Document Sample
					            MEDICINE AND
       NR 3,
             SCIENCE IN TENNIS

                Journal of the STMS, the ITF, the ATP and the WTA Tour

                                                   In this issue:
                                              2 EDITORIAL
                                              4 MEET THE EXPERT: DR. BERNARD MONTALVAN
                                              5 ULNAR SIDED WRIST PAIN
                                              6 ABDOMINAL INTERNAL OBLIQUE MUSCLE
                                                INJURY IN A TENNIS PLAYER
                                              8 ENERGY BALANCE MONITORING IN
                                                TENNIS PLAYERS
                                             10 ON THE PROBABILITY OF WINNING A
                                                TENNIS MATCH
                                             12 SCORING TO REMOVE LONG MATCHES,
                                                INCREASE TOURNAMENT FAIRNESS AND
                                                REDUCE INJURIES
                                             14 LETTER TO THE EDITOR AND
                                                REPLY TO LETTER TO THE EDITOR
                                             16 INTERNATIONAL COMPARISON OF
                                                TENNIS SUCCESS
                                             18 CONFERENCE CALENDAR
                                             20 SELECTED REVIEW OF THE LITERATURE
                                             22 STRETCHING RECOMMENDATIONS FOR TENNIS
                                             23 VISCOSUPPLEMENTATION NOT EFFECTIVE FOR
                                                THE TREATMENT OF POSTTRAUMATIC
                                                OSTEOARTHRITIS OF THE ELBOW
                                             24 WTA TOUR AGE ELIGIBILITY AND
                                                PROFESSIONAL DEVELOPMENT TEN YEAR
                                             CONFERENCE REPORTS:
                                              3 3RD ARGENTINE SYMPOSIUM OF SPORTS
                                                MEDICINE APPLIED TO TENNIS
                                              3 STMS HILTON HEAD MEETING
                                             18 13TH ITF WORLDWIDE COACHES WORKSHOP
                                                                                          ISSN: 1567-2352

                                   EDITORIAL                                              Medicine and Science in Tennis is a Journal produced by the Society
                                                                                          for Tennis Medicine (STMS) in co-operation with the ITF, the ATP, and
                                                                                          the WTA Tour, and is issued three times a year (April, August, and
                                                                                          December). The STMS is an international organization of sports
                                                                                          medicine and science experts aiming to serve as an international forum
Dear tennis friends,                                                                      for the generation and dissemination of knowledge of tennis medicine
                                                                                          and science.

                                                                                          THE INTERNATIONAL BOARD OF THE STMS
The end of the year is a good time to look back and reflect on                            President:
                                                                                          Babette M. Pluim, Arnhem,The Netherlands.
all that has happened in the preceding year. I would like to use                          Vice President:
                                                                                          Marc R. Safran, San Francisco,CA,USA;
this opportunity to look back at the activities of the STMS and                           Secretary:
                                                                                          Javier Maquirriain, Buenos Aires, Argentina;
of the main governing bodies in tennis (ATP, WTA Tour and                                 E-mail:
                                                                                          Membership Officer:
ITF) in the field of medicine and science. My main conclusion is                          Alan Pearce, Melbourne, Australia;
that everyone has been very active!                                                       Treasurer:
                                                                                          George C.Branche III, Arlington, VA, USA;
The WTA Tour has commenced a ten-year review of the Age                                   Past-president:
                                                                                          Per A.F.H. Renström, Stockholm, Sweden;
Eligibility Rule and the Professional Development Department                              Other members:
                                                                                          Peter Jokl, New Haven, CT, USA;
programs. Experts met during the WTA Tour’s end-of-season                                 W. Ben Kibler, Lexington, KY, USA.
                                                                                          Savio L-Y Woo, Pittsburgh, PA, USA
championships in Los Angeles to discuss the set-up of this                                Associates to the Board:
                                                                                          Miguel Crespo, Representative of the ITF;
proposed review (for more details, see page 24). WTA Primary Health Care providers        Kathy Martin, Representative of the WTA Tour;
                                                                                          Gary Windler, Representative of the ATP.
Cathy Ortega and Laura Eby spoke at the Tennis Teachers’ Conference during the US
                                                                                          North American Regional Committee:
Open, on athletic shoes and equipment, and Cathy Ortega presented at the ITF              Chairman: Marc R. Safran, San Francisco, CA, USA;
                                                                                          Peter Jokl, New Haven, CT, USA;
Worldwide Coaches’ Workshop in Portugal, on the importance of core stability for          W. Ben Kibler, Lexington, KY, USA;
                                                                                          Michael F. Bergeron, Augusta, GA;
tennis. The WTA and ATP had some joint activities, including the 2003 Coach               William Micheo, San Juan, Puerto Rico;
                                                                                          Carol L. Otis, Los Angeles, CA, USA;
Registration Symposium held at the US Open, and the ‘Evening with the Pros’ held          E. Paul Roetert, Key Biscayne, FL, USA;
                                                                                          Savio L-Y. Woo, Pittsburgh, PA, USA.
during Wimbledon to introduce the juniors to professional tennis.
                                                                                          EUROPEAN REGIONAL COMMITTEE
Paul Settles will be seeking new opportunities outside the ATP as the head coach at       Chairman: Giovanni di Giacomo, Rome,Italy,Chairman;
                                                                                          Gilles Daubinet, Paris,France;
the Claremont College in California. I would like to use this opportunity to thank Paul   Hartmut Krahl, München,Germany;
                                                                                          Hans-Gerd Pieper, Essen,Germany;
for all his enthusiasm and hard work for the STMS and the ATP Tournament                  Babette Pluim, Arnhem,the Netherlands;
                                                                                          Angel Ruiz-Cotorro, Barcelona, Spain;
Physicians, many of whom are members of the STMS. Per Bastholt has been appoint-          Michael Turner, London,United Kingdom;
                                                                                          Reinhard Weinstabl, Vienna, Austria.
ed as the new Director of Medical Services for the ATP.
                                                                                          SOUTH AMERICAN REGIONAL COMMITTEE
The ATP had several cases of positive doping tests for nandrolone. Anti-doping            Chairman: Rogério Teixeira Silva, São Paulo,Brazil;
                                                                                          Javier Maquirriain, Buenos Aires, Argentina.
experts are looking into the possibility that these positive tests may have been the
                                                                                          SCIENTIFIC COMMITTEE
result of supplement contamination which has become a significant problem in inter-       Chairman: W. Ben Kibler, Lexington, KY, USA;
                                                                                          Michael F. Bergeron, Augusta,GA,USA;
national sports due to lack of regulation of the supplement industry.                     Bruce Elliott, Perth, Australia;
                                                                                          Karl Weber, Cologne, Germany;
Among the many activities of the ITF in the sports medical and science field I would      Savio L-Y. Woo, Pittsburgh, PA, USA.
like to highlight the publication of the books ‘Strength and Conditioning for Tennis’     EDUCATIONAL COMMITTEE
and ‘Biomechanics of Advanced Tennis’, as well as the release of seven ‘Injury Cards’.    Chairman: Marc. R. Safran, San Francisco, CA, Chairman;
                                                                                          George C.Branche III, Arlington, VA, USA;
The ITF also organised its 13th ITF Worldwide Congress in Portugal, on the theme of       Henrik Ekersund, Gothenburgh, Sweden;
                                                                                          Stacie Grossfeld, Louisville, KY,USA;
Applied Sports Science for High Performance Tennis (see page 18). By inviting several     Peter Jokl, New Haven, CT, USA;
                                                                                          W. Ben Kibler, Lexington, KY, USA;
scientists and medical specialists to make presentations at this congress, the ITF made   Kathy Martin, Melbourne, Australia;
                                                                                          Fernando Segal, Buenos Aires, Argentina;
an excellent job of enhancing communication and building bridges between tennis           Piotr Unierzyski, Poznan, Poland;
                                                                                          Gary Windler, Summerville, SC, USA.
coaches and tennis scientists.                                                            Editorial Board:
The STMS organised two meeting in 2003, one in Paris and one in Hilton Head               Editor-in-Chief: Babette M. Pluim;
                                                                                          Jackie Bailey, Den Haag, The Netherlands;
(see page 3). The Board of the STMS met on both occasions. One of the decisions           Todd Ellenbecker, Scottsdale, AZ, USA;
                                                                                          Javier Maquirriain, Buenos Aires, Argentina;
made was to hold annual instead of biannual world congresses. The 2005 STMS World         Rogério Teixeira Silva, São Paulo,Brazil
                                                                                          Alan Pearce, Melbourne, Australia;
Congress will be hosted by Marc Safran in Indian Wells. An STMS educational               Gary Windler, Summerville, SC, USA;

committee was founded, in order to improve our ability to realise our educational         EDITORIAL OFFICE:
                                                                                          PO Box 302, 6800 AH Arnhem,
aims.                                                                                     The Netherlands.
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During the ITF Worldwide Coaches Workshop in Portugal, we took the opportunity            Fax +31-26-4834439
to organise a meeting between members of the STMS and several national tennis             MEMBERSHIP OFFICE:
coaches, and to discuss the aims and educational program of the STMS. It was              Alan Pearce, Ph.D.
                                                                                          C/o Tennis Australia
suggested that coaches may have a different view from doctors of the areas of tennis      Private Bag 6060
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that need research, so a survey among the 300 coaches was conducted to find out. And      Victoria 3121
I have to admit: the participants were right! The main research focus of the STMS is      T + 61 3 9286 1177
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coaches are most interested in are recovery, speed training, injury prevention, burnout   Full membership: $100.00
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of information in the future endeavours of the STMS, several coaches were invited to      MEMBERSHIP PAYMENTS:
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All in all, it has been an exciting and busy year, and I am particularly pleased to see   Australia
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how increased co-operation within the tennis world is leading not only to higher          Account # 10287882

quality research and education, but also to a greater motivation and interest among all   PHOTOGRAPHERS:
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those involved. I hope we can continue enhancing this positive working relationship,      FRONT COVER:
and I would like to wish everyone a happy, healthy and stimulating 2004.                  LeAnn Silva, ATP, Ponte Vedra Beach, Fl, USA

                                                                                          CIRCULATION: 2,400

Babette Pluim                                                                             PUBLISHING OFFICE:
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       The newsletter ‘Medicine & Science in Tennis’ is supported by:                     Disclaimer:
                                                                                          This journal is published by the Society of Tennis Medicine and
                                                                                          Science for general information only. Publication of information in the
                                                                                          journal does not constitute a representation or warranty that the
                                                                                          information has been approved or tested by the STMS or that it is
                                                                                          suitable for general or particular use. Readers should not relay on any
                                                                                          information in the journal and competent advice should be obtained
                                                                                          about its suitability for any particular application.

                                                                                          © 2003 Society of Tennis Medicine and Science. All rights reserved.
                                                                                          No part of this publication may be reproduced in any form without
                                                                                          prior written permission of the copyright holder. Opinions and research
                                                                                          expressed in this journal are not necessarily those of the STMS.

                                                 MEDICINE   & SCIENCE   IN   TENNIS 2
                                                   CONFERENCE REPORT:
       3rd Argentine Symposium of Sports Medicine Applied to Tennis:
                 Current Concepts in Tennis Player Medical Care

Opening lecture by Jorge Franchella (FACSM)      Alberto Osete, physical trainer of elite         Speakers at the Argentine Symposium:
consultant of the AAT.                           Argentine players (including Gabriela            F. Segal, C. Pena, J.M Flores, A. Osete,
                                                 Sabatini, Guillermo Coria, Gastón Gaudio         A. Kokalj and J. Mazzucco (from left to right).
    he 3rd Argentine Symposium of Sports         and David Nalbandian) was presented with a
T   Medicine Applied to Tennis was held in
Buenos Aires on 13 August 2003. The sci-
                                                 diploma by Javier Maquirriain (Medical
                                                 Director of AAT).                                Martin Sammartino (Hand Surgeon),
entific meeting was organised by the                                                              Fernando Segal (ITF Marketing Group),
Argentine Tennis Association and sponsored       tional Requirements of Tennis’. Before the       Juan Mazzucco (MRI expert) and Prof.
by the South American Tennis Confeder-           afternoon break, Lic. José Luis Echegaray        Alberto Osete (Davis Cup Trainer).
ation (COSAT).                                   presented an interesting talk about ‘Tennis      Professor Alberto Osete was honoured
                                                 Racquets: past, present and future’.             with the award ‘Relevant Action in Sports
One hundred and eighty five participants         The second part of the Symposium began           Science – 2003’ for his contribution on
attended the Elevage Hotel to exchange           with a keynote lecture on ‘Current Pattern       tennis players´ development in the last
ideas and learn about ‘Current Concepts          of Injuries in Elite Tennis Players’ by Dr.      decade.
in Tennis Player Medical Care’.                  Javier Maquirriain, Medical Director of          Sponsorship: the Symposium was support-
Dr. Jorge Franchella opened the Sympo-           Argentine Tennis Association.                    ed by Laboratorio Temis Lostalo.
sium with a lecture on ‘Physiological            The final session was an Open Forum              Abstracts of the presentation will be avail-
Issues in Tennis’. Juan M. Flores then pre-      Discussion on ‘How to support Argentine          able in Spanish at
sented an update on ‘Strength training for       Success in Tennis?’. Panellists included,
Competitive Tennis’ followed by Lic.             Carlos Pena (International Coach), Tony and
María Mazzei, who lectured on ‘Nutri-            Kokalj (Davis Cup Physiotherapist),    

                                                   CONFERENCE REPORT:
                                 STMS HILTON HEAD MEETING
   he 9th North American meeting of the
T  Society for Tennis Medicine and Science
was held at the Crowne Plaza Resort in
                                                 all three planes of motion. Kathleen Stroia
                                                 presented the WTA protocol for core stabi-
                                                                                                  more and better, as the result of better con-
                                                                                                  ditioning, more interest, and better medical
                                                 lization.                                        care, including joint replacement. It was dis-
Hilton Head, SC on September 12- 14,             Shoulder kinematics. Dr Glenn Fleisig pre-       covered that the medical community
2003. Many interesting presentations were        sented data from the 2000 Olympics regard-       appears to be much more conservative than
given on a variety of tennis related topics.     ing forces and loads on the shoulder and         the players desire about playing with joint
The level of presentation and the discussion     elbow during the tennis serve. The absolute      replacement, and there does not appear to
was high, and all who attended felt the          and relative values of the forces were high at   be a significantly higher risk of complication
meeting was a scientific success.                both joints, indicating a high rate of strain    with more vigorous play.
                                                 during these motions. The role of proper         Injury prevention. A symposium and work-
Flexibility. Dr Duane Knudson presented          mechanics was emphasized by showing that         shop highlighted problems and proposed
research showing that there is a difference      lack of knee flexion (less than 10 degrees) in   solutions. Dr Babette Pluim presented a
between static (how far the muscle/joint         cocking was associated with a 15-23%             framework for education and exercises that
complex can be moved) and dynamic (the           increase in loads at the shoulder and elbow.     has been developed by the Royal
rate of strain, or the stiffness) flexibility.   Glenohumeral internal rotation deficit           Netherlands Lawn Tennis Association to
Each component appears to be important           (GIRD). Dr Ben Kibler presented data             decrease injuries. There was a lengthy dis-
for performance and injury risk reduction.       regarding the acquired loss of internal rota-    cussion on the best methods to implement
Dynamic flexibility exercises should be done     tion seen in overhead athletes including ten-    the best strategies for different populations-
immediately before play, while static flexi-     nis players. The deficit creates abnormal        youth, adults, and professionals.
bility exercises are best done in between        motions of the glenohumeral joint in all         The social part of the meeting was high-
bouts of exercise (see page 22 for the full      phases of the serve. In cocking, the humerus     lighted by two days of high level tennis.
article).                                        moves posterior/superiorly on the glenoid,       Dennis van der Meer and his teaching pro-
Core Stability. Dr Joel Press presented the      in follow through, the humerus moves ante-       fessionals led a vigorous and entertaining
basic science rationale, evaluation process,     rior/superiorly. These abnormal motions are      clinic on one day, and then we put all the
and rehabilitation techniques for improving      thought to be the primary alteration that        teaching into practice the following day.
core stability to improve movement, speed,       leads to labral tears and partial rotator cuff   Evening activities included a patio cookout
and power, and decrease injury risk. Loss of     tears.                                           and reception.
core stability was shown to be a factor in       Older tennis players. Dr George Branche and      The Board, in its session, decided that the
ability to run, stop, plant, and swing. The      Dr Peter Jokl presented data that showed         next North American meeting will be held
emphasis was on motion and evaluation in         older tennis players can be expected to play     in Palm Desert, CA in 2005.

