How many players on tour do we hear referring to ‘health’ as being a big part of their success? Many of the top players on both men's and women's tours exclaim that being healthy and fit is a big part of it. But the reverse is also true. How many players have inconsistent results when they aren’t in top form?
Obviously it’s impossible to be in top form all the time, but when the balance tilts the other way, that’s usually when injury/illness could be lurking around the corner. But how can tennis players of all ages be in better form? And more importantly, how can we prevent the onset of injuries and illnesses?
We know that both on-court and off-court training are of paramount importance in our sport today - if either is neglected, odds are something will give. But there’s more to it than that. Managing training loads is key. Not enough and we won't be prepared for the demands of our sport. Too much and burnout - along with it’s harsh side effects - will likely ensue.
In this article, we’ll outline the unfortunate realities of injuries in tennis, take a closer look at the workloads dilemma and offer some practical solutions so that players - especially competitive ones - can better manage their tennis.
INJURY RATES AND ILLNESSES IN TENNIS
In tennis, it’s difficult to determine injury rates. Players of all ages and skill levels report aches and pains to their coaches, but rarely do these incidences get documented elsewhere.
A 2015 study by Pluim and colleagues aimed to resolve this issue. These researchers tracked 72 elite junior tennis players (between the ages of 11-14) during a 32 week period to analyze both injuries (acute and chronic) and illnesses.
Out of the 72 players, 67 reported a total of 187 various incidents during the 32 week time frame. A total of 47% were overuse injuries, 36% were illnesses (respiratory tract infection, gastrointestinal infection, tired athlete, viral infection etc.) and a mere 13% were acute. The story is similar in college settings (Taylor Aune et al 2015) - with acute injuries being a rare occurrence when compared to overuse injuries.
This is concerning. We know that tennis play places a tremendous amount of repetitive strain on players, but is there a way we can mitigate some of these overuse incidences? Furthermore, why are we seeing so many illnesses?
While 11-14 year olds are bound to get sick here and there, athletes across all ages and disciplines seem to be more susceptible to illnesses than most common folk. But why?
There’s no simple answer, but many experts in the sports world believe that the majority of injuries and illnesses are a result of poor management of both training and competition loads.
Does that mean injuries are preventable with proper planning, monitoring and so on? No injury or illness can be 100% prevented - but with proper care (as we’ll soon see), they can be mitigated.
Not sure how to monitor training load & player health? Sign up and you’ll be linked to the exact (research-backed) daily monitoring tool I use with my athletes.
Managing Training Loads: Is There a Thing as Too Much?
How often do you hear medical professionals telling players to ‘take it easy’, or to take a few days off. Is that all it takes? You train really hard for a period of time, then just take some time off and all is good in the world. Likely not.
The majority of training studies state that when training load increases, so does performance (Gabbett 2016). This is also seen in practical settings. When players play more, they usually improve, and at faster rates. This is especially true early on in a player’s training career.
But therein lies both the problem and the solution. It’s not the training load in and of itself which increases risk of injury/illness - research points to the sudden rise in either training load and/or competition frequency, which leads to an increase risk in health related problems.
Remember RPE (rating of perceived exertion)? When RPE - subjectively rating the intensity of training on a scale of 1-10 - is multiplied by the duration of a training session, we get a pretty good idea of how much training load is placed on an athlete.
Research has consistently shown that this is as good a method as any when it comes to monitoring workload. In fact, Gabbett et al (2010) found a training load threshold in rugby players using the RPE method - ~3000 AU (arbitrary units). When the athletes exceeded this threshold, they were 70 times more likely to incur an injury!!
While it’s easier to control training load in practice, we cannot control the intensity of competition. And in tennis, unlike most other sports, there’s no time clock - which makes matters even more complicated.
Interestingly, Gabbett (2016) reviewed a number of training studies and consistently noticed that when training loads increased (>10%) from one week to the next, the risk of injury also increased.
