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Original Research Mark S. Kovacs, Todd S. Ellenbecker, W. Ben Kibler, E. Paul Roetert, Paul Lubbers J Med Sci Tennis 2014;19(1): 19-23
Injury Trends in American Competitive Junior Tennis Players Abstract Understanding demographic data and potential trends from of national-level junior tennis players can assist strength and conditioning professionals in comparing their individual athletes to tennis norms based on age and gender. The purpose of this study was to analyze a series of demographic, technique, injury and training related questions in competitive junior tennis players. The data was collected during a major, combined gender, national team competition in the United States (age ranges from 10-17) a self-reported survey used and descriptive statistics were used to analyze the results. 41% of all respondents reported at least one injury per year. Approximately 1/3 of players injured once received a second injury that year. Females reported 57% of all injuries. As junior players age they reported more injuries: 12 and under age group (11%); 14 and under age group (28%); 16 and under age group (36%). The most commonly injured areas in order are: 1) back, 2) shoulder, 3) ankle, 4) knee, 5) wrist, 6) other. The results highlight the need for more focus of training (both on and off-court) that emphasis the back, shoulder, ankle, knee and wrist areas from an injury prevention perspective. The results from this study provide some important information about the trends seen in national-level junior tennis players in the United States. More injury data and further research is still needed in junior tennis players. Keywords: tournament, injury, elite performance, specialization.
Introduction Over the last decade more interest has been devoted to youth sport and the increased training and competition. In the tennis community this has certainly occurred and having a clear picture of the injury trends in junior tennis players is important from a research perspective, and also from a training and competition perspective. The average young tennis player experiences relatively few severe injuries. However, overuse is a concern and some researchers have stated that junior tennis players are at significant risk of injury, (1) yet these statements have been made based on limited research. More research is needed to better understand the type and amount of injuries and also causes and better methods of preventing injuries in tennis players. Although limited research has been performed on injuries in junior tennis players throughout training, some good information has been obtained during tournaments. (2) Very limited research is available on injury rates over the course of a year and the influence of training on injury rates, however, over a multiyear period at a major junior national tennis tournament
21% of participants sustained an injury. (2) Over the last few decades research has been inconsistent about which part of the body sustains the majority of tennis injuries. 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 and more prevalent.(4) Better understanding of injury data from large samples of junior tennis players can assist coaches as well as sport science/medicine staff in developing tennis specific training and injury prevention programs. The purpose of this study was to define injury patterns by anatomic location and to determine whether a link with other variables exists (e.g. training volume, tennis technique, court surface etc). These data could then be used to help promote future research into junior tennis injury rates and also prevention. Unfortunately a paucity of research exists in this area and much more research is needed to help improve the understanding of injury rates, causes, and potentially promote the development of prevention strategies in the future.
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Method The survey instrument was developed by the United States Tennis Association’s Sport Science Committee which is comprised of experts in tennis medicine and science including physical therapists, medical doctors, athletic trainers, strength and conditioning professionals, dietitians, sport psychologists and tennis coaches. This group of experts then worked with statistical experts to develop the survey instrument. The research project was approved by the Institutional Review Board of the University of Connecticut. The survey was administered during the summer of 2008 at the largest combined gender, junior national team competition in the United States (age ranges from 10-17). The survey was administered at 12 different locations throughout the country. See Table 1 for locations.
reported three injuries per year, 36% reported a fourth injury.
Table 1
Table 2 Overall percentage of injury occurrences
Geographic locations of data collection 12 and Under Age Division 14 and Under Age Division 16 and Under Age Division
Omaha, Nebraska
State College, Pennsylvania Virginia Beach, Naples, Virginia Florida St. Louis, Salt Lake, Missouri Utah
Tucson, Arizona
Knoxville, Tennessee
Huntsville, Alabama WinstonSalem, North Carolina
Dothan, Alabama Waco, Texas
The opportunity to participate in the survey was provided to all participants and the self-reported paper and pencil survey was returned by 861 junior tennis players with a 97% completion rate [males-43% (N=356); females-57% (n=476)]. Descriptive statistics were used to analyze differences between age, gender and injury rates. As the goal of the study was to evaluate injury patterns and trends a clear definition of injury was important. The committee that created the instrument agreed on the following definition of an injury: “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 an athletic trainer, physical, therapist, or doctor.”
