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Training a Healthy Junior Tennis Player Neeru Jayanthi, M.D

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Training a Healthy Junior Tennis Player Neeru Jayanthi, M.D Training a healthy junior tennis player Neeru Jayanthi, M.D. Director, Tennis Medicine Co-Directory Emory Youth Sports Medicine President, International Society for Tennis and Medicine Science (STMS) ATP World Tour Tournament Physician WTA Tour Medical Advisory Panel USTA Sport Science Committee Consultant iTPA USPTA/PTR certified www.emoryhealthcare.org/tennismedicine How much tennis should I play? ShouId I just play tennis? USTA Junior Competition Summit Neeru Jayanthi: Evidence-based recommendations for USTA Junior Tennis USTA Junior Competition Summit Neeru Jayanthi: Evidence-based recommendations for USTA Junior Tennis Neeru Jayanthi: STMS President Speech EMORY TENNIS MEDICINE Neeru Jayanthi: STMS President Speech On court evaluations Tennis specific Education partners Research Tennis Medicine Tennis Tennis-Specific Performance Rehab Training Relationships Tournament with teaching Coverage professionals and clubs • I’M AN EMORY SPORTS (AND TENNIS) MEDICINE PHYSICIAN • SPORT SCIENCE COMMITTEE • PAST-PRESIDENT • WTA PLAYER DEVELOPMENT PANEL Return to tennis during COVID-19 REF. JAYANTHI Return to tennis during COVID-19 Phase 1: Tennis with the Lowest Risk • Play in your own home (or on your court or community court) with asymptomatic, low risk family members of the same household. · Hit balls with a ball machine, against a backboard or wall by yourself at an outdoor court. · Play singles with an asymptomatic low risk partner at an outdoor court. · Teach/take a private lesson with an asymptomatic, low risk coach at an outdoor court. Adhere to strict social distancing measures, avoid settings with more than 10 individuals to allow for appropriate physical distancing. Return to tennis during COVID-19 • Phase 2: Tennis with Intermediate Risk • Play doubles with asymptomatic, low risk partners at outdoor court. · Play singles with an asymptomatic family/household member at an indoor court. · Play singles with an asymptomatic low risk partner at an indoor court. · Teach/take a private lesson with an asymptomatic, low risk coach at an indoor court. • Adhere to moderate social distancing measures, avoid settings with more than 50 individuals, and maximize physical distancing when possible. • Return to tennis during COVID-19 Phase 3: Tennis with Highest Risk · Play doubles with asymptomatic, low risk partners at an indoor court. · Teach/take a group tennis lesson or practice (>4 or more people) with asymptomatic, low risk players at an outdoor or indoor club. · Go to a tennis club event (social or tournament) with 10 or more individuals with asymptomatic, low risk or elevated risk players at an outdoor or indoor club. Physical distancing and precautionary efforts can be utilized to decrease further risks associated when returning to settings of larger group activity. Medical Training Load Strokes Comprehensive EXPERT TENNIS- SPECIFIC MEDICAL CARE • Clinical – Tennis-specific history – Tennis-specific clinical exams and treatments – ?on court evaluations • Continuing Tennis Education – Tennis-specific patient ed • Research – Creating and/or applying evidence • Injury Prevention/Performance • Comprehensive care – Nutrition, psychology emoryhealthcare.org/ortho • Tennismedicine.org • iTPA-tennis.org emoryhealthcare.org/ortho Objectives • 1. Discuss evidence based player development for what it takes to be successful • 2. Discuss potential for injury risk and specific recommendations • 3. Discuss potential stroke related risks and on court modifications What does evidence-based research mean? • Opinion – Anecdotal – Cases – NO definable outcomes – Significant inherent bias • Evidence – Levels of evidence (A, B, C) – Evaluating trends in larger populations of subjects – Can apply interventional strategies based on trends Training profiles of US Junior Elite 160 145 Median 16-20 hours/week training 140 117 120 103 11-25 tournaments/year 100 Number of 72 Responses 80 70% specialized in tennis 60 60 40 20 • Mean age specialization 10.4 20 0 • Jayanthi et al, Journal Med 0-5 6-10 11-15 16-20 20-25 25+ Practice hours/week Sci Ten 2009 “TRAINING AND SPORTS SPECIALIZATION RISKS JUNIOR ELITE TENNIS PLAYERS,” JAYANTHI, DECHERT, LUKE ET AL. 10 y/o mean age of 100% 95% 88% 90% 84% 79% 80% specialization71% 70% 63% 61% 58% 60% 55% 50% 40% Percent Specializing 30% 20% 10% 0% Age <10 11 12 13 14 15 16 17 18 2015 NCAA DATA ON SPORTS SPECIALIZATION (GOAL) •MAJORITY TENNIS SPECIALIZED <12 YEARS OLD Is our current model of training junior tennis players effective? USTA Junior Competition Summit WTA Age Eligibility Rule • 1993 specific problems were identified on the tour and an independent scientific/medical advisory player development panel was