by​ Patrick Aubone, CTPS & Dr. Mark Kovacs, CTPS, MTPS

For the first time in the Open era a Grand Slam lacked major star power on the men’s side with nearly half of the top players being unable to play due to injury. The list of casualties from the top 10 was pretty big: Andy Murray (hip), Novak Djokovic (elbow), Milos Raonic (wrist), Kei Nishikori (wrist), Stan Wawrinka (knee). Five of the top 11 players in the world missed the US Open this year. Last year Roger Federer took the final 6 months of the year to recover from an off court knee injury while Rafael Nadal has been battling injuries for years.
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This year at Wimbledon, the men’s draw alone had 7 first round retirements and 11 total in the first 2 rounds. According to an ESPN, since Wimbledon 2007 there has been 237 retirements in Grand Slam tournaments for men alone.  This is an astounding number!

"Are all these retirements due to the schedule? Too much travel? Off court stress? Ineffecitve off-court or on-court training? Looking at the ATP Tour website, post US Open, Alexander Zverev and Roberto Bautista Agut lead the top 10 players in matches played with 76 and 71. That doesn’t take into account the upcoming indoor season and year end tournament.  Nadal is a close third with 67 matches played, Federer is at 41, and Del Potro is at 46. Federer has only recently had some injury problem with his knee and most recently his back but prior to age 33 he only experienced an ankle issue one year and still came back for the season ending tournament. Del Potro aside from his multiple wrist surgeries has had an injury-free career though he is still young at 28. Outside of the top 10, Goffin and Theim are the only players above 75 matches.
How much is too much?

The players travel 25-35 weeks a year between tournaments, preseason camps, and home visits. While some individuals can argue that Courier, McEnroe and Lendl all played 85+ matches in the past, there are many variables that have changed. The athletes are stronger, faster and fitter than ever. Matches are going 5+ hours in Grand Slams with the winner having 36 hours to recover before playing again. The physical toll on the athlete’s body after these matches is tremendous. Technology has played a part in developing more powerful racquets allowing players to hit harder and add more spin to the ball.  It has also played a big part in the recovery process with such innovations as compression garments by 2XU & Body helix, Pneumatic Compression like Normatec or Recovery Pump Boots and non-fatiguing Muscle Stimulation machines like the Marc Pro Plus. Most are not even well versed in the various other aspects that contribute the the stress and recovery process.

Here is a good resource from the USTA with some in-depth review of Recovery in Tennis. Here is the Recovery in Tennis Coaches, Parents and Players Booklet - http://s3.amazonaws.com/ustaassets/assets/1/15/recovery_project_coaches_booklet.pdf 

If you are interested in reading more in-depth science around tennis recovery here is the expert written book on the topic (398 pages) edited by Drs. Kovacs, Kibler and Ellenbecker:

​http://assets.usta.com/assets/1/dps/usta_master/sitecore_usta/RECOVERY%20PROJECT%20FINAL.pdf

Even though the increase in top star players injuries is the focus of many articles (see below), the actual yearly data of overall injuries on the ATP World Tour is actually rather consistent with years past. It is just that we have for the first time a large percentage of the Top 10 players unable to play a major championship (the US Open). As a result, it attracts major attention and shines a light on injuries in the sport. However, it is always important to look at the data and understand what is actually happening.

https://www.nytimes.com/2017/07/06/sports/tennis/players-pull-out-at-wimbledon-and-calls-for-reform-flood-in.html?mcubz=0&module=ArrowsNav&contentCollection=Tennis&action=keypress&region=FixedLeft&pgtype=article

http://www.nytimes.com/2011/09/04/sports/tennis/pro-tennis-season-can-nearly-a-year.html?mcubz=0
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http://www.atpworldtour.com/en/performance-zone/win-loss-index

** An accompanying explanation and article discussing this topic and infographic is on the iTPA Inner Circle Member Only Website for our members and subscribers.

Attend the 2016 WORLD TENNIS FITNESS CONFERENCE (July 30th & 31st, 2016) in Atlanta, Georgia alongside the 2016 BB&T ATLANTA OPEN. Check out the website for more information and to register www.itpa-tennis.org/tennisfitconference.html

By Joshua Colomar and Mark Kovacs, PhD, CTPS, MTPS

Classical descriptions present tennis as a prolonged activity (2-4 hours) of repeated, high-intensity bouts interspersed with standardized rest periods. Such description establishes that the sport is physically and physiologically demanding. However, tennis can last more than 5 hours in some extreme cases like Grand Slam and Davis Cup matches. There’s a lack of literature when quantifying such extended matches. Professional players mainly would benefit in having knowledge of fatigue development in these conditions and how it evolves during matchplay, as well as during competition weeks. To try to contextualize these doubts, Reid & Duffield (2014) offer us an interesting review on fatigue, putting together information and possible future areas of study for unanswered questions.

