by Doug Eng EdD PhD, MTPS and Bharathan Sundar

TESTING UNILATERAL POWER
Measurement of initial leg power can be correlated to leg strength. Hewit et al. (2012) tested single leg countermovement (SLCM) jumps vertically (SLCM-V), horizontally (SLCM-H), laterally (SLCM-L) with either legs. The largest leg discrepancies were SLCM-L. Lockie et al. (2014) found some correlation between lateral power and COD but lateral jumps were not the strongest predictors of the COD test. Young et al. (2002) found that COD was related to the outside reactive leg strength. For example, athletes averaging 24% stronger in the right leg were 4% faster moving to the left; moving to the right was not correlated with leg strength. Lateral movement due to unilateral leg strength was not considered a factor unless there was a significant strength difference between legs. In addition, Young et al. suggested reactive leg strength was a greater factor than concentric leg strength. It was suggested that technique and perceptual factors also affect lateral speed. Both studies (Lockie et al., 2014; Young et al., 2002) look at linear speed with 20-60° as the range of COD which represents more traditional cutting in team sports. A test for 3 m COD and acceleration (CODAT) was devised using 45˚ and 90˚ COD (Lockie et al., 2013).

As opposed to many field sports, tennis involves significant movement back to the origin which implicates many 180° CODs. Therefore, unilateral leg reactive strength might be a greater factor in tennis. Hoppe et al. (2014) indicated high acceleration and deceleration with 180˚ COD was a major characteristic of tennis movement. Habibi et al. (2010) found single leg hop power was correlated with 10 m sprints. It was found that a triple single leg hop was even a better predictor for 10 m sprint times. That suggests reactive strength in landing with rapid muscle contraction and stored elastic energy is critical. In addition, the explosiveness movement from a previous jump, hop or bound is more critical for acceleration than from a standing position.

In tennis, lateral speed is initially generated after an athlete makes a modest vertical jump or split-step with a resultant lateral bound. Although Lockie et al. (2014) suggested lateral jumps were not the strongest predictors of 20-60˚ COD ability, 180˚ COD were not investigated. Therefore, lateral jumps may still remain a predictive test for tennis. By definition, a hop is when the take-off and touchdown is done off the same leg and the distance covered is relatively small. A jump is either one- or two-legged but the distance is relatively greater. A bound is when the take-off leg and touchdown leg are opposite legs. With that in mind, single leg lateral bounds for both legs can show promise for improving contralateral force production.
The well-known Pro Agility Test and 3 Cone Drill has been shown to be correlated to 10 m sprinting (Mann et al., 2016). Both can be useful for tennis testing since they utilize 180˚ COD and acceleration/deceleration. In addition, as Young et al. (2002) and Habibi et al. (2010) suggested, reactive unilateral leg strength can be important. Figure 1 shows a simple single leg lateral jump (SLLJ) in which a countermovement is allowed and the takeoff and touchdown leg are the same. Measurements should be on the outside edge of the foot or shoe (green line). Lateral bounds in both directions should be executed and measure from a best of three bounds.

EXERCISES
 
Wall Drives and Runs
 
Wall drives and runs are shown in Figures 3 and 4. In the crossover wall drive (Figure 3), the athlete crouches and leans with the inside shin angled towards the wall. A cross-over step is taken with the outside leg. The athlete can repeat in sets of 10 and then switch direction and legs. The lateral wall run is shown in Figure 4 has the athlete more upright. This exercise can be done with different number of steps: a) 1 step - lifting only the inside leg, b) 2 step, c) multiple step. A coach or another athlete can call the number of steps, e.g., “three,” or “four.”
 
Lateral Wall Drills
The single leg lateral jump test is often used as a repeated bounding exercise alternating legs (aka “alley hops”). Another set of simple movement exercises are wall drives and runs. Many athletes have trained with forward wall drives where the athlete faces a wall and leans forward at  45˚ with hands outstretched supporting the body against the wall. For tennis, lateral wall drives and runs are specifically applicable. Lateral wall drills allow the athlete to shift the center of gravity applying horizontal lateral force, while maintaining balance using a wall or fence.

The simplest drill is the lateral wall hold using either leg (Figure 3) which is also good for core and hips strength. The athlete leans sideways into a wall (fence is more difficult). The athlete lifts either leg with the knee up to the hips and maintains the leaning position for a few seconds and then may switch the legs and hold that position with the knee up for a few seconds. The athlete repeats leaning the other side. Once the athlete is comfortable with the positions, the athlete can do a second drill: lateral wall runs with sets of 2-6 rapid alternating steps. Repeat for a set of 6-8. Then the athlete does another set on the other side.

