Tennis is a very demanding sport as it requires a lot of volume/intensity in terms of training (on-court and off-court) and tournaments on varied surfaces during almost all the year. Because professional tournaments are played in 36 different countries, jet-lag and going from one hotel to another is part of the everyday life of the tennis player (Dakic, 2018).
All of these elements put a high level of stress on the body, significantly increasing the risk of injury.
In her study published in 2018, Dakic asked professional women tennis players from the WTA Tour about their injury during the 2015 season. 96% of them reported at least one injury during the year.
Dealing with an injury is a significant factor in a tennis player’s career. Even if the player can still compete, pain is most often related to a decrease in performance, which can profoundly affect results. We want to help you to help your players by giving you what we think are the four crucial steps to take from the injury to the Return To Compete (RTC). We will also give you three principles that you can keep in mind during these four steps to optimize the recovery.
THE 3 PRINCIPLES TO OPTIMIZE THE ROAD TO THE RTC
1 – TEAMWORK AND COMMUNICATION
2 – KEEP THE TENNIS PLAYER IDENTITY
3 – PLAN VS REALITY
1 – TEAMWORK AND COMMUNICATION
Communication inside the team is a crucial factor in athlete recovery (Dixon and al, 2019). Each person of the team has a different experience with the athlete. The more you share with your player and with each member of the team, the better chance the player will have to recover because it will bring you the most precise picture of the athlete. Building relationships of trust with your player and the members of the team will put the player in a safe position. She will likely speak freely and give you honest feedback during the recovery. Therefore, it will provide you with essential information to better adapt the plan to the RTC (Kraemer and al, 2009).
Friends and family, like social support, are essential. The road to the RTC is never easy, especially when it keeps the player off the court because due to a severe injury. Ups and downs are part of the process. Numerous studies have shown that maintaining a social activity and feeling support from friends and family have a significant impact on the road to recovery (Fernandes and al, 2014).
2 – KEEP THE TENNIS PLAYER IDENTITY
The injury doesn’t define your athlete; it is just an unfortunate moment in her career that she has to overcome with strong and full support from her team. Helping your athlete feel like she is still part of the tour during the recovery is often quite important to an athlete (Podlog and al, 2011). How is it possible? Get her back on the court as soon as possible. Even if it means that she plays tennis while sitting on a bench, or playing with her non-dominant arm. Whatever can be done on the court, do it.
Paul-Henri Mathieu after his knee surgery
Another great way to reinforce the feeling of being a tennis player when not being able to be on court is to use imagery (Barrow and al, 2015). Mental imagery is a tool that your player has to use. Whether it’s thinking and feeling of the moment, he will play again without pain or even thinking and feeling about the trophy he will reach when he gets back to competition. It is a powerful tool to help to keep the identity of a tennis player.
3 – PLAN VS REALITY
You all know this graphic. Things don’t always go exactly the way we plan them. And most of all, keep in mind that progression is non-linear. Even if your player works hard daily and is consistent with her rehab, you won’t see improvements every day. Mid-term and long-term visions are essentials instead of a short-term view. Make sure that your athlete is aware of it as she could feel discouraged in front of the first obstacle. Prepare her for hard times. Hard work always pays off. Trust the process and adapt your plan with the feedback of your athlete (Podlog and al, 2011).
Even if you don’t see the improvement every day, encourage your player to do what it takes to optimize their recovery. Consistency and dedication are the keys. Advise her in terms of sleep and nutrition. Athletes sometimes need to be reminded that periods of rest are essential to take because it’s the time when your body is healing and building new stronger tissues. Meditation, if practiced regularly, can also be used as a way to have a better connection between the brain and the body, enhancing a positive mindset and, therefore, the healing process (Arvinnen-Barrow and al, 2015).
THE 4 STEPS OF THE ROAD TO THE RTC
1 – UNDERSTAND THE INJURY
2 – HEALING AND WORKING ON BASICS
3 – RETURN TO TRAIN (RTT)
4 – RETURN TO COMPETE (RTC)
1 – UNDERSTAND THE INJURY
Understanding the injury is like playing a ‘detective game.’ It is essential to know how the injury started and what was the underlying cause. It’s not only the physio’s job, but trainer, tennis coach, and medical team job as well. It’s teamwork (Kraemer and al, 2009).