                                                     MEDICINE   & SCIENCE   IN   TENNIS 3
                                             MEET THE EXPERT:
                        Dr. Bernard Montalvan, Medical Director of the French Open

                                                                                            defined all the time, and the therapeu-
                                                                                            tic options are being coded better. I
                                                                                            congratulate Babette Pluim and all of
                                                                                            her staff for the work they have done,
                                                                                            which has helped us to progress, with-
                                                                                            out forgetting the medical teams of the
                                                                                            WTA and ATP. Finally, the contacts I
                                                                                            have been able to maintain with other
                                                                                            experts such as Brian Hainline, Medical
                                                                                            Director of the US Open, and Angel
                                                                                            Cotorro, the doctor from the Spanish
                                                                                            delegation, are always enriching. Of
                                                                                            course we have introduced measures for
                                                                                            occasional heat stress conditions – these
                                                                                            are very good measures.
                                                                                            From a practical point of view, we have
                                                                                            defined the emergency procedures that
                                                                                            offer our players the best possible care
                                                                                            in case there is an urgent problem.

                                                                                            8 Is there a difference in the medical
                                                                                               care of male and female athletes?
                         Bernard Montalvan and Jacques Parier                               The women have become more and
                                                                                            more athletic and in this sense, the
     r. Bernard Montalvan is Medical         nal medicine) at the Ambroise Pare             women’s game is now catching up with
D    Director of the Roland Garros tour-
nament and also works for the French
                                             public hospital.                               the men’s game. There is no clear dif-
                                                                                            ference in terms of traumatology,
Tennis Federation. In a long and distin-     4 Which tournaments do you cover?              except for the hormonal phenomenon.
guished medical career, he has played a      In addition to Roland Garros I also            We may not yet understand all the
key role in developing medical services      cover the Paris BNP Bercy tournament,          effects of this on women.
for tournament tennis players in France.     which is held in November.
Here he reviews some of the highlights of                                                   9 What is the most interesting medical
his career – including the salutory lesson   5 How did you first become involved               problem you have encountered?
that even the best physicians can some-         in providing medical cover for tennis       I remember an amusing story. On the
times get the wrong end of the stick !          tournaments?                                first day of the tournament, the match-
                                             I started working with Jean Pierre             es start at 11.00 a.m. I was called onto
1 What is your specialty?                    Cousteau at the FFT. We made progress          the court at 11.20, for a player who felt
I am rheumatologist with a degree in         together and when he left, which I very        tired and nauseated after only two
sports medicine and in tramatology and       much regretted, it was quite natural           change-overs. He looked very pale and
sport.                                       that I became his sucessor.                    sweaty. The clinical examination was
                                                                                            normal, so we told him to drink water
2 For how long have you worked as a          6 Are you responsible for the general          and take the time to catch his breath in
   tournament doctor?                           public as well?                             between the rallies. Finally he won and
I started working for the French Open        During the Roland Garros tournament,           slept all afternoon in the sickbay, snor-
in 1986, with Dr. Jean-Pierre Cousteau.      an independent medical service is              ing loudly. The medical tests were all
We developed the medical service espe-       responsible for the general public. We         normal, except for his nausea. The
cially for our players in 1985. Dr.          are only involved with the players. If         blood tests showed a rise in his SGOT
Cousteau retired in 2000, after which I      there is a serious medical problem that        and SGPT levels (liver enzymes). They
took over his position as Medical            requires urgent resuscitation or other         were about twice as high as normal. We
Director of the Roland Garros tourna-        intervention, the two medical teams            were therefore considering the possibili-
ment. I would like to mention two doc-       work together.                                 ty of the onset of liver disease and so
tors who have proved to be indispensa-                                                      on . . . and told the player it would be
ble to the effectiveness of the medical      7 What changes have you made over              very difficult for him to finish the tour-
service: Dr. Jacques Parier, sports physi-      the years that have had the greatest        nament. But finally his coach appeared
can, and Dr. Jean Louis Brasseur,               positive impact on care for players at      (late that evening, at 10.00 p.m.) and
echographist. It is a real pleasure to          tournaments?                                admitted to us that the evening before,
work with them.                              From a general point of view, we have          the player had been really drunk and
                                             made progress by taking the demands of         that we should wait with our diagnosis.
3 What is your regular job?                  the players into account. We can now           In two days, all the blood tests had nor-
I work part-time for the French Tennis       give them appropriate and high-quality         malised and the player felt as good as
Federation (FTF), I have a private prac-     care within a short time-span (24              new. We should not forget that the
tice and I have a post in the clinic of      hours). The specific pathologies of the        players are mischievous boys – and
Prof. Le Parc (rheumatology and inter-       tennis player are becoming better              most are only around twenty years old!

                                             SPORTS MEDICINE    & SCIENCE   IN   TENNIS 4
      LE                                           Ulnar Sided Wrist Pain
                                 ANGEL RUIZ-COTORRO1,2, MD, JAUME VILARÓ2, MD AND STEPHEN UMANSKY3, MD.
             1   Real Federación Española de Tenis, Federación Catalana de Tenis; 2 Clinica Fundació FIATC, Avda Diagonal 648, 08017 Barcelona, Spain
                                        3 Lexington Clinic Sports Medicine Centre, 1221 South Broadway, Lexington, KY, USA

   U    lnar sided wrist pain is characterized by
        pain on the ulnar border of the wrist and
   can be divided into degenerative or acute
                                                                                                                             ABOUT THE AUTHORS
                                                                                                                 Dr Angel Ruiz-Cotorro is sports physician
                                                                                                                 and medical director of the Spanish Tennis
   processes. The likely syndromes to affect ten-
                                                                                                                 Federation and the Catalan Tennis
   nis players are ulnocarpal impaction syn-                                                                     Federation. He is the team physician of their
   drome (degenerative) or triangular fibrocarti-                                                                Davis Cup and Fed Cup teams and has a
   lage complex (TFCC) tear (acute).                                                                             position at the FIATC Clinic in Barcelona.

   Anatomy                                                                                                       Dr. Jaume Vilaró is orthopedic surgeon at
   The ulnocarpal joint space is bounded by the                                                                  the FIATC Clinic and has a special interest in
   lunate, lunatotriquetral ligament, and tri-                                                                   tennis.
   quetrum superiorly, and the triangular fibro-
   cartilage covering the ulnar seat and distal                                                                  Dr Steve Umansky is an orthopedic surgeon
   radio-ulnar joint inferiorly (Figure 1). The                                                                  and chief of the Hand Surgery service at the
   disc-carpal ligaments (disc-lunate and disc-                     Figure 2 The articular disc                  Lexington Clinic in Lexington, KY. He did his
   triquetral) form the volar border, and the cap-                                                               residency at the University of Pennsylvania
   sule confluent with the extensor carpi ulnaris                                                                and his hand fellowship at the Indiana Hand
   tendon sheath forms the dorsal border. The            ing micro or macro instability to the distal            Center in Indianapolis, IN. His special inter-
   radial border is the sigmoid fossa of the distal      radio-ulnar complex.                                    ests are in wrist fractures and ulnar sided
   radius.                                                                                                       wrist pain in athletes.
                                                         In the ulna-positive individual, chronic
   The articular disc or meniscal homologus is a         impaction between the lunate, lunato-trique-
   fibrocartilagenous structure that forms a sling       tral ligament, or triquetrum with the promi-          help with symptoms. Rehabilitation and pro-
   between the dorsal and palmar radio-ulnar             nent head of the ulna or styloid can cause            gressive return to prior level of competition
   ligaments which has a broad attachment to             chronic degeneration of the interposed TFCC           should be supervised by a hand therapist.
   the sigmoid notch of the radius and inserts           and/or the cartilage surfaces that are subject-       If conservative management fails to get the
   along the ligaments to their insertions at the        ed to abnormal load, point stresses, and shear.       expected result, arthroscopic evaluation and
   distal ulnar fovea and ulnar styloid (Figure 2).      This occurs mainly during the rotation of an          staging of the lesion should be undertaken. In
                                                         ulnar deviated wrist, or repetitive ulnar devia-      some cases arthroscopic repairs or resection of
   Predisposing factors                                  tion.                                                 torn and unstable cartilage can be performed.
   Anatomic factors predisposing injury of this                                                                Other cases require open reconstruction of
   structure in a tennis player include ulna posi-       Clinical features                                     the wrist. Evaluation of other injuries and
   tive variance or styloid magna. Specific to           The main clinical features of the syndrome are:       limited synovectomy can be performed at
   tennis, the type of stroke and grip can predis-       • Pain in the ‘foveal region’ just distal to the      that time. Chondroplasty can also be per-
   pose to injury. The forehand drive is the               ulnar styloid. This may be elicited by pas-         formed to smooth moving surfaces and
   stroke that most frequently causes injury.              sive pronation and supination of the wrist          improve symptoms.
   The two-handed backhand (non-dominant                   with the examining fingers palpating stress-
   hand), the topspin (twist) serve and the fore-          ing the distal radio-ulnar relationship. It
   hand volley are also implicated. The Western-           may also be elicited by passive ulnar devia-
   like closed grip, predominantly adopted by              tion of the wrist (TFCC grind test).
   the Spanish and Argentinean clay court                • Synovitis or inflammation may be present.
   players, is without a doubt another principal         • There is usually preserved motility of the
   cause of the syndrome.                                  distal radio-ulnar joint and wrist joint
                                                         • X-rays show no degenerative changes of the
   Pathogenesis                                            distal radio-ulnar joint.
   When the wrist is extended and pronated, the
   extensor carpi ulnaris tendon is relaxed. The         Diagnosis
   movement of the head of the ulna is therefore         A detailed clinical history provides us with
   not limited. Forced translation of the head of        the most information. Standard neutral rota-
   the ulna dorsally, or hyper-pronation or              tion posteroanterior and lateral radiographs
                                                         provide information regarding the ulna vari-          Figure 3 Pain may be elicited in the ‘foveal
   hyper-supination may cause a tear of the                                                                    region’ just distal to the ulnar styloid by passive
   articular disc and/or the peripheral attach-          ance and status of the bones (degenerative
                                                                                                               pronation and supination of the wrist, with the
   ment of the radio-ulnar ligaments. This can           cysts or arthritis). Magnetic resonance
                                                                                                               examining fingers palpating stressing the distal
   cause pain from mechanical symptoms due to            imagery is promising but imperfect and must           radio-ulnar relationship.
   the torn cartilage interposing between highly         be correlated with a specific history and phys-
   congruent surfaces during motion or by caus-          ical examination. Bone scans can highlight
                                                         degenerative lesions of the lunate, triquetrum        Conclusions
                                                         or distal ulna. Precisely placed lidocaine injec-     Ulnar sided wrist pain can be classified as
                                                         tion tests can help localize the site of the          either acute or chronic. Anatomic factors and
                                                         pathology to a specific region.                       swing and grip can predispose a player to
                                                         The differential diagnosis includes:                  Appropriate training can help decrease the
                                                         • Extensor carpi ulnaris subluxation                  risk of injury by correcting maladaptive
                                                         • Distal radio-ulnar joint instability or arthritis   swinging technique. Appropriate diagnosis
                                                         • Fractures of the hook of the hamate                 rests on knowledge of the conditions and a
                                                         • Piso-triquetral arthritis                           complete history and physical examination,
                                                         • Flexor carpi ulnaris or Extensor carpi ulnaris      sometimes including arthroscopic examina-
                                                           tendonitis                                          tion.
                                                         • Ulna styloid fracture                               Medical and surgical treatment is effective in
                                                         • Luno-triquetral ligament ruptures                   treating these complex lesions.

                                                         Treatment                                             References
                                                         Acute cases of ulno-carpal impaction syn-             1. Garcia Elias M. Hand clinic 1998;14
                                                         drome or TFCC tears should be immobilized                (2):165-176.
                                                         in a splint or case that prevents forearm rota-       2. Rettig AC. Wrist problems in the tennis
                                                         tion for a period of 4 to 6 weeks. Non-                  player. Med Sci Sports Exerc
            Figure 1 The ulnocarpal space                steroidal anti-inflammatory medication can               1994;26:1207-1212.

                                                         SPORTS MEDICINE       & SCIENCE     IN   TENNIS 5
      LE                   ‘Abdominal Internal Oblique Muscle Injury
                                      in a Tennis Player’

