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ObjectiveThis scoping review examines how different levels and types of partial foot amputation affect gait and explores how these findings may affect the minimal impairment criteria for wheelchair tennis.MethodsFour databases (PubMed, Embase, CINAHL and SPORTDiscus) were systematically searched in February 2021 for terms related to partial foot amputation and ambulation. The search was updated in February 2022. All study designs investigating gait-related outcomes in individuals with partial foot amputation were included and independently screened by two reviewers based on Arksey and O’Malley’s methodological framework and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.ResultsTwenty-nine publications with data from 252 participants with partial foot amputation in 25 studies were analysed. Toe amputations were associated with minor gait abnormalities, and great toe amputations caused loss of push-off in a forward and lateral direction. Metatarsophalangeal amputations were associated with loss of stability and decreased gait speed. Ray amputations were associated with decreased gait speed and reduced lower extremity range of motion. Transmetatarsal amputations and more proximal amputations were associated with abnormal gait, substantial loss of power generation across the ankle and impaired mobility.ConclusionsPartial foot amputation was associated with various gait changes, depending on the type of amputation. Different levels and types of foot amputation are likely to affect tennis performance. We recommend including first ray, transmetatarsal, Chopart and Lisfranc amputations in the minimum impairment criteria, excluding toe amputations (digits two to five), and we are unsure whether to include or exclude great toe, ray (two to five) and metatarsophalangeal amputations.Trial registrationThe protocol of this scoping review was previously registered at the Open Science Framework Registry (https://osf.io/8gh9y) and published.

Altered biomechanics due to amputation can contribute to substantial limitations, influencing sporting activities. Individuals with lower extremity amputations or congenital lower limb deficiency are encouraged to participate in para-sports. However, to compete in Paralympic sports, the candidate must have an impairment that results in lower extremity loss of function and meets or exceeds the sport's minimum impairment criteria (MIC). This review will focus on the MIC for competitive wheelchair tennis. Limb deficiency is known as one of the MIC used to regulate participation in competitive para-sports since it impacts gait, kinematics, and biomechanics of both the upper and lower body. Notwithstanding, it is questionable whether the MIC concerning limb deficiency is set at the correct level for determining eligibility for participating in Paralympic sports. This study aims to provide an overview of the evidence examining the impact of different partial foot amputation (PFA) levels on gait as a proxy for sporting performance. This scoping review will be based on a 6-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis, extension for scoping reviews (PRISMA-ScR). Studies will be selected from PubMed, Embase, CINAHL, and SPORTDiscus. Two authors will screen the titles/abstracts independently. Selected studies will be scrutinised, and the same authors will extract data. Findings will be relevant to informing the evidence-based development of MIC for lower limb impairment after PFA and may be extrapolated to specific Paralympic sports, including wheelchair tennis. Results will be disseminated through scientific publications and conferences to audiences interested in Paralympic sports.

BackgroundDespite reported injury rates of up to 3 per 1000 hours exposure, there are no evidence-based prevention programmes in tennis.PurposeTo evaluate the effectiveness of an e-health prevention programme for reducing tennis injury prevalence.Study designTwo-arm, researcher-blinded randomised controlled trial.MethodsAdult tennis players of all playing levels were randomised in an unsupervised programme lasting 12 weeks (TennisReady group or control group). The primary outcome was the overall injury prevalence over a 16-week period, measured at 2 weekly intervals with the Oslo Sports and Trauma Research Centre questionnaire. Estimates for the primary outcome and associated 95% CIs were obtained using generalised estimating equation models. Secondary outcome scores included prevalence of substantial injuries, overall incidence, adherence and time-loss injuries.ResultsA total of 579 (83%) (TennisReady n=286, control n=293) participants were included in the primary analysis. The mean injury prevalence was 37% (95% CI 33% to 42%) in the TennisReady vs 38% (95% CI 34% to 42%) in the control group (adjusted p-value 0.93). The prevalence of substantial injuries was 11% (95% CI 9% to 14%) in the TennisReady vs 12% (95% CI 9% to 15%) in the control group (p value of 0.79). Analysis of the secondary outcome scores showed no difference between groups. The mean prevalence rates between high (8%) and low (92%) adherent groups were 32% (95% CI 23% to 44%) and 37% (95% CI 33% to 42%), respectively (p value 0.36).ConclusionProviding an unsupervised e-health tennis-specific exercise programme did not reduce the injury rates and should not be implemented.Trial registration numberNTR6443.

