ABOUT THE AUTHOR: Shane Wilson is a former Jamaican badminton national team player and captain, with over ten years experience competing at world and Pan American levels. He recently completed a MSc in Physiotherapy (Pre-Registration) from the University of Birmingham with distinction, having previously pursued an undergraduate degree, in Sport Rehabilitation at the University of Nottingham, achieving First Class Honours. Primarily, his passion is tennis youth development, dedicated to empowering athletes to reach their full potential both on and off the court, facilitating meaningful change within the tennis world. Currently, he resides in the United Kingdom and works as an MSK Physiotherapist at a private clinic.
ABSTRACT
Purpose: The aim of this study was to inductively explore the developmental journeys of sub-elite tennis players and its impact on injury and recovery.
Introduction: Tennis has long been a globally popular sport, played at varying levels, which include recreational, club, sub-elite (county, collegiate and national) and elite or professional level. Research suggests that an athlete’s developmental journey can impact their injury rates and recovery, although, there remains a paucity of sport-specific research, particularly as it relates to sub-elite tennis players.
Methods: This qualitative study adopted a cross-sectional design. One to one semi-structured interviews were conducted with eight current sub-elite, British male tennis players. The interviews were recorded and transcribed verbatim. The data was analysed using an inductive thematic analytic approach.
Results: From the analysis, two overarching themes of sampling behaviour and injury mitigation strategies emerged. These were further categorised into six themes and 16 sub-themes.
Conclusion: The findings of this study indicate that early sampling behaviour is associated with an increased injury risk in young athletes, although, it seems that these are minor injuries, characterised by relatively quick recovery times. Physiotherapists play a key role in enhancing recovery. Re-injury is likely if the recovery process is completed poorly.
Ultimately, the benefits of sampling seem to outweigh the costs. However, since injuries appear likely with sampling, there is a need for specific considerations for sub-elite tennis players, particularly, those aiming to get to an elite level. Recommendations are that key stakeholders implement a model or framework, which could help to mitigate injuries among this population. This could include sampling certain types of sports or activities, doing an appropriate warm up, engaging in strength and conditioning and effective load management strategies.
Keywords: tennis, sport specialisation, early sport sampling, early sport engagement, injuries, recovery.
Introduction
Tennis: An Overview
Tennis is regarded as one of the four traditional racket sports (Starzak et al., 2024). It has become a globally popular sport, played in over 200 countries across the world and attracts players of all ages and varying levels, which include recreational, club, sub-elite (county, collegiate and national) and elite or professional level (Pluim et al., 2006).
Tennis involves five disciplines, ranging from men’s and women’s singles and doubles, to mixed doubles. On the professional circuit, the three main playing surfaces include grass court, hard court and clay court, which each has different characteristics (Martin et al., 2014). Tennis matches do not have time limits, which means that a match can generally last, on average, anywhere from one to two hours (Bilić et al., 2023), but in certain cases, particularly at the professional level, can last over five hours (Oršolić et al., 2020).
In Great Britain (GB), the Lawn Tennis Association (LTA) serves as the national governing body (NGB) for tennis (Richardson et al., 2021). According to the latest global report conducted by the International Tennis Federation (ITF) in 2021, there were 49 British male tennis players who had a professional ranking, of which, only six were ranked within the top 250 and three in top 100 in the world (ITF, 2021).
Developmental Journeys
Transitioning towards an elite level is becoming more frequent in tennis, as there has been an increase in the number of tournaments, prize money and young players wishing to establish a career out of the sport (Young et al., 2006). Players aim to navigate this transition towards elite level with as minimal as possible injury risk and other negative consequences, as these can have a detrimental impact on their careers (Bozděch et al., 2023). However, the developmental journeys of tennis athletes will differ (Li et al., 2020).
There has been an ongoing debate as to whether specialisation (early/late) or early sampling behaviour increases the incidence of injuries within sport (Barth et al., 2022), as these two concepts appear to play a vital role in athletes’ development, particularly as they aim to progress towards an elite level (Jones et al., 2021). The more broad definition of sport specialisation is when an athlete intensively participates in a single sport, with high levels of deliberate practice and low levels of deliberate play, excluding any other sports or activities, for 8 months or more per year (LaPrade et al., 2016), whereas early sampling involves participating in multiple sports or activities during childhood (from 6-12 years old), characterised by high levels of deliberate play and low levels of deliberate practice (Côté et al., 2009). A third route has also been proposed in early engagement (Hendry et al., 2018), which forms part of the early sampling spectrum, and involves athletes “engaging” in high levels of specific deliberate play in their favoured or primary sport, while still participating in low to medium levels of deliberate play in other sports or activities (Ford et al., 2009).
