By Patrick Aubone, CTPS & Dr. Mark Kovacs, CTPS, MTPS

             
Headed into the professional clay court season, common perception is that in tennis surface matters. As we get older, clay courts are the surface of choice. “It’s easier on the body” is the most repeated phrase. “Hard courts hurt my knees and my back” is often heard. But what if the injuries were not a result of the playing surface?  Most players over time get some type of overuse injury. Whether it’s the playing arm, the back, or the knees and ankles, everyone gets “niggles.”
           
A recent 2016 study in Netherlands evaluated 4 different surfaces and their injury rates over a 6 month period. Hard courts, clay courts, sand filled artificial grass and red sand filled artificial grass were used. The average age of the participants was 49 years old. 20,000 adults were invited to participate, 18% (3656) participated. There were 4047 injuries (53%) reported by 1957 participants. 80% of the injuries were overuse injuries and 20% were acute injuries. Participants who played on multiple surfaces suffered from overuse injuries compared to those who played on one surface. The researchers concluded that there was no significant injury prevalence of injury with the different surfaces.
 
This study shows that unless a player suffers a freak injury such as Bethanie Mattek-Sands at the 2017 Wimbledon or David Goffin at the 2017 French Open, the grand majority of injuries are due to overuse and not surface type. Essential to maintaining a healthy body is rehabbing minor injuries and strength training to prevent injuries. Rest is vital for the body. More is not always better.
           
Another study evaluated the influence of tennis court surfaces on player perception and biomechanical response. The researchers noted that there was a difference in the way players stood on a hard court compared to a clay court. Players on a hard court were in a more upright position. This allowed the athlete to be more on their toes in anticipation of sliding. They did note that players with previous clay court experience may experience a reduction of injury as a result of reduced loading on the knees and lower limbs.
           
Research is clearly showing that playing surface has limited correlation with injuries in tennis. The injuries reported were preexisting injuries. Past injuries from other sports or accidents can be exacerbated because of the start/stop nature of the sport. The forces generated can place extra stress on the body and cause flare ups in injuries that were not properly rehabbed
So how much is too much in professional and recreational tennis?
           
Professional players travel 25-35 weeks a year between tournaments, preseason camps, and home visits. Recreational players play between 2 and 3 times a week. While some individuals can argue that Courier, McEnroe and Lendl all played 85+ matches in the past, there are many variables that have changed. For recreational players, you have to worry about outside stress from home and work. The professional athletes are stronger, faster and fitter than ever. Matches are going 4+ 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. In recreational players recovery can take a few days depending on how much outside weight lifting and endurance training is done. Technology has played a part in developing more powerful racquets allowing players to hit harder and add more spin to the ball.  
 
3 Takeaway points

1. Injury prevention begins before you step on court and does not stop when you leave the court. Stretching, foam rolling, dynamic warmup all help.
   1. Basic Injury Prevention Exercises for Tennis http://itpa-tennis.org/itpa-blog/basic-injury-prevention-exercises-for-tennis
2. Stress Management – outside stressors such as work and family can have a negative impact on the body. Meditation, reading a book or any activity that activates the parasympathetic nervous system will greatly reduce stress levels.
3. Technology- USE IT! With the advances in technology today there are a lot of tools that can speed recovery not just from an injury standpoint but also after a practice or match. Just make sure you use technology that has a track record of success and has evidence based support.

​Here are another few nice resources from the iTPA
Are You Helping or Hurting Your Young Tennis Players? - http://itpa-tennis.org/itpa-blog/april-19th-2013
 
Sources:
The influence of tennis court surface on player perceptions and biomechanical response
https://www.ncbi.nlm.nih.gov/pubmed/26699792
 
Injury rates in recreational tennis players do not differ between different playing surfaces
https://www.ncbi.nlm.nih.gov/pubmed/28209569

Common sports injuries in young tennis players
https://www.ncbi.nlm.nih.gov/pubmed/9777684


Alternating Hot and Cold Water Immersion for Athlete Recovery: A Review
http://www.sciencedirect.com/science/article/pii/S1466853X03001226

Preventing overtraining in athletes in high intensity sports and stress recovery management
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2010.01192.x/full

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 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.

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

               Keep Kids in the Game for Life Through the STOP Sports Injuries Campaign

                              Healthcare and, Business Leaders, and Professional Athletes Join Forces to  Help
                                                                    Young Athletes Play Safe and Stay Healthy

Atlanta, Ga. –– Today, leaders at International Tennis Performance Association are coming together with the American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Medical Society for Sports Medicine, National Athletic Trainers’ Association, National Strength and Conditioning Association and Safe Kids USA to promote the STOP Sports Injuries campaign. 

The campaign educates athletes, parents, athletic trainers, coaches and healthcare providers about the rapid increase in youth sports injuries, the necessary steps to help reverse the trend and the need to keep young athletes healthy. The STOP Sports Injuries campaign highlights include teaching proper prevention techniques, discussing the need for open communication between everyone involved in young athletes’ lives, and encouraging those affected to sign The Pledge to be an advocate for sports safety. The campaign website and pledge are available at www.STOPSportsInjuries.org.

Sports injuries among young athletes are on the rise.  According to the national Centers for Disease Control and Prevention (CDC), high school athletes, alone, account for an estimated two million injuries, 500,000 doctor visits and 30,000 hospitalizations every year. 

The iTPA is excited to join this important campaign, as a major emphasis of our education is focused on preventing and limiting injuries in young tennis players,” said Dr. Mark Kovacs, iTPA Executive Director.

The high rate of youth sports injuries is fueled by an increase in overuse and trauma injuries and a lack of attention paid to proper injury prevention. According to the CDC, more than half of all sports injuries in children are preventable.

“Regardless of whether the athlete is a professional, an amateur, an Olympian or a young recreational athlete, the number of sports injuries is increasing – but the escalation of injuries in kids is the most alarming,” said Dr. James Andrews, former president of the American Orthopaedic Society for Sports Medicine (AOSSM) and STOP Sports Injuries Co-Campaign Chair.  “Armed with the correct information and tools, today’s young athletes can remain healthy, play safe, and stay in the game for life.”

Supporting the STOP Sports Injuries campaign are the country’s leading sports medicine organizations along with professional athletes and business leaders who have signed on as members of the campaign’s Council of Champions. This Council will help raise additional awareness about this growing epidemic of youth sports injuries.  Some of the founding members of the Council include former Olympic champions Christie Rampone, Eric Heiden and Bonnie Blair, professional golfer Jack Nicklaus, NFL Hall of Fame quarterback Bart Starr, MLB baseball player John Smoltz, NFL Hall of Fame defensive end, Howie Long, and Heisman Trophy winner and St. Louis Rams quarterback Sam Bradford.

 “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

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.