Shoulder range of motion in competitive tennis players: systematic review and meta-analysis

Background

To compare shoulder range of motion (ROM) in dominant vs. nondominant shoulder of competitive tennis players, and to determine whether shoulder ROM is different between younger and older players, or males and females.

Methods

A search was performed on PubMed, Embase, and Epistemonikos on December 18, 2023. This study conforms to the principles of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Clinical studies or case reports on shoulder ROM including external rotation (ER; shoulder at 90° of abduction) and internal rotation (IR) in competitive, elite, or professional tennis players.

Results

We found 25 eligible studies that reported on a total of 18,534 tennis players, of which 20 studies reported the ROM for the dominant and nondominant side. Comparing dominant vs. nondominant shoulders revealed that dominant shoulders had significantly smaller IR (53.0° vs. 62.6°; P < .001). Comparing adults vs. children revealed that adults have significantly smaller IR (44.5° vs. 57.1°; P < .001) and ER (95.3° vs. 110.3°; P < .001). Comparing females vs. males revealed no significant differences in ER (113.4° vs. 104.9°; P = .360) or IR (54.3° vs. 56.4°; P = .710).

Conclusion

IR in shoulders of tennis players is significantly smaller in dominant vs. nondominant sides (53.0° vs. 62.6°, P < .001), and significantly smaller in adults vs. children (44.5° vs. 57.1°, P < .001). These findings could be relevant in the context of physical preparation and training of tennis players, to monitor evolution of IR as a result of their sport and/or as they transition from childhood to adulthood.

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.

Cold-water immersion and whole-body cryotherapy attenuate muscle soreness during 3 days of match-like tennis protocol

PURPOSE

This study aimed to investigate the effect of whole-body cryotherapy (WBC), cold-water immersion (CWI) and passive recovery (PAS) on tennis recovery.

METHODS

Thirteen competitive male tennis players completed three consecutive match-like tennis protocols, followed by recovery (WBC, CWI, PAS) in a crossover design. Five tennis drills and serves were performed using a ball machine to standardize the fatiguing protocol. Maximal voluntary contraction (MVC) peak torque, creatine kinase activity (CK), muscle soreness, ball accuracy and velocity together with voluntary activation, low- and high-frequency torque and EMG activity were recorded before each protocol and 24 h following the third protocol.

RESULTS

MVC peak torque (- 7.7 ± 11.3%; p = 0.001) and the high- to low-frequency torque ratio (- 10.0 ± 25.8%; p < 0.05) decreased on Day 1 but returned to baseline on Day 2, Day 3 and Day 4 (p = 0.052, all p > 0.06). The CK activity slightly increased from 161.0 ± 100.2 to 226.0 ± 106.7 UA L-1 on Day 1 (p = 0.001) and stayed at this level (p = 0.016) across days with no differences between recovery interventions. Muscle soreness increased across days with PAS recovery (p = 0.005), while no main effect of time was neither observed with WBC nor CWI (all p > 0.292). The technical performance was maintained across protocols with WBC and PAS, while it increased for CWI on Day 3 vs Day 1 (p = 0.017).

CONCLUSION

Our 1.5-h tennis protocol led to mild muscle damage, though neither the neuromuscular function nor the tennis performance was altered due to accumulated workload induced by consecutive tennis protocols. The muscle soreness resulting from tennis protocols was similarly alleviated by both CWI and WBC.

TRIAL REGISTRATION

IRB No. 2017-A02255-48, 12/05/2017.

The Impact of Recovery Practices Adopted by Professional Tennis Players on Fatigue Markers According to Training Type Clusters

Introduction: Modern tennis players face congested schedules that force the adoption of various recovery strategies. Thus, recovery must be fine-tuned with an accurate quantification of its impacts, especially with regards to training-induced fatigue. The present study aimed to examine the training type clusters and recovery practices adopted by elite tennis players under ecological training conditions. The respective impacts of training type clusters and recovery techniques on subjective variables, which reflect the players' recovery perceptions, were subsequently determined.

Methods: During 15 consecutive months, a total of 35 elite tennis players filled out questionnaires to report their daily training load, training session content, adopted recovery modalities after training, and perceived recovery.

Results: The hierarchical analysis identified three clusters: “combined tennis and S&C training,” “predominant tennis training” and “predominant S&C training.” Muscle soreness and perceived fatigue were not significantly different among these three clusters (p = 0.07–0.65). Across the 146 recorded training and recovery sessions, players primarily employed a combination of 2 or 3 modalities, with cooling strategies being the most widely used technique (87.6%). Mixed linear models revealed that independent of training clusters, cooling strategies significantly reduced muscle soreness (Δmuscle soreness: β = −1.00, p = 0.02). Among the cooling techniques used, whole-body cryotherapy induced a greater perceived recovery than cold-water immersion (p = 0.02).