Specialisation
Specialisation is often divided into two categories of either early specialisation (during childhood) or late specialisation (after childhood). Interestingly, tennis is one of the sports where early specialisation is more commonly practiced (Rice et al., 2022), at an average age of 10 years old (Jayanthi et al., 2011). However, it still remains a topic of controversy, as to which of the two is more beneficial to an athlete’s development (Moesch et al., 2011). The goals of early specialisation are centred around the notion that practicing a single sport at an early age signifies sporting success at the elite level (Brenner, 2016). Furthermore, cited within the literature are advantages of early specialisation in leading to enhanced skill acquisition through deliberate practice, improved time management skills, pleasure of talent development and access to better coaching (Normand et al., 2017). However, studies on young athletes have found that the practice of early specialisation does not necessarily guarantee sporting success, but instead may have detrimental effects on long-term achievement, and often result in other negative consequences, such as reduced sport enjoyment, overtraining, physical and psychological burnout, early drop out from sport and lastly, increasing injury risk (Coutinho et al., 2023; Hainline, 2019; Myer et al., 2016). Consequently, for most sports, while some degree of specialisation at some point is necessary to develop elite expertise, the longer the act of specialisation can be delayed, particularly to after childhood, the better the chances an athlete has to achieve optimal success in their later years (Jayanthi et al., 2013).
Early Sampling
The concept of early sampling assumes that participating in multiple sports or activities during childhood, is partnered with achieving elite success (Güllich et al., 2021). Sampling behaviour is built on the premise that it allows room for the transferability of skills, which can be advantageous for the athlete’s primary sport of choice (Normand et al., 2017). Additional benefits include enhancing enjoyment and motivation, facilitating prosocial behaviour, improving career longevity (Côté et al., 2009), reducing rate of dropout and lastly, posing a lower injury risk through the development of neuromuscular skills (Carder et al., 2020). On the contrary, there is an argument that early sampling can also give rise to a high injury risk, although these injuries appear to be minor and thus have less of a detrimental impact on the athlete’s career (Rejeb et al., 2017).
Early Engagement
The practice of early engagement during sampling years, fosters benefits in skill acquisition and enhances motivation for sport participation, through activities that focus primarily on promoting fun and enjoyment, rather than on improvement (Baker et al., 2017; Carder et al., 2020). Early engagement in a sport like tennis is often encouraged, to allow the development of the necessary fundamental movement patterns and skills (Oršolić et al., 2023). Li et al. (2020) recommended that the optimal age range to begin engaging in tennis is between 3-7 years old, in order to increase an athlete’s likelihood of achieving elite success in their later careers. Although, this early engagement in tennis does not discount combining that with participating in other sports or activities, during childhood, which appears to contribute to the overall elite success in tennis (Oršolić et al., 2023).
Tennis-Related Injuries
Due to the high physical demands to be able to perform several movements and strokes (Musa et al., 2022), inevitably, tennis players are subjected to an increased risk of developing injuries, which can vary by type and location (Abrams et al., 2012). Injuries are one of the limiting factors that reduce the chances of success within tennis (Fu et al., 2018). The risk of tennis-related injuries can be attributed to a combination of intrinsic (e.g., age, gender, muscle imbalance and previous injury) and extrinsic factors (e.g., court surface and equipment) (Oosterhoff et al., 2018). Furthermore, tennis injuries are typically divided into two categories: (1) acute traumatic injuries and (2) chronic overuse injuries (Fu et al., 2018). The lower extremities are more susceptible to acute traumatic injuries, whereas chronic overuse injuries are more commonly seen in the upper extremities (Llanes et al., 2023).
Overall, the most common types of tennis injuries among sub-elite tennis players include ankle sprains and fractures, knee ligament sprains and ruptures, lumbar and abdominal sprains, thigh and groin muscle strains, rotator cuff tear or tendinopathy, impingement and superior labrum anterior-to-posterior (SLAP) tears of the shoulder, medial and lateral epicondylitis of the elbow, extensor carpi ulnaris tendinitis and tendon subluxation of the wrist (Vasenina et al., 2022).
Injury Management and Risk Mitigation
The increasing number of injuries seen at youth level within tennis (Michel et al., 2023) and sport in general (Prieto-González et al., 2021), prompts the need to implement effective strategies to help appropriately manage them and reduce the risk of occurrences (Al-Qahtani et al., 2023).