  Introduction                                          showed a focal hyperintense area in the                         ABOUT THE AUTHORS:
  The muscles of the anterolateral abdomi-              proximal portion of the middle layer of
                                                                                                              Javier Maquirriain, MD, PhD, is an
  nal wall consist mainly of three broad, thin          the lateral abdominal wall (Figure 1).                orthopaedic surgeon working at CeNARD
  layers that are aponeurotic in front: the                                                                   (Argentine Olympic Centre). He is spe-
  external oblique, the internal oblique, and           Diagnosis of the left internal oblique strain         cialised in sports injuries and arthroscopic
  the transverses, from exterior to interior.6          muscle injury (grade 1) was established,              surgery. He has published several articles
  On both anterior sides of the midline,                and the player was advised to avoid com-              on ‘tendon endoscopic surgery’. He is
  there is a wide vertical muscle, the rectus           petition. Initial treatment consisted of rest,        Medical Director of the Argentine Tennis
  abdominis. The internal oblique muscles               girdle compression, cryotherapy, oral anti-           Association.
  are located deeper than the external                  inflammatory medication and physical                  Juan Pablo Ghisi, MD is a radiologist work-
  oblique ones. The internal oblique origi-             modalities. Afterwards, isometric strength-           ing at J.A. Fernandez Hospital, the largest
  nates from the lumbar aponeurosis, the                ening and static stretching was prescribed.           medical centre in Buenos Aires. He is spe-
  anterior portion of the iliac crest and the           As the patient did not refer pain during              cialised in MRI evaluation of musculo-
  inguinal ligament. It inserts superiorly on           those activities, he began concentric                 skeletal injuries. He is medical advisor of the
  the 9th, 10th, 11th and, 12th costal cartilages       strengthening exercises as well as aerobic            Argentine Tennis Association.
  on the linea alba, and is continuous with             conditioning. The final stage of rehabilita-
  the internal intercostal muscles. The inter-          tion emphasised eccentric strengthening              the upper limb. The abdominal obliques
  nal oblique muscles are flexor and homo-              and plyometric exercises. He returned to             showed greater than 100% maximum
  lateral axial rotators. They are innervated           high-level competition in four weeks and             manual test activity during the swing and
  by the 8th to 12th intercostals nerves and            he did not report recurrences in the fol-            follow through phases. The sustained high
  also by the abdominogenital nerve.                    lowing twelve months.                                muscle activity in the trunk muscles indi-
                                                                                                             cates the relevance of back and abdominal
  Several articles1,3 have been published               Discussion                                           stabilisation.
  about abdominal anterolateral muscle                  The internal and external oblique muscles
  trauma but, to the best of our knowledge,             are examples of muscles that do not follow           In the follow-through phase of the back-
  there is no description of internal oblique           a straight line between origin and inser-            hand ground stroke, the trunk is decelerat-
  indirect injury in the Sports Medicine lit-           tion, but wrap around the torso. This ellip-         ed. A high level of activity in the abdomi-
  erature.                                              tical model gives a mechanical advantage             nal oblique muscles during that stage sug-
                                                        to oblique muscles, especially in axial rota-        gests their eccentric role in decelerating
  The purpose of this report is to describe an          tion when the torso is flexed, extended or           the trunk after the impact. The relatively
  acute injury of the internal oblique                  twisted.4. Anatomic linkage between the              low level of activity in the scapulohumeral
  abdominal muscle in a professional tennis             shoulder girdle and the abdominal muscu-             muscles during batting indicates that the
  player.                                               lature has been demonstrated.2                       emphasis for rehabilitation or training
                                                                                                             should be placed on strengthening of the
  Case Report                                           Due to their anatomic location, the                  trunk and the hip muscles.
  A 22-year old right-handed professional               obliques can be considered as multiarticu-
  tennis player presented with acute pain in            lar muscles. As they link the torso and              In summary, strain injuries of internal
  the left anterolateral abdominal wall dur-            pelvis structures, they are particularly             oblique abdominal muscles are uncommon
  ing a practice session. He referred sudden            involved in sports actions.                          in the athletic population. They often
  pain during an uncoordinated twisting                                                                      result from extreme, unbalanced, eccentric
  motion in a one-handed backhand stroke.               Dynamic electromyographic analyses of                muscle contractions (in the adolescent
  He was immediately examined by the first              abdominal muscles during tennis strokes              injured athlete, avulsion iliac crest fracture
  author, presenting mild discomfort, ten-              have not been performed, but are expect-             should be ruled out). In sports involving
  derness close to the anterior arc of the 11th         ed to be similar to that calculated for base-        heavy trunk rotational motions, such as
  and 12th ribs and pain on contraction-                ball hittingbatting5. Such rotational athlet-        tennis, special emphasis should be placed
  against-resistance manoeuvres. Stretching             ic movements are sequences of co-ordinat-            oin hip and trunk strengthening.
  the left lateral abdominal wall also elicited         ed muscle activity, which begins in the
  pain. Magnetic resonance imaging (MRI)                hip, follows in the trunk and finishes in            References
                                                                                                             1 Balduini FC. Abdominal and groin
                                                                                                               injuries in tennis. Clin Sports Med
    A                                                                                                          1988;7(2):349-57.
                                                           B                                                 2 DeRosa C. The morphology of the
                                                                                                                abdominal muscles: implications of
                                                                                                                function from structure. J Orthop
                                                                                                                Sports Phys Ther 1999;29(1):A22.
                                                                                                             3 Emery CA, Meeuwisse WH, Powell
                                                                                                                JW. Groin and abdominal strain injuries
                                                                                                                in the National Hockey League. Clin J
                                                                                                                Sport Med. 1999;9(3):151-156.
                                                                                                             4 Gatton M, Pearcy M, Peret G.
                                                                                                                Modelling the line of action for the
                                                                                                                oblique abdominal muscles during an
                                                                                                                elliptical torso model. J Biomech
  Figure 1                                                                                                   5 Shaffer B, Jobe FW, Pink M, et al.
  A: Axial oblique MR image T2 weighted of left abdominal wall in a professional tennis player. There is a
  focal abnormal signal intensity in the upper portion of the internal oblique muscle (arrow), compatible
                                                                                                                Baseball batting. An electromyographic
  with strain. The hyper-intensity area in the surrounding soft tissue represents perifascial oedema.           study. Clin Orthop 1993;292:285-293.
   B: Axial image T1 weighted of the same patient shows high signal intensity at the tear site, indicating   6 Snell RS. In: Gross Anatomy. Boston:
  blood presence that characterizes the acute phase of muscular strain (arrowhead).                             Little, Brown and Company, 1990.

                                                             MEDICINE    & SCIENCE     IN   TENNIS 6
                                                         BOOK REVIEW
                              Strength and Conditioning for Tennis
    trength and Conditioning for Tennis is      short of suggesting that a player’s schedule    variety of techniques and exercises can be,
S   one of the most comprehensive
resources currently available on the topic
                                                may in fact limit the strength gains a
                                                player might experience if there was an
                                                                                                and have been, used effectively to
                                                                                                improved performance.
of training players to be able to meet the      ‘off-season’ in tennis.                         It is up to the coach to determine which
demands of today’s tennis game. Strength                                                        techniques are best suited for his/ her
and conditioning is a topic that has always     One of the most beneficial aspects of           players and design an appropriate strength
been important to all tennis players, yet       ‘Strength and Conditioning for Tennis’ is       and conditioning plan. ‘Strength and
historically it has been neglected for the      that it incorporates information from a         Conditioning for Tennis’ is a comprehen-
sake of additional ‘on-court’ training.         variety of sources and a number of coun-        sive resource that can assist any coach in
                                                tries; the reader is often presented with       doing this.
However, as the game has changed, we            multiple views on a topic and how it
now see more and more players playing a         should be approached.                           Scott Riewald, Sport Science Administrator,
faster and more powerful game. But has          The ITF does not promote one ‘best way’         USTA
their training been adapted to prepare the      to approach strength training and condi-
body for these increased demands? In            tioning for tennis players, but rather pres-
many cases the answer is no, resulting in       ents much of the available information          STRENGTH AND CONDITIONING FOR TENNIS
injury and impaired performance. This           pertaining to strength and conditioning         Machar Reid, Ann Quinn and
book can serve as a guideline for anyone        and discusses how it can lead to improved       Miguel Crespo (eds)
who is looking to develop a tennis specific     performance.
strength and conditioning program, from         This fits with the idea that there is not one   Number of pages: 272
the introductory coach who knows very           way that is going to be best for every play-    London: ITF 2003
little about the topic, to the advanced         er, other than every player needs a             ISBN 1 903013 19 4
strength and conditioning coach who is          strength and conditioning plan if perform-
looking for new ideas.                          ance is going to be improved. A wide            For orders please visit

The book begins with arguably the two
most important chapters, which deal
respectively with ‘Screening and Testing’
and ‘Athlete Development’. As highlight-
ed in the book, periodic testing is essential
to identify areas of weakness as well,
reveal any medical problems what would
impact how the player should be trained
as well as assess progress and strength
development. In looking at the long-term
development of a player it is important to
consider how strength and conditioning
can be used to optimize his/ her perform-
ance, not necessarily immediately, but
maybe several years down the road when
‘all the physical and mental pieces are in

A coach or trainer should be aware of how
a player develops, physically, emotionally
and psychologically, and then decide how
best to approach training based on the
athlete’s ‘maturity’. The remainder of the
book focuses on the different components
of a player’s game, like coordination,
power or agility, and how they can be
Finally the book concludes with several
chapters that deal with considerations to
take into account when dealing with
female, elderly, wheelchair, or professional

Throughout the entire text the concept of
periodization, or ‘cyclical training’ involv-
ing periods of work and rest, is touched
on. This is an important topic for discus-
sion since unlike most sports, tennis does
not have an off-season when players can
dedicate their efforts to building a strength

The authors present various ways for
working around this problem – providing
players an opportunity to build strength
without sacrificing playing time – but falls

                                                    MEDICINE   & SCIENCE   IN   TENNIS 7
      LE               Energy Balance Monitoring in Tennis Players
                                  DEPARTMENT OF EXERCISE AND SPORT SCIENCE, USA. 27599-8700.
                            TEL: +1-919-962-2260 FAX: +1-919-962-0489 E-MAIL: MARKS@EMAIL.UNC.EDU

      here is limited research regarding the     movement and was based upon the sub-
  T   caloric needs of college tennis players.
  Even though there are approximations for
                                                 ject’s personal characteristics programmed
                                                 into its memory. This is appropriate as
                                                                                                             ABOUT THE AUTHOR:
                                                                                                  Bonita L. Marks, PhD is an Associate
                                                                                                  Professor of Exercise Physiology and
  the energy cost of tennis match play, infor-   resting metabolic rate generally accounts        Director of the Exercise Science Teaching
  mation is scant regarding total energy out-    for 60-75% of one’s total daily caloric          Laboratory at UNC’s Exercise and Sports
  put which combines not only tennis prac-       expenditure, with activity, exercise, and        Science Dept. She also holds an adjunct
  tice and conditioning, but also routine col-   dietary thermogenesis plus other factors         Associate Professor position in UNC’s
  lege life. The ability to estimate energy      making up the balance.8 The athlete              School of Medicine. Bonita is a fellow of the
  expenditure during physical activity with                                                       American College of Sports Medicine and
                                                 recorded the unit’s caloric output value in
                                                                                                  an ACSM-certified Exercise Specialist. Her
  reasonable accuracy is important in order      a log prior to going to bed and upon wak-        research interests are tennis, fitness/weight
  to determine adequate caloric intake for       ing in the morning. During the same week,        management, and aging.
  optimal performance. Estimating the ener-      the athlete kept a daily log in which he
  gy expenditure in a sport such as tennis is    recorded all of his activities from rising to
  complex because of the wide variety of         going to bed.                                   sponded to the same time intervals used in
  movements performed during play. While         Time spent in each activity as well as per-     the activity logs (awake – noon, noon – 6
  many studies have used Caltrac™ activity       ceived intensity level were also recorded so    pm, 6 pm – bedtime). Each athlete was
  monitors (Figure 1) and self-reporting         that caloric expenditures could be estimat-     contacted periodically throughout the
  mechanisms in the general population as        ed using metabolic (MET) equivalents.9          week to ensure that the Caltrac™ device
  well as in various sports,4-6 none have        The calculation of caloric expenditure          was being used properly as well as to rein-
  reported use of the Caltrac™ nor self-         required the researcher to code the activi-     force accurate self-reporting. At the end of
  reports to determine energy balance in col-    ties according to the reported intensity        the week-long recording period, the logs
  lege-level competitive tennis players. The     level (Table 1).                                were privately reviewed with each player
  study of energy balance (caloric intake vs.                                                    to clarify reports.
  caloric expenditure) could assist with per-    Table 1 Metabolic Coding Table9
  formance enhancement.                                                                          Results
  Thus the purpose of this study was to          Activity                 MET Assignment         Eight of the 11 tennis players completed
  compare energy balance for a typical week      Description                                     the study. One failed to complete the
  of activity, including energy intake and       Sleep                     1 MET                 daily recalls and two others did not wear
  energy expenditure via self reports vs.        Light                     1.5 METs              their Caltrac‘ units consistently. The
  Caltrac activity recordings in male college    Moderate                  4 METs                team’s descriptive characteristics were as
  tennis players.                                Hard                      6 METs                follows (mean ± SD):
                                                 Very Hard                10 METs                age: 20.3 ± 1.8 years, weight: 77.5 ± 7.4 kg,
  Methods                                                                                        height: 180.6 ± 4.6 cm, estimated body fat
  Subjects: Eleven college men from a U.S.       The assigned MET value was then multi-          (skinfolds): 8.2 ± 3.5%,
  NCAA Division-I team were invited to           plied by the amount of time spent in each       VO2max: 61.0 ± 4.5 ml•kg-1•min-1.
  participate in this research. At the time of   activity, with the sum of the 24-hour
  the study, the team was ranked in the top      METs/hr adjusted for the subject’s body         The caloric outputs obtained during the
  25 by the ITA. All were healthy and            mass, thereby resulting in a daily kilocalo-    case-study comparison of the COSMED®
  between 18-23 years of age. During an          rie expenditure value.9 For example, if a       versus the Caltrac™ yielded almost identi-
  hour-long meeting, the players were given      75 kg player reported practicing for two        cal results (COSMED®: 7.75 kcal•min-1
  detailed instructions (both verbal and writ-   hours at a moderate intensity, the calcula-     versus Caltrac™: 7.70 kcal•min-1).
  ten) regarding the appropriate use of the      tion would be:                                  Furthermore, statistical analysis (repeated
  Caltrac™ device as well as for dietary         75 kg x 2 hrs x 4 METS = 600 kcal               measures with planned contrasts) of the
  intake and physical activity recording pro-    (where 1 MET 1 kcal•kg-1•hr-1).                 case study subject found no significant
  cedures.                                                                                       differences between the week-long
  One player also participated as a case         Concurrent with activity monitoring, the        Caltrac™ monitoring and the self-reported
  study pilot which compared the caloric         athlete kept a daily food log in which he       data (Caltrac = 3327 + 346 kcal•day-1 vs.
  output between a COSMED® portable              recorded everything he ate or drank for         activity log = 3315 + 303 kcal•day-1 vs.
  metabolic gas measurement unit to the          the entire day. The dietary reports corre-      dietary intake = 3433 + 613 kcal•day-1,
  Caltrac™ for 30 minutes during a practice                                                      p > 0.721). However the initial success
  hitting session (Figure 2). This case study                                                    with this one individual did not carry over
  subject agreed to wear two Caltracs™ for                                                       to the team study population.
  operational comparisons during an exhibi-
  tion match.                                                                                    Similar analyses for the team data showed
                                                                                                 that the Caltrac‘ caloric output reports
  Instrumentation: At the beginning of                                                           (3821.4 ± 593.5 kcal•day-1) were signifi-
  Day 1, a specific Caltrac™ device was pro-                                                     cantly higher (p < 0.04) than either of the
  grammed with the subject’s age, weight,                                                        self-reports for physical activity (3142.4 ±
  height, and gender. It was attached to the                                                     299.1 kcal•day-1) or dietary intake (3082.0
  waistband on the athlete’s non-dominant                                                        ± 594.4 kcal•day-1). The self-reports were
  side. The unit was worn continuously for                                                       not significantly different from each other
  the remaining six days unless sleeping,                                                        (p = 0.74).
  bathing, or swimming (and none reported
  swimming).                                                                                     Discussion
  During non-wearing times, the Caltrac™                                                         Under-reporting is a common problem
  continued caloric counting utilizing a rest-                                                   when self-reports of physical activity and
  ing metabolic formula for energy expendi-                                                      food intake have been utilized, especially
  ture which assumed little meaningful           Figure 1 The Caltrac™ accelerometer device      in female overweight populations.1 In this