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting. Funding Agencies|International Olympic Committee

This infographic outlines evidence-based recommendations on COVID-19 reverse transcriptase PCR (RT-PCR) testing in elite sport settings, aiming to protect personal and population health, and acknowledging resources and expertise that are often available in elite sport. Public health recommendations vary by country and region, and protocol decisions should be made in consultation with relevant public health authorities. An expert, multidisciplinary group with input from clinical virology, microbiology, public health, infectious diseases and sports medicine provides optimal implementation and interpretation of testing. Interventions to prevent COVID-19 transmission should be implemented consistently1 2 and should include The current gold standard of testing is RT-PCR testing.4–6 The test is highly sensitive and specific to SARS-CoV-2 viral RNA in laboratory conditions.2 Test results should be interpreted on the basis of the pretest probability, previous test …

In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.

In 2020, the IOC released a consensus statement that provides overall guidelines for the recording and reporting of epidemiological data on injury and illness in sport. Some aspects of this statement need to be further specified on a sport-by-sport basis. To extend the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sports and to meet the sport-specific requirements of all cycling disciplines regulated by the Union Cycliste Internationale (UCI). A panel of 20 experts, all with experience in cycling or cycling medicine, participated in the drafting of this cycling-specific extension of the IOC consensus statement. In preparation, panel members were sent the IOC consensus statement, the first draft of this manuscript and a list of topics to be discussed. The expert panel met in July 2020 for a 1-day video conference to discuss the manuscript and specific topics. The final manuscript was developed in an iterative process involving all panel members. This paper extends the IOC consensus statement to provide cycling-specific recommendations on health problem definitions, mode of onset, injury mechanisms and circumstances, diagnosis classifications, exposure, study population characteristics and data collection methods. Recommendations apply to all UCI cycling disciplines, for both able-bodied cyclists and para-cyclists. The recommendations presented in this consensus statement will improve the consistency and accuracy of future epidemiological studies of injury and illness in cycling.

The IOC has proposed standard methods for recording and reporting of data for injury and illness in sport. The IOC consensus statement authors anticipated that sport-specific statements would provide further recommendations. This statement is the tennis-specific extension of the partner IOC statement. The International Tennis Federation Sport Science and Medicine Committee, in collaboration with selected external experts, met in June 2019 to consider athlete health monitoring issues specific to tennis. Once the IOC consensus statement was finalised, the tennis-specific consensus was drafted and agreed on by the members over three iterations. Compared with the IOC consensus statement, the tennis consensus contains tennis-specific information on injury mechanism, mode of onset, injury classification, injury duration, capturing and reporting exposure, reporting risk and study population. Our recommendations apply to able-bodied as well as wheelchair tennis players. Where applicable, specific recommendations are made for wheelchair tennis.

For a sport to develop a meaningful injury prevention strategy, sound epidemiological data are crucial. This, in turn, needs to be based on the analysis of known risk factors involved in the sport so that mitigation strategies can be introduced by modifying the rules and laws if necessary. The key objective for medical advisors in sports is to reduce morbidity and to promote the sport as a health-enhancing leisure activity.1 In this editorial, we aimed to motivate other international sport federations to take similar action. Insufficient physical activity greatly increases the risk of non-communicable diseases, and physical inactivity is one of the biggest public health threats of the 21st century.2 Despite the incontrovertible evidence of the health benefits of physical activity, a WHO survey of 1.6 million participants in 146 countries revealed that 81% of children and adolescents aged 11–17 years participated in insufficient physical activity.3 In a climate dominated by COVID-19, obesity is clearly linked to poor outcome, along …

This study examined the association and predictive ability of several markers of internal workload on risk of injury in high-performance junior tennis players. Fifteen young, high-level tennis players (9 males, 6 females; age: 17.2 ± 1.1 years; height: 178.5 ± 8.7 cm; mass: 68.1 ± 4.8 kg) participated in this investigation. Data on injury epidemiology and internal workload during training were obtained for one competitive season. The session-rating of perceived exertion (s-RPE) was used to calculate internal workload markers in absolute (acute workload and chronic workload for 2-weeks, 3-weeks and 4-weeks) and relative terms (acute:chronic workload ratios [ACWR] for 2-weeks, 3-weeks and 4-weeks). Associations and diagnostic power for predicting tennis injuries were examined through generalised estimating equations and receiver operating characteristics analyses. During the season, a total of 40 injuries were recorded, corresponding to 3.5 injuries per 1000 h of tennis practice. The acute workload was highly associated with injury incidence (

