“A growing epidemic of preventable sports injuries is dismantling the hopes and dreams of young athletes at an early age.” – Dr. James Andrews and the STOP (Sports Trauma and Overuse Prevention) Sport Injuries Organization.

As April is National Youth Sport Safety Month, it is important to evaluate the quality and quantity of training and competition that your young athletes are exposed to. Tennis is a sport that typically has a very high volume at a young age, and although tennis is an early initiation sport, it should be a late specialization sport. This means that to be highly successful (i.e. earning a college scholarship or dreams of playing professionally) in the sport an individual needs to be exposed to the sport at a young age – typically before 10 years of age. However, it is a late specialization sport. This means that it is important to learn the sport at a young age, but also participate in multiple sports to at least till 12-14 years of age. Over the past decade a number of studies in different sports have consistently shown that athletes that specialize in one sport from a very young age have a greater number of injuries. Some of the most recent research was presented at the American Medical Society for Sports Medicine (AMSSM) meeting in San Diego in April. The study is titled “Risks of Specialized Training and Growth in Young Athletes: A Prospective Clinical Cohort Study” and was led by Dr. Neeru Jayanthi (iTPA Certification Commission member) http://www.itpa-tennis.org/certification-commission.html.

Below are some of the most relevant notes from the study :

• Between 2010 and 20103, Neeru Jayanthi (iTPA Certification Commission member) and colleagues at Loyola and Lurie Children’s Hospital of Chicago enrolled 1,206 athletes ages 8 to 18 between who had come in for sports physicals or treatment for injuries.

• There were 859 total injuries, including 564 overuse injuries, in cases in which the clinical diagnosis was recorded. The overuse injuries included 139 serious injuries such as stress fractures in the back or limbs, elbow ligament injuries and osteochondral injuries (injuries to cartilage and underlying bone). Such serious injuries can force young athletes to the sidelines for one to six months or longer.

• Young athletes who spent more hours per week than their age playing one sport – such as a 12-year-old who plays tennis 13 or more hours a week – were 70 percent more likely to experience serious overuse injuries than other injuries.

• The study confirmed preliminary findings - that specializing in a single sport increases the risk of overall injury, even when controlling for an athlete’s age and hours per week of sports activity.

• Young athletes were more likely to be injured if they spent more than twice as much time playing organized sports as they spent in unorganized free play — for example, playing 11 hours of organized soccer each week, and only 5 hours of free play such as pick-up games.

• Athletes who suffered serious injuries spent an average of 21 hours per week in total physical activity (organized sports, gym and unorganized free play), including 13 hours in organized sports. By comparison, athletes who were not injured, participated in less activity – 17.6 hours per week in total physical activity, including only 9.4 hours in organized sports.

• Injured athletes scored 3.3 on researchers’ six-point sports-specialization scale. Uninjured athletes scored 2.7 on the specialization scale. (On the sports specialization scale, an athlete is given one point for each of the following:

1. Trains more than 75 percent of the time in one sport;
2. Trains to improve skill or misses time with friends;
3. Has quit other sports to focus on one sport;
4. Considers one sport more important than other sports;
5. Regularly travels out of state;
6. Trains more than eight months a year or competes more than six months per year.

Dr. Jayanthi offers the following tips to reduce the risk of injuries in young adults:

• Do not spend more than twice as much time playing organized sports as you spend in gym and unorganized play.
• Do not specialize in one sport before late adolescence.
• Do not play sports competitively year round. Take a break from competition for one-to-three months each year (not necessarily consecutively).
• Take at least one day off per week from training in sports

The iTPA Parent’s Guide To Basic Injury Prevention

The iTPA has created a Parent’s Guide To Basic Injury Prevention Course which is specifically designed to help the tennis parent to appropriately work with their junior players to help reduce the chance of injury through appropriate prevention exercises. The course comes with over one hour of practical video instruction showing detailed injury prevention exercises and tutorials, in addition to an 85-page color Workbook. Please see the webpage for a detailed description and sample videos of the course http://www.itpa-tennis.org/parentcourse.html

Perspective below from Dr. Ellen Rome, Head of the Center for Adolescent Medicine at The Cleveland Clinic and a Member of the iTPA Certification Commission (www.itpa-tennis.org/certification-commission) and a member of the USTA Sports Science Committee.

• How does the brain develop when an athlete is very young?
• Adolescent age and stage is important.
  
• Understanding the differences between the different stages is important for the Tennis Performance Trainer or Certified Tennis Performance Specialist.

AUDIO clip below:

Short video featuring several basic injury prevention exercises for tennis players. Presented by iTPA Executive Director Dr. Mark Kovacs. Watch in HD!