created. • Problems: (Unhealthy for the WTA Tour) • Early participation on the professional tour 17 and under, and specifically (13-14 y/o) (with burnout, increased stress) • Early retirements (<22y/o) • Decreased career longevity Neeru Jayanthi: Evidence-based recommendations for USTA Junior Tennis USTA Junior Competition Summit WTA Age Eligibility Rule-10 year review • Measure the results • (2004 Results): 10 year review • Increased career longevity increased nearly 43% (nearly 2 years) • Decrease in premature retirements (<22 y/o) from 7% to 1% • Improved stressors • Current 20 year review Neeru Jayanthi: Evidence-based recommendations for USTA Junior Tennis EARLY VS LATE SPECIALIZATION Jayanthi, Otis, et al. Highest Rank Early Specializer (<10 yo) Late Specializer (>10 yo) No differenceN=84 N=108with Top 10 4 (40%) 6 (60%) Top 20 age of 10specialization (56%) 8 (44%) Top 50 13 (51%) 29 (69%) Top 10010 y/o 23mean (51%) age22 (49%) of Top 150 14 (47%) 16 (53%) Top 200specialization9 (43%) 12 (57%) Top 300 11 (42%) 15 (58%) USTA PATHWAY SURVEY • Coaches did not feel using ranking was an appropriate method to transition players between orange, green, and yellow • Participation stars was a preferred method to transition between the ball colours. • Parents think it is a race to yellow • Not much competitive play in red • Too much tournament play and not enough team • Need to have more fun in competition • Karl Davies, USTA (personal communication) HEALTHYSPORTSINDEX.COM TENNIS INDUSTRY ESTIMATES 4.57 million youth players in the U.S. 4% PLAY USTA RETENTION 40% CONTINUE TO PLAY USTA (after one tournament) 60% LEAVE USTA (after one tournament) Injury Prevention Recommendations RECOGNIZING INJURY § JUNIOR/COMPETITIVE § Low Back § Medial Elbow § Shoulder § Knee § Ulnar wrist § Hip joint (lead hip) § Foot/ankle JUNIOR RISK AND RTP TABLE ADULT RISK AND RTP TABLE LOAD TOLERANCE •Junior• What is the loadtolerate tolerance in an adult tennis 2player?-3 times • Junior tennis player? as much? Stroke Mechanics and Injury risk • Can MSK screening predict injury in elite tennis players? – Evidence: Maybe (Sort B, C) • Can stroke mechanics create injury risk in junior/elite tennis players? – Evidence: Maybe (Sort B, C) Individual Risks ¨ Physical evaluations (strength, flexibility) ¡ Ellenbecker ¡ Roetert ¡ Kovacs ¡ Hjelms No clear link to injury risk ¨ Injury Risks ¡ Jayanthi Risk of sports specialization ¡ Hjelms Risks with low back ¨ Stroke Evaluations ¡ Gomez ¡ Kibler ¡ Kovacs ¡ Fleisig Can have increased loads/stress shoulder/elbow ¡ Abrams/Safran Can have increased loads/stress shoulder Asymmetric Tennis Player • Structural Evaluations – Asymmetric tennis player – GIRD • Serial MRI’s lumbar – Wrist, forearm spine – Rectus, iliopsas – 85% with abnormalities • Ellenbecker, Roetert, • Spondylolysis Hjelm, Kibler, Baxter-Jones, – Turner, et. al Cools/Johannsen assessments • Unclear relationship to injury – Can improve GIRD (Kibler) Serve-Kinetic Chain É Leg Drive-->Trunk rotation-- >Rapid shoulder internal rotation-->Forearm pronation-- >wrist flexion-->Arm adduction É Legs/trunk: 54% É Shoulder: 21% É Elbow: 15% É Wrist: 10% Ð From Kibler, WB,1995 Stroke changes and injury risk Upper Extremity Lumbar spine • There is no known interventional study testing biomechanical changes and injury risk in junior elite players! VOLUME ! • Jayanthi, Esser, CSMR, 2013 Biomechanical Risks • 13 yr old appropriate age for kick serve (SORT C) – Increased lumbar spine forces • Kick serve places higher demands on the low back and shoulder – Abrams • More shoulder and elbow stress with limited knee bend (<10 degrees) – Fleisig, et al. • Recommendation: Delay kick serve until after age 13 to reduce stressful loads (SORT C) – Kovacs, Abrams Methods • Study Design: Retrospective case series • Subjects – 74 patients who were tennis players (64/74 junior elite/competitive) – (2011-2014) Diagnoses (on court evaluations) • Low back pain (17) (34.0%) – Pars stress fracture – Lumbar facet/axial low back pain • ShoulDer pain (14) (28.0%) – Rotator cuff impingement • With or without scapular dyskinesis – Labral tear – Instability • Ulnar wrist pain (9) (18.0%) – ECU tendonitis – Dequervain’s, ulnar shaft stress injury • MeDial elbow (8) (16.0 %) – UCL – Ulnar nerve – triceps Follow up • 47/50 (94.0 %) returned successfully to tennis at a minimum of 6 months post on court evaluation • 1 recurrence, (parents chose surgery for spondylolysis) • 1 axial low back pain lost to follow up • 1 is currently unable to play with partial UCL of elbow [email protected] SER Study (2017) ■ 11 areas of risk: (102 point total scale) – Preparation (loading) – Acceleration – Deceleration *for serve, forehand, backhand ■ IRA score -> asses risk for future injury ■ SER score -> measures the efficiency of the stroke Stroke Type Points Serve • 33 (SER) 15 biomechanical
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