The majority of sports injuries can be managed conservatively (Foglia et al., 2013), with the overall aim of the rehabilitation process being to return the athlete to a higher than previous level of sport-specific function, without causing further damage or re-injury to the body part or other parts (Dhillon et al., 2017). Within the clinical team, a physiotherapist can contribute to the enhancement of the rehabilitation process, through helping to address pain and restore optimal function (Alyami, 2022; Dhaliwal et al., 2022).
An area which is often neglected, but one which is effective in reducing injury risk, is doing a proper warm-up (Al-Qahtani et al., 2023). Warming up is aimed at preparing the athlete to engage in more vigorous activity and can be either an active (general or sport-specific) or a passive routine (e.g., saunas or heating pads) (Mukhopadhyay, 2022).
It has also become more necessary for athletes to engage with an appropriate strength and conditioning (S&C) programme. This enhances their resilience to injury by incorporating a range of various exercises that involve upper and lower body strength, endurance, dynamic stability, speed, agility, coordination, core exercises, plyometric training, mobility, flexibility and sport-specific training (Haff and Triplett, 2016).
Another factor that can influence injury rates in athletes, is load management (Drew et al., 2016). The goal of optimal load management in sport is to strategically organise training, competition and other activities, in order to maximise adaptation and performance, while limiting the risk of injury (Soligard et al., 2016).
Overall, the current evidence suggests that an athlete’s developmental journey can impact their injury rates and recovery. However, there is currently a paucity of available evidence exploring the effects of development journeys, in specific sports and particularly relating to tennis players. The need for sport-specific studies is that it can help to guide the recommendations of NGBs. Additionally, an athlete’s developmental journey is influenced by the type of sport or activity they participate in, which can impact their health-related outcomes, so therefore, it is also important for practitioners to understand this journey, to then be able to appropriately manage and enhance recovery from injuries, should they arise.
Methodology
Study Design
This qualitative study adopted a cross-sectional design, incorporating one-to-one semi-structured interviews. The interview guide included 3 main sections and interspersed between those sections were follow up questions.
Study Criteria
The participants included, were selected based on pre-determined inclusion and exclusion criteria. The sample included British male, sub-elite tennis players (minimum county standard), aged 18-25 years old, who either currently or previously attended a British university and currently or previously competed in British Universities and Colleges Sport (BUCS) leagues or individual championships. Any individual who did not meet the inclusion criteria, was not recruited for this study.
Sample
Initially, the participants were recruited through convenience sampling, by making direct approaches to known contacts within the field, who were available to take part. The remaining participants were recruited through snowball sampling, performed by the existing participants referring other individuals, who also met the inclusion criteria and were willing to take part. Overall, a total of eight participants were included in this study.
Ethical Considerations
Ethical approval to conduct this study was granted by the University of Birmingham Sport Participation to Performance School Ethics Committee on the 30th of January, 2024 (Reference Number: SPP2324_13). Further ethical considerations, prior to data collection, involved ensuring maintenance of confidentiality and anonymity, and seeking informed consent.
The use of pseudonyms to identify each participant helped to preserve anonymity and confidentiality. Each participant was sent an official letter via email, thanking them for agreeing to take part in this study, alongside an attached participant information sheet. Additionally, participants also completed a consent form. The right to withdraw from this study, at any point up to two weeks after the completed interview, was outlined within the consent form and participant information sheet, and each participant was again verbally reminded of this, on the day of their interview. In accordance with the University of Birmingham’s Data Protection and Record Management policies, and to maintain participant confidentially, all forms of documentation and audio recordings, including signed consent forms and interview transcripts, were securely stored on a password protected computer.
Pilot Interview
A pilot interview was conducted to assess the feasibility of the study design, the type and order of the interview questions and to identify any practical issues that may have arisen. The pilot interview was conducted online via Zoom, with an individual who almost fulfilled the inclusion criteria. As a result of the pilot interview, changes were made to the interview questions and process.
Data Collection
The semi-structured interviews were conducted online via the Zoom meeting platform and lasted approximately 30 minutes. The data collection period for the eight interviews was between the 22nd of February and the 24th of March.