SYNOPSIS: High-quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best-practice methods-methods matter (greatly!). The first METHODS MATTER meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting. Meeting participants agreed that the definition of sport injury depends on the research question and context. It was considered essential to be explicit about the goal of the research effort and to use frameworks to illustrate the assumptions that underpin measurement and the analytical strategy. Complex systems were discussed to illustrate how potential risk factors can interact in a nonlinear way. This approach is often a useful alternative to identifying single risk factors. Investigating changes in exposure status over time is important when analyzing sport injury etiology, and analyzing recurrent injury, subsequent injury, or injury exacerbation remains challenging. The choice of statistical model should consider the research question, injury measure (eg, prevalence, incidence), type and granularity of injury data (categorical or continuous), and study design. Multidisciplinary collaboration will be a cornerstone for future high-quality sport injury research. Working outside professional silos in a diverse, multidisciplinary team benefits the research process, from the formulation of research questions and designs to the statistical analyses and dissemination of study results in implementation contexts. This article has been copublished in the British Journal of Sports Medicine and the Journal of Orthopaedic & Sports Physical Therapy.

Objective To review the literature related to different treatment strategies for the general population of individuals with amputation, spinal cord injury, and cerebral palsy, as well as how this may impact pain management in a correlated athlete population. Data sources A comprehensive literature search was performed linking pain with terms related to different impairment types. Main results There is a paucity in the literature relating to treatment of pain in athletes with impairment; however, it is possible that the treatment strategies used in the general population of individuals with impairment may be translated to the athlete population. There are a wide variety of treatment options including both pharmacological and nonpharmacological treatments which may be applicable in the athlete. Conclusions It is the role of the physician to determine which strategy of the possible treatment options will best facilitate the management of pain in the individual athlete in a sport-specific setting.

OBJECTIVE: For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. DATA SOURCES: Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. MAIN RESULTS: Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. CONCLUSIONS: The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance. Refereed/Peer-reviewed

ObjectiveThe aim of this study was to determine whether there is a difference in the prevalence of tennis injuries between the four most common court surfaces in the Netherlands, including hard court, clay, sand-fill artificial grass and red-sand-fill artificial grass. Natural grass was not included in this study.MethodsThis was a repeated cross-sectional study over 6 months, involving members of the Royal Netherlands Lawn Tennis Association (KNLTB). A monthly questionnaire was sent to a random sample of 20 000 KNLTB members, stratified by their club’s playing surface. The questionnaire included questions on court surface, tennis exposure and physical complaints, using the Oslo Sports Trauma Research Centre questionnaire on health problems.ResultsA total of 3656 (18%) of the 20 000 invited members completed at least one of the monthly questionnaires [mean age 49 years (15)]. A total of 4047 injuries were reported by 1957 respondents. Of these injuries, 3246 (80%) were overuse and 801 (20%) were acute. There were no statistically significant differences in injury prevalence between groups who played primarily on any one of the four court surfaces. However, players who played on multiple surfaces had a higher injury prevalence, particularly of overuse injuries, than those who primarily played on one court surface. Compared with the other court surfaces, there was a higher prevalence of lower limb overuse injuries when playing on hard court.ConclusionThere is no significant difference in the overall prevalence of injury on clay, hard court, sand-fill artificial grass and red-sand-fill artificial grass.

Objectives We compared the utility of four cooling interventions for reducing heat strain during simulated tennis match-play in an environment representative of the peak conditions possible at the Australian Open (45 °C, Design Nine trained males undertook four trials in a climate chamber, each time completing 4 sets of simulated match-play. Methods During ITF-mandated breaks (90-s between odd-numbered games; 120-s between sets), either iced towels (ICE), an electric fan (FANdry), a fan with moisture applied to the skin (FANwet), or ad libitum 10 °C water ingestion only (CON) was administered. Rectal temperature (Tre), mean skin temperature (Tsk), heart rate (HR), thermal sensation (TS), perceived exertion (RPE) and whole body sweating (WBSR) were measured. Results After set 3, Tre was lower in ICE (38.2 ± 0.3 °C) compared to FANdry (38.7 ± 0.5 °C; p = 0.02) and CON (38.5 ± 0.5 °C; p = 0.05), while Tre in FANwet (38.2 ± 0.3 °C) was lower than FANdry (p = 0.05). End-exercise Tre was lower in ICE (38.1 ± 0.3 °C) and FANwet (38.2 ± 0.4 °C) than FANdry (38.9 ± 0.7 °C; p Conclusions Fan use must be used with skin wetting to be effective in hot/dry conditions. This strategy and the currently recommended ICE intervention both reduced Tre by ∼0.5–0.6 °C and Tsk by ∼1.0–1.5 °C while mitigating rises in HR and TS.