The second wall drill (Figure 4) is the load and crossover hold which brings the outside leg across and up. Athlete should start low with the outside leg at an angle and ready to push off. Both arms can be placed on the wall or fence and movement is more powerful and angled.

In Figure 5, the crossover load and lift applies greater force. Figure 5 shows loading off the outside leg. Balance is maintained only using one leg and the wall. Either inside or outside leg may be used in loading. Drive upwards and bring the knee above the hips.

Hops + Bounds + Sprints
 
Most split-steps in tennis involve a vertical component with landing first on the leg farther away from the intended direction and the other leg taking a lateral step with the toe pointing toward the intended direction. For training, the following exercises are useful:
 
Figure 6. Vertical single leg hop + lateral bound

Figure 7. Lateral single leg hop + lateral bound

Figure 8. Vertical single leg hop + lateral bound + short sprint opposite direction

Figure 9. Lateral single leg hop + lateral bound + short sprint opposite direction

In these exercises, the single leg hops mimics the initial split-step landing but develops GRF for the lateral bound. An important concept is developing appropriate leg stiffness with short ground contact time (GCT) (Ferris et al., 1999; Morin et al., 2007). It is important to note both leg stiffness and GCT affecting split-steps and the initial takeoff and touchdown steps may change on clay courts (Ferris et al., 1999). In the drill, the athlete shifts weight inside after the lateral bound to sprint in the opposite direction of the bound. Exercises shown in Figures 6 and 7 can be done in sets of 12-20 reps. Exercises in Figures 8 and 9 can be done in sets of 6-10 reps resting between reps. Exercises in Figures 8 and 9 could be combined with additional COD agility movement for tennis-specific repeated sprint ability (RSA).
 
Contrast Resisted and Assisted Training
Contrast training refers to varying loads with similar movement or exercises. For speed training, often contrast training involves only slight changes in force (Dintiman, 2020; Mann & Murphy, 2018) since larger forces can alter mechanics to alter movement. A classic contrast training is performing the same resistance exercise (e.g, leg press) with different loads. A classic contrast training for speed involves running uphill and downhill but at modest angles so not to alter running mechanics (Dintiman, 2020). Bungees and resistance bands can provide assistance or resistance forces without dramatically altering lateral movement. Shown in Figure 9 shows the bungee-assisted lateral explosion. Attached a bungee high so it pulls the athlete laterally but also upwards. Use a split-step into a crossover step and sprint 2-3 m. Figure 9 shows the bungee-assisted exercise. For bungee-resisted lateral explosion, attach the bungee low on the fence (see Figure 10). The athlete can split-step into a crossover step, focusing on a more upwards pull upwards and away and from the fence.
 

CONCLUSIONS
Tennis movement is mostly lateral but athletes may have differences in movement to either side which should be trained. Movement in tennis is mostly short accelerations and decelerations rather than top end speed. In this article, specifically lateral acceleration was tackled from a physical off-court training with regards to technical training. Tennis players who use the forehand weapon to cover most of the court often run farther for the forehand than backhand, which requires higher acceleration to the forehand. Focus in this article was on physical training with some technical training. Physical training should require elastic unilateral reactive leg strength training and COD movement. Little research exists on unilateral reactive leg strength training which has implications in tennis. A series of tests were recommended but need to be correlated to actual lateral speed and acceleration in future studies.

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Hoppe, M. W., Baumgart, C., Bornefeld, J., Sperlich, B., Freiwald, J., & Holmberg, H. C.
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A common problem seen in tennis players is cramping.  Cramping is seen during Grand Slams tournaments when matches are played in hot and humid conditions. They are very common to see in longer physical matches. In lower levels of tennis such as league or recreational play it is common due to lack of practice time during the week or lack of fitness.  A lot of the time cramping is preventable with proper hydration, nutrition and physical preparation leading into a match or tournament.