Data Analysis
After each of the interviews had been completed, the qualitative data was organised and prepared for further analysis by transcribing the recorded discussions. In order to explore patterns across the dataset, the Braun and Clarke (2022) six phase thematic analysis approach, was used as the guiding framework for the data analysis process. An inductive approach to thematic analysis was utilised, which enabled theme generation based on emergent data. Firstly, the interview transcripts and recordings were reviewed. The qualitative coding software, Delve, was then used to organise the data into codes. Subsequently, from identified similarities and differences within the coded data, it was further grouped into themes and sub-themes. Furthermore, the themes and sub-themes were encapsulated under two overarching themes, in order to structurally organise broader conceptual ideas, which anchored a number of themes together. The final analytic report included direct quotations from the participants (pseudonyms used), which enabled the presentation of a more rigorous argument.
Two overarching themes of (1) sampling behaviour and (2) injury mitigation strategies emerged from the data analysis. These were further categorised into six themes and 16 sub-themes, all of which will be discussed within the following section.
Sampling Behaviour
Every participant in this study practiced early sampling behaviour. Although, they would have stated that they “specialised” in tennis during childhood, this was not the case. Rather, within their sampling years, there was also an element of early engagement in tennis, with an average starting age of four years old, across the participants. Ultimately, the main focus was the impact that they believed sampling behaviour had on skill transfer and on their injury risk and recovery.
Theme 1: Skill Transfer
The participants identified a variety of common sports or activities that they sampled, where the skills could be transferred to enhance their tennis development. They highlighted aspects such as endurance, coordination, depth perception, agility, speed, explosiveness, technique and upper and lower body strength. Schmidt et al. (2000) determined that movement patterns, perceptual and physical conditioning components, could be transferable across sports.
“Tennis is one of those sports where I think a lot of other sports relate to it and there's a lot of transferable skills that could be learned on the journey.” – P8
Swimming
As it relates to endurance, swimming places high demands on the cardiovascular system, thus boosting aerobic fitness (Shi et al., 2023). Tennis matches do not have time limits and can often last for hours, so therefore, adequate aerobic capacity levels are required (Genevois, 2019). Swimming also works the entire body, recruiting muscles in the upper body, core and lower body (Westcott et al., 2015), which can be instrumental for a tennis player, in increasing the power and speed of their strokes and also in providing the foundation for all movement patterns needed for efficient court coverage (Erzeybek et al., 2020).
“I think the endurance of swimming and having good upper body strength, that's really important for tennis players.” – P8
Football
Football was played by all the participants, as it is a very popular among youth (Al-Qahtani et al., 2023). The demands of playing football involved having good lower body strength for explosive movements (e.g., shooting), coordination to execute ball skills (e.g., dribbling), agility for rapidly changing direction, acceleration and deceleration, endurance to maintain the high intensity activity levels during play (e.g., running) and balance to perform dynamic movements (e.g., kicking) (Nurhidayat et al., 2019). These combined skills benefit tennis players by helping them move more quickly and efficiently around the court, enhancing shot power and accuracy and being able to sustain their performances throughout the duration of a match, without being limited by fatigue (Pratama et al., 2023).
“Football is great for endurance, and so like being strong in your legs and everything. Like obviously tennis, you have to be strong in your legs, too.” – P2
“Football I think coordination obviously is one of them, my balance, my reaction times as well. So, yeah, it's a few of those skills that I think helped with my tennis.” – P5
Rugby
The multi-directional nature of rugby means that it generally involves quick changes of direction, acceleration and deceleration, to either avoid being tackled by an opponent or when advancing with the ball (Aubin et al., 2021). While tennis is not regarded as a contact sport, it can often be unpredictable (Kovacs, 2006), so therefore, this developed agility from rugby can be transferred to tennis players, in enhancing their reaction times and ability to rapidly change direction in response to stimuli, which can either be the opponent’s movement or the ball (Ali et al., 2020). Rugby also involves the skill of depth perception (Bisht et al., 2023), which in a fast-paced sport like tennis, is a key skill for players to have, in order to be able to visually track the movement of the ball and make a calculated quick decision, that results in more accurate ball placement with their return shot (Wei et al., 2017).
“With rugby, it’s all about depth perception, in terms of catching the ball, throwing the ball, speed, changing direction. Tennis is a lot about changing direction.” – P6
Badminton
Playing badminton shots, such as drops, clears and smashes, all involve the use of upper limb strokes (Awatani et al., 2018), and although tennis is a different racket sport, it is most similarly related to badminton, in terms of arm movements, to perform certain tennis strokes, such as serves and volleys etc. (Steels et al., 2020). If there are similarities in upper body kinematics between sports, it is entirely feasible to identify fundamental motor patterns in overarm movements in one sport and apply them to another (Wagner et al., 2012).