2. Andy Murray's Blisters

After the hundreds of hours of pre-season work by Andy Murray, he came into the Australian Open in great physical shape and moved through the first few rounds of the Australian in devastating form. He came into the Open final looking good and played well in the first couple of sets. Then he called the trainer to work on a major blister on the inside of his left foot. As most of you are aware, bad blisters can be devastating for a tennis athlete due to the constant stop, start nature and the hundreds of movements that the athlete goes through in every match. Unfortunately, something as simple as blisters derailed Andy's chance of really contending at 100% for the last 2 sets of the final. This is an important lesson to everyone working with competitive athletes. The athlete is only as strong as his or her weakest link. Although every major factor was accounted for in Andy's training leading to the final, the one area that led to his downfall was something as simple as blisters. This is an important lesson to teach all athletes. Everything needs to be accounted for when preparing for a major tournament - including blisters.

3. Serena Williams Injury

Serena was a strong favorite going into the Australian Open this year; she was looking very strong in the lead up tournament in Sydney.  During her first round she rolled her right ankle 19 minutes into the match. On television it appeared to be rather severe, but she was able to still win her match 6-0 6-0 but with very little movement. Even though it was obvious that her movement was impeded, she continued to win through to the Quarterfinals where she faced the young American Sloane Stephens. Midway through the match while running for a short ball Serena aggravated a back injury which was noticeably painful. Although it is impossible to say with certainty,  the weakened ankle likely led to compensation up the leg and lower back, and this weakness and compensatory movements led her back to require movements that were atypical. This atypical movement likely was the cause of the back injury. This is an important concept to remember at any level of the game. It is important to take care of any injury (no matter how small) as an injury in the lower body can, at some point, have a deleterious effect on other parts of the body.

The Prone Scapula Retraction exercise is a very beneficial exercise for tennis athletes. The athlete faces the ground in a pushup position and slowly squeezes the shoulder blades together as demonstrated in the video. The purpose of this exercise is to help develop strength and stability in the muscles surrounding the scapula. These muscles are very important for tennis athletes to help in the prevention of shoulder related injuries. These smaller muscles that help to stabilize the scapula (shoulder blade) are very important because if they are not strong and stabilized, the smaller muscles of the rotator cuff become over active and end up performing more work than they can handle. Remember that the shoulder is a complex joint and to protect the shoulder it is important to work on improving strength, stability as well as the endurance of the muscles surrounding the joint.

For the beginner tennis player, 1-2 sets of 10 repetitions will be challenging. As the athlete develops more strength and stability this can be increased to 2-4 sets of 10-15 repetitions. It would be recommended to rest at least 60 seconds between sets.

It was a real honor for the iTPA to be heavily involved in this Tennis Medicine & Injury Prevention Conference held in Atlanta, Georgia Dec 15th & 16th, 2012 hosted at Life University. The quality of speakers was outstanding. The great educators, researchers, clinicians, coaches, trainers and tennis performance specialists who presented are the leaders in the tennis industry. The information presented was the latest tennis-specific information on aspects of medical conditioning and the prevention of injuries in tennis athletes from juniors to senior players. The depth and breadth of the speakers experiences was very impressive and the feedback from the attendees was very positive. Below is a summary list of speakers that presented at the event followed by a brief outline from the opening session:

Speakers:

Elizabeth Chaffin, PT, DPT, MS, ATC - USTA Medical Coordinator

Brian Hainline, MD - Chief Medical Officer, United States Tennis Association Chair and will be the new Chief Medical Officer for the NCAA starting in 2013. He is also a member of the iTPA Certification Commission.

Neeru Jayanthi MD - USPTA, Vice President, STMS.  Dr. Jayanthi is also the Director of Loyola Tennis Medicine and Primary Care Medicine Program at Loyola School of Medicine in Maywood, IL. Dr. Jayanthi is also a member of the iTPA Certification Commission.

W. Ben Kibler, MD - Dr. W. Ben Kibler is the Medical Director for Lexington Clinic Sports Medicine Center and Shoulder Center of Kentucky of the Lexington Clinic in Lexington, KY. He is the team physician and orthopedist for the Lexington Legends; class A minor league team in the Houston Astros Organization. He also is team physician for numerous colleges and high schools in the Lexington area. Currently, Dr. Kibler serves on the Sports Science Committee of the U.S. Tennis Association, as a consultant for the Women’s Tennis Association, and is a founding member of the Society of Tennis Medicine and Science. Dr. Kibler is a Fellow and former Vice President for the American College of Sports Medicine. Dr. Kibler has presented and written prolifically on all areas of sports medicine. He specializes in the upper extremity, shoulder pathology, scapula, and biomechanics of tennis. Dr. Kibler is a member of the iTPA Certification Commission

Mark Kovacs, PhD, FACSM, CTPS, CSCS is the Executive Director of  the International Tennis Performance Association (iTPA) and is a tennis researcher, certified strength and conditioning specialist and certified tennis professional. He was a former tennis All-American and NCAA champion.