Talented athletes use metacognitive skills to improve their performance. Also, it is known that these skills are important for managing one's health. The goal of this study was to identify the relationship between metacognitive skills and overuse injuries in talented tennis players. Metacognitive skills were measured in 73 talented tennis players (45 boys and 28 girls, age 11-14) at the start of the season, using the Self-Regulation of Learning Self-Report Scale. Overuse injuries were monitored for one season using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Ordinal regression indicated that moderate or low selfmonitoring skills (compared to high selfmonitoring) (OR 4.555, CI 1.096-18.927, P = 0.037) and exposure time (OR 1.380, CI 1.106-1.721, P = 0.004) were associated with more time loss overuse injuries. A second analysis showed that this was the case in girls (OR 10.757, CI 1.845-62.714, P = 0.008), but not in boys. Linear regression revealed that higher reflection scores and exposure time predicted overuse severity (F(5,58) = 2.921, P = 0.020, R-2 = 0.201). Possibly, selfmonitoring can help players to prevent themselves from time loss overuse injuries. Coaches should be aware that players can differ in selfmonitoring ability and thus in the ability to prevent overuse injuries. The role of reflection needs more research.

Purpose:To determine the relationship between outcomes of the shuttle wheel test (SWT) and peak oxygen uptake (VO2peak) during that test and whether SWT and VO2peak can discriminate between different skill levels of wheelchair tennis players. Methods:Fifteen wheelchair tennis players performed an SWT on a tennis court while VO2 was measured continuously. Outcome measures were VO2peak and achieved stage. Relations between outcomes and Dutch wheelchair tennis ranking were calculated with Spearman correlation. Independent t tests were used to test for differences between national and international players. Results:Moderate correlations were found between VO2peak and SWT outcome (r = .40–.47). The tennis ranking correlated weakly with VO2peak (r = –.35) and strongly with SWT outcome (r = –.80). A significant difference was found between national and international players for achieved stage (P = .027) and VO2peak (P = .027). Conclusions:The SWT outcome only explained a small part of the variance in VO2peak among players, so it cannot be considered a valid test for aerobic capacity. However, SWT outcomes are related to the skill level of the player and give a good indication of the overall peak wheelchair performance.

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of loadincluding rapid changes in training and competition load, competition calendar congestion, psychological load and traveland health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified. Funding Agencies|IOC

High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods-methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting. Funding Agencies|BJSM

Historically, epidemiology researchers have identified bespoke units of measurement to express each sport’s injury narrative. In 2009, respected industry professionals suggested that tennis injuries be reported per 1000 player-hours rather than athletic exposures (such as 1000 matches) due to large variations in the time component of such exposures.1 This goes some way to addressing the lack of uniformity in tennis injury data, which McCurdie et al 2 have identified as the most significant challenge to understanding injury in elite tennis. However, given the streams of data now available, it seems timely to revisit whether this recommended choice of exposure remains as pertinent as it once was. Gescheit et al 3 recently highlighted how the choice of exposure can influence study conclusions. For example, when comparing female muscle injury rates using game exposures (strongly correlated to match duration) versus set exposures at the Australian Open between 2011 and 2016, they found 14% variation in the number of reported injuries …

Pain and injury are not synonymous. Pain can occur without sport injury, and sport injury may not necessarily manifest with pain. It is …

BackgroundThis study describes the epidemiology of men's and women's tennis injuries reported by the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009/2010–2014/2015 academic years.MethodsInjuries and athlete-exposure (AE) data originated from 19 varsity men's programmes (38 team-seasons); women's tennis data originated from 25 varsity programmes (52 team-seasons). Injury rates, injury rate ratios (IRRs) and injury proportions ratios (IPRs) were reported with 95% CIs.ResultsThe ISP captured 181 and 227 injuries for men's and women's tennis, respectively, for injury rates of 4.89 and 4.88/1000 AE for men and women, respectively. There were 32.2% and 63.9% reductions in men's and women's tennis practice injury rates between 2009/2010–2011/2012 and 2012/2013–2014/2015, but no reductions in competition injury rates. Competition injury rates were higher than practice injury rates in men's (IRR=2.32; 95% CI 1.72 to 3.13) and women's tennis (IRR=1.77; 95% CI 1.35 to 2.33). Most injuries in men's and women's tennis occurred to the lower extremities (47.0% and 52.4%, respectively), compared with the trunk (16.6% and 17.6%, respectively) and upper extremities (23.8 and 23.8, respectively).ConclusionsInjury rates in NCAA men's and women's tennis were similar overall. Practice injury rates in men's and women's tennis have declined, although competition rates have not changed. These findings may help inform injury prevention programmes in the future.