1. Hydration - Dehydration is one of the main causes of cramping. The majority of athletes walk into a match or practice already dehydrated. During a match an individual can lose between 1.5 to 3 liters of sweat. The main element lost in sweat is salt. An easy test to see how much an individual sweats is to wear a dark colored shirt. Once the practice or match is complete look for white stains around the shirt, as this is a sign of the amount of sodium lost during the practice or match. The more white (salt) the shirt has is the heavier a sweater he/she is. Consuming a sports drink such as Gatorade will help prevent cramping. If he/she does not like a sports drink, adding salt to your water or drink of choice is a good way to substitute the sodium lost during play. Recent research has shown that drinking Alkaline water also helps keep a higher PH level in the body. This allowed for more efficient utilization of lactate after high intensity exercise. Also remember that hydration begins before the match or practice.
   
   
2. Nutrition – Nutrition plays a big role in an athlete’s performance. Tennis is a high intensity sport with short points (5-20 seconds) and long breaks (20-25 seconds). Carbohydrates are very important for a tennis player. They provide immediate energy during a match. Gel packets and sports drinks are commonly seen being consumed by tennis players because they provide quick energy. Recent research shows that consuming 16g of glucose improved endurance by 14% compared to drinking only water. A suggested consumption of 20-90g of carbohydrates is recommended per hour. This all depends on your ability to digest a gel or sports drink during competition. It is also important to consume enough calories before and after playing. Consuming the right balance of carbohydrates, fats, and protein in your diet is important to have enough energy throughout the practice or match and prevent cramps.

 

1. Physical Preparation – The final piece to the puzzle is fitness. For most professional athletes this is not a problem, but for recreational players it can be. Most recreational players participate in a league or play with friends once or twice a week. The problem is that if they don’t do any work in the gym or supplemental fitness when they aren’t playing tennis they run the risk of cramping during longer matches. Tennis is a high intensity sport. Combined with the pressure of winning and possible hot and humid conditions there is a high risk of cramping no matter the level of he or she competes in. He or she should try and exercise 2-3 times a week outside of a practice or match in order to improve their fitness levels. This will help prevent cramps muscle fatigue which can lead to cramping.

 

1. Emotional & Mental Preparation – Most cramping occurrences happen during matches and competitive environments. Therefore, it is very important to not overlook the stress response and the impact it has on muscle function and physiological responses that contribute to the exercise associated muscle cramping timeline and mechanical process. Working on breathing routines, focusing on the process rather than the outcome and having overall general routines is very beneficial in this perspective. Here is a great resource that has many lesson plans and practical examples on how to improve the emotional and mental skill development  https://www.amazon.com/USTA-Mental-Skills-Drills-Handbook/dp/1606790803
   
   

In conclusion, the 4 main causes of cramping are a lack of hydration, nutritional deficiencies, physical preparation and emotional/mental preparation.

​Here is another great resource from the iTPA on Cramping in Tennis:
Cramping in Elite Level Tennis - http://itpa-tennis.org/itpa-blog/cramping-in-elite-level-tennis
Calambres musculares en el tenis http://itpa-tennis.org/itpa-blog/muscle-cramping-in-tennis-espanol
 
Resources:
https://link.springer.com/article/10.2165/00007256-200434010-00002
https://www.ncbi.nlm.nih.gov/pubmed/29158619
https://link.springer.com/article/10.1007/s40279-014-0148-z
http://www.sciencedirect.com/science/article/pii/S1440244003800051
 

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.
​
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
​
http://www.atpworldtour.com/en/performance-zone/win-loss-index

By Dean Hollingworth, CTPS


It’s been a little over a month since I’ve come back home from the US Open. It took a bit of time to settle back into my routine and gather my thoughts on what was a great experience. Having gone over the month that I was on the road, at three different tournaments (Cincinnati, New Haven and New York), I found myself wanting to share my professional experience with others that have the goal of traveling with a tennis player. Training concepts remain consistent whether you are in your own stable home environment or on the road dealing with different gyms and surroundings each week. On the other hand, having the ability to deal with an always changing environment is where the challenge lies.

Here are three points that every strength coach should adapt to their training concepts and philosophies in order to succeed:

1.      Preparation: Like the famous quote says “By failing to prepare, you are preparing to fail.” -Benjamin Franklin. This is true at any level of coaching, whether on the road or not, but becomes increasingly more important at the higher levels of athletics. Do not expect to be successful if you plan on showing up and figuring out what to do within minutes of a training session. Elite athletes need to be precisely challenged for positive changes to occur. A plan must be set forth with goals and objectives that you, the coaches and the player have gone over. Without this path in front of you, the likelihood of spinning your wheels in one spot is inevitable. This means having a long-term plan with short and long-term goals. Weekly and daily planning is crucial. Being prepared for every training session is necessary in order to focus on the athlete and not guess at what you are going to do next. A good athlete is capable of seeing who is and who isn’t prepared. This preparation will give you and the athlete confidence in the training.

