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

Practice may be the most important part of playing tennis but recovery is just as, if not more, important in order to stay injury free. Injuries increase every year. Tennis elbow makes up for 50% of arm injuries in recreational tennis. Plantar fasciitis and knee tendonitis are other common injuries found in tennis players at both the competitive and recreational level. Technological advancement in the last 10 years has helped recreational and professional athletes increase recovery times post practice/match. As a recreational athlete you want to be able to play as much as possible and stay injury free. Below are the top 6 bang for your buck ways to decrease injuries and increase performance.

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1. Stretching Routine – A stretching routine can take as little as 4 minutes or as long as you want. Getting a good stretch post match or practice will not only help with muscle tightness the following day but will also increase muscle range of motion. A simple routine including 4-6 exercises completed for 30-60 seconds at a time for 1-3 rounds will help in numerous ways with muscle flexibility.

 

1. Foam Rolling – The foam roller might be painful but your body will thank you for it afterwards. The soft tissue massage provided by the foam roller also helps improve blood flow and reduce stiffness. Research shows that foam rolling post practice or competition can help reduce the feeling of fatigue and reduce the soreness in your muscles.

 

1. Muscle Stimulation -  Are now made available to the public at an affordable price. It is commonly used to treat various issues in the recovery space. A decade ago it was common to utilize ice as a prevention treatment after training. Now using electrical muscle stimulators and other blood flow focused devices has become a more appropriate and common technique to help speed recovery.  Here is some info on ways to utilize these technique on various parts of the body  -  http://mark-kovacs.com/marc-pro.html

 

1. Sports Massage – A massage is probably the most commonly used recovery/relaxation technique in sports. If you have ever had a massage you know the body “feels” great once it is completed, but is it worth your time and money? Current research shows that a massage as a modality does not improve recovery or that it benefits performance. Does that mean you should not do it? Absolutely not! If you feel like getting a massage after a match or practice will help get the aches and pains out then do it.

 

1. Recovery Boots - These techniques have become very popular over the past few years due to the portability and ease of use. The concept revolves around compression followed by relaxation around the muscles involved. The basic premise focuses on vasoconstriction followed by vasodilation of blood cells. The goal is to increase oxygenated blood to the area while moving deoxygenated blood away. Here are two companies that provide the technology and are used by athletes on a regular basis.
   1. Recovery Pump -https://www.rpsports.com/recoverypump  
   2. Normatec –  https://www.normatecrecovery.com/how-compression-works/how-and-science/

 

1. NSAIDS or Nonsteroidal Anti-Inflammatory Drugs – NSAIDS are probably the most commonly used of all the above modalities. A lot of players will take some before, during, and/or after a practice or match. Research shows that in the short term there are benefits in pain reduction. The long term risk may involve increase risk of cardiovascular disease, gastrointestinal and renal problems.  The short term effects of taking NSAIDS will allow you to practice discomfort free but taken over the long term on a consistent basis is not recommended. Below are a few articles of interest related to the topic of NSAIDS in athletes.
   1. Bring on Exercise, Hold The Painkillers https://www.nytimes.com/2017/07/05/well/move/bring-on-the-exercise-hold-the-painkillers.html
   2. International Olympic Committee consensus statement on pain management in elite athletes - http://bjsm.bmj.com/content/51/17/1245

Here is a link to another older blog post dating back to 2012 from the International Tennis Performance Association discussing recovery modalities that is another great resource http://itpa-tennis.org/itpa-blog/tennis-recovery-some-simple-terms
 
All of the above mentioned modalities can help increase performance and decrease injury risk. Some have more benefits than others. It is up to you to pick which ones work best for you and combine it with your daily routine to get the most of your tennis playing experience.  
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Sources:
https://pdfs.semanticscholar.org/3697/9adb857bd0e925268684acd86d9d94077008.pdf
http://journals.lww.com/nsca-jscr/abstract/2014/01000/the_effects_of_myofascial_release_with_foam.8.aspx
https://www.fitmasterfreddy.com/data/blog/bloggen-mei/macdonald-2014-foam-rolling-as-a-recovery-tool-after-an-intense-bout-of-physical.pdf
http://journals.lww.com/nsca-jscr/Abstract/2009/12000/Comparison_of_Swim_Recovery_and_Muscle_Stimulation.19.aspx
 

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

By Josh Bramblett, iTPA Staff

The modern game of tennis continues to progress and evolve. There are numerous ways for any player at any skill level to participate. Physicality of tennis continually grows along with the demands placed on the body. The focus of the game has changed from finesse to power and speed.

The primary skills needed to play tennis are racquet and ball handling skills along with strokes. Even if a player has fantastic strokes these attributes are not enough to overcome a top-notch opponent. A high level of physical fitness is required to take the game to the next level. “Increasing evidence suggests that motor skills such as power, strength, agility, speed, and explosiveness, as well as mental strength, and a highly developed neuromuscular coordinating ability correlate with tournament performance.” (Fernandez)  Non-conditioned athletes can impair all other tennis specific skills such as technique and tactics if fatigue sets in early into the match. A great article was published a few years ago by Dr. Jaime Fernandez-Fernandez in the Strength & Conditioning Journal. Here is a short summary providing the major practical aspects:

Match activity during tennis play

A tennis match consists of short 4-10 second spells of high intensity exercise interrupted by 10-20 second periods of recovery. Further recovery of 60-90 seconds appears at changeovers. An average tennis match lasts about 1.5 hours. Of this time, a relatively small percentage is effective playing time. Players can run anywhere from 1,300 to 3,600 meters per hour of play depending on the levels of players. Take this information into account when scheduling training.

Factors affecting match activity:

• Court Surface
• Tactical Behavior
• Gender
• Thermal Stress

How to apply this information to a training program?

1. Training players should focus on performing high intensity exercise and recovering quickly. This is because the body gets its energy from anaerobic and aerobic pathways. Therefore, it is beneficial to perform aerobic and anaerobic training. For example, running sprints one day and running several miles the next.

2. It is important to train one’s aerobic capacity because a larger portion of energy needed can be supplied aerobically. This allows players to work at higher intensities for longer periods of time preventing fatigue.

3. Most of a tennis player’s training is focused on low to moderate intensity exercise. These exercises include “technical and tactical on-court training”(Fernandez). Therefore, additional high intensity aerobic exercise must be incorporated into training. Increasing the rate of rise in oxygen uptake is the goal. This can be accomplished by interval training.

Effective training is planned for players to use maximal effort for periods of less than 10 seconds with rest periods long enough for players to replicate maximal or near-maximal effort.

4. Develop a hydration schedule. While every player is unique, all players can take advantage of some general guidelines. While playing in competitions players should drink at every change over drinking anywhere from 1.2-1.6 Liters per hour. It is also recommended players drink a combination of water and sports drink.

5. Acclimatizing to hot humid conditions is critical. Acclimatization can help prevent major physiological problems and heat illness during competition. At least 2-3 days of preparation in hot/humid environments can help before competitions.

Feel free to share any specific exercises for interval training! *iTPA Members: A much more detailed version of this post is now on the iTPA Inner Circle Member Only Website.

References

Fernandez, J., Sanz-Rivas, D., Villanueva, A. (2009). A review of the Activity Profile and Physiological Demands of Tennis Match Play. Strength and Conditioning Journal, 31(4), 15-25.

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.

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

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