Conclusion: These results showed that perceived recovery was not sensitive to training clusters or the associated acute training load. However, cooling strategies were relevant for the alleviation of tennis training-induced soreness. This study represents an initial step toward a periodized approach of recovery interventions, based on the interactions between training load, training contents, and perceived recovery.

On the Use of the Repeated-Sprint Training in Hypoxia in Tennis

PURPOSE

To examine physiological and technical responses to repeated-sprint training in normobaric hypoxia at ∼3,000 m (RSH, n = 11) or in normoxia (RSN, n = 11) compared to a control group (CON, n = 8) in well-trained tennis players. Participants were 28.8 ± 5.9 years old without any previous experience of training in hypoxia.

METHODS

In addition to maintaining their usual training (CON), both RSH and RSN groups completed five tennis specific repeated-shuttle sprint sessions (4 × 5 × ∼8 s maximal sprints with ∼22 s passive recovery and ∼5 min rest between sets) over 12 days. Before (Pre), the week after (Post-1) and 3 weeks after Post-1 (Post-2), physical/technical performance during Test to Exhaustion Specific to Tennis (TEST), repeated-sprint ability (RSA) (8 × ∼20 m shuttle runs-departing every 20 s) and heart rate variability (HRV) were assessed.

RESULTS

From Pre to Post-1 and Post-2, RSH improved TEST time to exhaustion (+18.2 and +17.3%; both P < 0.001), while the "onset of blood lactate accumulation" at 4 mmol L-1 occurred at later stages (+24.4 and +19.8%, both P < 0.01). At the same time points, ball accuracy at 100% V̇O2m ax increased in RSH only (+38.2%, P = 0.003 and +40.9%, P = 0.007). Markers of TEST performance did not change for both RSN and CON. Compared to Pre, RSA total time increased significantly at Post-1 and Post-2 (-1.9 and -2.5%, P < 0.05) in RSH only and this was accompanied by larger absolute Δ total hemoglobin (+82.5 and +137%, both P < 0.001). HRV did not change either supine or standing positions.

CONCLUSION

Five repeated sprint training sessions in hypoxia using tennis specific shuttle runs improve physiological and technical responses to TEST, RSA, and accompanying muscle perfusion responses in well-trained tennis players.

Biomechanical analysis of the "waiter's serve" on upper limb loads in young elite tennis players

Waiter's serve (WS) is a specific tennis serve posture frequently observed in young players, and commonly considered as a technical error by tennis coaches. However, biomechanical impact of WS is unknown. The aims of this study were to identify the potential consequences of WS in young elite players relating to performance and injury risk, and to explain the kinematic causes of WS. Serve of 18 male junior elite players (Top 10 national French ranking, aged 12-15 years) was captured with a 20 camera, 200 Hz VICON MX motion analysis system. Depending on their serve technique, the players were divided into two groups (WS versus Normal Serve [NS]) by experienced coaches. Injury data were collected for each player during a 12-month-period following the motion capture. Normalized peak kinetic values of the dominant arm were calculated using inverse dynamics. In order to explain WS posture, upper limb kinematics were calculated during the cocking and the acceleration phases of the serve. Shoulder internal rotation torque, wrist proximal and anterior forces (P < .05) and elbow varus torque (P < .01) were significantly higher in WS group, with no difference from NS group concerning serve velocity. Moreover, significant lower shoulder abduction and higher wrist extension (P < .05) were observed for WS players during the cocking phase. Even if no significant difference was found between groups concerning injuries, higher upper limb joint loads suggested WS could be considered as pathomechanical in young elite players and could lead to upper limb joint injuries.

Os Acromiale in Professional Tennis Players

Background:

Os acromiale is a rare condition mostly reported in the literature through case reports, imaging studies, or reports of surgical treatment. This condition is the result of nonunion of growth plates of the acromion during the natural developmental process that occurs between 15 and 25 years of age. Its incidence is low, and few studies are available in the literature on athletes with high functional demands, and particularly on athletes within a specific sport.

Purpose:

To collect epidemiological data and to report the amount of time out of play as well as the type of treatment and its efficiency in professional tennis players.

Study Design:

Case series; Level of evidence, 4.

Methods:

We performed a retrospective study using the medical data of athletes within our national tennis league who complained about their shoulder between 2011 and 2016. Nine professional tennis players (mean age, 20 years) with painful shoulders were diagnosed with os acromiale; 3 of them played at an international level, with the other 6 playing at a national level. The diagnosis was confirmed using radiography, including the axillary view, and magnetic resonance imaging (MRI). One female player had associated subacromial bursitis.