Results Forty-one percent of all respondents reported at least one injury per year (Table 2). One third (33%) of players who reported one injury per year, also reported a second injury that year. Thirteen percent of young athletes reported two or more injuries per year. Of those individuals that reported two injuries per year, 38% reported a third injury. Of those individuals that
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Females reported 57% of all injuries and males had 45% of all injuries. As junior players age they reported more injuries: 12 and under age group (11%); 14 and under age group (28%); 16 and under age group (36%). The most commonly injured areas are presented in Figure 8. Male and female junior players use the following training components respectively: 51% & 54% use free weights; 38% and 40% use machine based strength training; 36% & 49% use elastic tubing/bands; 43% and 58% use medicine balls during training. 83% of players report that they usually play on a hard court surface.
At least one injury per year 2 injuries per year 3 injuries per year 4 injuries per year
Percentage (%) 41 12.9 5 2
Table 3 Major findings from all age groups (12 and under, 14 and under, 16 and under) Major findings from this study t'PSCPUIUIFBOEVOEFSBOEBOEVOEFSBHFHSPVQUIFTIPVMEFS was the most often injured area. However for the 16 and under age group the back was the most commonly injured area. t0OMZBOE NBMFBOEGFNBMF PGSFTQPOEFOUTVTFGSFFXFJHIUT and only 38% and 39% use machines. t0OMZBOE NBMFBOEGFNBMFVTFNFEJDJOFCBMMEVSJOHUSBJOJOH tBOE NBMFBOEGFNBMF VTFBEPVCMFIBOEFECBDLIBOE tBOE NBMFBOEGFNBMF VTFBOBCCSFWJBUFETIPSUTFSWJDFNPUJPO tPGBMMQMBZFSTQSFEPNJOBOUMZUSBJOBOEQMBZPOBIBSEDPVSUTVSGBDF tPGBMMJOKVSJFTJOKVOJPSUFOOJTQMBZFSTXFSFUFOOJTSFMBUFE tPGBMMBUIMFUFTUIBUSFQPSUFEBOJOKVSZWJTJUFEB1IZTJDJBOPS1IZTJDBM5IFSBQJTU
Figure 1 Type of injury in the 12 and under age group (male and female combined)
Figure 2
Figure 3
Type of injury in the 14 and Under Age Group (Male and Female Combined)
Type of injury in the 16 and under age group (male and female combined)
Figure 4 Figure 4: Type of injury in the 12 and under age group (gender comparisons)
Figure 5 Type of injury in the 14 and under age group (gender comparisons)
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Figure 6
Figure 7
Type of injury in the 16 and under age group (gender comparisons)
Relationship between days off per week and percentage of all injuries
Figure 8 Rank order of injuries observed in junior tennis players
tennis players as they go through the pubertal years and appropriate training and education and research needs to be focused on these important competitive years.
Discussion The information obtained from this data collection is very important to coaches, athletic trainers, sports medicine clinicians and tennis administrators. This is one of the few studies that evaluated tennis injuries in competitive junior tennis players throughout the United States. This adds to the current body of literature that has evaluated injuries in tennis players (both junior and adult). Once a player reports an injury, the likelihood of the same player being injured a second time is 31%, or nearly a third of those injured will incur a second injury in the same year, and roughly a third of those will incur a third injury that year and a third of those will incur a 4th injury in the same year. As individuals age they report more injuries: 12 and under age group 11%; 14 and under age group 28% and 16 and under age group 36%. This increase in injury rates as athletes’ age through the junior tennis career is rather interesting when looked at in comparison to withdrawal rates from junior tournaments. A similar trend of increased medical withdrawal rates in junior tournaments are seen as athletes age. (5) Therefore, it would be prudent for coaches, athletic trainers and administrators to understand the increased risk of injury in the junior
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When combining all age groups the overall injury prevalence reported was (Figure 8): 1) Back, 2) Shoulder, 3) Ankle, 4) Knee, 5) Wrist, 6) Other. Reece et al (3) in the 1980s reported 176 injuries at the Australian Institute of Sport over a four year period. The results showed that 59% of injuries occurred in the lower limbs with other injuries equally distributed between trunk and upper extremity.(3) In a prospective study of 104 elite athletes injuries were 46% in the upper extremity with 39% and 11% of injuries in the lower extremities and back, respectively. (4) Pluim et al. (6) identified 28 epidemiological studies on injuries in tennis published since 1966. 35% were prospective and of the 19 studies published only three were performed on junior tennis players. Although population groups and methodological differences exist, the authors concluded that most injuries occur in the lower extremities (31-67% of all injuries), followed by the upper extremities (20-49%) and the trunk (3-21%). (6) Hutchinson et al (2) found similar results. Kibler and Safran also found similar values but a slightly higher degree of trunk injuries (11-30% of all injuries). In competitive juniors players in their study, the most commonly injured body parts were reported to be the thigh, ankle joint, shoulder and elbow joints as well as the lumbar spine.(1)