                                                     MEDICINE   & SCIENCE   IN   TENNIS 8
study, errors in self-reporting were likely                                                    expanded future study should be done to
reduced due to rigorous individual follow-                                                     validate the Caltrac™ output, testing the
up with the players as well as the subject                                                     various alternate modes under a variety of
population being lean athletic males. As                                                       tennis play conditions. In addition, weekly
such, the self-report recalls were in agree-                                                   weight monitoring would also be useful
ment, suggesting that the tennis players                                                       for cross-validating. While weigh-ins are
were eating enough calories to meet their                                                      routine in sports such as football and
energy demands.                                                                                wrestling for dehydration prevention, this
On the other hand, the Caltrac™ device                                                         has not been done in any systematic fash-
has been shown to both over- and under-                                                        ion with tennis.
estimate caloric expenditure, depending
upon the nature of the activities being                                                        The probable overestimation of caloric
monitored.3 The daily Caltrac™ caloric                                                         output with week-long Caltrac™ monitor-
outputs measured in this study were 679                                                        ing as seen in this study may be inherent in
calories higher than the activity self-                                                        the device’s internal mathematical compu-
reports and 739 calories higher than the                                                       tations or it could have been due to inad-
reported daily caloric intake.                                                                 vertent user error. Nevertheless, the
                                                                                               Caltrac™ units are small, do not interfere
If this outcome were true, then it would                                                       with tennis mechanics, are less time con-
have been expected that the players would                                                      suming for recording purposes, and are
have experience lost approximately 0.5 kg                                                      fairly affordable (about 70 US$) in com-
monthly. Anecdotal reports suggested that                                                      parison to other more sophisticated meas-
these players tended to lose about 2.5 kg                                                      urement devices. Therefore, they are
from pre-season (September) to post-col-                                                       attractive units to use for energy balance
legiate season (May). Although we were                                                         determination.
not able to monitor the players for this
extended time period, it was estimated                                                         However, until the Caltrac™ device can
that if the Caltrac™ output data were                                                          be proven to provide more accurate meas-
true, a total weight loss of 4.5 kg would                                                      ures of caloric output under tennis training
have been expected for the 9 month peri-                                                       conditions as well as daily living, it is sug-
od. That would equate to almost twice the                                                      gested that the traditional self-report logs
amount of weight loss reportedly seen.                                                         with follow-up checks continue to be used
Hence it appears that the Caltrac™ device       Figure 2 Case-study subject waiting a ten-     for assessing energy balance in tennis
overestimated the players’ energy expendi-      nis ball while fitted with the COSMED®         players.
tures in this study.                            portable metabolic gas measurement device.
The Caltrac™ has been shown to be a                                                            1 Ballew C and Killingsworth RE. Esti-
relatively accurate device to estimate          body mass movement (such as with                 mation of food and nutrient intakes of
caloric expenditure in a two-dimension          cycling or weightlifting), then an alternate     athletes. In: Driskell JA and Wolinsky I
plane of movement5 as well as in a game-        mode should be utilized for the duration         (eds). Nutritional assessment of
sport such as basketball.2 During the bas-      of the alternate activity. The ‘pedal’ mode      athletes. Boca Raton:CRC Press 2002:
ketball study (n = 10), caloric output for      is to be used not only during cycling, but       7-42.
30 minutes of simulated play (running,          also when weightlifting with short rest        2 Ballor D, Burke L, Knudson D, Olson J,
walking, jumping, dribbling, passing,           periods (< 1.5 minutes rest between sets).       Montoy H. Comparison of three meth-
blocking) was measured with a Parkinson-        The additional modes incorporate correc-         ods of estimating energy expenditure:
Cowan gasometer and on a separate occa-         tion factors to the metabolic formula in         Caltrac, heart rate, and video analysis.
sion, 37 minutes of actual game play was        order to prevent the under-estimations           Res Quart Exerc Sport 1989;60:
monitored with a Caltrac™ unit. The             that were reported in the earlier                362-368.
caloric outputs were similar with expired       literature.7 Our case study subject had also   3 Bassett D. Validity and reliability issues
gas analyses measured during simulated          worn two Caltracs™ while competing in            in objective monitoring of physical
play resulting in 6.2 kcal•min-1 vs. 5.8        an exhibition match, with one set on             activity. Res Quart Exerc Sport 2000;
kcal•min-1 as recorded by the Caltrac™          ‘regular’ mode and the other set on ‘pedal’      71:21-29.
(p > 0.05).                                     mode.                                          4 Kriska A, and Casperson C. A collection
While these caloric expenditures are lower                                                       of physical activity questionnaires for
than what we measured with our case             The ‘pedal’ mode nearly doubled his              healthy- related research. Med Sci
study tennis player, it is the only published   caloric output (8.3 vs. 16.3 kcal•min-1,         Sports Exerc 1997:29:S1-S205.
study that attempted to determine the           ‘regular’ vs. ‘pedal’ modes, respectively).    5 Miller D, Freedson P, Kline G.
validity of using the Caltrac‘™ for energy      Hence, we were very clear in our instruc-        Comparison of activity levels using the
monitoring during an intermittent-type          tions to the team to be extremely careful        Caltrac accelerometer and five ques-
sport with a variety of movement                when utilizing the various modes of the          tionnaires. Med Sci Sports Exerc
patterns.                                       Caltrac™ device. Although no player              1994;26:3376-382.
                                                admitted to misusing the device, it is pos-    6 Montoye H, Kemper H, Saris W,
A more recent report by Bassett concluded       sible that some did not immediately return       Washburn R. Measuring physical activ-
that the Caltrac‘ may overestimate the          their unit of operation back to ‘regular         ity and energy expenditure. Champaign:
energy cost of certain activities by as much    mode after their weightlifting or cardio         Human Kinetics:1996; pp 42-90.
as 20-40%.3 Although our team data              (cycle) off-court training sessions.           7 Muscles Dynamics Fitness Network.
appears to concur with Bassett’s findings       Alternatively, they could have also acci-        Caltrac Instruction Manual. Torrance,
wherein the difference between the self-        dentally bumped the unit into an alternate       CA, 1993.
reported activity versus the Caltrac™ was       mode at anytime during the day. Either         8 Poehlman, ET. A review: Exercise and
almost 18%, this corroboration may also         situation would have resulted in an overes-      its influence on resting energy metabo-
have been influenced by potential user          timation of caloric expenditure. ‘               lism in man. Med Sci Sports Exerc
error. The Caltrac™ device has three                                                             1989;21:515-525.
modes of use: ‘regular’, ‘bicycle’, and         Conclusions                                    9 Sallis J. Seven-day physical activity
‘weightlifting’. Regular mode is most often     Even though the COSMED® is expensive             recall. Med Sci Sports Exerc 2000;
used, however, if one engages in activities     and somewhat obtrusive to both peripher-         29:S89-S103.
that require limb movement without total        al vision and tennis stroke mechanics, an

                                                    MEDICINE   & SCIENCE   IN   TENNIS 9
      LE        On the Probability of Winning a Tennis Match
                                         FRANC J.G.M. KLAASSEN, PHD1 AND PROF. JAN R. MAGNUS, PHD2
                        1   Department of Economics, University of Amsterdam, Roetersstraat 11, 1018 WB Amsterdam, The Netherlands.
                                              Tel: +31-20-5254191, Fax: +31-20-5254254. E-mail:
                              2 CentER for Economic Research, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.

                                               Tel: +31-13-4663092, Fax: +31-13-4663066. E-mail:

                                uring a tennis         these respects (which is not surprising,
                            D  match broad-
                          cast on TV, a num-
                                                       because their main objective is to provide
                                                       insights into the way players play the
                                                                                                                       ABOUT THE AUTHORS
                                                                                                            Franc Klaassen is Associate Professor of
                          ber of interesting           points).                                             Economics at the University of Amsterdam
                          statistics are pre-          An estimate of the probability that A wins           in The Netherlands. He obtained his Ph.D. at
                                                                                                            Tilburg University in the Netherlands in
                          sented to the view-          the match, however, provides a direct
                                                                                                            2000. His main research interests are empiri-
                          ers. The most obvi-          indication of the likely winner of the               cal international economics and finance (for
                          ous one is the score,        match. In addition, the graph of probabili-          instance, exchange rates, exports, effects of
                          but the percentage           ties at all points played so far gives an            the Euro on trade in the European Union),
                          of first serves in, the      overview of the match development up to              econometrics and the statistical analysis of
                          number of aces, and          now; in fact, it makes the information               sports, mainly tennis.
    Franc Klaassen        a few other statistics       visible at a glance, so that it may be useful
                                                                                                            Jan Magnus is Research Professor of
                          are also regularly           to project the graph on TV and let it sup-
                                                                                                            Econometrics at Tilburg University in The
  reported on TV. These statistics are then            port the commentator in his/her discus-              Netherlands. He obtained his Ph.D. at the
  discussed by the commentators to provide             sion of the match.                                   University of Amsterdam in the Netherlands
  a deeper insight into various aspects of the                                                              in 1981. His research interests include
  match. However, a direct statistic concern-          Method                                               econometrics, both methodology and appli-
  ing the most important aspect of the                 To discuss the computation of the proba-             cations, matrix calculus, statistics, national
  match – namely who will win – is not                 bilities and thereby the complete graph,             accounts estimation and sport statistics, in
                                                                                                            particular tennis.
  shown. In this article we present a method           we distinguish between the pre-match
  to compute such a statistic: i.e. the proba-         probability (the first point of the graph),
  bility that a given player will win the              and the updated probabilities during the
  match.                                               match (rest of the graph). To estimate the         probabilities, ‘Tennisprob’ computes the
                                                       first probability, we suggest using a trans-       probability that A wins the match at the
  There are already several methods for cal-           formation of the official rankings. This           beginning of the point under considera-
  culating that probability at the start of the        leads to a probability of (e.g.) 80% that          tion. This probability is computed exactly
  match. One could use the odds from                   player A will win against B.                       (not by simulation) and very fast (within a
  bookmakers. Alternatively, one could                 Of course, rankings are just one indicator         second). The first input probability is the
  employ a statistical model, such as the              of the relative strength of the players. If        pre-match probability estimated above.
  model developed by Clarke and Dyte,1                 other information is available, on special         The second input consists of the sum of
  who use official (ATP and WTA) rating                abilities on the court surface and injury          two point probabilities: the probability
  points to estimate the probability that a            problems, for example, then adjustments            that A wins a point on serve and the prob-
  player will win. In a match between                  can be made and possibly the ranking-              ability that B wins a point on serve. As
  players A and B, for instance, this could be         based estimate can be improved.                    before, we have developed a method that
  70% for player A. However, as the match              Ultimately, there will be one pre-match            uses the rankings to estimate this sum.
  progresses, new data become available,               estimate of e.g. 70%. Klaassen and                 This leads to e.g. 120%. This estimate
  and these can be used to update the pre-             Magnus3 show that taking another reason-           needs no further adjustment, because the
  match probability. For instance, if A has            able pre-match estimate shifts the graph           probability of interest (that A wins the
  lost the first set, then the probability that        somewhat, but leaves its form practically          match) hardly depends on it. These two
  A wins drops: the question is by how                 unchanged. Hence, the usefulness of the            pieces of information are all we need. In
  much. This article describes the method of           graph in practice does not depend on the           particular, we do not need to estimate the
  Klaassen and Magnus1 to estimate this                exact starting point.                              two point probabilities - just their sum and
  probability.                                                                                            the initial match probability are sufficient.
  More specifically, we show how one can               To update the estimate as the match pro-           This is important, because the latter prob-
  compute the probability of A winning, not            gresses, we have written a computer pro-           abilities are more robust to misspecifica-
  only at the start of the match, but also             gramme called ‘Tennisprob’. Given the              tion. Note also that no information on the
  (and in particular) at each point during the         rules of the tournament (best-of-three-sets        future development of the match is
  match. This results in a graph of subse-             or best-of-five-sets match, tiebreak in final      needed.
  quent winning probabilities, which unfolds           set or not), the current score, the current
  during the match. If the estimate exceeds            server, given the statistical assumption that      To show how the forecasting procedure
  50% for a player, then that player is pre-           winning points on serve is an independent          works in practice, let us consider the 2003
  dicted to win the match. Hence, the graph            and identically distributed process (see           women’s singles Wimbledon final between
  also gives forecasts for the winner of the           Klaassen and Magnus2 for a justification of        Serena and Venus Williams. Before the
  match.                                               this assumption), and given two input              match starts, we have to choose the two
                                                                                                          input probabilities introduced above. The
  The graph and underlying probabilities can                                                              first one is the probability that Serena
  be informative for TV viewers watching a                                                                (player A) wins the match before any
  tennis match. After all, the score,                                                                     point has been played. Because Serena’s
  although implying who currently leads the                                                               WTA ranking was 1 and Venus’ ranking
  match, does not give a perfect indication                                                               was 4, we obtain a pre-match estimate of
  of the likely winner of the match: a top                                                                81%.
  player may still be the favorite after losing                                                           However, the knowledge that Venus had
  the first set. The score also gives only par-                                                           reached the Wimbledon final for the last
  tial information on the development of the                                                              three years and had won two of them
  match: a score of 5-5 can result after 4-4,                                                             means that the pure ranking based esti-
  but also after 5-0. Summary statistics, such                                                            mate was probably too high. On the other
  as the percentage first serves in and the                                                               hand, Venus was injured. Taking this
  number of aces, do not contribute much in                                                               information into account, we believed that

                                                          MEDICINE    & SCIENCE   IN   TENNIS 10
a reasonable starting probability is 70%.       sports science sound
Of course, one may put more weight on
the injury aspect and prefer a higher prob-
ability; in that case the starting point has    I’m going to get an I.T.N,                    My patella tendonitis,
to be adjusted upwards. The second input        and win the biggest points.                   I think is getting well.
probability for ‘Tennisprob’ is the sum of      I’ll run all day on hard courts,              But with all my Osgood-Schlatters,
both players’ probability of winning a          and ignore my aching joints.                  it’s kind of hard to tell.
point on service. Our ranking-based esti-
mate is 116%, implying an average 58%
probability of winning a point on service.      I’ll never lose a match again,                Well I thought I was all ready,
This seems reasonable.                          I’m feeling fairly fit.                       to play the biggest match,
                                                My strings can stand the tension,             But with all this dermatitis
With these two inputs the probability that      and I’ve got a flash new kit.                 perhaps I’d better scratch.
Serena will win the match can be comput-
ed at each point in the match. In fact,
once a point is finished and the new score      My approach is scientific,                    Yeah, perhaps upon reflection,
is known, the updated probability is pre-       it’s all sports science sound.                I think I’d better rest.
sented within one second. Suppose the           And with ground reaction force field shoes,   I’ll have another bowl of chips,
second set of the final has just been com-      my feet won’t touch the ground.               And then I’m off to bed.
pleted (the score from Serena’s point of
view is 4-6/6-4). Then the following graph
can be generated.                               I’ve got a brand new racket,
                                                it’s simply called ‘THE FORCE’.               By Alistair Higham
The graph shows that at the start of the        It’s a carbo-techno-jedi bat,
final set (145 points have been played)                                                       Dedicated to Dr. Babette Pluim and
                                                of the sci-fi, high-fly sort.                 Dr. Bruce Elliott
Serena’s probability has shrunk from the
starting point of 70% to about 60%. The
graph also gives a summary of the devel-        It’s racket rocket science,
opment of the match so far. Venus’ start        with a fuel injected mould.
was overwhelming. Serena came back but          It makes Newton’s laws look obsolete,
still lost the first set. The first few games
of the second set were shared, but then
                                                and Astro-physics, old.
Serena took a decisive lead. In the second
part of the second set the graph is quite       With strings that move on contact,
stable, indicating that halfway through the     to impart the strangest spins.
second set, it was already quite certain        The reverse spin, chip-chop sling-shot,
that Serena would win the set. It took
Serena some time before she could end
the second set. During the third set the        is one… that doesn’t go in.
graph can be extended.
                                                I’m stuffed full of carbo-hydrate,
Conclusion                                      pancake, pasta, chips and all.
The Serena-Venus match is just one exam-
ple. A graph can be produced for any            Hmmm……. I like that carbo-loading,
match for which we have the two pre-            it could be my downfall.
match input probabilities and the point-
to-point information as the match unfolds.      Yes, I’m ready for the challenge,
Therefore, the approach described above
                                                the battle, the fight, the set.
is a generally applicable forecasting
method.                                         Prepared equipped and ready,
By giving information on the likely winner      but I’d better see Babette.
and the past development of the match,
the graph gives extra information besides       You see, my forehand is a killer,
the score and the summary statistics that
are commonly presented on TV. It also
                                                but my calf’s a little tight.
makes this information visible at a glance      And without my lumbar pillow,
and the graph can be generated instantly.       I don’t sleep too well at night.
Hence, it may be interesting to show the
graph on TV at the changes of ends.             And with Dr Bruce’s Bio-stuff,
Commentators could then use the graph
to discuss the match, and also to evaluate      my serve is very good.
                                                                                                           ABOUT THE AUTHOR
the match afterwards.                           And I would be firing rockets,
                                                                                               Alistair Higham is an L.T.A. Coach Education
                                                if my wrist moved as it should.                Tutor, and runs his own business ‘Coaching
References                                                                                     Edge’, working with different sports on the
1 Clarke SR, Dyte D. Using official rating      But it feels a little creaky                   subject of momentum in sport. He was
  to simulate major tennis tournaments.                                                        Great Britain National Tennis Coach from
  Intern Trans Oper Res 2000;7:585-             around my ganglion cyst,                       1994 to 2001. He is author of two books:
                                                I’ve had tennis leg and elbow,                 ‘Momentum - The Hidden Force in Tennis’ is
                                                                                               a coaching tool for players and coaches and
2 Klaassen FJGM, JR Magnus. Are points          I must have tennis wrist.                      is used by coaches on the ATP and WTA
  in tennis independent and identically                                                        world tennis tour. ‘Off the Frame’ is a
  distributed? Evidence from a dynamic                                                         humorous collection of short stories and
  binary panel data model. J Am Stat
                                                And take my topspin backhand,
                                                                                               sketches from Club and County Tennis
  Assoc 2001;96: 500-509.                       the swing path is just fine.                   based in a fictional Northern County in
3 Klaassen FJGM, JR Magnus. Forecasting         But with all my tendonitis,                    England. For more information, the author
  the winner of a tennis match. Eur J                                                          can be contacted at
                                                It’s my pain that’s low to high.     
  Oper Res 2003; 148: 257-267.