Background Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance. Objective The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters. Methods FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated. Results Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented. Conclusion The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention.

the course of the study, 67 players reported a total of 187 health problems. The average weekly prevalence of all health problems was 21.3% (95% CI: 19.2–22.9), of which 12.1% (95% CI: 10.9–13.3) constituted overuse injuries and 5.8% (95% CI: 4.6–6.9) illnesses. The incidence of acute injuries was 1.2/1000 h of tennis play (95% CI: 0.7–1.7). The high occurrence of overuse injuries among elite junior tennis players suggests that an early focus on preventative measures is warranted, with a particular focus on the monitoring and management of workload.

In addition to the musculoskeletal injury emphasis described in other chapters of this book, there is a tremendous stress to the entire body during tennis play. This requires high-level medical care for the competitive tennis player against illness and overtraining syndromes. This chapter overviews these key medical issues.

Overuse injuries are a serious problem in junior tennis. Gaining insight in age-specific risk factors can contribute to prevention. The developmental cognitive processes that take place during adolescence make talented players more inclined to take risks. This may be even more pronounced in the high performance culture in which they move. Therefore, this study focuses on the relationship between risk-taking and overuse injuries in talented tennis players. Seventy-three talented tennis players (45 boys and 28 girls, age 11–14 years) were monitored for 32 weeks, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Risk-taking was measured at the start of the season with the Iowa Gambling Task. Linear regression analyses were executed to predict (a) overuse injuries, (b) time loss overuse injuries and (c) overuse severity, by risk-taking, exposure time, and injury history. In boys, risk-taking contributed significantly to time loss overuse injuries [F(1,39) = 7.764, P = 0.008, R2= 0.15] and to overuse severity [F(1,39) = 5.683, P = 0.022, with an R2 of 0.13] In girls, time loss overuse injuries [F(1,23) = 6.889, P = 0.018, R2= 0.20] and overuse severity [F(1,23) = 7.287, P = 0.013, R2= 0.24] were predicted by exposure time. Coaches and trainers should be aware that talented male tennis players who are inclined to take risks, are more likely to maintain risky behavioral patterns related to overuse injuries.

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic. Refereed/Peer-reviewed

Objectives To explore the factors that facilitate or hinder the development of healthy tennis clubs in the Netherlands and to identify suitable interventions that would help clubs to reach ‘healthy club’ status. Methods A maximum variation, purposive sampling strategy was used to identify and recruit board members (n=16) from 10 Dutch tennis clubs. Data were collected using in-depth interviews based on an interview guide. The interviews explored what steps the clubs had taken to create a healthy tennis club, and what the respondents perceived to be the barriers to reaching healthy club status. The data were analysed using thematic content analysis. An ecological model was used to frame the interpretation of the themes and guide the development of the interventions. Results Four emerging themes were identified: provision of healthy foods, injury prevention and health services, social health and safety around the club. The main facilitators were found to be support from club management, having appropriate policies in place and having appointed officers. The main barriers were identified as a lack of policy templates, inadequate knowledge of coaches on injury prevention and injury management and fragmented access to relevant information. Conclusions Guided by an ecological model, this study demonstrates the many factors that influence tennis clubs and the individual members of a healthy tennis club. Using this model, a multilevel intervention framework has been created that could be used by the Royal Netherlands Lawn Tennis Association to increase the number of healthy tennis clubs in the Netherlands.