2.      Be flexible: So with all this discussion of preparation, now you have to be able to adjust on the fly. One of the challenges is that with every city comes new surroundings. Mostly it has to do with adjusting to the gym that you will have access to for training. This includes the warm-up, fitness training and recovery work. Each site will present you with different problems including space, crowdedness and lack of equipment. It’s great that it is supposed to be a box jump day, but what if there are no boxes, or a leg training day and the heaviest dumbbell is 25lbs. This is where preparing ahead and being malleable is crucial. This can be achieved by trying to find facilities to suit your training or by being creative and challenging the athlete in other ways to obtain the desired results. What also helps is bringing your own equipment (tubing, TRX, cones, ladder, recovery tools, etc.) to help out in difficult situations. It’s about making the best of a situation that is not optimal.

3.      It’s all about the detail: To me, attention to detail is what separates good coaches from great ones and good athletes from great ones. Yes, the planning should be very detailed, but I see detail in another light, detail to the athlete’s training and surroundings. When in a gym setting with your athlete, the gym is your office. When in your office, the person you are with should get all the attention. Focus should be on the athlete and not others around you. No detail is too small not to realign or correct. Other details to be taken into account are the sport specific needs of the athlete. This can be hydration, food consumption, appropriate rest and recovery needs. Understanding their individual differences, rituals or quirks assist in helping them achieve optimal performance. The difference that separates a lot of these athletes is often extremely small. In order to make up that difference, the details should be focused on and adjusted for success.

This was my third time traveling with a player and of course it was easier than the first. Like it is often said, “if I knew now what I knew then,” well now you do. Incorporate these tips and let them help you become the best coach possible. In the end everyone wins.

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

By Oliver Statham, CTPS,  iTPA Staff

Tennis is one of the most popular sports in the world with participation in more than 200 countries affiliated with the International Tennis Federation. Like many other sports, playing tennis places participants at risk of injury, and although many injuries that occur in tennis are common to other sports, tennis does have a unique profile of injuries. For example, there is no time limit in tennis, and so the players can be battling out on court for hours, producing hundreds of short, explosive bursts of energy. The aerobic and anaerobic requirements, combined with the variety of strokes and movements, induce a unique profile of injuries (figure 1). For the professional tennis player, the consequence of injury results in a lack of income and missed opportunities to gain and sometimes protect precious world ranking points in order to compete at the highest level. If the injury isn’t managed right, it may increase the servility of the injury or cause physiological changes from time off training that can take quite some time to regain (figure 2). On the other hand, a good rehabilitation presents a rear opportunity to review, recondition, and improve athleticism and general robustness. Treating injury as an opportunity is often a helpful mind-set to offer injured athletes as coaches navigate them through a difficult and uncertain period.

To begin the process of recovery, this article will firstly highlight the importance of an integrated approach to injury management for all support staff to ensure the best possible outcome is achieved, and then go on to provide some management strategies that should be incorporated during the design and progression stages of a rehabilitation program.

Planning the Process

When a player gets injured, it is of little use for him/her to start thinking about injury management because it will only lead to precious time lost and mistakes made through inadequate preparation. What is important at this time is the player's confidence in the plan of care as well as the performance team that puts the player at the heart of the rehabilitation process. This may involve:

·         Coach

·         Physician

·         Strength and Conditioner

·         Psychologist

·         Nutritionist

·         Physiotherapist, Chiropractor, Athletic trainer

Unless the player is a world-class professional or on a prestigious college tennis team, most players usually involve a few individuals; however, the one person who does not vary and should remain at the forefront of the management process is the player. Regardless of whom is involved as a member of the performance team, it is vital that the roles and responsibilities of each member are clarified and that they combine as a unified interdisciplinary team, not just a multidisciplinary team! This will prevent confusion from many separate opinions and outcomes, because many aspects of rehabilitation are interrelated and consequently there will be elements of crossover in terms of input at any given time. An interdisciplinary approach will ensure that there is no uncertainty among the performance team and promote the philosophy of a "One Athlete-One Program”.

