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It's not the destination, it's the ‘road to load’ that matters: a tennis injury prevention perspective
  1. Babette M Pluim1,
  2. Michael K Drew2,3
  1. 1 Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amersfoort, The Netherlands
  2. 2 Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia
  3. 3 Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
  1. Correspondence to Dr Babette M Pluim, Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Displayweg 4, Amersfoort 3821 BT, The Netherlands; b.pluim{at}

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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 a higher load that causes injuries: the ‘road to load’.4 In rugby, cricket and football, rapid and/or excessive increases in training, over a short period of time, lead to injury.

Gabbett3 elegantly explained this concept in his article ‘The training-injury prevention paradox: should athletes be training smarter and harder?’

Internal loads were measured using the rate of perceived exertion (RPE) score and external loads were measured using the number of minutes played. Athletes who were accustomed to very low loads (undertrained athletes), and had a sudden increase in their training, were at increased risk of injury. Conversely, athletes who were already used to high training loads, and continued with these high loads, had a much lower chance of injury.

Gabbett concluded that it is not so much the total load itself but the week-to-week changes that matter—the acute:chronic workload ratio (acute=weekly load and chronic=average load over the past 4 weeks). Using this ratio, there is a sweet zone of where the week-to-week load ratio remains between 0.8 and 1.3 and the risk of injury is lowest (figure 1).

Figure 1

The risk of injury is lowest with an acute:chronic work load ratio between 0.8 and 1.3, from Gabbett.3

Applying load principles to tennis

At the start of the outdoor tennis season, players start to compete on a regular basis (2–3 matches on 1 day) and suddenly increase the hours of tennis from 2–3 h per week to 4–6 h a day! It is no surprise then, that there are numerous injuries at this time and during the 7-week team competition in the Netherlands.5 A similar problem occurs when junior tennis players are selected for an elite training programme with a sudden increase in the volume and intensity of their training programme.6

So despite the fact that these injuries were considered almost inevitable, we know now that many of them can be avoided by adhering to the following guidelines:

Six load management tips to prevent tennis injuries:

1. Establish a basic fitness level

Continue to play tennis during the off-season and winter 2–3 times a week, and include basic strength and conditioning exercises in your weekly programme. Consistent and moderate training levels will protect you at the start of the season and when playing tournaments.

2. Minimise the week-to-week changes

Build up training load gradually and have a longer preparation period—at the start of the season, when entering a new training programme or when resuming play after injury.

3. Try to avoid peaks in load

This may be difficult—tennis is very unpredictable with long and short games, and matches that last two to three sets (or even five sets in Men's Grand Slams and Davis Cup). Think twice before signing up for more than one division in a tournament (eg, under 18 and adult) or before signing up for both singles, doubles and mixed doubles.

Tip for tournament organisers: reduce the variability by removing the deuce/advantage system during games and introduce a super tiebreak instead of a third set.

4. Make sure you maintain a correct work–rest balance

Taper off in the period leading up to a match or tournament and schedule recovery training the day after a tough match or training session. Schedule enough rest between tournaments.

5. Ensure a minimum training load is maintained

You should continue to exercise regularly during holidays and in the winter period. When injured, try to continue some form of cross-training.

6. Don’t overdo it!

There is a maximum that any athlete can handle. More than three matches a day or more than eight matches a week is a risk for any tennis player, no matter how well trained they are, with a lower number for juniors.6


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  • Twitter Follow Michael Drew at @_mickdrew and Babette Plium @docpluim

  • Contributors BMP has designed and written the article and made it tennis-specific. MKD has provided the ideas and background for the load management tips and approved the final version of the article.

  • Competing interests BMP is Deputy Editor of the BJSM. This paper was not commissioned and externally reviewed at arm's length by two experts in the field. The second revised version was accepted.

  • Provenance and peer review Commissioned; externally peer reviewed.

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