A multi-year injury epidemiology analysis of an elite national junior tennis program

Are Junior Tennis Players Less Exposed to Shocks and Vibrations than Adults? A Pilot Study

This study investigated muscle activation, shocks, and vibrations of the upper extremities during tennis serves between junior and adult tennis players. Thirty-five well-trained tennis players (15 juniors and 20 adults) performed 10 maximal successful tennis serves. Two triaxial accelerometers recorded the shock and vibration on the racket and the hand on the dominant side. Eight surface EMG electrodes were also used to measure the arm muscles' activities. Linear mixed models were used to test the fixed effect of age on muscular activation and vibration. Statistical non-Parametric Mapping was employed to make statistical inferences on the EMG and accelerometer data obtained from the continuous wavelet transform. Comparing EMG parameters between junior and adult players reveals similar upper limb intermuscular coordination. The junior players experienced lower racket and hand vibration amplitudes, which were partially explained by a lower ball velocity. This study revealed that young players showed no difference in EMG parameters in the tennis serve but were as exposed to shocks and vibrations as adults when compared based on a given speed and a given handgrip force. These vibrations apply to an immature skeleton, which can increase the risk of injuries caused by overuse. In addition, differences in the racket vibration frequency provide original knowledge to engineers who need to develop innovative sports equipment for tennis.

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.

Injury Profile in Youth Female Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

An increasing number of epidemiological studies assessing the incidence, prevalence and severity of injury in youth female sport are available. However, no study has sought to synthesise the current evidence base across all youth female sport. As such, a systematic review and meta-analysis of injury in this cohort is necessary to understand the diversity of injury and its associated burden between sports in addition to identifying the density of research available.

OBJECTIVE

To conduct a systematic review and meta-analysis of epidemiological data of injuries in youth female athletes with particular attention to injury incidence, mean days lost and injury burden.

METHODS

Searches were performed in PubMed, EBSCO (SPORTDiscus with Full Text MEDLINE, APA PsycINFO, CINAHL, Academic Search Complete) and Cochrane databases. Studies were considered if they reported time-loss injury incidence or prevalence in youth female (≤ 19 years old) athletes. Study quality and risk of bias were assessed using STROBE-SIIS extension, Newcastle-Ottawa Scale, and funnel plots, respectively. Injury incidence and burden rate data were modelled using a mixed-effect Poisson regression model. Days lost data were modelled using a generalised linear mixed model.

RESULTS

Thirty-two studies were included. The overall incidence rate, mean days lost per injury, and burden rate were 4.4 injuries per 1000 h (95% CI 3.3-5.9), 10 days (95% CI 6-15), and 46 days per 1000 h (95% CI 23-92), respectively. Forty percent of athletes sustained at least one time-loss injury. Competitive level was a significant moderator of match and training injury incidence, with elite youth athletes presenting greater pooled injury incidence estimates than non-elite athletes (p = 0.0315 and p = 0.0047, respectively). The influence of moderators on days lost and injury burden could not be determined due to an insufficient number of studies for analysis.

CONCLUSION

Despite a broad inclusion criterion, there is limited injury surveillance research available across youth female sport. Outside of soccer, little research density is evidenced with single studies available in popular team sports such as Australian football and rugby union. Insufficient study numbers reporting mean days lost and injury burden data were available for analysis, and pooled days lost data could only be estimated for soccer. This highlights a need for future research to report days lost data alongside injury number and exposure so burden can be calculated and the full risk of injury to youth female athletes can be identified.

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.

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.

The Epidemiology of Youth Sport-Related Shoulder Injuries: A Systematic Review

Background

Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies.

Methods

All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included.

Results

Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect.

Conclusions

Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.

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.

Athletic Identity and Shoulder Overuse Injury in Competitive Adolescent Tennis Players: The Smash Cohort Study

Objectives

Our primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume.

Methods

A cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS).

Results

The adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36–2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74–8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training.

Conclusions

Our results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.

Determinant Physical Factors of Tennis Serve Velocity: A Brief Review

PURPOSE

To review the main physical aspects that could positively or negatively influence serve velocity (SV).