Managing the diagnosis

Injures present a time of uncertainty and can be very disheartening. It is little wonder the first question usually asked by the player is 'how long until I can get back on court?' or 'do you think I'll be ready to play the ___ tournament?' At this point, the appointed health professional should manage the player's expectations while providing an accurate, realistic, positive answer. In which case the player should receive the following.

1.      A judgment that is not influenced by the pressures of those who stand to gain e.g. contracted practitioner’s attachment to the player’s on-court success.

2.      A correct diagnosis with discussions involving other practitioners in the team before providing narrow time lines to return to play.

3.      A best and worst case scenario along with a detailed explanation on what is involved before returning to court or competition.

4.      Be provided with a clear, criteria-driven program that includes input from all relevant members and accounts for external life priorities and pressures, and athletic capabilities that need to be developed.

But there is little point of the player knowing all this if he/she is not mentally ready to commit to the rehabilitation process. The next stage is for the player to gain a level of acceptance and desire to move forward. Usually the player's major barrier and source of anxiety is uncertainty, particularly in the diagnosis. It is therefore critical the explanation of the injury is explained fully and is understood by the athlete. This may involve multiple explanations to best suit the players learning style and for the information to be accepted. Adequate time needs to be given as well as opportunity for the player to ask questions.

Thinking in terms of abilities, not disabilities

A good rehabilitation program is drawn from an in-depth understanding of what body parts can be pushed, for how long, and why. This highlights the importance of developing a interdisciplinary approach as opposed to the traditional medial approach. The focus should not just be on what the player cannot do at this time; instead, emphasis should be placed on what the player can do. It is this approach that unites the coaching staff, athlete and strength and conditioner with the medical team so that the player can gain more out of the recovery stage.

Injury as an opportunity

Injury can offer an opportunity to review the player's capabilities as a whole, without merely focusing on the injury. A holistic approach at this time provides the opportunity to improve

·         Physical capacities (e.g. upper body strength, aerobic power)

·         Tactical awareness

·         Emotional and psychological resiliency

·         Movement efficiency

·         Injury profile

For these elements to be improved requires close communication between all involved in the interdisciplinary team on all components to meet the player’s needs without compromising rehabilitation outcomes.
 
Design and delivery

All of the above amounts to nothing if the practical elements (that is, the delivery of the rehabilitation program), lacks precision and effectiveness. All members involved in the performance team have essential roles and responsibilities in the planning and delivery of the rehabilitation process. The stages of rehabilitation are divided into staged phases of escalating demand (such as acute, low load, moderate load, high load and return to tennis sections). in conjunction with consideration to pre-habilitation once the athlete has returned to full function. The program format should be clear to all members involved with a structured pathway demonstrating where the player stands currently in the program and where he/she needs to be in order to move to the next stage. The progress stages of the program should also be manageable stepping-stones that ensure the player has a series of win. In order for a successful progression there needs to be close networking between the athlete and support team to determine what tennis-specific exercises concern the player.
 
Importance of periodising rehabilitation

Adaptation to an imposed demand requires both stimulus and recovery. We know and apply this principle when designing periodised training programs, and this should be the same for periodising rehabilitation, yet this is not always the case. For example, a player might be assigned a daily upper-body strength program in order to not load an injured knee, or extra running if the player has a shoulder injury. This type of approach that has not strategic, long-term view of loading may overwork the player and cause him or her to become stale when they return from injury. To avoid these types of continuously dreary and ineffective programs, start by estimating the return to play date and then work backwards, incorporating low-, medium-, and heavy- load weeks. This will ensure all bases are covered and before competition prevent the player from losing his competitive edge.

Importance of exit criteria

The progression stages of the rehabilitation program should be judged on achievement formulated, objective exit criteria. This will provide a clear direction of player’s recovery status and minimize the likelihood of inappropriate rehabilitation drills, sequencing, volume and loads. Doing so requires a good understanding of how the tissues functions and become stressed, and players technical and technical requirements. Developing a clear road map to recovery with definitive exit points allows the performance team to be more aggressive with the program, while having the confidence to know where the boundaries lie, and therefore reducing the risk to the athlete.