                                                MEDICINE    & SCIENCE     IN   TENNIS 11
      LE                  Scoring to Remove Long Matches,
                  Increase Tournament Fairness and Reduce Injuries

                                                    above, a range of tennis scoring systems is
                                                                                                                 ABOUT THE AUTHORS
                                                    allowable under the rules of tennis. Two
                                                    (or more) scoring systems can be com-             Emeritus Professor Graham Pollard is a for-
                                                                                                      mer professor of applied statistics and pro-
                                                    pared for characteristics such as the             vice-chancellor of the University of
                                                    expected number of points played in a             Canberra, Australia. He is a former first
                                                    match, the probability each player wins           grade tennis player and state squash cham-
                                                    the match, and the efficiency of the sys-         pion, has a PhD in statistics from the
                                                    tem. Given two scoring systems, Scoring           Australian National University, and has
                                                    System 1 and Scoring System 2, with the           international research publications in tennis,
                                                    same expected number of points played in          squash, theoretical statistics, maths educa-
                                                                                                      tion and physics.
    Graham Pollard             Ken Noble            a match, Scoring System 1 is said to be
                                                    more efficient (at identifying the better         Dr. Ken Noble owns and operates a small
       disadvantage or weakness of most ten-        player) than Scoring System 2 if Scoring
  A    nis scoring systems presently in use is
  the considerable variation in the duration
                                                    System 1 has a higher value for the proba-
                                                    bility that the better player wins the
                                                                                                      computer software company that markets
                                                                                                      specialised energy system modelling soft-
                                                                                                      ware. He is a former A-grade tennis and
  of matches. Some matches can be reason-           match. The efficiencies of scoring systems        squash player, and as a leisure time pursuit
  ably short whilst others can last a long          with differing values for the expected            enjoys devising computer programs for
                                                                                                      solving puzzles and games.
  time. Some other sports (e.g. golf, foot-         number of points played can also be evalu-
  ball) have a small variation in match dura-       ated.1
  tion, or even no variation at all.                                                                 single point under the no-ad rule.
                                                    The most commonly used scoring system            (Further, it is interesting to note that
  Disadvantages in using a scoring system           in professional tournaments is the best-of-      under the no-ad rule, there can be a total
  with considerable variation in match dura-        three tiebreak sets system. In this paper        of four points to one service court and
  tion include:                                     we use several constructs to identify an         only three to the other, involving a clear
  • The winner of a long match or sequence          alternative scoring system with a substan-       lack of symmetry. With a draw at deuce
    of long matches can be relatively tired,        tially reduced variation of duration (num-       this lack of symmetry is removed. It can
    and so can be disadvantaged when play-          ber of points played). Other characteristics     also be seen that, under the draw at deuce
    ing a fresher opponent in the next              of this alternative scoring system such as       construct, a point such as 40-30 becomes
    round. Thus, scoring systems with a big         the expected number of points played, and        considerably more important and exciting
    variation in match duration can be unfair       the probability each player wins are shown       than under the present game-finishing
    in the tournament setting.                      to have acceptable values.                       structures.)
  • A long match or sequence of long                The alternative scoring system analysed in
    matches for a player can lead to injuries       this paper makes use of the deciding             In this paper we show that a key to achiev-
    for that player. Indeed, the very need to       match tiebreak game concept in order to          ing a substantial reduction in the variation
    train for the reasonable likelihood of          reduce the variation in match duration.          of the duration of a match, is to make use
    long matches can lead to additional and         This variation is further reduced by using       of a deciding match tiebreak game, and to
    arguably unnecessary strain on players,         two new constructs.                              allow a win/draw/loss option at the set and
    and injuries.                                   The first new construct involves not play-       at the game level.
  • Long matches can lead to considerable           ing a tiebreak game if the game score            Under the present rules a set of tennis is
    delay in the starting time of matches           reaches 6-6 in a set, but simply declaring       won 6-0, 6-1, 6-2, 6-3, 6-4, 7-5 or 7-6.
    scheduled to follow. An enhanced relia-         the set a draw, with the match being won         Thus, unless a tiebreak game is required, a
    bility of the scheduled starting time for       by a set score of 11/2-0 or 11/2-1/2, unless     set of tennis is a hybrid of the best-of-ten
    matches would be attractive to players,         one set all is reached in which case a           games system and the best-of-12 games
    spectators and officials.                       deciding match tiebreak game is played.          system. It can be shown that, in some dou-
  • Television broadcasters would see an            Since a match can be won by a set score of       bles contexts and in singles with an ‘end
    advantage in reducing the likelihood of         11/2-0 or 11/2-1/2, we prefer to describe this   effect’ (e.g. wind effect or sun effect), the
    very long matches, and knowing that a           as a best-of-two sets match.                     best-of-ten games (and hence a set of ten-
    match is almost certain to last less than a     The drawn set construct clearly reduces          nis under the present rules) is unfair.2 By
    given duration.                                 the variation of the match duration. We          contrast, in these doubles and singles with
                                                    have also shown that when playing no-ad          an end effect, best-of-four games, best-of-
  There are several approved scoring system         games and a best-of-two sets match with a        eight games, best-of-12 games, can be
  options within the present rules of tennis        TB (7,2) deciding match tiebreak game, it        shown to be fair. In order to achieve fair-
  (see the ITF publication, Rules of Tennis         is (perhaps surprisingly) more efficient not     ness in these broader contexts, we have
  2003). For example, we have the best-of-          to play the tiebreak game at 6-6 in the first    taken a set of tennis in our alternative sys-
  three and best-of-five sets systems, we           two sets than it is to play it.                  tem to be the best of 12 games. Thus,
  have no-ad games in which only one point                                                           given games can be drawn, a player can
  is played if deuce is reached, and we have        The second new construct for reducing            win a set 61/2-0, 61/2-1/2, 61/2-1, …,
  ‘short’ sets that have completed game             variation is an analogous one within the         61/2-51/2, or the set is drawn at 6-6.
  scores of 4-0, 4-1, 4-2, 5-3 or 5-4 follow-       game structure. It involves declaring a          The alternative scoring system considered
  ing a tiebreak game at 4-4. We also have          game a draw if deuce is reached. Thus, if        in this paper has one further refinement.
  the first to seven (or first to ten) lead by at   deuce is reached each player is awarded          Since games are shorter under the
  least two points deciding match tiebreak          half a game. The variation of match dura-        win/draw/loss game modification, and as
  game (denoted here by TB (7,2) or TB              tion is reduced using this construct. We         no tiebreak games are played in the first
  (10,2)) that can be played instead of the         have also shown that when playing the            two sets, a longer deciding match tiebreak
  third or fifth set in a best-of-three or best-    best of two (win/draw/loss) sets with a TB       game can be justified as a third set. As TB
  of-five sets match.                               (7,2) deciding match tiebreak game, it is        (7,2) and TB (10,2) are both unfair in the
  By using different combinations of the var-       more efficient to declare a service game a       contexts mentioned above, we modelled
  ious scoring system options mentioned             draw if deuce is reached than it is to play a    the first to at least nine points lead by at

                                                       MEDICINE   & SCIENCE    IN   TENNIS 12
least two points tiebreak game, TB (9,2),         The following observations can be made from       means ranging from 137.0 to 146.3). It
which has been shown to be fair in the            the tables:                                       can be seen that p(A wins) can be
above-mentioned contexts.3                        • The variation in match duration is sub-         increased at the expense of increasing
Thus, the alternative scoring system con-           stantially smaller for the alternative scor-    the standard deviation.
sidered in this paper can be described as a         ing system. For example, the standard
best-of-two sets system that can be won by          deviation of the duration of a match           In conclusion we note that the best-of-
a set score of 11/2-0 or 11/2-1/2, unless one       ranges from 40.0 points to 42.2 points in      three tiebreak sets scoring system has the
set all is reached in which case a TB (9,2)         Table 1, whereas it ranges from only           disadvantage that some matches last a long
deciding match tiebreak game is played.             10.3 to 14.9 in Table 2.                       time. For example, one match in fifty lasts
In our modelling we have made the stan-           • The value of the difference between the        more than about 240 points.
dard assumptions that Player A has a con-           98% point and the mean ranges from 74          Combining several constructs including
stant probability pa of winning a point on          points to 91 points in Table 1 whereas it      drawn games and drawn sets, an alterna-
his/her service, whilst Player B has a con-         ranges from only 22 to 30 points in            tive best-of-two sets system has been
stant probability pb of winning a point on          Table 2, highlighting the substantial          shown to have the attractive characteristic
his/her service, and the points are inde-           reduction in variability for the alterna-      of a much smaller variation of match dura-
pendent. The tabled results for each                tive system. It is noted however that the      tion. Indeed, forty-nine matches in every
parameter set are those of 1,000,000 sim-           2% points for the two systems are virtu-       fifty have been shown to last less than 150
ulated matches as this is a sufficient num-         ally identical.                                points.
ber for appropriate accuracy.4                    • The mean duration varies from 148.8
                                                    points to 168.9 points or by about 20          Other statistical measures of the alterna-
Table 1 gives results for the present best-         points in Table 1, whereas it varies by        tive scoring system have been shown to be
of-three tiebreak sets scoring system. For          only about 7 points in Table 2. Thus, the      acceptable. Thus, it has been demonstrat-
men’s singles, the probability a player wins        present best-of-three tiebreak sets sys-       ed that it is possible to remove the occur-
a point on service averages, over a range of        tem not only has substantially greater         rence of long matches from tournament
surfaces, about 0.61. For women’s singles           variation in duration for any particular       play.
the average is closer to 0.55 and for men’s         type of match (or any particular pair of
doubles it is closer to 0.7 and even higher         parameters (pa, pb)), but it also has          References
for players with very strong serves. In the         greater variation across the various types     1 Miles RE. Symmetric sequential analy-
table we have given results for parameters          of matches (men’s, women’s, doubles),            sis: the efficiencies of sports scoring
averaging 0.5, 0.6, 0.7 and 0.75. Thus, the         adding further to the unpredictability of        systems (with particular reference to
table gives results for a large range of sin-       the length of matches.                           those of tennis). J Royal Stat Soc B
gles and doubles matches. It can be seen          • When pa is not equal to pb, the probabili-       1984;46(1):93-108.
from Table 1 that when pa = 0.62 and pb =           ty player A wins the match is somewhat         2 Pollard G and Noble K. A solution to
0.58, the probability Player A wins the             smaller for Table 2 than for Table 1             the unfairness of tiebreak tennis dou-
match is 0.697, and the mean and stan-              (although there is very little difference in     bles. In: Miller S (ed.). Tennis Science
dard deviation of the number of points              columns 11 and 12). This is not particu-         and Technology 2. London: Interna-
played is 160.0 and 41.5. Two per cent of           larly surprising as matches are shorter in       tional Tennis Federation 2003: 325-332.
matches have a duration of less than or             Table 2. The values for the probability        3 Pollard G and Noble K. A solution to
equal to 93 points, and 2% of matches               that A wins in Table 2 can be increased          the unfairness of the tiebreak game
have a duration of greater than or equal to         by modifying the alternative system and          when used in tennis doubles. In: Cohen
246 points.                                         using a longer third set or deciding             G and Langtry T (eds). Proceedings of
                                                    match tiebreak game. Alternatively this          the 6th Australian conference on
Table 2 gives the corresponding results for         probability in Table 2 can be substantial-       Mathematics and Computers in Sport.
the alternative best-of-two sets scoring sys-       ly increased by modifying the alternative        Sydney: University of Technology
tem we have described (each set is the              system to a best-of-four sets in which           Sydney Printing Services 2002: 231-235.
best-of-12 games with a drawn set if the            each set is a best-of-eight games whilst       4 Pollard G and Noble K. A new tiebreak
game score reaches 6-6; games are drawn             the rest of the system remains                   game with four proposed applications.
if deuce is reached; if a deciding match            unchanged. This best-of-four sets alter-         In: Miller S (ed.) Tennis Science and
tiebreak is needed as a third set it is a TB        native system has standard deviations            Technology 2. London: International
(9,2) tiebreak game).                               ranging from about 21.6 to 26.4 (and             Tennis Federation 2003:317-324.