METHODS

An examination of existing literature including studies analyzing positive (biomechanical aspects, anthropometrics, range of motion, strength, and power) and negative (competition-induced fatigue) associations to SV are summarized in this review.

RESULTS

Aspects such as lower-leg drive, hip and trunk rotations, upper-arm extension, and internal rotation seem to be the major contributors to racquet and ball speed. Favorable anthropometric characteristics, such as body height, arm length, and a greater lean body mass, seem to positively influence SV. Also, strength indicators such as maximal isometric strength and rate of force development in specific joint positions involved in the kinetic chain alongside upper-body power seem to be related to faster serves. On the other hand, the effects of prolonged or repetitive match play may impair the aforementioned factors and negatively influence SV.

CONCLUSIONS

Following specific serving models that seem to enhance velocity production and efficient motion is highly recommended. Moreover, achieving a higher impact point, alongside shifting body composition toward a greater lean body mass, will most likely aid toward faster serves. Programs aiming at improving maximal isometric strength and rate of force development in specific positions involved in the kinetic chain including stretch-shortening cycle predominance and the mimicking of the serve motion seem of great interest to potentially increase SV. Effective recovery and monitoring of these variables appear to be essential to avoid impairments produced by continued or repetitive competition loads.

A Scoping Review on Shoulder Injuries of Wheelchair Tennis Players: Potential Risk-Factors and Musculoskeletal Adaptations

Wheelchair tennis players are prone to develop shoulder injuries, due to the combination of wheelchair propulsion, overhead activities and daily wheelchair activities. A methodical literature search was conducted to identify articles on shoulder complaints in wheelchair tennis, wheelchair sports and tennis. The aims were to identify (1) type of shoulder complaints; (2) possible risk factors for the development of shoulder injuries; (3) musculoskeletal adaptations in the shoulder joint in wheelchair tennis players. Fifteen papers were included in this review, five on wheelchair tennis, three on wheelchair sports and seven on tennis. Type of shoulder complaints were acromioclavicular pathology, osteoarthritic changes, joint effusion and rotator cuff tears. Possible risk factors for the development of shoulder injuries in wheelchair tennis are overhead movements, repetitive activation of the anterior muscle chain and internal rotators, as well as a higher spinal cord injury level. Muscular imbalance with higher values for the internal rotators, increase in external range of motion, decrease in internal range of motion and reduced total arc of motion were the most common proposed musculoskeletal adaptations due to an unbalanced load. These presented risk factors and musculoskeletal adaptations might help researchers, coaches and wheelchair tennis players to prevent shoulder injuries.

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.

Association Between Spikes in External Training Load and Shoulder Injuries in Competitive Adolescent Tennis Players: The SMASH Cohort Study

BACKGROUND

Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics.

HYPOTHESIS

Rapid increases in external workload are associated with the incidence of shoulder complaints and injuries.

STUDY DESIGN

A cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

At baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire).

RESULTS

For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries.

CONCLUSION

Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players.

CLINICAL RELEVANCE

Consistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.

External Training Load and the Association With Back Pain in Competitive Adolescent Tennis Players: Results From the SMASH Cohort Study

Background:

In young tennis players, high loads on the spine and high training volumes in relation to age are associated with a high lifetime prevalence of back pain. The primary aim of this study was to investigate if accumulated external workload “spikes” in the acute:chronic workload ratio (ACWR) of tennis training, match play, and fitness training, and if high or low workload/age ratio were associated with back pain events in competitive adolescent tennis players. Additional aims were to report the incidence of back pain stratified by sex and level of play and to describe the characteristics of players with back pain.

Hypothesis:

Rapid increases in external workload are associated with the incidence of back pain.

Study Design:

Cohort study of 198 competitive tennis players, 13 to 19 years, with a weekly follow-up for 52 consecutive weeks.

Level of Evidence:

Level 3.

Methods:

Accumulated external workload spikes (uncoupled ACWR >1.3), and the workload/age ratio, were time-varying exposures in Cox regression analyses with the outcome back pain (pain intensity ≥2/10 in the lower back and/or in the upper back/neck with a pain-related disability).