Another important point to note is that the rehabilitation stages should not be based on time, but rather achievement of functional competencies. Although there are certain healing times for particular injuries, the performance team should stay focusing on the achievement of functional goals rather than passing time. For example, the right-handed player may take 10 days to recover from a minor right ankle sprain, but he/she can't demonstrate competency in decelerating when recovering from an on the run forehand. It is much better to develop a return to play criteria for the athlete to satisfy rather than cross days off on a calendar. Lets say the player with the minor ankle sprain can start with drills that involve change of direction. Speed should only be incorporated once the player can do the drills slowly; the player can perform the drills slowly once he/she can decelerate; the player can decelerate once he or she can run; the player can run once he or she can hop; and so on. This competency-based approach to the rehabilitation stages ensures a logical and methodical flow to tissue loading to make sure the body is ready to handle the stresses of match play once returning to competition.

In summary:

1.      Teach players to have a perspective that injury is an opportunity to build on what they can do, not what they cant, which will improve recovery times and provide the opportunity to review and develop the player.

2.      The rehabilitation process must be carefully constructed with clear exit criteria at each stage to ensure a timely, holistic, and safe progression.

3.      A “champion team” will always beat a “team of champions”. The rehabilitation process should include input from the whole performance team and be delivered as one plane to the athlete, demonstrating unity, a clear direction, and purpose.

The presentations by Dr.  Neeru Jayanthi focused on an areas of great interest to me which considered injury prevention in elite junior tennis. With my main philosophy being that tennis can help develop young people positively whilst having great interest in talent development, I was intrigued to listen to the session. Indeed one of the first points made was that coaches (45%) have the most influence on players wishing to train at a high level in comparison to the player (35%) and then the parent (15%). This straight away made me think with coaches being the most influential person determining how intensely the player considers to take the game, even with the best intentions are coaches educated to a level where they understand volume, levels of appropriate intensity and how growth effects a young person’s body? Indeed the thoughts of children not being miniature adults sprung to mind. Jayanthi went onto discuss a number of research articles he has published in recent years including considering risk factors for medical withdrawals from USTA National junior tournaments and training and sport specialisation risks in junior elite tennis players. A host of possible conclusions can be made from these two pieces of research. For example cumulative match scheduling and competition without adequate recovery and rest (approximately two hours) can be detrimental for junior tennis players. Despite this many systems across the world which rank and rate players are based on volume such as how many matches you win within a certain time period which ultimately may lead to excessive volume. Other conclusions were that players should consider delaying early specialisation until middle or late adolescence due to a potential increase risk of burnout and injury alongside playing only one or two tournaments per month, having adequate time away and recovery from the sport. Thanks must go to Jayanthi for his passion and drive to delivery outstanding research in this area of youth development.

There were a host of other fascinating presentations attended by myself and Mike James. Page Love delivered a session on nutrition focusing on recovery and reducing the potential risk of injury for tennis players. Much of the focus was on tart cherry juice and the antioxidant nature of this to reduce muscle soreness and aid recovery. Indeed this would be a very interesting research topic for anyone in tennis considering the benefits of tart cherry juice during intense match play and recovery. Ollie Stephens then considered the important factors when working as a team to develop competitive tennis players and Dr. Larry Lauer discussed bringing back players from injury. This lecture provided a great insight into the stages an athlete goes through when being injured, such as going through the grief stages and how a team can respond in a way to create a supportive, nurturing environment to help get the athlete back to full fitness. This included factors such as clear and transparent communication, education and listening to the athlete. Other excellent sessions discussed injury and illness data from the US Open for the past 15 years and the age eligibility rule and managing WTA players. Both gave a great insight to working with elite professionals.

The practical elements from USTA Head of Strength and Conditioning Satoshi Ochi, Director of Strength & Conditioning at the University of Georgia, Katrin Koch, and Spanish Director of Education for the iTPA Lalo Vicencio gave delegates an opportunity to actively get involved and take home tennis specific drills and exercises. Focus on these areas included the split step and the opening of the hip and initial step, footwork and agility movements and co-ordination exercises to use with both younger and older tennis athletes. It must be said that with the great range and diversity of presentations and break out groups unfortunately we couldn't make each one, but based on other delegates thoughts and reviews every researcher or practitioner must be recognised for their excellent delivery and information either on a coaching, sport science or medicine level.