Professional players should be prepared for a typical situation that happens during tournament weeks and especially when playing Grand Slams. This involves scenarios of  the potential of 4-5+ hour matches and the possibility of playing 7 matches in a two week period, with only 24-49 hours of rest between each match. Fatigue occurs: the challenge for everyone is to determine the amount of fatigue and the impact it has on performance, recovery and possible injury.  It’s unclear if players experiment movement changes, poor technique or reduced cognitive performance. Fatigue responses (i.e. an athlete’s physiological profile) can be divided into changes in mechanical, contractile and cognitive characteristics:

Physiological profile:
Researchers have studied internal load parameters that are produced during tennis. This information is summarized briefly below. Most of this data is based on matches lasting 120 minutes or less:

• 60%-70% maximal heart rate.
• 60%-70% maximal oxygen consumption.
• 5mmol/L concentration of lactate.
• Elevated testosterone.
• Elevated creatine kinase.
• Reduced cortisol.
  
  

These indicators respond only to internal load in response of matchplay and not necessarily to mechanisms of fatigue or in reduced performance outcome. Nevertheless, also registrations of hypohydration and reduced glycogen availability have been recorded. This has been linked to reduced serve performance as well. To limit these negative effects, all tennis athletes should have clear strategies to limit any negative outcomes -- hydration strategies, carbohydrate ingestion and fluid replenishment.

Movement characteristics: Although literature is clear in quantity (around 8-12m per point and 600-800m per set) and duration (<10 seconds per point), movement patterns variations produced by fatigue is unclear. While it’s known that certain technical approaches have different oxygen costs it remains dubious if movement patterns change due to fatigue. Other factors may contribute as well (surface type, game style or tactical decisions). What is confirmed is that over 4 hours of prolonged matchplay and then again after 3-4 consecutive days of matchplay there is a reduction in overall movement patterns: 5% within respective days and 15% from day 1 to day 4. Whether this profile represents fatigue, or alternatively, a deliberate change in game style, isn’t clear and should be investigated in the future.

Changes in mechanical, contractile and cognitive characteristics: Studies have observed decreases in serve and groundstroke velocity during training and matches, as well as following training/matches. Despite these results, previous studies also found that the reductions in velocity were not necessarily accompanied by decrease in accuracy. This suggests that many tennis players adapt to the fatigue, by reducing the pace of the ball, but maintain accuracy. This is makes theoretical sense as it holds to the speed accuracy trade-off. In addition to these results, most of the studies were performed in simulated environments rather than in “real” competition situations. While these findings were unclear to determine if fatigue itself affects mechanical aspects like the groundstrokes, studies also indicate that velocity and accuracy can be altered during matchplay by expert players. With so many doubts, the most appropriate advice we can give and that is supported by these studies is to train for these type environments through a combination of tennis-specific strength training to allow for repeated stroke and movement mechanics over an extended period of time.

Contractile function seems to clearly reduce its function following prolonged tennis matchplay in addition to reduced neuromuscular function, particularly of the lower body, during matchplay greater than 2 hours and over consecutive days of matchplay. If this altered function precedes the reduction in movement activity profiles or relates to the accumulating physiological load remains unknown. A well-organized training program enhancing muscle resistance and function, as well as neuromuscular stimulation, should theoretically result in less reductions of these parameters.

Cognitive aspects such as perception of fatigue are also interesting in which to comment. Simulated and matchplay situations result in elevated ratings of perceived exertion, muscle joint soreness and suppressed mood states. Recent data reveals that cognitive load relates directly to physical exertion of on-court tennis training although few studies report these variables in competitive scenarios. What does seem to be clear is that there is a reduction in motivation that’s part of the fatigue process irrespective of the capacity of the muscle to contract which we’ve discussed above these lines. We can also highlight increased RPE and mental exertion to prolonged matchplay and increased error rates throughout longer or more taxing drills. This may mean that motivation and exertion are affected by the physical state, and thus alterations in stroke play and/or movement patterns. Nevertheless, motivation to perform within research settings is distinct from the motivation to perform within competitive scenarios.

Reference:
Reid, M. Duffield, R. The development of fatigue during match-play tennis. British Journal of Sports Medicine. 2014; 48:i7-i11.