Page Love, MS, RD, CSSD, LD, CSCS, ACSM - Registered Dietitian and Certified Specialist in Sports Dietetics, Certified Strength and Conditioning Specialist. ACSM Certified Health and Fitness Instructor, President and Founder of Nutrifit, Sport, Therapy, Inc. Page is a member of the iTPA Certification Commission.

Satoshi Ochi, CSCS, CTPS - Head Strength and Conditioning Coach at the United States Tennis Association (USTA). He is based at USTA National Training Center Headquarters in Boca Raton, FL. Satoshi oversees and manages Strength and Conditioning programs for the USTA Player Development program. Prior to joining the USTA, Satoshi was the Head Strength and Conditioning Coach at Creighton University where he was also an instructor for the Exercises Science Department. Satoshi, from Shizuoka, Japan, received his M.A. in Exercise Science from the University of Nebraska at Omaha. Satoshi also received his B.A. in Exercise Science at Creighton University and played tennis for the BlueJays while attending the university. Satoshi is a member of the iTPA Advisory Board.

Marc Safran, MD - Past President STMS, Orthopaedic Consultant WTA.  Dr. Safran is also the Associate Chief of Sports Medicine and Fellowship Director of Sports Medicine, Professor of Orthopaedic Surgery. Dr. Safran specializes in Sports Medicine and arthroscopic and ligament reconstructive surgery on the shoulder, elbow, hip and knee. He is a diplomat at the American Board of Orthopaedic Surgery and member of such prestigious societies such as: The American Orthopaedic Society for Sports Medicine, the ACL Study Group, the American Shoulder and Elbow Surgeons Society, the Paradicus Society, the Multicenter of Arthroscopic Hip Surgery Outcomes Research Network, the Multicenter Orthopaedic Outcomes Network, and the Society of Tennis Medicine and Science in addition to the American College of Sports Medicine. Dr. Safran is a member of the iTPA Certification Commission.

Oliver Stephens,PTR Master of Tennis-Performance, PTR Clinician & Tester (currently studying for the TPT exam)

Kathleen Stroia MS, PT, ATC - Vice President, Sport Sciences & Medicine and Player Development WTA Tour, Inc. Kathleen is a member of the iTPA Certification Commission.

Walter C. Taylor, III, MD - Program Director for Primary Care Sports Medicine Fellowship, Mayo School of Graduate Medical Education, College of Medicine, Mayo Clinic, Department of Education Services, Jacksonville, Florida and Medical Advisor - WTA Tour, Florida

Joseph S. Wilkes, MD - Dr. Joseph S. Wilkes has been providing Orthopaedic care to his patients for over 20 years. He is a general Orthopaedic surgeon with fellowship training in sports medicine, and surgery of the hand. Dr. Wilkes’ practice encompasses total orthopaedic care including upper and lower extremity and joint replacement. He specializes in complex disorders of the shoulder, elbow, wrist, and hand, including arthroscopy repair reconstruction.

The conference hosts Drs. Neeru Jayanthi, MD (STMS Vice-President and Director, Tennis Medicine Program at Loyola University) and Mark Kovacs, PhD, CTPS (iTPA) opened the conference talking about the importance of balancing improving performance with reducing tennis injuries. One important takeaway from this presentation was for the different specialists (physical therapists, athletic trainers, medical doctors, certified tennis performance specialists etc) to continue to look at each athlete as a total person and focus on finding the cause of the problems rather than just focusing on symptom. Focus training and analysis from the core region out and the lower body up. It is important to understand why you choose certain exercises at certain time with each athlete. One important concept was that exercises are not typically good or bad. The problem is exercises that are applied at the wrong time in a periodized program, to the wrong type of athlete, at the wrong age and stage of development or for the wrong goals. These were a couple of simple concepts that sometimes you may forget when working with your tennis athletes.

The iTPA Inner Circle (www.itpamembers.org) will be bringing an in-depth summary of the major presentations over the next two weeks including some video footage from the on-court sessions. The iTPA Inner Circle is available to all iTPA members. Register for TPT or CTPS today and you will gain access to the Inner Circle. Happy holidays!

iTPA's Executive Director Dr. Mark Kovacs was interviewed on today's ParentingAces radio show and discussed fitness and injury prevention for the junior tennis player. You can listen to the hour-long recorded version at http://www.blogtalkradio.com/ur10s/2012/11/19/parenting-aces

Thanks ParentingAces for the opportunity, and the great discussion on fitness for the junior tennis player. If anyone has any more questions feel free to post them!