Cross et al (2015) came across a similar finding in rugby union players. When training loads increased by 5%-10% from one week to the next, injury rates were less than 10%. But when they suddenly increased by 15% or more, the chances of injury ranged from 21% to 49%. Want a reason to start monitoring training loads using the RPE scale? In my opinion, that’s a pretty good one.
The take-home message here is that it’s ok to increase training loads over the course of a training cycle, season and career. In fact, this is absolutely necessary if one has even the slightest chance of achieving elite levels of performance. It’s just that these increases need to be done gradually, over time.
But many of us in the tennis world aren’t patient enough. How often do we see players, for example, going from playing 8 hours a week in the winter to more than 15 hours a week once the weather improves? Or increasing serve volumes three-fold because the coach says it’s a weakness.
And don’t get me started on tournament scheduling. Summer hits and there’s a tournament every weekend, so what do players do? They start playing EVERY weekend.
Even at the pro level, they play 6, 7 or more weeks in succession. If you’ve ever competed at a high level, you know that nothing will tax you mentally and physically like competition.
Sure practices can be intense, but there’s an added level of pressure, of stress, that accompanies tournament play...and only tournament play can replicate it. But that’s exactly why proper planning, scheduling AND monitoring, is so important.
Is Overtraining the Only Cause of Injury & Illness?
Do athletes only get injured because they train too hard and don’t manage the workloads appropriately? Earlier we saw that an increase in training load does improve performance. But according to research (Gabbett 2016), training also acts as a protective mechanism.
When it comes to tennis, this means that all those cross-courts our players hit and those serves they practice, are also acting in a positive manner. Our bodies - specifically the tissues that are involved in each stroke of the game - are adapting after each strike of the ball, each exposure.
Recall that players attempt around 40-50 serves in a set. If a junior player plays 5 sets of tennis in one day (which is not uncommon in weekend tournaments), they could very well serve close to 250 serves in one day.
If we don’t expose a player to these loads in training, they won’t be able to handle them in matches...that is certain.
The same story is true when it comes to off-court training. We prepare the body for tennis play by exposing it to loads, angles, speeds of movement - and so on - that are reflective of what they’ll encounter in a tennis match.
So let me reiterate, training acts as a protective mechanism. If we assume this to be true, we can also say that ‘undertraining’ may also lead to injury. And this too has been reflected in the literature.
In cricket (Dennis et al 2003) bowlers who threw the least with the greatest recovery time between sessions AND those who threw the most with the least amount of recovery time between sessions, were at greater risk of injury compared to bowlers who threw a moderate amount and had a moderate amount of recovery time.
Other studies have seen similar results; too little training - while not as dangerous as too much, too soon - is also a risk factor for injury.
Legendary track coach Dan Pfaff has spoken about the topic of undertraining in the past. He refers to breaks in training as ‘training gaps’. In other words, how much time off between sessions, between cycles, between competitions, is an athlete taking? Limiting these training gaps, in his view, is one of the keys to reaching peak performance in the long run.
How to Tell if a Player is Undertraining OR Overtraining
Given this information, what can we do? Well, there are ways to monitor training loads in a manner that provides useful information - one of the methods is called the Acute:Chronic Workload Ratio (figure below).
Different metrics exist that coaches could use to determine this ratio - I’ll provide one example, which seems to be the simplest and most effective to date.
Essentially, what coaches/trainers can do is monitor session RPE and add up all the sessions throughout the week and average them out to determine an ‘acute’ (or weekly) training load.
Once you’ve monitored enough weeks, you divide this ‘acute’ workload by a ‘chronic’ workload. The chronic workload is simply the average workload of 4 weeks of training. As you can see in the figure, the so-called ‘sweet spot’ seems to be a ratio between 0.8 and 1.3.
Let’s look at a couple examples to gain further insight into this metric. Let’s say that your athlete has a an average weekly training load of 1500 (acute workload) and the average monthly training load is 1750 (chronic workload). We would simply divide 1500 by 1750 - which provides us with a ratio of 0.86. In this case, we’re in the sweet spot, we’re ok.