Table 1 Best of Three Tiebreak Sets
                             1         2         3         4          5           6        7         8         9        10       11       12
pa                         0.5        0.52      0.54      0.6      0.62       0.64        0.7      0.72       0.74     0.75      0.77    0.79
pb                         0.5        0.48      0.46      0.6      0.58       0.56        0.7      0.68       0.66     0.75      0.73    0.71
p (A wins match)          0.500       0.704     0.858    0.500     0.697      0.849      0.500     0.680     0.824    0.499     0.669   0.809
mean                      164.6       160.2     148.8    164.0     160.0      149.6      165.6     162.4     154.0    168.9     166.2   158.8
sd                         42.0        42.2      41.4     41.2      41.5       40.7       40.4      40.6      40.4     40.0      40.3    40.4
2% point                    94          91        85       95        93         87         98        96        92      100        98      95
98% point                  251         248       240      248       246        239        245       244       239      243       242     239
98% point - mean            86          88        91       84        86         89         79        82        85       74        76      80

Table 2 The Alternative Scoring System
                             1         2         3         4          5           6        7         8         9        10       11       12
pa                         0.5        0.52      0.54      0.6      0.62       0.64        0.7      0.72       0.74     0.75      0.77    0.79
pb                         0.5        0.48      0.46      0.6      0.58       0.56        0.7      0.68       0.66     0.75      0.73    0.71
p (A wins match)          0.500       0.665     0.801    0.500     0.666      0.802      0.500     0.666     0.804    0.499     0.668   0.806
mean                      122.3       121.0     117.4    121.9     120.7      117.4      120.5     119.4     116.6    119.1     118.2   115.8
sd                         13.6        14.0      14.9     12.9      13.3       14.1       11.2      11.5      12.1     10.3      10.5    10.9
2% point                    93          91        86       94        92         88         97        95        91       98        97      93
98% point                  149         148       147      147       147        146        144       143       142      141       141     139
98% point - mean            27          27        30       25        26         29         24        24        25       22        23      23

                                                     MEDICINE    & SCIENCE   IN   TENNIS 13
                                                   Letter to the Editor
Dear Editor,

I read the article ‘Comparison of Abdominal Muscle Patterning in the Tennis Serve using Different Footwork Techniques’ in Medicine
and Science in Tennis with great interest. I regard the question of foot-up or foot-back as a fascinating issue, especially in the women’s
game. Both techniques have advantages and disadvantages, depending on the type, size and style of game which the player adopts.

To imply that, because a player changed from foot-back to foot-up, they have achieved their true potential is a little speculative, as
many variables would contribute to the development of a players success (Medicine and Science in Tennis 2003;8(1):11).

Not only could this assumption be invalid, but coaches may well accept this information on face value and start changing their players’
serving style on the basis of this premise.

David Lovejoy,
United Kingdom

                                      Reply to Letter to the Editor
                                                 E-MAIL: HRVOJEZ@TENNISEUROPE.ORG

   irstly, I would like to thank you for          ed to publish the results for another player   while using the foot-back technique. Very
F  your interest in my article. In the mid-
dle paragraph on page 11, I wrote: ‘The
                                                  that we examined at the same time. Both
                                                  players had an excellent serve (in the
                                                                                                 tall players like Krajicek, Ivanisevic,
                                                                                                 Philipoussis or Rusedski all use the foot-up
results of the given EMG signal analysis, as      coaches’ opinion). The 16-year-old player      technique. A possible explanation is a
well as the facts given in the bibliography       (A) was right-handed and 207 cm tall. The      longer moment of inertia of the back foot,
(Nos. 2 and 4), indicate that if he applied       other player (B) was aged 32 at the time,      which is further away of the centre of
the Foot Up footwork technique while              left-handed and 167 cm tall.                   rotation and causes less acceleration of the
serving, he would better realise his true                                                        dominant side of the body with the foot-
potential. Now, six years later, he uses the      Similarities can be seen in the signals of     back technique. A possible solution for tall
Foot Up technique and has reached ATP             the left and right rectus abdominis in both    players who use the foot-back technique is
ranking 170.’                                     players. In both, the majority of the mus-     to land on the back foot, as Boris Becker
                                                  cle activity is produced with the foot-up      did.
This means that the player would be able          technique. Different activity of the right
to better realise his true potential in serv-     (player A) and left (player B) obliquus
ing. To avoid any misunderstanding or             externus is recorded. A greater amount of
incorrect interpretation, the next sentence       muscle activity is produced by player B
should be: ‘After the discussion with the         with both footwork techniques. The dif-
coach, the player adopted the Foot-up             ferences can be explained by the following
serving technique. We are convinced that          hypothesis.
this decision has contributed to the fact
that, six years later, he has reached ATP         Comparing the constitutional characteris-
ranking 170.’                                     tics of top players, we see that players of
As an additional argument that supports           average height, such as Agassi, Sampras
the results described in this article, I decid-   and Ferreira, are very successful in serving

          Right obliquues externus                     Right rectus abdominis
                                                                                                     Foot-back                 Foot-up

                                                                                                 We can assume that taller players have
                                                                                                 greater relative explosive leg power and
                                                                                                 strength in the lower trunk muscles. The
                                                                                                 signals recorded in our experiment support
                                                                                                 the idea that such players can use the
                                                                                                 lower trunk muscles almost simultaneous-
                                                                                                 ly, in order to achieve optimal acceleration
                                                                                                 of the dominant side of the body. The
                                                                                                 smaller number of movements and the
            Left obliquues externus                      Left rectus abdominis
                                                                                                 wider base of support (balance) can also
                                                                                                 positively influence the precision and
                                                                                                 accuracy of the serve while using foot-back
                                                                                                 technique (Groppel).

                                                                                                 This hypothesis certainly needs to be test-
                                                                                                 ed on a larger number of players. I would
                                                                                                 also like to stress that neither technique is
                                                                                                 better by definition, but coaches should
                                                                                                 take constitutional characteristics and
                                                                                                 serve effectiveness into account when
                                                                                                 deciding which foot-work technique is
Figure 1 Maximum peak signals of player B                                                        best for an individual player.

                                                     MEDICINE   & SCIENCE   IN   TENNIS 14
                    Development of the Kinaesthetic Channel
                             in Tennis Training
                                FERNANDO SEGAL, AV. PUEYRREDON 1376 1 PISO, BUENOS AIRES, ARGENTINA

                            tennis player’s         fying the sensitive-sensorial afferences.
                        A   degree of devel-
                       opment is shown by
                                                    Anochin1, when formulating his neuro-
                                                    motor model, underlines the importance
                                                                                                                ABOUT THE AUTHOR
                                                                                                     Fernando Segal was in charge of the
                       his ability to estab-        of the data in the efferent synthesis (the       National Development Programme of
                       lish patterns (tacti-        information we have about the move-              Argentine Tennis Federation. This pro-
                                                                                                     gramme brings a new generation of
                       cal, technical, physi-       ment), and in the returning afferences (as
                                                                                                     Argentinean players to the international ten-
                       cal, biomechanical           a way to point out the mistakes in the           nis circuit, such as: Guillermo Coria, David
                       and mental) that             movement perfomed). Bernsteijn1 empha-           Nalbandian, Clarisa Fernandez, José
                       can resolve as many          sises in a more particular way that we are       Acasuso, Maria Salerni and others.
                       variables of plays           always conscious of the sensorial signal in      He has written 8 books about several
                       and throws as possi-         the highest level, ‘which is determined by       themes of development players, organisa-
   Fernando Segal      ble in his or her per-       a certain intention in singular conditions,      tions and projects. Many of them are used
                                                                                                     for various clubs and organisations of
                       formance, effective-         defined as the intention and / or motor
                                                                                                     others countries
ly and efficiency. The player inputs the            task that turns out to be the starting point
information through three channels: the             for each construction (stroke)’. At the
visual channel (generally the most fre-             same time, this implies that various factors
quently-used channel from the start, in             lead up to the impact, including the con-       Conclusions
both instruction and training), the auditive        servation and transmission of force, the        Any variation in the recognition, interpre-
channel (hearing the acoustic rhythm gen-           precision of the movement and correct co-       tation and execution of a movement needs
erated by the stroke and the bouncing of            ordination of motor parts.                      a programming component, that gives
the ball) and the kinaesthetic channel                                                              value to the execution (tactical aspect), an
(through the sensitivity of touch in the            Once the stroke has been executed, the          execution component, that makes what
corporal aspect, in the transmission of the         first and essential condition is the kinaes-    has been programmed with a sequence
stroke through the hand, and in the posi-           thetic afferent way. This is referred to a      integrated by parts of the movement
tion of the body, with sense stimuli trans-         pool of impulses that go from the active        (technical aspect), and a component that
mitted by the body and the support of the           part of the body to the brain, carrying         delves deeper into the kinesthetic channel,
feet).                                              information about the special position of       by means of some practical exercises that,
                                                    the body, the muscular intensity and tone,      when applied, allow us to improve the
The concept of working on kinaesthetic              the movement and the quality of the exe-        sensations of the relationship between the
sensitivity is heavily underrated in compar-        cution.4 Without recognising these afferent     hand, the racket and the stroke: to hit, to
ison with other aspects3. Nevertheless, the         data, the movement would lose its efferent      reduce, to accelerate, to accompany and to
process of mental decisions on the stroke           basis and its quality of development            block,5 with the subsequent development
(both strategic and tactical), its tactical         would be minimised. Finally, Luria2 states      of a technical and tactical amplitude of
and biomechanical execution and its phys-           that ‘the construction of a voluntary           resources.
ical preparation are reflected in an impact,        movement includes a whole system of
in which information about the quality              efferent and afferent rings which are           References
and the result of the executed stroke is            placed in different sections and at different   1 Anochin PK, Bernsteijn NA, and
collected and carried to the brain.                 levels of the central nerve system. Each          Sokolov EN. Neuro-physiology and
                                                    one of the rings belonging to this system         cybernetics. Rome: Ubaldini, 1973.
Results and discussion                              has a specific function, securing the motor     2 Luria AR. How the brain works.
The most perceptive cells are in the hand           formation, the spatial and kinaesthetic           Bologna: Mulino, 1977.
and feet. Consequently, every voluntary             schema of the movement, the tone and            3 McArdle WD, Katch FI, and Katch VL.
human action with an objective is always            the co-ordination of the muscular groups.’        Exercise physiology. Baltimore:
subject to a dominant motive (tactical              This system feeds back information and            Williams & Wilkins,1996.
objective). It requires a programme that            integrates a series of afferences that, once    4 Raimundi P. Kinesiology and psycho-
elaborate the perceptive stimulus – in this         they are recognised, allow a bigger and           motricity. Sperling & Kupfer, 1998.
case, the kinaesthetic ones – and an internal       more permanent organisation of perform-         5 Segal F. SAF. Sistema Analítico
dialogue that determine the action, decodi-         ance, with improved quality.                      Formativo,1997.

 Internal Impingement in the Etiology of Rotator Cuff Tendinosis Revisited
                                                  BUDOFF JE, NIRSCHL RP, ILAHI OA, RODIN DM
    he theory of internal impingement holds         being treated for partial-thickness undersur-   thickness rotator cuff tears also had superi-
T   that, in overhead athletes, repeated con-
tact between the undersurface of the rotator
                                                    face rotator cuff tears.
                                                    The study was a retrospective case series.
                                                                                                    or labral lesions. A statistically significant
                                                                                                    increased prevalence of superior labral
cuff and the posterosuperior glenoid rim            We retrospectively reviewed the records of      lesions in the dominant shoulder was seen
leads to articular-sided partial-thickness          75 shoulders arthroscopically treated for       (P =.03). In addition, our patients who
rotator cuff tears and superior labral lesions.     partial-thickness articular-sided rotator       engaged in overhand throwing had signifi-
However, we have noted this same constel-           cuff tears. With the exception of one pro-      cantly fewer superior labral lesions in the
lation of lesions in our general patient popu-      fessional tennis player, no patients were       dominant shoulders than did nonthrowers
lation. These recreational athletic patients        playing sports at a professional or major       (P =.017). Conclusions: The ‘kissing
do not routinely assume the position of             college level. No professional or collegiate    lesions’ of undersurface rotator cuff tears
extreme abduction and external rotation,            throwing athletes were included. The            and posterosuperior labral damage may be
and thus are unlikely to experience signifi-        prevalence of these lesions and their asso-     explained by mechanisms other than
cant internal impingement forces. The goal          ciation with recreational athletics was         ‘internal impingement’.
of this study was to document the preva-            noted. We found that 55 of 75 (73.3%)           Published in:
lence of superior labral lesions in patients        shoulders with articular-sided partial-         ARTHROSCOPY 2003;19(8):810-814.

                                                       MEDICINE   & SCIENCE   IN   TENNIS 15
                          International Comparison of Tennis Success
                                           1 Free University of Brussels, Fac. LK, BSVB, Pleinlaan 2, 1050 Brussels, Belgium
                                       2   Flemish Tennis Federation (VTV), Edegemse Steenweg 100, 2610 Wilrijk, Belgium

                                olitics and a lack       players. By calculating the rankings of
                           P    of effective
                            sports policies are
                                                         players in the ATP and WTA top 100, a
                                                         total score can be given for each country.
                                                                                                                                ABOUT THE AUTHORS
                                                                                                                     Veerle de Bosscher is an assistant at the
                                                                                                                     faculty of Physical Education of the Free
                            often blamed for             The sum of ATP and WTA singles ranking                      University of Brussels (VUB), Belgium. She
                            inferior achieve-            was calculated. Doubles where not includ-                   graduated in Physical Education and earned
                            ments in sport. Still,       ed, as there is a high correlation with the                 both a master’s degree in sports manage-
                            the nature of effi-          singles result.4 There is also a close correla-             ment and in training/coaching.
                            cient sports policies        tion with the top 200 and 500 players, and
                            is not completely            even with the number of players. The                        Paul De Knop has a PhD in Physical
                            clear.2 In fact, it is       same method was applied for the top                         Education at the Faculty of Physical
                                                                                                                     Education of the Free University of Brussels
                            not even clear how           1,000 players. The top 100 and top 1,000
                                                                                                                     (VUB), Belgium, graduated in leisure studies
    Veerle De Bosscher to distinguish suc-               may give different interpretation of ‘suc-                  at the same university and earned a Master
                            cessful from unsuc-          cess’.                                                      Degree in Sports Sociology and Sports
   cessful countries in a given discipline, or in        The literature suggests that international                  Management from the University of
   sports in general. A primary aim of this              success depends heavily on socio-economic                   Leicester (UK). He is a full time professor at
   paper is to do precisely that. Using tennis           factors.1,5,6,7 The main factors mentioned                  the VUB and is the head of the Youth
   as a case, we demonstrate how different               are population, wealth, area, urbanisation,                 Advisory Centre for Sport, an interdiscipli-
                                                                                                                     nary research and advisory center.
   parameters can be developed for a coun-               religion and the political system.2 The
   try’s success.                                        starting point for our empirical work is a                  Bruno Heyndels, PhD, is senior lecturer at
   Typically, success is expressed in absolute           simple ordinary least square estimation                     the Free University of Brussels (Vrije
   terms. Nevertheless, such comparisons are             (regression analysis) of a reduced form                     Universiteit Brussel). His research interests
   obviously biased by structural differences            model that captures the main macro-                         are in the field of public choice, economics
   in national socio-economic situation, such            determinants of absolute success. This esti-                of sports, cultural economics and economic
   as gross domestic product, population,                mation gives information on the extent to                   psychology.
   area, etc. As such, indicators of absolute            which absolute success is explained by
                                                                                                                     Ivo Van Aken is the performance director of
   success carry little information on how               macro-(economic) determinants. This is                      the Flemish League of the Belgian Tennis
   successful or efficient countries ‘really’ are        the definition of relative success.                         association. He is Fed Cup Captain and was
   in allocating their (scarce) resources. Such                                                                      Olympic Coach in Barcelona, Atlanta and
   information can only be given by indica-              The basic estimation equation for tennis                    Sydney. He is a member of the department
   tors of relative success. We offer a method           success is:                                                 of Top Sport of the Belgian Olympic
   to measure relative success through an                AS-Olympic Games = 0 + 1 POP + 2                            Committee.
   abstraction of the macro-economic deter-              GDP + 3 AREA + 4 URB + 5 RELI +
   minants. Countries are then placed in                  6 GOV +                                                   URB = urbanisation
   comparable positions with regard to top-                                                                         RELI = religion
   level performance in sports.                          Where:                                                     GOV = type of government
                                                         AS     = absolute success
   Method                                                POP = population                                           Results and discussion
   International rankings (ATP and WTA)                  GDP = gross domestic product                               Table 2 shows that 46 % of the variation
   are based on the success of individual                AREA = the size of the country                             in tennis success can be attributed to dif-