PURPOSE: To assess the efficacy of different in-play cooling strategies for mitigating heat strain during simulated tennis match-play activity in a hot/humid environment representing the most extreme conditions during the US Open (36 degrees C, 50{%} RH). METHODS: On three occasions, nine males completed an intermittent treadmill-protocol with an exercise intensity and activity profile simulating a 4-set tennis match, with 90-s breaks between odd-numbered games and 120-s between sets, according to ITF rules. During breaks, either (1) the currently used cooling strategy - an ice-filled damp towel around the neck and a cold-damp towel on the head and thighs (ICE), (2) wetting of arms, neck, face and lower legs with a sponge in front of an electric fan (FANwet), or (3) no cooling (CON), were applied. Rectal (Tre) and mean skin (Tsk) temperature, and heart rate (HR) were measured throughout. Thermal sensation (TS) and ratings of perceived exertion (RPE) were assessed during breaks. Trials were terminated upon reaching a Tre {\textgreater}/=39.5 degrees C or volitional exhaustion. RESULTS: Seven, five and one participant completed FANwet, ICE and CON respectively. By end set 1, DeltaTre was lower in FANwet (0.92+/-0.15 degrees C) compared to CON (1.09+/-0.09 degrees C; P=0.01), and by end set 2 DeltaTre was lower (P{\textless}0.001) in FANwet (1.55+/-0.23 degrees C) and ICE (1.59+/-0.17 degrees C) compared to CON (1.99+/-0.19 degrees C). Mean RPE (FANwet:13.9+/-2.2; ICE:13.6+/-1.8; CON:16.6+/-1.8), HR (FANwet:163+/-21; ICE 164+/-22; CON: 175+/-19 beats.min), Tsk (FANwet:36.56+/-0.69 degrees C; ICE 36.12+/-0.44 degrees C; CON:37.21+/-0.42 degrees C) and TS were lower in FANwet and ICE (P{\textless}0.05) compared to CON by end set 2. CONCLUSIONS: The currently recommended ICE strategy successfully mitigates thermal strain during simulated tennis match-play in hot/humid conditions. The FANwet intervention is an equally effective alternative that may be more practical in limited resource settings.

The aim of the study was to explore the role of tennis in the promotion of health and prevention of disease. The focus was on risk factors and diseases related to a sedentary lifestyle, including low fitness levels, obesity, hyperlipidaemia, hypertension, diabetes mellitus, cardiovascular disease, and osteoporosis. A literature search was undertaken to retrieve relevant articles. Structured computer searches of PubMed, Embase, and CINAHL were undertaken, along with hand searching of key journals and reference lists to locate relevant studies published up to March 2007. These had to be cohort studies (of either cross sectional or longitudinal design), case-control studies, or experimental studies. Twenty four studies were identified that dealt with physical fitness of tennis players, including 17 on intensity of play and 16 on maximum oxygen uptake; 17 investigated the relation between tennis and (risk factors for) cardiovascular disease; and 22 examined the effect of tennis on bone health. People who choose to play tennis appear to have significant health benefits, including improved aerobic fitness, a lower body fat percentage, a more favourable lipid profile, reduced risk for developing cardiovascular disease, and improved bone health.

When the current editorial team was given the privilege and responsibility of leading the BJSM into the 2010s, part of the job description was to write a ‘Warm Up’ for each of the 12 annual issues. We have dodged that responsibility pretty consistently and still get paid. However, at the end of our 10th year in the role we share 10 Level 5 opinions. 1. BJSM aims to serve the clinical community. This resulted from our ‘listening for direct’ consultations in 2008. It meant that BJSM differentiated itself from leading physiological journals such as Journal of Applied Physiology and also from surgical journals such as the American Journal of Sports Medicine . BJSM was for clinicians who treat those in the physical activity, exercise and sporting community and those who use physical activity, exercise and sport as medicine. 2. 25 member societies make up the current ‘ BJSM family’ without including ‘ the special’ relationships we have with organisations such as the International Olympic Committee, the World Confederation of Physical Therapy, the Concussion in Sport Group (CISG), the International Federation of Sports Physical Therapy etc. The value proposition is that by being a full BJSM member, a …

IntroductionDespite an injury incidence of up to 3.0/1000 hours of play, there are no published tennis injury prevention programmes. This article aims to describe the developmental process of TennisReady, an e-health tennis-specific injury programme for adult recreational tennis players.Five-step approachA bottom-up, five-step approach was used with the Knowledge Transfer Scheme as a guideline. During the first step, a problem statement among targeted users was carried out. 475 (partially) completed surveys and group interviews (n=8) revealed a preference for an app-based prevention intervention of 10–15 min. As a second step, a systematic review was performed to identify prevention strategies in tennis. None were found. In step 3, during two expert group meetings (n=18), the findings of the first two steps were discussed and goals were formulated. Relevant and potential exercises for the programme were discussed. A subgroup of a total of six physical therapists, physicians and trainers developed the content of the programme in step 4. Step 5 included an evaluation of the exercises in 33 recreational tennis players. Participants evaluated the exercises during training sessions with trainers involved in the programme’s development or their colleagues. Participants evaluated the programme through standardised surveys or group interviews. Based on this evaluation, the programme was adjusted by altering exercises and frequencies, and it was evaluated in a second target group (n=27). The second evaluation did not result in any major changes to the final prevention programme.ConclusionThrough a five-step approach guided by the Knowledge Transfer Scheme, we developed an e-health tennis-specific prevention programme for adult tennis players. This 10 min intervention will require testing in a randomised controlled setting.