Away from the presentations the forums provided delegates to ask questions related to tennis science and medicine questions with two themes. The first one focused on developing young healthy tennis athletes. Indeed the topics varied from ways in which to strength train, manage volume and nutrition such as supplementation. The second panel discussed working with elite full time tennis professionals. It was also a pleasure to hear Atlanta based ATP tennis professional Robby Ginepri give his opinions on how tennis has changed over the past decade since he began his career on the tour. There was great acknowledgement that sport science and medicine has a larger part now to play when developing players and this is due to the advancement of the game physically. Ginepri explained that within his academy sport science plays an important role with the use of physical conditioning and performance psychology and nutrition sessions. This gave me great confidence with me recently starting my own business (www.scienceintennis.com) which is a sport science business solely focusing on tennis.

Ultimately both Mike and I feel there were a number of take home messages for practitioners working in tennis to be aware off. First of all you have to know the game, be aware of the common areas of injury, the challenges both junior tennis and senior professional players face alongside understanding the uniqueness of how to train a tennis player. Secondly, every tennis player is different and knowing your athlete and allowing them to feedback to you and the team you work with is essential to develop a strong professional relationship and maximise their potential. Thirdly don't over complicate things, tennis is a difficult sport to plan and periodise for so use the most effective ways of training but keep things as simple as possible. It was clear that educating players, coaches and parents alongside communicating with and understanding the roles of practitioners who can help develop tennis players, reduce injury and enhance performance is essential, the goal of any of us working within tennis. 

Over 11 Hours of Presentations from the 2014 Tennis Medicine & Performance Conference available for download at the iTPA Dartfish Channel

http://www.dartfish.tv/CollectionInfo.aspx?CR=p90378c98277

Junior tennis injuries are starting to get more media attention as youth sport injuries have increased over the past decade; it is more common to see surgeries performed on young athletes for overuse injuries. Much of this media attention stems from other sports like baseball and football, but tennis is also one sport where overuse injuries is an area that every coach, parent, tennis performance trainer (TPT) and Certified Tennis Performance Specialist (CTPS) should hold a strong education. Many of these injuries, and even surgeries, used to be only performed on college and adult athletes. Fortunately for tennis, the average young tennis player experiences relatively few severe injuries and is considerably lower than many other sports [1]. However, overuse is a concern in competitive young tennis athletes. Although injury rates and types of injuries are not as well researched as in some other sports (i.e. baseball, soccer, etc.) some interesting data exists that can help us better understand young tennis athletes and the typical issues that they see. Over a multiyear period a major junior national tennis tournament 21% of participants sustained an injury [2]. Over the last few decades research has been inconsistent about where the majority of tennis injuries occur. Earlier research showed that a large percentage of injuries occurred in the lower body [3]. However, more recent research has showed that upper body and core injuries are becoming more prevalent [4]. This is likely due to the change in technique (more open stance movements and greater reliance of upper body in stroke production, the slower surfaces and new technologies in the racket and strings.)

One unique study involved a series of questions on training, technique, competition and other factors that was provided to all participants at the largest junior team tennis event in the US [5]. It was collected at 12 different locations and 861 junior tennis players completed the survey:

- 97% of individuals who completed the study

Gender breakdown:

• males-43% (356);
• females-57% (N=476).

Age: 10-17

As the goal of the study was to evaluate injury patterns and trends a clear definition of injury was important. “An event that forces a player to miss 3 or more consecutive days of tennis play, either practice or competition, or that requires medical attention from a trainer, therapist, or doctor.”

Major Findings From This Study

• For both the 12 and under and 14 and under age group the shoulder was the most often injured area. However for the 16 and under age group the back was the most commonly injured area.

• Only 51% and 54% (male and female) of respondents use free weights and only 38% and 39% use machines.

• Only 43% and 58% (male and female use medicine ball during training).

• 90% and 97% (male and female) use a double-handed backhand

• 20% and 22% (male and female) use an abbreviated/short service motion

• 83% of all players predominantly train and play on a hardcourt surface

• 81% of all injuries in junior tennis players were tennis related

• 51% of all athletes that reported an injury visited a Physician or Physical Therapist

Below are three charts that provide the breakdown of the location of injuries based on the three different age groups (12 and under; 14 and under; 16 and under).

When all the data was pooled together the following showcases the most common injury areas in the junior players who participated in this study (male and female combined ages 10-17)

Summary:

The shoulder and back are two major areas that need a greater focus in training and injury prevention programs. The high prevalence of hardcourt tennis play is something that needs to be taken into account when devising on and off-court training programs. The increase in injuries as athletes’ age through their junior career is also something that should be of major interest to coaches, trainers and administrators. More education is needed to ensure that appropriate understanding of volume and injury prevention programs are implemented to help reduce the likelihood of injuries in junior tennis players. This is something that requires good communication between tennis coaches, certified tennis performance specialists and parents to ensure that the young tennis players develop and optimize performance while limiting the occurrence of injury.

