Physios discuss: can injuries serve to extend a tennis career?

This month, we published an article in Australian Tennis Magazine posing the question: can long-term injury absences actually serve to lengthen a player’s competitive career?

In preparing the story we chatted to two physiotherapists – both prominent in the sport of tennis – who discussed the processes that can occur during a player’s injury break and why many players are now competing longer than ever in spite of injuries.

Paul Ness, ATP World Tour Director of Medical Services, Senior Physiotherapist, and Milena Mirkovic, a physiotherapist with Britain’s Lawn Tennis Association, spoke to tennismash and also explained how the grasscourt season brings with it its own set of factors relating to potential injury that players must prepare for and guard against.

tennismash: Injuries are never ideal for a player, but do they provide the silver lining of some much-needed rest, recovery and rehabilitation?

Paul Ness: “An injury break can be stressful for players as they are always worried about losing ranking points taking weeks off. At the same time if they approach it from another angle they can benefit from the time off also. Many players have numerous aches and pains and do not always have enough time in the day to attend to them so it is possible to have the ‘main injury’ treated, but also other niggles to be ironed out. On top of that there is the mental freshness that can be regained. Many players spend most of the year on the road and can become stale, so a break can be great for restoring motivation and a love of the game.

Milena Mirkovic: “Tennis players have a much shorter off-season compared to other sports, and unsurprisingly their injuries are predominantly overuse related. From an early age they are chasing ranking points and playing week in, week out, often not allowing enough time for optimal off-court physical development and recovery. Time out due to injury usually provides an opportunity to work on other aspects of physical development which may have been neglected or put on hold as a result of long stint of tournaments.”

T: What processes occur in the body when a player is sidelined? Aside from obviously rehabbing the specific injury, does this time also see the body’s muscles, tendons, joints, and skeletal system regenerate after vigorous use? Perhaps some other existing niggles also heal up?

PN: “As mentioned above it is possible for some of the other small injuries to be more fully addressed, which is great. One thing to remember is that these guys are top professionals for a reason – their bodies can withstand the loads required to be the best of the best. Many of the guys can keep going and going because their bodies are so good at recovering. Saying that, time off can allow better recovery if coupled with good treatments, massage and rehabilitation programs.”

MM: “Rest allows the body to recover both physically and mentally from any overreaching or overtraining that it may have been exposed to. However, too much rest can also result in tennis-specific deconditioning of tissues, especially other tendons and bones, which may predispose a player to new injuries, or see the flair up old injuries if the player rushes back to competition too soon. Therefore a rehabilitation program should be carefully designed by the player’s physiotherapist with input from the relevant doctor, the player, their strength-and-conditioning coach and tennis coach, to ensure that progressions are gradual, and that as many factors contributing to past and current physical (and wellbeing) problems are addressed in this time.”

T: Players like Serena Williams, Tommy Haas, Lleyton Hewitt and Flavia Pennetta have all suffered multiple injuries that combined to sideline each them for several years. Yet all of these players competed well into their 30s, and some of them are still playing now. Is there some merit in the theory that their bodies are “younger” than their chronological age, given they haven’t pounded their bodies on the match court and in practice to the same extent as some of their rivals who haven’t spent as long on the sidelines?

PN: “Players are competing well in to their 30s now in general, not just those who have had extensive time off with injuries. The average age of the top 100 has increased steadily over the last 15 years. I believe much of this is due to a better understanding of the body and increased professionalism. The game has advanced physically and as a result players have had to adapt physically also. Players train better and smarter, take care of their bodies more – through preventative rehabilitation programs, appropriate weights programs and good warm-ups – eat better and have better recovery strategies, including ice baths, stretching, physiotherapy, massage, etc. The ATP World Tour Medical Services started a tennis specific screening program over 10 years ago to test a range of important physical attributes and address deficiencies seen. I believe I have seen fewer significant injuries over the years partly because of this program.”

MM: “There is evidence to suggest that women reach their physical peak in their mid-20s and men in their late 20s. And let’s not forget the maturity and mentality factor as well. Therefore it very much depends on each player’s situation. Generally if they have good fitness foundation, manage their training load and competition schedule effectively, are content with their life and if they still have the passion to continue playing tournaments after years of competitive play, there is no reason why they can’t compete into their 30s. But if they have skipped steps along the way or ineffectively managed their training load then they are more susceptible to injury, and time off may provide them with an opportunity to improve their overall fitness and optimise development. Such scenarios may explain the theory of having a ‘younger’ body than their chronological age at a given time during injury.”

T: What kinds of physical precautions might players take when making the switch from playing on clay to grass? Do they need to do more stretching, seek more physio, and/or alter their warm-up and training exercises?

PN: “Changes of surfaces always cause players a bit of trouble. The ball bounces differently so you have to set up for a shot in different positions. In essence, muscles are used slightly differently. Because tennis professionals are such finely tuned athletes they notice small changes. They do try to get onto the new surface as soon as possible to allow time to adapt and hopefully their fitness trainers start them on exercises to simulate the surface change toward the end of the previous swing, but this is not always possible in competition as recovery is often most important. It is certainly extra busy in the treatment room ironing out those change-of-surface sorenesses in the first week or two of playing on the new surface.”

MM: “On grass, the ball bounce is lower, which means the player requires good back and hip mobility and muscle control to get to lower positions, as well as good dynamic balance. Plus, the ball bounce is more unpredictable, which requires the player to adjust quickly to the change, and at times rely more on the wrist to better direct the ball when out of position. Grass has a tendency to absorb moisture and may become slippery following rain, so players need to have good dynamic stability and proprioception in ankles. Compared to other surfaces, players should allow themselves at least a couple of weeks to prepare off court by working on the areas mentioned above with their physiotherapists and trainers, as well as slowly building up time and movement complexity on court. It is not uncommon for players to develop delayed onset muscle soreness around hips, buttocks and lower back to start with, so recovery strategies should be used more regularly. And, in addition to warming up, hitting on court should be slower than usual to allow the body to adjust to unpredictable bounces with minimal compensation.”