SUMMARY: A TENNIS-SPECIFIC STRENGTH AND CONDITIONING PROGRAM CAN PLAY A KEY ROLE IN PREVENTING COMMON INJURIES IN TENNIS PLAYERS. THE INFORMATION PROVIDED IN THIS ARTICLE IDENTIFIES COMMON TENNIS INJURIES AND THE TENNIS DEMANDS AND MUSCULAR IMBALANCES THAT MAY PLAY A ROLE IN CAUSING THEM. SPECIFIC EXERCISES ARE SUGGESTED BASED ON THESE SPORT-SPECIFIC MUSCULAR IMBALANCES THAT HAVE A GOAL OF BOTH PREVENTING INJURIES AND ENHANCING A PLAYER'S PERFORMANCE.

The aim of the study was to examine whether differences in playing level influence the activity profile and physiological demands of advanced and recreational veteran men's tennis players during an hour of tennis match play. Ten advanced (International Tennis Number [ITN] 3-5, 45.3 ± 5.1 years) and 10 recreational (ITN 7-9, 44.8 ± 4.7 years) veteran men's tennis players participated in 4 experimental sessions: (1) an ITN on-court assessment, (2) a laboratory incremental treadmill test, (3) an hour of simulated tennis match play, and (4) 30 minutes of tennis match play using a portable gas analyzer. Subjects' [latin capital V with dot above]o2 and heart rate (HR) were recorded by portable analyzers. Moreover, energy expenditure was evaluated by indirect calorimetry. Temporal structure and distance covered were determined from video recordings. Subjects' [latin capital V with dot above]o2 (24.5 ± 4.1 vs. 23.3 ± 3 ml·kg-1·min-1), HR (148.3 ± 11.5 vs. 149.8 ± 8.4 bpm), duration of rallies (DR) (6.3 ± 4.1 vs. 7.6 ± 5.5 seconds), and effective playing time (EPT) (21.7 ± 5.0 vs. 23.6 ± 5.4%), HR (148.3 ± 11.5 vs. 149.8 ± 8.4 bpm), and energy expenditure (263.1 ± 49.4 and 281.3 ± 61.8 kcal·min-1) during play did not differ significantly (p > 0.05) between advanced and recreational players. The advanced players covered significantly more meters than the recreational players during their 1-hour tennis matches (mean ± SD: 3568.8 ± 532.2 vs. 3173.8 ± 226 m, p < 0.01) at lower running speeds. The results indicate that, independently of ability, tennis match play satisfies the American College of Sports Medicine recommendations for quantity and quality of exercise for the development and maintenance of cardiovascular fitness in healthy adults and seems to be a viable and highly popular mode of healthy activity.

OBJECTIVE: To assess possible ergogenic properties of corticosteroid administration. DESIGN: A balanced, double blind, placebo-controlled design was used. PARTICIPANTS: Twenty-eight well-trained cyclists and rowers. INTERVENTION: Four weeks daily inhalation of 800 microg budesonide or placebo. Main outcome measurements: The subjects performed three incremental cycle ergometer tests until exhaustion, before and after two and four weeks of placebo or budesonide administration, to measure maximal power output (Wmax). Once a week they filled in a profile of mood state (POMS) questionnaire. RESULTS: There was no significant difference in Wmax between the placebo (376+/-25 watt) and the corticosteroid group (375+/-36 watt) during the pre-intervention test, and there were no significant changes in either group after two and four weeks of intervention. No effect of the intervention on mood state was found. CONCLUSION: Four weeks of corticosteroid or placebo inhalation in healthy, well-trained athletes did not affect maximal power output or mood state. Hence no ergogenic properties of four weeks corticosteroid administration could be demonstrated, which corroborates previous studies with short-term corticosteroid administration.

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities. Funding Agencies|International Olympic Committee