   Table 1 Ordinary least square estimates: explaining variance for international tennis success
   Dependent variable                 Independent variables                t-value          Level of significance       Adjusted R square        Standard error
                                                                                                                                                 of the estimate
                                           Population                        3,057                 0,003
   Tennis success top 100                   GDP/cap                          3,428                 0,001
   (WTA+ATP)                                   Area                          2,448                  0,17                       0,46                   4157
                                       Protestant countries                  2,304                  0,24

   Table 2 Relative success: residuals from AS-1000 and AS-100 regressions (Residual R)
   Country             Predicted      AS-100                R        Players           Country               Predicted        AS-1000           R          Players
                                      ranking                                                                                 ranking
    1.   Spain           3611          22208             18597          23              1.   Spain             5504            29016         23512           128
    2.   USA            21286          37463             16177          26              2.   USA              29203            47157         17954           184
    3.   Belgium         3780          15112             11332           6              3.   France            8425            22305         13880           127
    4.   France          5685          14992              9307          19              4.   Argentina         5463            16862         11399            77
    5.   Slovakia         459           4686              4227           6              5.   Belgium           5927            16486         10559            23
    6.   Croatia         -496           3349              3845           6              6.   Czech             2200            11665          9465            85
    7.   Czech           1217           4867              3650           6              7.   Slovakia          1123             7150          6027            39
    8.   Russia         14721          18014              3293          16              8.   Croatia            -259            5614          5873            37
    9.   Argentina       3734           6967              3233           8              9.   Italy             7459            12167          4708           108
   10.   Switzerland     4367           6962              2595           5             10.   Germany           9127            12779          3652           120
   11.   Yugoslavia      -970           1187              2157           1             11.   Russia           19488            22585          3097            93
   12.   Armenia        -1133            798              1931           1             12.   Yugoslavia         -979            1910          2889            16
   13.   Chilli          1202           2932              1730           3             13.   Bulgaria             66            2333          2267            17
   14.   Slovenia         691           2376              1685           3             14.   Switzerland       6791             8886          2095            24
   15.   Morocco          206           1851              1645           2             15.   Armenia          -1176              798          1974             1

                                                             MEDICINE    & SCIENCE     IN   TENNIS 16
    ferences in population, wealth, area and         wealth and large population, it still has a    References
    religion. Population alone explains 23%.         very high residual. Belgium, the Czech         1 Colwell J. Socio-cultural determinants
                                                     Republic and Croatia, with six players in        of Olympic success. In: J. Segrave and
    A regression analysis serves two purposes.       the top 100, are more successful than e.g.       D. D. (Eds.). The Olympic Games in
    Firstly, it identifies the determinants for      Russia. Besides the differences between          transition. Champaign: Human Kinetics
    international success at the macro-level.        absolute and relative success, we also find      Publishers, 1981.
    Secondly, the analysis of the residuals          differences between the top 100 and top        2 De Bosscher V, De Knop P. The influ-
    allows us to compare countries on a ceteris      1,000 players. While the top 1,000 can           ence of sports policies on international
    paribus basis, so that we can define their       serve as an indicator of the available           success: An international comparative
    relative success. A case-by-case analysis of     resources for tennis in any one country,         study. In: Proceedings of the 9th World
    each country gives an objective answer to        the top 100 may be a better parameter of         Sport for All Congress. ‘Sport for all
    the question: ‘what do successful countries      how these resources are invested. In some        and elite sport: rivals or partners?
    control in terms of socio-economic cir-          countries, such as Argentina, Italy,             (pp.31). Arnhem: IOC, 2002.
    cumstances?’. The residuals – the unex-          Bulgaria, and the UK, success diminishes       3 De Bosscher V, De Knop P, Heyndels
    plained variation – are taken as an indica-      when the top 100 players are used for a          B. The influence of sports policies on
    tor of this relative success, and as such, are   definition of absolute success.                  international success of countries: equal
    considered a more efficient measure of                                                            opportunities or not? 11th congress of
    sporting success.                                Conclusion                                       the European association for sport man-
    A country above the regression line (repre-      By monitoring exogenous influences on            agement. Stockholm, 4-7 September
    sented by the residual) performs better          success, the methodology allows successful       2003.
    than would be expected on the basis of the       countries and effective sports policies to     4 De Bosscher V, De Knop P, Van Aken
    socio-economic situation. The reason for         be identified. While our focus is on tennis,     I, Heyndels B. Comparing tennis success
    this might lie in the efficiency of sports       the method proposed has a much wider             among countries. Presented at the ITF
    policies. Table 2 shows the differences          application. Tennis was taken as a case          world-wide coaches workshop.
    between absolute and relative success for        study in order to further determine the          Villamoura, 20-26 October 2003.
    the 15 best performing countries, using          importance of an efficient and effective       5 Den Butter F AG, Van der Tak CM.
    the top 100 and top 1,000 players, given         sports policy for international success. To      Olympic medals as an indicator of social
    the residual: R(esidual) = A(bsolute)-           examine the effect of sports policies on         welfare. Soc Indic Res 1995;35:27-37.
    P(redicted).                                     national sporting success, external factors    6 Van Bottenburg M. Het topsportkli-
                                                     should be eliminated as far as possible.         maat in Nederland. ’s-Hertogenbosch:
    The table shows that monitoring of socio-        The higher efficiency results from the fact      Diopter-Janssens en van Bottenburg bv,
    economic determinants presents a differ-         that the method boils down to monitoring         2000.
    ent image of tennis success. A clear –           the systematic influences on macro-deter-      7 Stamm H, Lamprecht M. Sydney 2000
    though not unexpected – result of this           minants.                                         – The best games ever? World sport and
    analysis is that the U.S. is no longer the       The model for explaining international           relationships of structural dependency.
    most successful nation in tennis. Regard-        success could be further refined. A major        Summary of a paper presented at the
    less of whether we use information on the        route for further research involves taking       1st World Congress of the Sociology of
    top 1,000 players or only the top 100,           cultural effects more closely into consider-     Sport. Seoul, Korea, 2001. Webpage
    Spain is the most successful country.            ation. Sports and its organisation remain
    It should nevertheless be noted that the         specific to culture, which is revealed in
    U.S. remains successful. ‘Despite’ its           different ways.

          E             Science and the Major Racket Sports: a Review
                               HENRY COTTON CAMPUS, 15-21 WEBSTER STREET, LIVERPOOL L3 2ET, UK
                                                    E-MAIL: A.LEES@LIVJM.AC.UK

         he major racket sports include bad-         ing programmes to improve players’ fit-        mechanisms of both performance and
    T    minton, squash, table tennis and ten-
    nis. The growth of sports science and the
                                                     ness; guide players in nutritional and psy-
                                                     chological preparation for play; inform
                                                                                                    injury. They have provided a unique chal-
                                                                                                    lenge to sports engineers in relation to
    commercialisation of racket sports in            players of the strategy and tactics used by    equipment performance and interaction
    recent years have focused attention on           themselves and their opponents; provide        with the player. Racket sports have
    improved performance and this has led to         insight into the technical performance of      encouraged developments in notational
    a more detailed study and understanding          skills; understand the effect of equipment     analysis both in terms of analytical proce-
    of all aspects of racket sports. The aim         on play; and accelerate the recovery from      dures and the conceptualisation of strategy
    here, therefore, is to review recent devel-      racket-arm injuries. Racket sports have        and tactics. Racket sports have provided a
    opments of the application of science to         also posed a unique challenge to scientists    vehicle for investigating fast interceptive
    racket sports. The scientific disciplines of     and have provided vehicles for developing      actions, hand-eye co-ordination and per-
    sports physiology and nutrition, notational      scientific methodology. Racket sports pro-     ception-action coupling in the field of
    analysis, sports biomechanics, sports medi-      vide a good model for investigating the        motor control. In conclusion, science has
    cine, sports engineering, sports psychology      interplay between aerobic and anaerobic        contributed considerably to our knowledge
    and motor skills are briefly considered in       metabolism and the effect of nutrition,        and understanding of racket sports, and
    turn. It is evident from these reviews that      heat and fatigue on performance. They          racket sports have contributed to science
    a great deal of scientific endeavour has         have driven the development of mathe-          by providing unique challenges to
    been applied to racket sports, but this is       matical solutions for multi-segment inter-     researchers.
    variable across both the racket sports and       actions within the racket arm during the
    the scientific disciplines. A scientific         performance of shots, which have con-          Published in:
    approach has helped to: implement train-         tributed to our understanding of the           J SPORTS SCI 2003;21(9):707-732.

                                                        MEDICINE   & SCIENCE   IN   TENNIS 17
                                                 CONFERENCE REPORT:
                     The 13th ITF Worldwide Coaches Workshop
     he 13th ITF Worldwide Coaches
T    Workshop - the showpiece of the ITF’s
coaches’ education programme - was held
in Vilamoura, Portugal from October 20
to October 26. The biennial event was
organised by the ITF and the Portuguese
Tennis Federation (FPT) and attracted
more than 300 coaches from 100 countries
worldwide. It was the first time for ten
years that this event had been held in
Europe. The workshop theme was
‘Applied Sport Science for High
Performance Tennis’ and it provided an
ideal setting for coaches and other profes-
sionals involved in tennis to learn and
interact. Speakers included some of the        Speakers of the workshop
tennis world’s most highly respected scien-
tists, coaches and coach educators and we
would like to take this opportunity to         for tennis. Dr. Babette Pluim and Frank         many coaches have taken the opportunity
thank them for their efforts in making the     van Fraaijenhoven, both from the Dutch          to join us in Vilamoura.”
Workshop such a success.                       Tennis Federation, illustrated how doctors
                                               and coaches can improve their communi-          FPT President and co-host Manuel Valle-
Among the coaches presenting at this           cation and interaction by given a joint         Domingues also confirmed Portugal’s
year’s Workshop were Bob Brett, former         presentation on this topic.                     commitment to coaches education by sign-
coach to Boris Becker; Niki Pilic, ex-top                                                      ing an agreement with the ITF to use the
ten player and former doubles world No.        Also, for the first time at a worldwide         ITF’s material in Portugal’s coaches educa-
1; Emilio Sánchez Vicario, director of a       coaches workshop, there was an opportu-         tion programme. More than 80 countries
High Performance Centre in Barcelona,          nity for young investigators and coaches to     worldwide are currently using the ITF
ex-top ten player and former doubles           present their work and ideas during the         coaching syllabi in their coaching pro-
world No.1; and Javier Duarte, Spain’s         ‘free communication’ sessions.                  grammes.
former Davis Cup captain and ex-coach of
Alex Corretja and Alberto Berasategui.         “It’s been a fantastic week,” said Richard
                                               Gonzales, School Tennis Initiative Co-
Several scientists and medics had been         ordinator of Uruguay. “The quality of the           CONFERENCE CALENDAR
invited to present. Prof. Karl Weber from      presentations both on and off court by           10-13 D ECEMBER 2003
                                                                                                  2nd Symposium for Tennis and Ski
the Sports University in Cologne tackled       experts in all aspects of high performance         Medicine, St. Anton am Arlberg, Austria
the issue of high speed training on the ten-   tennis has been first class. Plus the chance     Information: Dr. Rudi Schabus, Sport &
nis court in a very elegant, albeit compli-    to mix with coaches from all over the            Trauma e.v., Liechtenstraße 53, A-1090
cated, presentation with many interesting      world, makes this event very special.”           Vienna, Austria.
                                                                                                Fax + 43 1 40180 780,
videos. Dr. Joachim Mester from the same                                                        E-mail
University took us into the future with his    Speaking at the closing dinner, ITF              Website
elaborate presentation on e-learning.          President Francesco Ricci Bitti said: “The
Catherina Ortega (WTA) discussed the           ITF regards its relationship with the coach-     Conferences in 2004
                                                                                                15-18 J ANUARY , 2004
issue of core stability. Vitor Cabral, coach   ing community as one of the most effec-            9th Australian Tennis Conference,
and scientist, talked about the physical       tive ways of growing the sport of tennis           Melbourne, Australia – leading into The
preparation for tennis (strength training),    throughout the world.. Coaches play a              Australian Open
                                                                                                Information: Sarah Foott: Tennis Coaches
whereas Dr. Ann Quinn showed how               vital role in the development of players at      Australia, Private Bag 6060, Richmond Sth,
players can mentally prepare themselves        every level and I am gratified to see that so    Vic, 3121 Australia
                                                                                                Tel + 61-418-995-843 Fax +61-3-9824-8050

                                                                                                19-20 J UNE 2004
                                                                                                  STMS 6th International Conference on
                                                                                                  Medicine and Science in Tennis- The LTA
                                                                                                  Sports Science and Sports Medicine
                                                                                                  Conference, London, UK. Held in conjunc-
                                                                                                  tion with the Wimbledon Championships.
                                                                                                Information: Dr. Michael Turner, LTA,
                                                                                                The Queens Club, London W14 9EG,
                                                                                                United Kingdom.
                                                                                                Tel + 44 207 381 7071 Fax + 44 207 381 3001

                                                                                                13-16 S EPTEMBER 2004
                                                                                                  5th International Conference on the
                                                                                                  Engineering of Sport, University of
                                                                                                  California, Davis, USA
                                                                                                Information: Mont Hubbard, Conference
                                                                                                Organizer, Department of Mechanical and
                                                                                                Aeronautical Engineering, University of
                                                                                                California, Davis, California 95616, USA.
                                                                                                Tel +530-752-6450 Fax +1-530-752-4158
Participants of the workshop

                                                  MEDICINE   & SCIENCE    IN   TENNIS 18
               Special Offer for STMS Members
      Journal Science and Medicine in Sport (Tennis Edition) and
      Sports Medicine Australia 2003 Conference, Book of Tennis

Tennis Australia and Sports Medicine Australia (SMA) are offering STMS members a package deal of
the Journal of Science and Medicine in Sport (Tennis edition) plus a book of Tennis Abstracts from the
2003 Australian Conference of Science and Medicine in Sport.

The Tennis edition of the JSMS features multi-disciplinary research in tennis from physiology,
biomechanics, physiotherapy, medicine and technology. Sports scientists involved in this issue include
Dr Babette Pluim (Dutch Tennis Federation), Prof. Bruce Elliott (University of Western Australia),
Dr Miguel Crespo and Machar Reid (ITF), and Prof. Howard Brody (University of Pennsylvania).

        Only US$10

The Book of Abstracts is not available anywhere else, and with the Conference recently held in October,
it is your opportunity to receive the latest tennis research.

For further information or to purchase your copy of the JSMS (Tennis Edition) and Book of Tennis
Abstracts please contact Dr Alan Pearce at Tennis Australia on or
phone +61 3 9286 1177.