Results:

For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.17 (95% CI, 1.06-1.28) for back pain. The corresponding HRR for fitness training was 1.13 (95% CI, 1.05-1.22). Training workload/age ratio was not related to back pain.

Conclusion:

Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of back pain events in competitive adolescent tennis players.

Clinical Relevance:

Back pain is a troublesome clinical problem that may affect the performance of talented young tennis players. Structuring the training schedule to minimize rapid increases (ie, spikes) of training load on a weekly basis may enhance performance and reduce back pain in adolescent tennis players.

Effects of Lumbar Spine Abnormality and Serve Types on Lumbar Kinematics in Elite Adolescent Tennis Players

Background

Low back pain (LBP) is pervasive among elite junior tennis players. Previous research has explored the relationship between serving mechanics and LBP, though the participants in these studies had already experienced LBP. Therefore, it is unclear whether their serving mechanics caused the LBP or are a result of having LBP. Thus, the purpose of this study was to compare the flat and kick serve kinematics of asymptomatic elite adolescent male and female tennis players with and without lumbar spine abnormalities. Twenty-four players (nine of which had confirmed lumbar spine abnormalities) carried out a series of flat and kick serves, while marker trajectories were recorded by a 3D motion capture system. Pelvis and lumbar spine kinematics (anterior/posterior tilt, lateral tilt, axial rotation and flexion/extension, lateral flexion and axial rotation respectively) were compared between players with and without lumbar spine abnormalities, genders, and serve types using a mixed-effects model. Exploratory data pertaining to the order and timing of key serve events was also collected.

Results

Males had significantly greater posterior pelvis tilt than females during the drive phase of both flat (M, − 7.1 ± 5°; F, 4 ± 5.5°) and kick serves (M, − 8.6 ± 5.1°; F, 2.1 ± 5.8°). Independent of serve type, males also impacted the ball ~ 15 cm further into the court than females, while all players contacted flat serves significantly further forward (~ 17 cm). There were no effects for abnormality in the magnitude of pelvis and trunk kinematics. The order and timing of key serve events, however, did tend to differ between those with and without lumbar spine abnormalities. Players with abnormalities entered peak front knee flexion and initiated pelvis rotation earlier than players without abnormalities. Lastly, the timing of pelvis rotation was highly variable among females though not males.

Conclusion

Pelvis and ball toss kinematics vary with gender and serve type but not necessarily abnormality in the elite adolescent serve. There is evidence to suggest that the order and timing of key serve events might help to identify those at risk of lumbar spine abnormalities; however, further research is needed to investigate the statistical significance of the timing of these events.

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.

Tennis-specific extension of the International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020

The IOC has proposed standard methods for recording and reporting of data for injury and illness in sport. The IOC consensus statement authors anticipated that sport-specific statements would provide further recommendations. This statement is the tennis-specific extension of the partner IOC statement. The International Tennis Federation Sport Science and Medicine Committee, in collaboration with selected external experts, met in June 2019 to consider athlete health monitoring issues specific to tennis. Once the IOC consensus statement was finalised, the tennis-specific consensus was drafted and agreed on by the members over three iterations. Compared with the IOC consensus statement, the tennis consensus contains tennis-specific information on injury mechanism, mode of onset, injury classification, injury duration, capturing and reporting exposure, reporting risk and study population. Our recommendations apply to able-bodied as well as wheelchair tennis players. Where applicable, specific recommendations are made for wheelchair tennis.

Association of acute and chronic workloads with injury risk in high-performance junior tennis players