“Badminton is a similar racket sport to tennis, only that the shuttlecock doesn’t bounce on the floor, obviously. But I guess, like a lot of the aerial play, such as volleying and smashing are similar, and hitting the serve is the same sort of arm action, such as a badminton clear, drop shot or smash.” – P7
Cricket
From playing cricket, the identified skill that was transferrable to tennis was hand-eye coordination. Hand-eye co-ordination can be a natural talent, but can also be a developed skill, commonly acquired through playing ball sports, such as cricket (Knight et al., 2023). Since tennis also uses a ball, it could be argued that a degree of hand-eye coordination is required (Patel et al., 2018), to be able to visually track the speed and movement of the ball and then perform more precise and quicker tennis strokes (Nugroho et al., 2023).
“Being able to play a different sport like cricket, where it's related to hand eye-coordination. I think that has helped my tennis massively.” – P8
Theme 2: Injury Risk
The majority of the existing literature suggests that early sampling behaviour poses a low injury risk (Carder et al., 2020). However, this study found the opposite, where it appeared to lead to a high risk of getting injured. Despite what the majority of the literature states, there was one research, by Rejeb et al. (2017), which investigated 166 male multi-sport youth athletes at a sports academy in the Middle East and found that early sampling can indeed pose a high injury risk.
“And I guess, with other sports like football and stuff, if you're doing it all the time, and then playing tennis and playing, say, badminton and doing loads of different sports, you could be more likely to pick up injuries.” – P3
Incidentally, some of the injuries occurred from sampling football, and due to the physical contact nature of the sport, playing it can be associated with high injury rates (Al-Qahtani et al., 2023). To further support this finding, a retrospective analysis conducted by Habelt et al. (2011) studied 4,468 youth athlete injuries from a sample of 20 different sports in the United States of America (USA) and found that football posed the highest injury risk (31.1%).
“The football again, you'd pick up lots of little like ankle issues, even at a young age.” – P1
Recovery
From the findings, despite sampling behaviour being linked with an increased likelihood of getting injured, it appeared that the initial recovery times for these injuries were relatively quick (few days to no more than one month), implying that the injuries were not serious or major ones. These findings also mirror that of the Rejeb et al. (2017) study, in that, even though sampling behaviour might have led to an increased injury risk, the majority of the reported injuries were seen as minor, resulting in minimal time lost from sports.
“It was nothing super. It was nothing more than like a month, like it wasn't long term at all, those sort of breaks with injuries.” – P2
“I've actually been quite lucky with my injuries. I really haven't had a long-term injury.” – P5
“I haven't taken more than 2 or 3 weeks off before with an injury.” – P6
Physiotherapy
One of the commonly identified reasons that expedited the recovery process, was accessing physiotherapy services. This finding is corroborated by the literature, which suggests that physiotherapists can enhance an athlete’s recovery, facilitating their return to sport or activity, within the shortest achievable timeframe (Quartey et al., 2019).
Additionally, the participants reported that the physiotherapists adopted a range of tools, primarily involving either massage therapy or tailored exercise programmes, which the research suggests are frequently utilised within a physiotherapists’ arsenal and are theoretically effective in addressing pain and facilitating restoration of function (Dhaliwal et al., 2022). Although, there still remains a paucity of clinical evidence to support the mechanisms that underpin these approaches, particularly in sport settings (Alyami, 2022; Gasibat et al., 2024).
“It'd be more like physio sports massages I would need to then, like just alleviate sort of like the pain and stress in my back area.” – P2
“I went to a physio and just got exercises to strengthen my muscles and it helped strengthen the knee. And over time, it worked.” – P6
Re-injury
From this study, even though sampling behaviour appeared to lead to an increased injury risk and that the initial recovery times were relatively quick, it was also found that beyond that, risk of re-injury was likely, if the participants recovered poorly. This was characterised by them either playing through injury or returning to sport or activity prematurely. The overall goal of the rehabilitation process for sports injuries should be to facilitate a full recovery, while minimising the risk of re-injury (Dhillon et al., 2017). Young athletes are particularly prone to risk-taking behaviours (Al Qahtani et al., 2023). Therefore, it could be argued that because of this trait, they are more likely to return to sport prematurely (Mayer et al., 2020), or train and compete with an injury (Schnell et al., 2014), as they are unaware or lack the understanding regarding the importance of recovery and the potential negative consequences associated with not adhering to its principles, which include risk of re-injury and or it developing into more of a chronic issue (Kontos, 2004).