1.         Kibler, W.B. and M. Safran, Tennis Injuries, in Epidemiology of Pediatric Sports Injuries, D. Caine and N. Maffuli, Editors. 2005, Base, Karger. p. 120-137.

2.         Hutchinson, M.R., et al., Injury surveillance at the USTA boys' tennis championships: A 6-yr study. Medicine and Science in Sports and Exercise, 1995. 27(6): p. 826-30.

3.         Reece, L.A., P.A. Fricker, and K.F. Maguire, Injuries to elite young tennis players at the Australian Institute of Sport. Aust J Sci Med Sports, 1986. 18: p. 11-15.

4.         Winge, S., U. Jorgenson, and L. Nielson, Epidemiology of injuries in Danish championship tennis. Int J Sports Med, 1989. 10: p. 368-371.

5.         Kovacs, M.S., et al., Demogrpahic data and injury trends in American national junior tennis players. Journal of Strength & Conditioning Research, 2012. 26(1): p. S62.

by Josh Bramblett, iTPA Staff

Athletes and coaches must understand that tennis requires quick reactive responses in order to improve movement on the court. Tennis specific movement training must take into account the athlete’s strengths, weaknesses, and style of play. The movements of tennis players are different from many other sports. For example, the movement of a tennis player reacting to his opponent’s next shot is different from a wide receiver breaking from the line of scrimmage.

So what makes movement in tennis different from other sports?

In tennis the average point last less than 10 seconds. Recovery in between points lasts around 20-25 seconds and 90-second rest periods every two games. Knowing the style of movement in which tennis is played is critical to developing conditioning programs for high-level players. “Tennis players make an average of 4 directional changes per point but can range from a single movement to more than 15 directional changes on a very long point.”(Kovacs) It is normal for players to make up to 1,000 or more directional changes in a match.

The majority of tennis movements are side to side, which is important for trainers to focus on a player’s lateral acceleration and deceleration for developing ample movement ability on court. “In a study of professional players’ movement, it was found that more than 70% of movements in lateral direction less than 8% of movements in a backward direction.”(Kovacs) It is recommended that training time focuses 60-80% on lateral movements, 10-30% on forward movement, and only around 10% backward movement.               

The game of tennis is evolving as the speed and power involved are constantly improving. Due to increased speeds players have adapted their split step movement. The split step was originally describes as both feet landing at the same time, however resent studies have shown that athletes actually land first with the opposite leg to the direction that they will move toward. For example, a right-handed player hitting a forehand would land first with their left foot as the support stance and then the right leg lands with the right hip turned to the direction of the next step.

How can this information be used to train athletes?

Trainers and coaches must understand the movement patterns of tennis. The movements of tennis players are different from other sports. Strengthening and training lateral movement patterns is critical in developing tennis players at every level of the game – junior, collegiate, professional, adult recreational, adult competitive and senior players.

Here are some exercises to help with lateral training:

• Lateral movement with medicine ball (MB) catch-This exercise is great to simulate movement laterally. In addition the MB helps the athlete visually to accelerate and decelerate to the MB.
• Side lateral mini hurdle runs- This plyometric exercise has athletes laterally hurdle through a set of small hurdles. Once through, the athlete must decelerate, stop and hold for a few seconds, then resume the exercise the opposite way.
• Lateral resistive running- Once an athlete has appropriate strength then they should incorporate this exercise. Have the athlete put on the waist-band and attach the other end of the elastic band to the fence. Have the athlete side shuffle low to the ground keeping the upper body balanced as the lower body drives against resistance.
• T-line to S-line shuffle- Have the athlete start at the center service mark. Side shuffle to the singles line and then back to the service mark. This exercise is about the same distance an athlete will travel before having to change directions.

Example of a lateral tennis-specific training session:

Please check out the International Tennis Performance Association (iTPA) for education courses, tennis-specific fitness certification and hundreds of exercises and drills to help improve tennis-specific training www.itpa-tennis.org
 
Please share some other exercises that you have found to be beneficial in developing lateral movement!

References

Kovacs, M., (2009). Movement for Tennis: The Importance of Lateral Training. Strength and Conditioning Journal, 31 (4), 77-85.

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