young male (14.9 ± 0.9 years) and female (14.5 ± 0.9 years) players participated in this within-subject crossover study, and they were randomly but sex-matched assigned to different training sequences (serve exercise before tennis training (BTS) or after tennis training (ATS)). Pre- and post-tests included serve velocity performance and accuracy, shoulder strength, and range-of-motion (ROM) performance (internal/external rotation). Results showed that after one week of serve training conducted following the ATS sequence, significant decreases were found in serve performance (e.g., speed and accuracy), with standardized differences ranging from d = 0.29 to 1.13, as well as the shoulder function (strength [d = 0.20 to 1.0] and ROM [d = 0.17 to 0.31]) in both female and male players, compared to the BTS sequence. Based on the present findings, it appears more effective to implement serve training before the regular tennis training in youth players. If applied after training, excessive levels of fatigue may cause shoulder imbalances that could be related to an increased injury risk.

Rotator Cuff Injuries in Tennis Players

PURPOSE OF REVIEW

This review presents epidemiology, etiology, management, and surgical outcomes of rotator cuff injuries in tennis players.

RECENT FINDINGS

Rotator cuff injuries in tennis players are usually progressive overuse injuries ranging from partial-thickness articular- or bursal-sided tears to full-thickness tears. Most injuries are partial-thickness articular-sided tears, while full-thickness tears tend to occur in older-aged players. The serve is the most energy-demanding motion in the sport, and it accounts for 45 to 60% of all strokes performed in a tennis match, putting the shoulder at increased risk of overuse injury and rotator cuff tears. Studies have shown deficits in shoulder range of motion and scapular dyskinesia to occur even acutely after a tennis match. First-line treatment for rotator cuff injuries in any overhead athlete consists of conservative non-operative management with appropriate rest, anti-inflammatory drugs, followed by a specific rehabilitation program. Operative treatment is usually reserved for older-aged players and to those who fail to return to play after conservative measures. Surgical options include rotator cuff debridement with or without tendon repair, biceps tenodesis, and labral procedures. Unlike rotator cuff repairs in the general population, repairs in the elite tennis athlete have less than ideal rates of return to sport to the same level of performance. Rotator cuff injuries are a common cause of pain and dysfunction in tennis players and other overhead athletes. The etiology of rotator cuff tears in tennis players is multifactorial and usually results from microtrauma and internal impingement in the younger athlete leading to partial tearing and degenerative full-thickness tears in older players. Surgical treatment is pursued in athletes who are still symptomatic despite an extensive course of non-operative treatment as outcomes with regard to returning to sport to the same pre-injury level are modest at best. Debridement alone is usually preferred over rotator cuff repairs for partial tears in younger players due to potential over-constraining of the shoulder joint and decreased rates of return to sport after rotator cuff repairs.

Whole-body morphological asymmetries in high-level female tennis players: A cross‑sectional study

This cross-sectional study aimed to examine the degree of whole-body morphological asymmetries in female tennis players. Data were collected in 19 high-level female tennis players (21.3 ± 3.4 years). Based on anthropometric measurements (upper arm, lower arm, wrist, upper leg and lower leg circumferences as well as elbow and knee widths) and dual x-ray absorptiometry research scans (bone mineral density (BMD), bone mineral content (BMC), lean mass (LM), fat mass (FM) as well as humerus, radio-ulnar, femur and tibia bone lengths), within-subject morphological asymmetries for both upper (dominant vs. non-dominant) and lower (contralateral vs. ipsilateral) extremities were examined. Upper arm (p = 0.015), lower arm (p < 0.001) and wrist circumferences (p < 0.001), elbow width (p = 0.049), BMD (p < 0.001), BMC (p < 0.001), LM (p = 0.001), humerus (p = 0.003) and radio-ulnar bone length (p < 0.001) were all greater in the dominant upper extremity. BMC (p < 0.001) and LM (p < 0.001) were greater in the contralateral lower extremity, whereas FM (p = 0.028) was greater in the ipsilateral lower extremity. This is the first study to report significant side-to-side differences in both upper and lower extremities in high-level female tennis players.

Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review

CONTEXT

Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.

OBJECTIVES

To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature.

DATA SOURCES

A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus.

STUDY SELECTION

Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score.

RESULTS

Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.

CONCLUSION

Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.

The Impacts of Shoulder Position Sense, Vision, Racket Weight, and Gender on Racket Positioning Accuracy in Tennis Players

Repetitive loading to the shoulder joint can compromise shoulder position sense, which may further contribute to injuries and performance deficits. The first goal of the study was to examine the correlation between shoulder position sense and racket positioning accuracy. The second goal of the study was to examine the impact of visual feedback, racket weight, and gender on racket positioning accuracy in tennis players. Fifty-eight tennis players participated in the study. Active shoulder position sense was examined in 3 abduction (45°, 90°, 135°) and 2 external rotation (45°, 90°) angles. For racket positioning accuracy, participants went through a tennis swing and had the center of the racket touch the ball with full or peripheral vision, and with normal or added (0.6 oz.) racket weight. Low correlation (Pearson's r: from 012 to .381) was found between shoulder position sense and racket positioning accuracy. Shoulder position sense varied among different target angles (p < .001) and the variation was similar between genders (p = .123). Subjects performed better with full vision than with peripheral vision in both racket weight conditions (p < .001). However, racket weight (p = 1.000 for peripheral and p = .362 for full vision) and gender (p = .380) had no impact on racket positioning accuracy. Although the shoulder joint is part of the upper limb kinematic chain, shoulder position sense integrity may not have a direct impact on end-point racket positioning accuracy. Through motor learning, tennis players may have learned to coordinate all upper limb joints and muscles to achieve desired racket positioning accuracy.

Beach tennis injuries: a cross-sectional survey of 206 elite and recreational players

Objectives: Although a million people regularly play beach tennis (BT) through the world there is no published information on BT injuries. The aim of this study was to describe the epidemiology of BT injuries, and to identify differences between injured and non-injured players.Methods: This was a retrospective cross-sectional epidemiology study of 206 BT players from Réunion Island describing the injuries occurring in BT. A questionnaire was developed to capture the type and chronicity of the injuries they had suffered over the prior three years. Comparisons were made between elite, regional and recreational players.Results: There were 178 injuries in 92 players (44.7%), which was an incidence of 1.81 injuries per 1000 hours of play. There were 77 acute injuries (23.8% of players, incidence of 0.78 injuries/1000 hrs.) and 101 chronic injuries (30.6% of players, incidence of 1.03 injuries/1000 hrs.). The shoulder was the most frequently injured area. The main upper limb injuries were chronic tendinopathy while most acute injuries occurred in the lower limbs. The incidence of lateral epicondylitis at the elbow was 0.36 per 1000 hours of play, or a prevalence of 4.2%. The incidence of injuries in elite players was less than that in non-ranked players (1.71 vs 2.04 injuries/1000 hours play). Recreational players more often had chronic injuries (p < 0.001).Conclusion: Information about musculoskeletal injuries is invaluable for healthcare professionals involved in the care of athletes. Such knowledge can be used to guide the medical surveillance of athletes and to help develop injury prevention strategies.