It’s true whether it’s a chronic or acute injury. Even an acute injury has an origin. You have to work on it from the beginning of the rehabilitation up to the specific tennis work. Let’s use and ankle sprain as an example. You may put something like that down to bad luck, and maybe it is. But the player may also have a hip strength deficit on the same leg as the ankle sprain. She may have a poor change of direction pattern as she is putting too much weight on the front of the foot. Is that ankle sprain still unluck? We are not saying that 100% of the injuries are related to that. But it can give you cues to better understand the injury and things to work on during training. Don’t be afraid of working on the glutes when it comes to ankle sprains!
Understand the origin of the injury is essential. Use videos, carefully watch the way your player moves. Start with basic movements like squats or lunges. When she is on-court, watch her for her weaknesses. Most of the time, the weaknesses on the court are the same that you find in the gym when you test your player on strength, power, and mobility). Find the weakest link.
It’s the same process when it comes to chronic pain! When, where, and how did it first begin? Shoulder pain during serve? Does your player have enough back motion in extension, rotation, inclination? If not, maybe she is overcompensating with too much motion on her shoulder and overusing it, causing tendon inflammation. Or perhaps she doesn’t have enough scapular stability due to a deficit in the activation of the serratus anterior, leading to shoulder instability, therefore putting too much mechanical stress on the shoulder joint and tendon inflammation.
Watch videos, take time to run precise and straightforward tests with your player. When you get all the information, put everything in together, and you will be able to create the big picture to understand the injury of your athlete. It is essential to do it as you can’t start to plan and determine the elements you have to work on if you don’t understand why the injury first came. It will help you optimize the recovery.
2 – HEALING AND BASICS WORKING
There are some healing delays you can’t overcome. The entire team must respect setbacks and organize the plan around it. The medical team will decide how much time the anatomical structure needs to heal (and will adjust it if needed), based on science. The medical team needs to have clarity around what can be done, on and off the court when it comes to working with the fitness coach and the tennis coach. Constant communication is key (Dixon and al, 2019).
Sometimes, the injury will need immobilization for three weeks, and you need to respect it. Don’t try to overcome healing delays as it will eventually end with wasted time, or reinjury, which can be even worse than the first one. If your player is immobilized, focus on what is trainable. Healing is not a waste of time. Make sure your player understands it as well. Many benefits will show up when she is in the Return To Training phase.
Each member of the team, not only the physio, has to listen carefully to the player’s feedback, especially when it comes to pain. Build a relationship based on trust, so she doesn’t lie to you when she is in pain and try to hide it.
As soon as possible, the physio and fitness coach should work on the weaknesses and movements you pointed out during the first phase, “Understand the injury.” Poor hip stability? Work on glutes and reprogram the brain of your player for the particular movement. It affects like a single leg squat with the knee collapsing inwards.
What is brain reprogramming when it comes to movements? It’s using brain neuroplasticity to change a motor pattern, which is a movement that the player is doing automatically. In the context of injury, your player’s brain has registered the “bad” motor pattern as if it’s normal for her, even if it is the cause of the pain. Understand that the brain doesn’t know what is good or bad for the body; it just registers the pattern you are doing the more often as automatic.
How can we reprogram a motor pattern by using brain neuroplasticity?
Let’s take the example of a player with shoulder pain coming from a lack of motor control in her rotation. You can reprogram the movement in 5 steps :
1 – Make sure your player understands what is wrong with their movement patterns (use videos, mirror). It’s about understanding what is wrong. It can be that the shoulder is going too far forward when rotating internally or lifting because she is using his upper trapezius. Lack of stability coming from scapulae stabilisators deficit is also often seen during the test.
2 – Correct the movement (use external cues and internal cues, feedback, mirror). Be sure that she is working on the corrected movement.
3 – Repetition. Repeat the movement to replace the old motor pattern. It’s about getting from the consciousness to the unconsciousness, so the new “good” motor pattern becomes the automatic one.