“I injured my ankle again. The problem was I kept playing on it, which was wrong. And I made it quite a bit worse, and it took me out for like eight or nine months.” – P3
“Initially pulled my glute, then tried to get back a little too soon, pulled it a little bit again, and prolonged it to more of a five, six-month injury.” – P4
Injury Mitigation Strategies
Despite the number of injuries experienced by the participants through sampling behaviour, they identified common strategies that they believed, and also for the most part utilised, to help mitigate this risk. They highlighted including some form of low-impact sport or activity into sampling behaviour, warming-up properly, engaging with S&C and load management. Given the nature of youth sport, while injury prevention is a noble goal, completely eliminating risk can be unrealistic, so instead, athletes should be driven to pursue practical ways to limit risk (Short et al., 2020).
Theme 3: Low-impact Sports or Activities
Those participants within this study who sampled at least one low-impact sport or activity, e.g., swimming or cycling, had less injuries, when compared to those who did not sample at least one of them. A likely explanation is that for example, swimming provides a full body and cardiovascular workout, while exerting minimal stress on your bones and muscles, and cycling offers cardiovascular benefits and improves lower limb strength, while also avoiding high impact (Mercer et al., 2023).
“Having a low impact sport that you can do, as a sort of like extra filler into your workout routine is very helpful. Especially considering it’s unlikely to damage any joints as much as another sport might.” – P3
Recovery
Additionally, the participants highlighted that doing low-impact sports or activities as a form of recovery, helped to protect against injury occurrences. These can provide a means of active recovery, while still promoting strength and cardiovascular gains, but without causing extra harm to the body (Mayr et al., 2016). They are often either incorporated separately to an athlete’s program or done after a training session or competition, and can involve cycling or water-based activity such as swimming etc. (Cheung et al., 2017). Commonly, these are done at fairly low intensity, with this better form of recovery leading to a reduction in neuromuscular fatigue, which subsequently can help to decrease injury risk (Van Hooren et al., 2018).
“Like low impact sports, it's really good for recovery. And yeah, so it's a good one to sort of lean into to help reduce your chances of getting injured.” – P6
Court Surface
Due to the British weather not always being suitable to accommodate outdoor sport or activity (Kay et al, 2006), it is quite common for them to be moved indoors. As a result, with tennis, one of the main court surfaces that is utilised throughout the year, is indoor hard court (LTA, 2019), which was the main court surface for all the participants. From the existing research, not only does court surface influence the rate and nature of injuries in tennis, but more specifically, among male tennis players, hard court was found to lead to the highest rate of injuries (Breznik et al., 2012), particularly lower extremity injuries (Alexander et al., 2022). The increased injury rate on hard court is likely due to fact that these courts have a higher frictional resistance, in comparison to the other court surfaces, which increases the load and stress that the joints and muscles are exposed to (Starbuck et al., 2015). The participants who sampled some form of low-impact sport or activity identified this as a strategy that was crucial to helping them reduce their injury risk, particularly as it counteracts having to constantly play on hard court, which is more or less unavoidable for British players.
“Playing tennis on a hard court, can really screw up and impact your knees and ankles and stuff. So, I think it's good to have sports like cycling, swimming, just low impact sports that you could do to keep your fitness up, without doing any extra harm.” – P3
Theme 4: Warming Up
The majority of the participants identified that incorporating an appropriate warm-up into their routine was an effective strategy to help reduce their injury risk. This finding mirrors that of Erdogan et al. (2022), who surveyed 167 male and female young Turkish tennis players and found that 91% reported that they believed doing a warmup helped to reduce their risk of getting injured. The main principles by which warming up can facilitate the reduction in injury rates is through (1) improving joint lubrication (Yoke et al., 2020), (2) increasing body temperature, which enhances their flexibility and resistance to strain and lastly (3) stimulating the neuromuscular system, which enhances an athlete’s preparedness to meet the demands of their given sport (Afonso et al., 2023).
“I found more recently that my injuries are starting to go away, but that's because I'm doing more of a warmup, and I’ve found that that's been quite helpful.” – P2
“I do think that if you don't warm up, you will increase your chances of getting injured.” – P5
Furthermore, the participants highlighted commonly included components within their warmup routine, which comprised mainly of active elements, such as stretching and use of exercise bands. This concurs with the research by Ayala et al. (2016), that suggested that for tennis and also for other sports, the most effective warm-up should primarily include active elements.