By Mark Kovacs, PhD, FACSM, CSCS*D, MTPS
iTPA Executive Director

@mkovacsphd

www.mark-kovacs.com

The 2015 US Open has seen a number of players struggle with cramps this year. Many years at the US Open players struggle when they compete in New York in the hot and humid conditions. In general the hottest, most difficult days in New York have temperatures between 85-95°F and 45-60% humidity. This temperature and humidity is not dissimilar to many parts of the US throughout the entire summer period. Therefore, why do some of the best players in the world struggle so mightily to combat the conditions? Also, what can the regular tennis player do to help avoid the dreaded exercise associated muscle cramps? I have been fortunate to have been around cramping research and researchers for more than 15 years. I have worked in three different thermal physiology labs under some of the smartest minds in the fields of heat, humidity, temperature regulation and cramping in athletes. These labs are designed to study everything including blood, sweat, urine, saliva and everything in between. Many questions about cramping have been answered, and some questions still remain. Cramping is a multi-faceted problem and many different types of cramps occur in athletes. Fatigue cramps can occur in hot and cold conditions. Heat related cramps are different, night time cramps are different again and eccentric exercise (think of doing 100 calf raises in a row) cramping differs as well. Also, some athletes are more cramp-prone than other athletes. As a result, solving the cramping problem requires a personalized solution from a highly trained individual who understands the many causes of cramping and appropriate solutions to prepare the athlete and prevent cramping. With the right training and appropriate monitoring and education, limiting and completely avoiding cramping is possible. Below are some initial areas that should be part of a training program to limit the chance of experiencing exercise associated muscle cramps during tennis play.

1)      Poor and/or incorrect conditioning

This is usually the most common cause. Many well-meaning athletes are just not training the correct way to prepare for the conditions. This includes training specifically for tennis. As a result many athletes are being put through tough workouts, but these general workouts are not actually training the athlete to be fully prepared for the demands of matches. Remember that tennis is all about quick explosive movements over short periods of time in specific movement pattern, with short recovery periods (<25 seconds). Many times the tennis player will not train specifically for the demands of tennis, which can cause the athlete to be ill prepared (even though a lot of hard work and sweat has been put into training). The old adage train smart is a lot better than just training hard – if hard training is not smart.

2)      Nutrition

Most of the top players are doing better with nutrition and understanding the needs of the elite tennis athlete. However, many players (especially young players) are still not taking care of individual nutrition well. Tennis specific nutrition is highly individual and each player has a different physiology and needs a different composition of nutrients based on their unique biology, training habits, game style and energy needs. Remember that everyone burns different amount of fats and carbohydrates throughout the day and especially during training and competition. How nutrients are used by the body are somewhat different as well; nutrients are used differently. Many individuals may have deficiencies in different areas that may need adjustments.

 

3)      Hydration & Electrolytes

An athlete’s hydration is always talked about when it comes to cramping. Although hydration is an important aspect of the equation it is usually not the sole answer to stop cramping alone. Most elite tennis players are aware of the hydration needs, and generally most do a good job of taking care of the hydration appropriately. The challenge is that the human body can only replace between 1.5-1.8 liters of fluid per hour comfortably. However, tennis athletes (especially male athletes) can sweat up to 3 liters per hour. Therefore, the balance of hydration is always somewhat of a challenge, and it is very important that the athletes come onto the court well-hydrated. The major electrolyte lost in sweat is sodium, and many tennis players are not supplementing with enough sodium in the days leading up to matches. On-court hydration, although important, is usually not the answer. Only so much can safely and effectively be consumed during matches, so the pre-match routines and day before and week before match routines are very important. Other electrolytes that can play a role are potassium (although at a much lower extent), magnesium and calcium. There is one caution that players need to be aware of before and after tennis matches. Many well-meaning players may try to overdrink. Overdrinking is a concern, especially if the fluid is just water. The problem is that once an athlete sweats out a lot of fluid (sodium rich fluid) and then replaces the lost sweat just with water, the electrolyte content of the blood becomes diluted which can result in significant health consequences. This is sometimes termed water intoxication, or the more medical term of “hyponatremia.”

4)      Neuromuscular Fatigue

The neuromuscular theory of exercise related muscle cramping suggests that muscle overload and neuromuscular fatigue cause an imbalance between excitatory impulses from muscle proprioceptors that control length and tension in muscles. These tend to occur when the muscle is contracting in an already-shortened position. This is very common (the shortened position) when tennis players move. Therefore, the nervous system plays a significant role and working on better strategies of relaxation of the nervous system may help to reduce the likelihood of muscle cramps. This is likely the explanation for much of the muscle cramping that occurs when fluid levels are appropriate and sometimes when cramping occurs in colder conditions. Good methods to train this in preparation is to incorporate high velocity speed and power movements including plyometric and high velocity power movements to train the body to handle these movements in varying conditions.

5)      Lack of Emotional Control

Developing strategies to cope with hot and humid conditions is very important for elite athletes in all sports. Having well defined between point and changeover routines is very important to conserve energy and control/manage energy levels appropriately. Athletes that are highly emotional, talkative or generally burn a lot of excessive energy may result in more problems just due to more calories being burned each minute which requires more energy, etc.