4 – add variations to the movement. Once the movement gets automatic (the player doesn’t have to be focused on it to do it the right way), change speed and intensity: add weight, do it at different speeds.
5 – Specific tennis movement. Make sure your player transfers it when she plays (for example, during the serve motion).
The above is true when it comes to injury, but you will see benefits as it will affect performance as well.
3 – RETURNING TO TRAINING
Once the injury has healed, it is time to get back on the court to practice. But be careful with the amount of practice you want to schedule: an injury healed doesn’t mean that your player can handle a regular practice schedule. Progression is the key to prevent pain and reinjury. It allows all the tissues of the body (muscles, fascias, ligaments, tendons) to adapt to the stress induced by training (Pluim and al, 2016).
An excellent way to prevent reinjury is including a few exercises during the warm-up. It can cover a lot of areas such as mobility, strength, plyometrics. To continue with the shoulder, you could start the warm-up with general drills working on mobility and strength (like bear position and all the moves from this position). To be more tennis-specific, you could then add some plyometric drills (close to the service range of motion position).
https://m.youtube.com/watch?v=Hxp0Hl9J9lc
Bear position
https://m.youtube.com/watch?v=L1TdYwc7OV4
Plyometric drills
4 – RETURN TO COMPETITION
The decision to schedule the first competition after an injury shouldn’t only be based on the player feeling like they are ready to go. It should be a decision made by the whole team and based on objective facts. An excellent way to do it so is to make sure that the mechanical load applied to the body during competition matches the amount of mechanical load during practice (Murphy and al, 2015).
The technology evolution in the last few years now offers an easy way to monitor a training load during practice. For example, connected wristbands can quantify the numbers and types of shorts played (Genevois and al., 2018). It makes it easy to compare data collected from practice sessions with data from competition.
For example, if the number of serves hit during a single match or a week of tournament is superior to the numbers you get during the pre-competition period, the risk of injury would be highly present. The reason is that the tissue can’t handle the mechanical stress applied to the body, as it is not ready for that amount of load (Pluim and al, 2016). Be careful about the occurrence of new injuries in the same area or another location as the body is very good at compensating!
Bibliography
Arvinnen-Barrow, M., Clement, D., Hamston Hutley, J., Zakrajsek, R., Lee, S.-M., Kamphoff, C., Lintunen, T., et al. (2015). Athletes’ Use of Mental Skills During Sport Injury Rehabilitation. Journal of Sport Rehabilitation, 24, 189–197.
Dakic, J. G., Smith, B., Gosling, C. M., & Perraton, L. G. (2018). Musculoskeletal injury profiles in professional Women’s Tennis Association players. Br J Sports Med, 52(11), 723–729.
Dixon, A., & Porter, T. (2019). Return to Play—Transitioning from Rehabilitation to Strength and Conditioning with the Football Athlete, 4(NSCA Coach).
Fernandes, H. M., Reis, V. M., Vilaça-Alves, J., Saavedra, F., Aidar, F. J., & Brustad, R. (2014). Social support and sport injury recovery: An overview of empirical findings and practical implications. Revista de Psicología del Deporte, 23(2), 445–449.
Genevois, C., Amsallem, C., Brandli, C., & Rogowski, I. (2018). Using inertial sensors to monitor on-court tennis training sessions. ITF Coaching and Sport Science Review, 75(26), 18–19.
Kraemer, W., Denegar, C., & Flanagan, S. (2009). Recovery From Injury in Sport: Considerations in the Transition From Medical Care to Performance Care. Sports Health, 1(5), 392–395.
Murphy, A. P., Duffield, R., Kellett, A., & Reid, M. (2016). A Comparison of the Perceptual and Technical Demands of Tennis Training, Simulated Match Play, and Competitive Tournaments, 11(1), 40–47.
Pluim, B. M., & Drew, M. K. (2016). It‘s not the destination, it’s the ‘road to load’ that matters: a tennis injury prevention perspective. Br J Sports Med, 50(11), 641–642.
Podlog, L., Dimmock, J., & Miller, J. (2011). A review of return to sport concerns following injury rehabilitation: Practitioner strategies for enhancing recovery outcomes. Physical Therapy in Sport, 12(1), 36–42.