Results:

All cases of os acromiale were classified as involving the mesoacromion, following the Lieberson classification. No patient underwent surgery, and no patient was treated with local or subacromial infiltration. Patients stopped competition and training throughout the rehabilitation period. All patients received medical treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), ice, and physical therapy with a specific rehabilitation program. All athletes returned to their former level of play after a mean of 37 days. No patient suffered from recurrent pain. One patient underwent MRI after 2 years, showing a normal bone signal and complete healing of the acromion.

Conclusion:

Conservative treatment including NSAIDs, rest, ice, and physical therapy allowed for good recovery and return to the former level of play. Surgical treatment is usually not indicated for os acromiale in the professional tennis player.

Medical reasons behind player departures from male and female professional tennis competitions

BACKGROUND

The number of retirements, withdrawals, and "lucky losers" (the replacement of a player who withdraws before the start of the tournament by a losing player from the qualifying round) from professional tennis tournaments has increased, but the reasons behind such departures have not yet been analyzed. An official consensus statement has been conducted to allow a general categorization of injuries in tennis.

PURPOSE

To determine the reasons for departure and injury rates in professional tennis.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

All reasons for departures were collected from official Association of Tennis Professionals (ATP) and Women's Tennis Association (WTA) web pages. All tournaments apart from the 4 major competitions (the Australian Open, French Open, Wimbledon, and US Open) were included for the period 2001-2012 for men and women. Personal data, tournament information, surface, match setting, date, and reason were obtained for each departure scenario.

RESULTS

Variations in departure and injury rates were seen throughout the season. Women left and were injured significantly more than men. Women mainly left because of thigh injuries, whereas men left mainly because of back injuries. Playing surface only had an influence on the risk of lower back injuries. Only women's departures were affected by the tournament round.

CONCLUSION

A high number of departures from tournaments have occurred during the past 10 years on the ATP and WTA circuits. Injuries were the main reasons of these departures, regardless of the type of departure and player sex. The back and thigh were the main locations of injuries for men and women, respectively.

Success and decline: top 10 tennis players follow a biphasic course

INTRODUCTION

The victory percentages for tennis players who entered the top 10 women and men rankings show various evolutions related to age and time since 1968.

METHODS

The study analyzed the careers of all top 10 players: 97 women (50,933 matches) and 144 men (92,450 matches). For each player, we describe a biphasic performance course. Two generations were compared: the first one (G1), including players who started their professional career before 1985, and the second one (G2), with players starting after 1985.

RESULTS

The average career length is 16.1 ± 3.8 yr for the top 10 men and 15.8 ± 4.4 yr for women. Compared with G1 players, G2 players begin earlier (women = 1.3 yr, men = 0.8 yr), but career length remains the same. An exponential model describes the time course of the victory percentage with a great similarity for both genders. Using this equation, the peak victory rate reaches 82.5% at 21.5 yr for number 1 (no. 1) women and 78.5% at 23.7 yr for no. 1 men, showing a greater precocity and earlier decline in women. Finally, the area under the curve shows a potential that is 22.8% (men) to 56.8% (women) larger for the no. 1 players as compared with all other numbers 2-10.

CONCLUSIONS

Tennis players in the top 10 show a biphasic career. Women reach their highest level earlier than men, consistent with their more precocious biological development. For the current generation, the peak performance tends toward a younger age than the first generation. We show how to precisely quantify and compare tennis performances using indicators that follow the trends of development and aging and demonstrate that precocity does not provide a larger victory potential.

Consensus statement on epidemiological studies of medical conditions in tennis, April 2009

BACKGROUND

The reported incidence, severity and nature of injuries sustained in tennis vary considerably between studies. While some of these variations can be explained by differences in sample populations and conditions, the main reasons are related to differences in definitions and methodologies employed in the studies.

OBJECTIVE

This statement aims to review existing consensus statements for injury surveillance in other sports in order to establish definitions, methods and reporting procedures that are applicable to the specific requirements of tennis.

DESIGN

The International Tennis Federation facilitated a meeting of 11 experts from seven countries representing a range of tennis stakeholders. Using a mixed methods consensus approach, key issues related to definitions, methodology and implementation were discussed and voted on by the group during a structured 1-day meeting. Following this meeting, two members of the group collaborated to produce a draft statement, based on the group discussions and voting outcomes. Three revisions were prepared and circulated for comment before the final consensus statement was produced.