Check out more information about cramping, nutrition, hydration and appropriate training for tennis players in either the Tennis Performance Trainer (TPT) certification program (www.itpa-tennis.org/tpt.html ) or the Certified Tennis Performance Specialist (CTPS) program through the International Tennis Performance Association (iTPA).

@itpatennis

www.itpa-tennis.org

Heat-related illness and death are on the rise. Each year about 200 people in the US die from heat stroke, making it one of the top three causes of death in athletes - and the leading cause of death among athletes in July and August. Yet heat illnesses and dehydration are largely preventable...

Click on the below link to download the PDF with much more information on this topic. Produced in conjunction with our partner, STOP Sports Injuries.

Hydration Issues in Sports PDF

Photo author credit:  https://traineracademy.org/

The American College of Sports Medicine (ACSM) Annual Meeting is held each year and brings together over 5000 scientists and doctors from all over the world who are experts in sports medicine and exercise science. This year the meeting was held in the home town of the ACSM – Indianapolis, Indiana. Unfortunately this year had very few tennis studies that were presented – only 3 presentations on tennis and 2 of them were case study examples. Fortunately hundreds of studies from around the world were presented on topics that have relevance to tennis athletes.  Below is a short summary providing some of the major highlights. If you are an iTPA member, please visit the Inner Circle Member site (http://www.itpamembers.org ) which has a much more detailed summary with abstracts of dozens of relevant studies for individuals who work with tennis athletes.

Effect of Competitive Match Play on Handgrip Strength in Division III Tennis Players

George L. Hoyt, III, Andrew L. Sykes. Methodist University, Fayetteville, NC.

A rather simple study was conducted looking at the effect of competitive matchplay on grip strength in In Division III male tennis players. The results of the study found that the athletes showed significant ratings of fatigue after the matchplay, but did not show any difference in grip strength. This study is interesting because it highlights that feelings of fatigue does not necessarily show a decrease in grip strength in the population measured.

The take-home is that subjective feelings of fatigue may not be always linked to actually a decrease in performance. It is important to understand that just because an athlete is fatigued, does not mean that they cannot continue to perform at a high level. Just be careful not to overdo this principle which can result in a situation of overtraining or a constant state of fatigue.

Here are some other take homes from research that was presented:

-       Functional Movement Screen (FMS) was shown to be a poor predictor of non-contact overuse injury in college athletes. However, performance on the lunge movement did show some promise in predicting injury.

-       An interesting study evaluating the walking/running mechanics of 2 and 3 year old children found that excellent runners vs inferior runners at that age had different mechanics. This may suggest the need to develop technique at a younger age than first thought.

-       A separate study also on 3 year old children found that children that took longer steps were able to throw a ball further. Also, children with higher motor abilities at that age (measured by scores on 7 different motor ability tests) could transfer muscular strength and power of lower limb to ball speed better than children with lower motor abilities.

-       In a baseball study focused on shoulder strength and power in high school baseball players, a six week training program focused on either:

1) controlled motion exercises (using bodyweight, dumbbells & tubing)

2) explosive motion exercises using constant air resistance machines

3) plyometrics (explosive motion exercises using 4-8lb medicine balls & tubing)

All three programs were effective in increasing shoulder strength & power. Group 1 was most effective in increasing shoulder strength, while groups 2 & 3 were most effective in increasing shoulder. Therefore, it would be acceptable to conclude that a combination of all three training programs would be beneficial for tennis athletes to improve strength and power in the shoulder region.

-       Heart Rate Variability (HRV) has inconsistent results in the literature and may not be a valuable tool to monitor overtraining

-       The Relative Age Effect (RAE) is attainment inequalities as a result of interactions between biological age and age-grouping procedures. In simple terms it is when an older kid (i.e. someone born in February is perceived to be more athletic than a younger kid (i.e. born in December) and chosen for teams or talent squads over the younger kid. A very good study found the influence of the RAE varies across age groups, but is most pronounced  between the ages 9-12. This is very important for coaches and parents to understand that during this time period, a 6-12 month difference in birth month can have a major impact on perceived sports competency.

-       When working with older adults higher speed resistance training (i.e. power training) improves peak power but also shifts the point at which peak power was produced to lower external resistances. This is beneficial for older populations.

-       In a different study also focused on power training in the older population, functional fitness is positively influenced by muscular power.

-       Consumption of leucine-enriched essential amino acids mixture suppressed exercise-induced muscle damage and muscle soreness (DOMS), and aided muscle recovery.

-       In college athletics the majority of the athletes use at least one dietary supplement. However, the overall nutrition and dietary supplement knowledge is inadequate.

-       A study looking at basketball camp found that parents descriptions of an optimal motivational environment involved focusing children on their effort, improvement and positive interactions with other campers and coaches.

Photo credit: https://traineracademy.org/

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.