Stretching
The concept of stretching can further be broken down into static and dynamic stretching (Gelen et al., 2012), Both forms of stretching help to increase stretch tolerance, muscle flexibility and extensibility and reduce stiffness (Page, 2012), which when performed effectively, adhere to the principles of warming up, and thus could contribute to a reduction in injury risk (Armstrong et al., 2023).
“Doing a little static and dynamic stretching, to make sure that you know, all your body and all your joints and muscles are loose and warm to minimise or prevent injuries.” – P7
Equipment
Performing slow or fast repetitions through the range of motion, using exercise bands, is a form of resistance exercise that can also be incorporated into a warm-up routine (Myburgh et al., 2020). It provides a relatively safe option for muscles and joints, in minimising the stress or load that they are exposed to (Graham et al., 2023) and works by activating and enhancing neural drive within muscle groups (Christensen et al., 2016). In tennis and some other sport settings or venues, it may not necessarily be feasible to implement the use of heavy resistance exercises for warming up (e.g., weighted machines), so therefore, using exercise bands has been found to provide a more practical alternative, while still inducing the intensity needed to establish the potentiating effects of a warm-up (Chua et al., 2021), alongside helping to minimise risk of injury (Faigenbaum et al., 2020).
“I started using a resistance band to warm up my shoulder. And ever since I started doing that, I've not had shoulder problems at all.” – P2
Theme 5: Strength and Conditioning
Another injury mitigation strategy that was commonly reported among the participants was engaging with a general and sport-specific S&C program. S&C is pivotal in enhancing an athlete’s resilience to injury, through improving the body's overall physical capabilities, making it better equipped to handle the demands and stresses that it will be exposed to, through sport (Haff and Triplett, 2016).
“It [strength and conditioning] was good to be done, because it did strengthen me, and I had less problems.” – P2
General
The general aspects within a S&C program seek to address the improvement of fundamental movement patterns and overall physical fitness, which enhances the body's ability to perform basic tasks safely and efficiently (Myer et al., 2011). This broad physical development of the athlete helps to make them less prone to injuries, during general physical activity or sport (Weldon et al., 2022).
“A lot of it [strength and conditioning] was very general, just in terms of sort of building up like strength and sort of trying to reduce our chances of getting injured.” – P6
Sport-Specific
Due to the physical demands associated with tennis, it becomes more necessary for a tennis player to have a S&C program that is also inclusive of sport-specific elements (Reid et al., 2008). Performing tennis-specific movement patterns (e.g., for court coverage and performing different strokes) can create muscular imbalances or decreased range of motion, which subsequently increases injury risk (Fernandez et al., 2022). Therefore, including sport-specific elements within an S&C program is central to mitigating this risk (Fernandez et al., 2022), because the exercises will strengthen and condition the muscle groups that are explicitly essential for playing a particular sport, such as tennis, which will enhance an athlete’s injury resilience (Weldon et al., 2020).
“For our strength and conditioning sessions, we’d also do a lot of leg work to make sure we've got a strong base and we’d also do some upper body work, you know, for our ground strokes.” – P8
Theme 6: Load Management
The majority of the participants also highlighted that managing their training and competition loads, played a key role in influencing their injury risk, with the defining factor being the ability to find the right balance between the two. This finding is supported by the existing literature, which suggests that load management is also a factor that can indeed influence injury risk (Drew et al., 2016) and should be structured in a way that will best help to limit this risk (Soligard et al., 2016). Attaining equilibrium between external stresses and tissue capacity is a crucial aspect in the occurrence of injuries (Soligard et al., 2016).
Gabbett (2016) proposed a model of the acute: chronic workload ratio (ACWR) to highlight the correlation between changes in load and injury risk, which can be applied to young athletes who play multiple sports (Armstrong et al., 2023), including tennis (Myers et al., 2020). It outlines that if acute load is low (i.e., the athlete is experiencing minimal fatigue) and the chronic load is high (i.e., the athlete has developed fitness), then they are regarded as being well prepared and are less likely to get injured from training and competition.