RESULTS

A definition of medical conditions (injuries and illnesses) that should be recorded in tennis epidemiological studies and criteria for recording the severity and nature of these conditions are proposed. Suggestions are made for recording players' baseline information together with recommendations on how medical conditions sustained during match play and training should be reported.

CONCLUSIONS

The definitions and methodology proposed for recording injuries and illnesses sustained during tennis activities will lead to more consistent and comparable data being collected. The surveillance procedures presented here may also be applicable to other racket sports.

Echocardiographic characteristics of professional tennis players at the Roland Garros French Open

BACKGROUND

Intensive sport may induce cardiac modifications. No recent study has been performed in elite tennis players. The aim of this cross-sectional study was to analyze the cardiac characteristics in a population of professional tennis players.

METHODS

During the 2004 French Open Tennis Tournament, we offered complete echocardiographic screening to all professional tennis players. The study population consisted of 160 subjects: 80 tennis players (50 men and 30 women) and age- and sex-matched control groups (n = 80).

RESULTS

Indexed left ventricular mass was significantly higher in tennis players (P < .0001). Left ventricular hypertrophy was present in 18 male (36%) and 6 female (20%) tennis players versus 2 men (4%) and no woman in the control groups (P < .0001 and P = .02, respectively). All indexed right and left atrial measurements were significantly higher in tennis players (P < .003). The incidence of left and right atrial dilation was significantly higher in tennis players (P < or = .0001). Indexed right atrial area and left atrial volume were significantly higher in baseline players as compared with offensive players and to control groups (P < .0001), whereas there was no significant difference in left ventricular mass according to the style of play (P > .75). No significant between-group difference was observed in Doppler data.

CONCLUSIONS

In the present study, professional tennis players presented significant cardiac differences, as compared to a control group, with moderate left ventricular hypertrophy, bilateral atrial dilation, and normal systolic and diastolic functions. Atrial dilation is related to the style of play (baseline or offensive) and should be considered as physiological in tennis players.

Imagerie du poignet du sportif

Wrist imaging is currently used for diagnosis of sport injuries as part of a global strategy of rapid recovery. Standard x-rays are the first step in this procedure. Although arthrography is still the reference for the diagnosis of intrinsic ligament and cartilaginous lesions, MRI can sometimes be sufficient. Ultrasonography is a dynamic process and is accurate in detecting tendon injuries. Wrist sport injuries are frequent and often asymptomatic. Here we review the usual aspects of bone, ligament, and tendon lesions encountered in each sport, while providing advice on the most appropriate imaging for each clinical symptom.

Extensor carpi ulnaris injuries in tennis players: a study of 28 cases

Pain on the ulnar side of the wrist is common among elite tennis players. Ten years of experience has allowed identification of a pathology involving the extensor carpi ulnaris (ECU) tendon. On the basis of 28 clinical cases seen over the last five years, three clinical patterns are described: (a) acute instability of the ECU; (b) tendinopathy; (c) ECU rupture. Each of these clinical entities requires a different therapeutic approach. A review of the relevant anatomy is provided.

Ultrasonographic rotator-cuff changes in veteran tennis players: the effect of hand dominance and comparison with clinical findings

The aim of this study was to correlate sonographic abnormalities of the rotator cuff with clinical findings in veteran tennis players. One hundred fifty individuals playing competition-level tennis, aged from 35 to 77 years (mean age 55 years), underwent physical and US examinations of their shoulders. The US abnormalities found in the dominant shoulder were compared with those observed in the non-dominant shoulder and in different subsets of players defined by the absence or presence of former and/or current pain. Tears of the long head of the biceps tendon were seen only in dominant shoulders ( n=8), and tears (23 complete and 20 partial) of the supraspinatus tendon were observed in 43 dominant vs 16 (3 complete and 13 partial) contralateral shoulders ( p<0.001). Subscapularis tendon calcifications were depicted in 23 dominant vs 12 contralateral shoulders ( p<0.05). Seventy players had no pain, 49 had former-but-not-current pain, and 31 had current pain. Abnormal thickening (>2 mm) and effusion of the subacromial-subdeltoid bursa and complete tear of the supraspinatus tendon were more frequent in the latter two groups ( p<0.001 and p<0.05), respectively. Although 90% of the players with a complete supraspinatus tear had experienced former pain, no relationship was found between current pain and the presence of a supraspinatus tear or tendon calcification. The rotator cuff may present important asymptomatic lesions, such as complete tears of the supraspinatus tendon or calcifications, that do not prevent the playing competitive tennis. The only US abnormality associated with pain was subacromial-subdeltoid bursa effusion.