In one of the most robust studies conducted on junior tennis players, Hutchinson et al,(2) collected data at the biggest individual national junior tournament in the United States for 16 and under and 18 and under male tennis players. This study collected data over a six year period. In this study 21% of participants sustained an injury that involved them visiting the medical staff at the tournament.(2) The major findings from this extensive study were that “overuse” appears to be a primary factor associated with low back strains and sprains in elite tennis athletes.(2) Lower extremity injuries are twice as frequent as upper extremity or central injuries in the young elite tennis athlete.(2) Central injuries especially those of the spine are common and similar in frequency as upper extremity injuries.(2) As can be seen from these previous studies, some variability in injuries exists and much of this variability is due to methodological differences in data collection, and the population groups studied (i.e. adults vs. youth, elite vs. recreational etc). A simple measure of training volume in this study was to determine how many days per week each athlete trained/competed. The Individuals that trained/competed 6 days per week had more than 50% of all the injuries reported (Figure 7). Whereas individuals that had 2 days rest per week (i.e. training/competing 5 days per week) had 50% fewer injuries than the individuals that only had one day of rest per week (Figure 7). The findings from this study show a predominance of overuse injuries occurring in elite junior tennis players. This points to the important role of strength and conditionings and prevention programs play in the development of elite junior tennis player. Reed and Schneiker (7) have provided an extensive review of the importance of sports specific strength and conditioning programs for elite level tennis players, with several other reports specifically targeting shoulder and scapular stabilization and
hip and core strengthening as areas of emphasis in elite tennis players.(7,8,9,10) The limitations of a self-reported survey must be acknowledged and the data is based upon recollections of young athletes. However, due to the rather large sample size, it does provide a robust overall picture of junior tennis injuries. Hopefully this study will encourage more research in the area of junior tennis injuries with a specific emphasis on prospective studies as well as longitudinal studies looking at injury rates and possible links with training, equipment and volume.
Conclusions The results from this study provide important information about the injury trends seen in competitive junior tennis players in the United States. The shoulder and the back were identified as the two major areas that need a greater focus in training and injury prevention programs based on the high number of injuries reported by competitive elite junior players in this study. The increase in injuries as athletes age through their junior career is also something that should be of major interest to coaches, sports medicine professionals, and administrators. More research and 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.
Acknowledgments The authors would like to acknowledge the work of the entire USTA Sport Science Committee who served during the 2007-2008 and 2009-2010 terms. The authors would also like to acknowledge Scott Riewald for his work as the Administrator of Sport Science for the USTA at the time of the survey development.
Conflicts of Interest: none declared.
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About the authors
10. Roetert EP, Ellenbecker TS. Complete conditioning for Tennis. Champaign, IL: Human Kinetics, 2007.
Mark Kovacs, PhD, CTPS, MTPS Dr. Kovacs is a co-founder of the International Tennis Performance Association (iTPA) He formally directed the Sport Science and Coaching Education departments for the USTA. He currently chairs the ITF Health Benefits of Tennis Taskforce and the PTR Sport Science Committee. Todd S. Ellenbecker Physiotherapy Associates Scottsdale Sports Clinic - ATP World Tour W. Ben Kibler Lexington Sports Medicine Center E. Paul Roetert American Alliance of Health Physical Education, Recreation & Dance Paul Lubbers United States Tennis Association
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