“I think I was playing tennis around 3 or 4 times a week, and then competitions as well. I never really gave myself like a break. So, that's when I noticed these problems happening.” – P2
“I'm really lucky that I haven't had anything worse happen to me. I've probably managed my workload quite well, in that respect.” – P8
Training
Training load monitoring can either be accomplished through subjective or objective means, although, the most accurate and reliable method for athletes and developing tennis players has been found to be utilising a combination of the two, through athlete perception, alongside more quantifiable methods, such as heart rate monitoring and global positioning system (GPS) tracking (Bourdon et al., 2017; Fraser et al., 2019). Ultimately, with monitoring training load, the goal is to find the “sweet spot”, which optimises performance potential, while limiting adverse effects, such as atypical training adaptions (maladaptation) and subsequent injury (Gabbett, 2016).
“If I was training loads it [injury] would flare up. If I gave myself a week rest, or a few days’ rest, it would get a little bit better. It was just too much load, I think.” – P4
Competition
In comparison to training, it could be argued that competition imposes a higher demand on an athlete, as it can represent a rapid increase in load (i.e., higher acute load from competition) in contrast to the athlete’s preparation (i.e., lower chronic load from training) (Soligard et al., 2016). Young athletes who are aspiring to become elite, tend to have a higher competition workload (Hartwig et al., 2018), however, saturated competitive schedules, leave limited opportunity for adequate recovery, which can contribute to an increased injury risk (Armstrong et al., 2023). Research by Jayanthi et al. (2009) on youth tennis tournaments from the USA, found that from a sample of 28,336 match exposures, medical injury withdrawal rates increased significantly if players played five or more matches, when compared with four or less matches in a tournament. These results signify that competition loads can be linked with an increased injury risk, particularly if adequate recovery between tournaments or matches is not appropriately factored in.
“Yeah, I think my injury was down to just too much competing.” – P5
Limitations
A main limitation of this study was that there was an element of survivorship bias, in that none of the participants had a major injury. However, the argument against this is that if they had a major injury, potentially a career ending one, as they can often be, it would be unlikely that they would have been interviewed, since they would no longer be regarded as a current player.
Another possible limitation of this study is that the sample size (n=8), might be considered to be small, and thus, can limit the external validity and generalisability of the findings. However, in qualitative research, the focus is more on data saturation, rather than on quantifying sample size. For this study, the sample size was deemed appropriate by the researcher, in that a sufficient amount of thematic information had been accumulated, in order to accomplish the aim of the study.
Summary of the Findings and Conclusion
All participants practiced early sampling behaviour (inclusive of early engagement in tennis), which appears to lead to the ability to transfer skills from a variety of sports or activities to tennis, which are vital for the athlete’s development. Additionally, it also appears that the practice of sampling behaviour increases a young athlete’s risk of getting injured, although, the initial recovery times are relatively quick, suggesting that these are minor injuries. A significant factor that enhanced the recovery process, was accessing physiotherapy services, which highlights our role as practitioners in the management of injuries for these young athletes.
Another finding from this study, was that re-injury was likely if the appropriate recovery steps were not taken, which for young athletes, is generally characterised by either playing through injury or prematurely returning to sport or activity.
While it could be argued that that the benefits of early sampling behaviour outweigh the negatives effects, injuries are still one of the limiting factors that reduce chances of success within tennis. However, as early sampling does not appear to be inherently bad for a tennis athlete’s development, this instead raises the need to implement evidence-based strategies, to help mitigate injury risk among this population, without removing the practice of early sampling altogether. From the findings of this study, these strategies could include incorporating low-impact sport or activity of some description into sampling behaviour, as those who engaged in them, reported less injuries. This is particularly important due to the unpredictable nature of British weather forcing most of the tennis to be played on indoor hard court, a surface which increases the load on muscles and joints, often resulting in increased injury risk. The challenge with this is that most young athletes might not be inclined to just engage with low impact sport or activity, so therefore, also including other sports, such as a football, which, even though it has high injury rates, is still very popular among youth. With this approach in mind, there will always be an element of calculated risk, in finding the right balance between playing, for example, football, but then also counteracting it with low impact sports or activities, since they seem to be good for tennis players in reducing injury risk. Additionally, including sports such as badminton, cricket, rugby or other activities or sports that may involve transferrable skills to tennis, could also prove advantageous. Other injury mitigation strategies that were found to be useful, involved doing appropriately structured warm-ups, engaging with general and specific S&C programs and lastly, effectively managing training and competition loads.
Great Britain does not have a plethora of professional male tennis players, and
although this study does not represent the entire picture of an athlete’s developmental journey, these injury mitigation strategies, can, at the very least, provide a framework or model, which the LTA and or other NGBs, can implement to help limit risk of injury among sub-elite tennis players, which hopefully will enhance their ability to successfully progress towards an elite level.
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