But let’s say the acute workload is 2750 and the chronic workload is still at 1750 - well, now our ratio is 1.57 and we’re in the ‘danger zone’.
While you may think this is a big gap, it’s really not. If we go from 5 sessions a week of training to 6, this could very well widen the gap and place a player into the danger zone.
While the acute:chronic workload ratio has been validated in certain sports like rugby, it’s yet to find its way into the tennis literature. As with all monitoring tools, we must still use it with caution...but it’s an interesting theory that warrants further investigation.
Mitigating Injury and Illness in Tennis: Practical Recommendations
Below are several ideas - derived both from research (Pluim and Drew 2016) and from experience - that may be of use to coaches and players.
While these suggestions could help players stay in the so-called ‘sweet spot’, the list is by no means exhaustive - other strategies do exist. But before we use advanced methods (like recovery schemes, nutritional supplements and so on), let’s try to get these right first.
Avoid Sudden Spikes in Training
In junior settings, if you’re transitioning from indoor tennis to outdoor tennis, do so with caution. Adding an extra 2-3 sessions a week can have huge implications in the long run.
Players at all levels should not play every tournament on the schedule. Whether it be open tournaments or pro events, it’s easy to try and ‘chase points’, but it won’t do you much good if you’re chronically fatigued and can’t train with the type of intensity needed to improve.
Increase Training Loads and Competitions Gradually
Similar to the first point, don’t rush the training process. Figure out how much increase still allows the athlete to feel fresh, motivated and ready to train. Playing a few weeks of tournaments in succession is normal, but playing more than 4-5 weeks in a row isn’t.
Athletes need time to recover and adapt to competitions, just like they do to training. Find out how many weeks in a row your player can play without looking completely drained - and then plan the schedule accordingly.
Monitor Training Loads (and Matches)
We spoke at length about the RPE scale and the acute:chronic workload ratio. These can be great tools to help monitor long-term workloads.
But it’s not enough to simply track training, coaches must also track matches (and then compare matches to training). If we can’t come close to matching training loads with competition loads, we’re doomed.
Planning and Scheduling
While plans change, it doesn’t mean we shouldn’t have them. Outlining the schedule several months in advance can be an effective way to keep workloads in check - and to motivate players during training sessions.
Implement a Strength & Conditioning Program
If you or your player are serious, then you likely already have this covered. But many players still don’t!
It’s imperative to prepare the body to meet the demands of our sport both on the court AND off the court. If a player doesn’t have the appropriate internal rotation in their shoulder, for example, the risk of encountering an arm injury increases significantly (because we know that chronic serving leads to a decrease in shoulder ROM).
Or if we can’t absorb forces effectively with our lower-body, those forces acting on the tissues and joints during tennis play will surely lead to injury over time - recall that overuse injuries were leading the way in elite junior settings.
If you don’t have a program yet or looking for a new one, check out our High-Performance Preparation program.
Lifestyle Factors Matter
Young players have a lot on their plates these days. Not only are they expected to do well on the tennis court, but they’re also expected to perform in the classroom. That’s fair enough but knowing that class time, studying and so on can be draining, should also be factored into the training plan.
If your players are in exam time, your training workloads need to be adjusted to reflect this. Rest and recovery through sleep, nutrition, hydration (even social outings) are also factors here (all of which we’ll cover in more detail moving forward).
While I have no problem with high volumes of training and competition, I do oppose high volumes that are incorporated too quickly and with little thought given to progressions.
You can’t imagine how many times I’ve been asked by senior coaches to ‘push’ players. Oftentimes during off-season/pre-competition scenarios.
Planned overreaching - implementing higher than normal training loads (pushing players) - can be an effective stimulus but it’s something that should be used sparingly and only with more advanced athletes.
That said, less is not always more - there’s a fine balance between too much and too little.
And I do believe that Gabbett (2016) is on to something, and I’ll echo his words - athletes must train progressively harder AND smarter - in order to reach higher levels of performance.