This study examined the association and predictive ability of several markers of internal workload on risk of injury in high-performance junior tennis players. Fifteen young, high-level tennis players (9 males, 6 females; age: 17.2 ± 1.1 years; height: 178.5 ± 8.7 cm; mass: 68.1 ± 4.8 kg) participated in this investigation. Data on injury epidemiology and internal workload during training were obtained for one competitive season. The session-rating of perceived exertion (s-RPE) was used to calculate internal workload markers in absolute (acute workload and chronic workload for 2-weeks, 3-weeks and 4-weeks) and relative terms (acute:chronic workload ratios [ACWR] for 2-weeks, 3-weeks and 4-weeks). Associations and diagnostic power for predicting tennis injuries were examined through generalised estimating equations and receiver operating characteristics analyses. During the season, a total of 40 injuries were recorded, corresponding to 3.5 injuries per 1000 h of tennis practice. The acute workload was highly associated with injury incidence (P=0.04), as injury risk increased by 1.62 times (95% CI: 1.01-2.62) for every increase of 1858.7 arbitrary units (AU) of the workload during the most recent training week. However, acute workload was a poor predictor of injury, and associations between injury and internal workload markers were weak (all P>0.05). These findings demonstrate an association between high values of acute workload and the risk of injury in high-level tennis players. However, a high acute workload is only one of the many factors associated with injury, and by itself, has low predictive ability for injury.

A 2-year prospective study of injuries and illness in an elite national junior tennis program

Objectives: Injury and illness in elite national tennis programs can limit players' current and future performance. This study aimed to prospectively examine injuries and illnesses in an Irish elite national junior tennis program over 2 years. Methods: All injuries and illnesses that led to missed tennis training and match play in the Irish national junior tennis program (n = 82) over 2 years were collected in a prospective cohort study. Injury and illness prevalence and rates were calculated and reported with respect to gender and age group. Descriptive statistics were calculated for the type of illness and the region, location, type, nature, mechanism, and severity of injury. Results: Over the course of the study, 54% of players became injured, with 9.0% receiving more than one injury. Injuries were most frequent in the under-16 age group (12.93 injuries per 1,000 athletic exposures), compared to younger age groups (4.13 [U10], 3.43 [U12], 4.63 [U14] injuries per 1,000 athletic exposures) and seniors (1.98 injuries per 1,000 athletic exposures). Lower (49.5%) and upper limb (35.9%) injuries were frequent and mostly occurred due to overextension (35.9%). No significant differences in males and females injury rates were noted. However, females received a greater proportion of shoulder injuries (23.5% vs 10.9%), with more knee injuries in males (29.1% vs 7.8%). 0.52 illnesses per 1,000 athletic exposures were reported, with respiratory/cardiorespiratory (43.5%) most frequent. Injuries lead to greater average sessions lost (6.77 ± 11.56) than illness (1.83 ± 1.11). Conclusion: These findings can inform injury and illness preventative strategies to minimize absence from tennis play and should be prioritized in the under-16 group. Due to the different injury profiles between males and females, tailored preventative programs should be developed for males and females individually.

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.

Epidemiology of musculoskeletal injuries in tennis players: risk factors

BACKGROUND

Tennis practice involves repetitive stresses through several strokes and movements during several hours. These factors can lead to injuries on musculoskeletal structures. This study aims to determine injury epidemiology in tennis players, as well as their type, location, mechanism of injury and risk factors.

METHODS

The sample was constituted by 218 tennis athletes, aged 9 to 72, being 156 (71.6%) male. The measurement instrument was a questionnaire concerning characterization of the population, and aspects related to the modality and injuries.

RESULTS

86 athletes (39.4%) referred having an injury in a 12-month period, totalizing 107 injuries, and 76 athletes (34.9%) in a 6-month period, totalizing 95 injuries. There were 3.49 injuries per 1000 hours of tennis training. The most common injuries were joint injuries (29.5%), following by tendinopathy (22.1%), located in the ankle (20%) and wrist (15.8%), both occurred by service (23.2%). Tennis athletes who trained three times or more per week had 2.29 higher probability of injury (95% CI: 1.28-4.13; P=0.006), those who trained more than 4.5 hours per week had 2.04 more chances (95% CI: 1.16-3.60; P=0.013), those who were elite tennis players had 2.81 more chances (95% CI: 1.41-5.59; P=0.003), and those who trained on a clay court more frequently, had 4.11-fold higher probability of injury (95% CI: 1.46-11.55; P=0.007).

CONCLUSIONS

In the analyzed sample, data revealed a high prevalence of injuries in tennis athletes, being joint injuries the most common type of injuries, and the most affected body area were the ankle and the wrist.