Background: Creatine supplementation is popular among tennis players but it is not clear whether it actually enhances tennis performance. Objectives: To examine the effects of creatine supplementation on tennis specific performance indices. Methods: In a randomised, double blind design, 36 competitive male tennis players (24 creatine, mean (SD) age, 22.5 (4.9) years; 12 placebo, 22.8 (4.8) years) were tested at baseline, after six days of creatine loading, and after a maintenance phase of four weeks (14 creatine, 10 placebo). Serving velocity (10 serves), forehand and backhand velocity (three series of 5×8 strokes), arm and leg strength (bench press and leg press), and intermittent running speed (three series of five 20 metre sprints) were measured. Results: Compared with placebo, neither six days nor five weeks of creatine supplementation had a significant effect on serving velocity (creatine: +2 km/h; placebo: +2 km/h, p = 0.90); forehand velocity (creatine: +4 km/h; placebo: +4 km/h, p = 0.80), or backhand velocity (creatine: +3 km/h; placebo: +1 km/h, p = 0.38). There was also no significant effect of creatine supplementation on repetitive sprint power after 5, 10, and 20 metres, (creatine 20 m: −0.03 m/s; placebo 20 m: +0.01 m/s, p = 0.18), or in the strength of the upper and lower extremities. Conclusions: Creatine supplementation is not effective in improving selected factors of tennis specific performance and should not be recommended to tennis players.

A systematic search of published reports was carried out in three electronic databases from 1966 on to identify relevant articles relating to tennis injuries. There were 39 case reports, 49 laboratory studies, 28 descriptive epidemiological studies, and three analytical epidemiological studies. The principal findings of the review were: first, there is a great variation in the reported incidence of tennis injuries; second, most injuries occur in the lower extremities, followed by the upper extremities and then the trunk; third, there have been very few longitudinal cohort studies that investigated the association between risk factors and the occurrence of tennis injuries (odds ratios, risk ratios, hazard ratios); and fourth, there were no randomised controlled trials investigating injury prevention measures in tennis. More methodologically sound studies are needed for a better understanding of risk factors, in order to design useful strategies to prevent tennis injuries.

Concerns have long existed over the participation of adolescent athletes in professional sports. In 2004, the Sony Ericsson WTA Tour (WTA Tour) commissioned a Professional Development Advisory Panel (PDAP) to evaluate the WTA Tour’s age eligibility rule (AER) and professional development programmes (PDPs) for female tennis players since their inception in 1995. More than 75% of the 628 respondents supported the principles of the AER, and 90% indicated a need for PDPs. Statistical analysis of WTA Tour players’ careers found that premature retirements (players leaving the Tour at or before age 21) decreased significantly from 7% before the AER to less than 1% afterward, and median career length increased by 43%. The PDAP recommends that the WTA Tour continues a phased-in, developmentally appropriate AER, enhances the PDPs, and works with other sport governing bodies to coordinate rules and programmes at earlier ages to aid the transition of adolescents into adult sports.

Owing to players such as Maria Sharapova, Serena Wiliams, Rafael Nadal and Roger Federer, tennis has generated a lot of public interest. Tennis players have become superstars, their names being mentioned alongside those of popular musicians and actors. Behind the glamour, however, a lot of hard work is going into improving the quality of the game. The high level of tennis did not happen overnight. Sporting excellence is supported by scientific research in all aspects of the sport. What are the major scientific advances of the past 10 years and what is their impact on the game of tennis? ### Player analysis technology Specialised equipment (‘smart’ devices) are now available that have the ability to measure the way the player performs or interacts with his equipment.1 This gives objective information that was previously only available from a subjective analysis by the coach. These devices include the KITRIS-KIT, the Babolat Play racket and the PlaySight smart court. Players now have access to sophisticated coaching information at low cost, even if they have no coach, and this is having a major impact on the sport. The information is of real time (or very close to real time) and is much more detailed than was previously possible. It is also possible to relay this analytical information to spectators and the media which could significantly change the way that these groups interact with tennis. The development of this player analysis technology is evolving so rapidly that the 2014 Rules of Tennis have been amended to permit International Tennis Federation (ITF)-approved devices to be used during play. The use of the technology is restricted in accordance with the Coaching Rule, which means that players cannot access any coaching information generated by their equipment when coaching is not permitted. ### Electronic line-calling A particularly noticeable scientific recent advance has been the introduction of …

Consistent training is conducive to reaching performance goals in sport and essential for optimal performance. A study in athletics has shown that the likelihood of achieving a performance goal was seven times higher in those athletes who completed >80% of their planned training weeks and that training availability accounted for 86% of successful seasons.1 This means that the goals of the coaches and strength/conditioning experts and the sports medicine/physiotherapy team are not distinct entities but rather complementary, with the clinical team trying to avoid failure and the coaches improving the chance of success. How do we keep our athletes injury-free? There is the perception that higher training loads inevitably result in higher injury rates in athletes. Although it is true that high absolute training loads are associated with greater injury risk, there is also evidence that training may have a protective effect and that undertraining increases injury risk.2 The new ‘train smart AND hard’ paradigm3 suggests that it is not so much the load itself, but an inappropriate transition to …