                                     MEDICINE   & SCIENCE   IN   TENNIS 19
                                    SELECTED REVIEW OF THE LITERATURE
                           The Development of Racquet Speed
                                       THE UNIVERSITY OF WESTERN AUSTRALIA, AUSTRALIA

This article is a modified version of a         speed by either reducing the time to move                     ABOUT THE AUTHOR
chapter from the ITF book ‘Biomechanics         a given distance (greater acceleration), or
                                                                                                   Bruce Elliott is the Professor of biomechan-
of Advanced Tennis’ 2003 and is                 increase the distance so that speed can be         ics at the School of Human Movement and
published with approval of the editors.2        developed in a more controlled manner.             Exercise Science at the University of
                                                                                                   Western Australia. He has a passion for
Tennis scientists are continually asked by      Research has shown that modern players             tennis research and has spent his academic
players to develop techniques that permit       generally use the later method by increas-         life providing a theoretical basis to tennis
more power, while those involved more           ing racket displacement in the backswing           stroke production.
with the medical aspect of the game are         phase of power strokes. A looped back-
forced to develop better preventative pro-      swing further increases the distance the          this chain of movements (kinetic chain) is
grams and rehabilitative treatments to          racket can develop speed for impact.              followed.
meet the demands placed on the body             • In a modern serve the racket is ‘away
from movements associated with this addi-         from’ and behind the level of the               Most coaching texts include a section that
tional power. There are several elements          pants/skirt to increase the distance the        deals with the flow or summation effect in
that contribute to an increase in racquet         racket can move to impact. This further         the service action that leads to optimal
and therefore ball speed:                         enhances performance by putting the             racket speed at impact.
                                                  muscles around the shoulder on-stretch.                           Leg drive
1 Elastic energy and muscle pre-tension         • It is now common for advanced players                                 +
   in the enhancement of racket speed             to rotate their racket such that it is paral-                  Trunk rotation
While neurological factors also play a role       lel with the back fence in the one-hand-                              +
in the enhancement of racket speed in ten-        ed backhand, and approximately 45°                   Upper arm elevation and forward
nis, it is perhaps easiest for coaches to         beyond a line pointing at the back-fence                         movement
attribute the increase in this speed follow-      in the forehand stroke, in an attempt to                              +
ing a preceding stretch of the muscle-ten-        increase the distance over which racket                       Elbow extension
don complex to 1) the recovery of stored          speed can be generated.                                               +
elastic energy and 2) a higher active mus-                                                          Shoulder internal rotation and forearm
cle state at the start of the drive to the      3 The use of co-ordinated movements                                pronation
ball.                                           In tennis, where a high racket speed is gen-                            +
                                                erally required, a number of body                                 Wrist flexion
The theory underlying the use of elastic        segments must be co-ordinated if speed
energy in stretch-shorten cycle activities is   and accuracy are both to occur. Each              4 The linking of linear and angular
a relatively simple process. During the         movement during stroke production may                motion
stretch phase the muscles, tendons and          be considered as a separate segment, the          The linking of forward (linear) and rota-
associated tissues are actually stretched       removal of which will detract from the            tional (angular) motions are important to
and store energy. Energy is therefore           ability to generate racket speed. A multi-        the generation of racket speed. In general
stored in tennis during the racket and          segment approach to stroke production,            terms it is preferable at impact to have the
upper-trunk rotations (backswing) or            the norm for all high speed stroking,             body moving forward (linear motion).
movement preparation phase (e.g, bending        requires a co-ordinated sequence of move-         Remember that forward linear movement
of the legs during the split step in a vol-     ments if miss-timing/ poor sequencing is          of the shoulder is generally created by
ley). On movement reversal, during the          not to occur.                                     rotation of the trunk, and upward move-
shortening phase, the stretched muscles                                                           ment of this shoulder is created by an
(that are now in a higher active muscle         The motion of segments in high-speed ten-         effective ‘leg-drive’. In modern tennis an
state than for resting muscles) and tendons     nis stroke production is generally                ‘open stance’ is used to create more rota-
recoil back to their original shape and in so   sequenced in a proximal-to-distal fashion.        tional speed (Andy Roddick - forehand)
doing a portion of the stored energy is         The only joint movement that has been             and a ‘square stance’ is often used to effec-
recovered and assists the movement.             shown to occur very late in the for-              tively link angular and linear motion.
Research has shown that:                        wardswing (and therefore not in proximal-         Work by Bahamonde and Knudson1 has
• 10-20% additional racket-speed is             to-distal sequencing) for the service and         shown that similar upper extremity ‘load-
  achieved following a stretch-shorten          forehand strokes is internal rotation of the      ing’ was recorded for open and square
  cycle.                                        upper arm. Ben Kibler from the USA has            stance forehands.
• Energy is lost if there is more than a        presented injury and joint loading data to
  brief pause between the stretch and           support his view that performance will
  shorten phases of a movement.                 improve and injuries will be reduced, if          5 The role of muscle strength, power and
  Approximately 50% of the stored energy                                                             endurance
  is lost if a pause of 1 s occurs between                                                        The relationship between selected physical
  the backswing-forwardswing phases of a                                                          capacities such as muscle strength/power
  stroke (Figure 1).                                                                              and performance is difficult to quantify in
                                                                                                  tennis. Varied relationships have been
2 The distance over which greater racket                                                          found between muscle strength and serv-
  speed can be developed:                                                                         ing speed, although research has shown
One of the main reasons of having a back-                                                         that a specifically designed exercise pro-
swing is to increase the distance over                                                            gram can improve racket speed.
which greater racket speed can be devel-                                                          This long-term training together with play
oped during the forwardswing to the ball.                                                         leads to muscle imbalances, particularly of
This means a greater stretching of muscle                                                         the upper extremity and trunk in
and associated tissues.                                                                           advanced tennis players. While a muscle
Theoretically speed = distance/ time,           Figure 1 Energy loss with incraesed pause         imbalance between the right and left fore-
therefore a player may develop racket                    period                                   arms may be acceptable, an imbalance at

                                                   MEDICINE   & SCIENCE    IN   TENNIS 20
                                                                                                Sampras had a more vertical rotation (top-
                                                                                                spin), when compared with the rotation
                                                                                                produced by Rudeski (more topspin/
                                                                                                sidespin). While a similar ball speed was
                                                                                                recorded at the position where the receiv-
                                                                                                er would hit the ball, impact height was
                                                                                                consistently higher for the Sampras serve
                                                                                                (0.1-0.3 m) and the ball had a greater top-
                                                                                                spin rotation by approximately 500 rpm.
                                                                                                This goes part the way to explaining the
                                                                                                difficulty in returning the Sampras serve.

                                                                                                7 The role of equipment design
                                                                                                While modern racket technology has obvi-
                                                                                                ously assisted in the development of
                                                                                                power in the modern game, no attempt
                                                                                                will be made to discuss these because of
                                                                                                word limits on this article

                                                                                                Coaches in reading this chapter will now
                                                                                                realise that there are a number of inter-
                                                                                                related ways to address the question on
                                                                                                how to increase racket speed. More seg-
                                                                                                ments and increased stretch on muscles
                                                                                                and associated tissues are often linked to
Machar Reid (l) and Bruce Elliott
                                                                                                an increase in the level of racket displace-
                                                                                                ment in the backswing and early for-
the shoulder (internal vs. external rotators)   racket trajectories are typical for advanced    wardswing. Performance in an injury free
or in the trunk for example (left vs. right     players preparing for, and then hitting         environment will only occur if the body
erector spinae) must be rectified if injury     through the impact zone of groundstrokes.       has been prepared to meet the loads
is not to follow. An appropriate balance        • Flat stroke            25-30°                 imposed on the body during high-speed
between muscles responsible for the devel-      • Topspin stroke         35-45°                 stroke production.
opment and stopping of high speed seg-          • Topspin lob            50-70°
ment rotations will both lead to improved       It is this combination of high levels of top-   References
performance and a reduced likelihood of         spin and ball speed that produce ‘stroke        1 Bahamonde R, Knudson D. Kinetics of
injury.                                         heaviness’. Possibly the best example of           the upper extremity in the open and
                                                this phenomena is evident in the return of         square stance tennis forehand. J Sci
In powerful tennis strokes, the stability of    serve. Yandell2 reported on the service            Med Sports 2003;6(1):88-101.
the lower trunk is critical to a successful     actions of two of the games ‘big servers’ in    2 Elliott B. The development of racquet
forwardswing and to the prevention of           Greg Rusedski and Pete Sampras.                   speed. In: Biomechanics of advanced
low-back injury. This stability, commonly       While they both served at a similar speed         tennis. Elliott B, Reid M and Crespo M
referred to as ‘core stability’, involves the   ( 190-200 km/hr), impacted the ball at a          (eds). London: ITF 2003. ISBN 1 9030
co-ordinated muscle action of the stabilis-     similar height ( 2.85 m) and with almost          12 23 2.
ers of the lumbar spine. Precisely timed        identical initial rotations ( 2,500 rpm)        3 Yandell J. Comparing the serves of
co-contraction muscles such as transversus      there was a key difference in their service        Sampras and Rusedski. Tennis Pro
abdominis, lumbar multifidus, the               technique. The rotation on the serve hit by        2003; May/June:28-29.
diaphragm and the pelvic floor must
therefore be trained to stabilise the lumbar
spine and provide a base on which other
muscles can effectively contract.

6 ‘Heaviness’ of a stroke
Professional players often refer to the term
‘heaviness of stroking’ as a reason for the
success of a particular player and for that
reason a brief discussion of this is included
as a part of the reason for racket speed at
impact. This ‘heaviness’ will be referred to
as the amount of spin on the ball in com-
bination with its speed just prior to

Ball rotation is created by the movement
and orientation of the racket with respect
to the ball at impact. No purposeful move-
ment between the racket and the ball is                           BIOMECHANICS OF
possible once impact has occurred, so                             ADVANCED TENNIS
movement of the racket must follow a pre-
determined path. Upward movement of                  Bruce Elliott, Machar Reid and
the racket combined with the downward                            Miguel Crespo (eds)
motion of the ball creates topspin. In                         Number of pages: 221
groundstokes the forwardswing trajectory                            London: ITF 2003
tends to be shallow until just before                          ISBN 1 903013- 23 2
impact, then increases to produce the                           For orders please visit
desired spin on the ball. The following                   

                                                   MEDICINE   & SCIENCE    IN   TENNIS 21
      LE              Stretching Recommendations for Tennis Players
                                             CHICO, CA 95929-0330, USA

                                lexibility is an     stretching was consistent across skill levels
                           F    important tissue
                            property that allows
                                                     and gender. The lack of a performance
                                                     decrement may have been due to move-
                                                                                                                   ABOUT THE AUTHOR
                                                                                                        Duane Knudson, PhD is associate professor
                            the tennis player to     ment complexity or dose-response effects.          and associate chair of the Department of
                                                                                                        Physical Education and Exercise Science at
                            freely move with a       Another study with longer stretching holds         California State University, Chico. He is an
                            low risk of muscular     and a simple throwing task showed signifi-         active researcher on tennis biomechanics
                            injury. Recent           cant reductions in overarm throwing per-           and is a member of the USTA Sport Science
                            research on flexibili-   formance.11                                        Committee.
                            ty and stretching has
                            shown that the typi-     In summary, if tennis players have normal
                            cal ‘more must be        levels of flexibility the warm-up routine         an increase in range of motion that could
     Duane Knudson
                            better’ approach to      for tennis should focus on generalised            have both positive and negative injury-risk
                            stretching of tennis     movements and strokes of gradually                effects depending on the static flexibility
   players and coaches is likely incorrect.          increasing intensity. Stretching should not       status of the person. Theoretically, a
   Studies support the theory that both low          be performed in the warm-up because               hypermobile person increasing their range
   and high levels of flexibility may increase       there are no documented performance               of motion through stretching could result
   the risk of injury compared to normal flex-       benefits and could very well decrease per-        in a less stable joint, greater accessory
   ibility.5 Stretching exercises also have a        formance. The next section will show that         motion, and a higher risk of injury.
   variety of effects on the biomechanics of         stretching in the warm-up also cannot be
   muscle and can adversely affect perform-          justified based on the hypothesis of              Stretching is also colloquially believed to
   ance. This paper will summarise the recent        decreasing risk of injury.                        decrease injury by decreasing the stiffness
   research on the effect of stretching on per-                                                        of muscle. Unfortunately, this belief seems
   formance and injury risk, and conclude by         Stretching and Injury Risk                        to be based on the accurate perception of
   making recommendations for stretching in          Since flexibility has a complex relationship      decreased tension (stress relaxation) at
   tennis players. These mass prescription           with injury-risk, it should not be surprising     specific joint angles and an incorrect
   guidelines are intended for uninjured             that performing stretching exercises to           understanding of the mechanical variable
   players since sports medicine professionals       increase range of motion do not directly          stiffness. Figure 1 provides a schematic of
   will likely create individualised stretching      result in reductions in injury risk.              the rise in passive torque at a joint during
   programs for players with injuries or flexi-      Unfortunately, the dominant opinion               the elongation phase of multiple slow
   bility imbalances common in tennis.               among most players and coaches is that            stretches to the same length. Plotting the
                                                     stretching prior to play decreases the risk       angular variables of torque and angle
   Stretching and Performance                        of muscular injury. A closer look at the          approximate the classic linear load-defor-
   One of the largest paradigm shifts in sports      association between stretching and injury         mation curves of isolated tissues. The
   medicine in recent years is the elimination       risk is needed on the court and in the            behaviour illustrated in Figure 1 has been
   of static stretching in warm-up routines for      research laboratories.                            observed in several human studies of a
   physical activity. Generalised warm-up                                                              variety of muscles, primarily in the lower
   movements are critical for increasing tissue      The author is aware of no prospective             extremity.
   temperature, improving performance, and           studies of the association between stretch-
   increasing the resistance of the tissue to        ing (short or long term) and injury risk in       The musculotendinous response to passive
   injury. Stretching in a warm-up, however,         tennis. The largest and best prospective          stretch is non-linear, initially with a slow
   has considerable research showing substan-        studies in this area have shown that              rise in torque called the toe region that
   tial decreases (5 - 30%) in muscular per-         stretching in the warm-up prior to physi-         normally corresponds to physiological
   formance following stretching.2,4,6 Most of       cal training in the military has no12,13,17 or    loading for most musculotendinous tissues.
   these studies show static stretching              minimal effect1 on musculoskeletal injury         The stiffness or Young’s Modulus of
   decreases high-force muscular perform-            rates compared to warm-up alone. One              Elasticity (E) of the muscle group is the
   ance,10 although there are also studies           acute and long-term effect of stretching is       rate of increase (slope) in passive torque in
   showing this effect in lower load move-                                                             the elastic (linear) region of the graph. If
   ments like jumping and throwing.3, 11                                                               the tissue were elongated further the
   The effect appears to be equally related to                                                         torque would increase and eventually
   decreased muscular contractile force and                                                            reach the elastic limit where permanent
   activation,2 and can last up to an hour.4 It                                                        damage (plastic region) to the tissue and
   is interesting to note that the performance                                                         would occur. Note that the short-term
   decrements of stretching before activity                                                            effect of stretching does not affect the
   have been consistently observed when                                                                stiffness of the muscle group (E), although
   most subjects would be expecting superior                                                           there would be less passive resistance for a
   performance (reverse placebo effect) fol-                                                           given joint angle. The studies on the long-
   lowing stretching.                                                                                  term effects of stretching also show no sig-
                                                                                                       nificant effects on muscular stiffness.7
   The question arises if stretching induced
   decrements also occur in high-speed                                                                 These measures of the passive stiffness of
   movements like tennis strokes. A recent                                                             muscle groups are different than the stiff-
   study examined if typical static stretching                                                         ness measured in during muscle activation.
   done by tennis players in warm-ups                Figure 1. Schematic of a torque-joint angle       Clinical observations and research show
   decreased service performance.9 First serve       plot during for repeated passive stretches of a   many muscular injuries tend to occur dur-
   speed and service percentage of diverse           muscle group. Stress relaxation makes the         ing eccentric (lengthening) contractions.
   sample of players were measured following         passive torque at a given joint angle in subse-   While some studies have measured the
   a traditional warm-up and then following a        quent stretches (thin line) less than the first   stiffness of muscle groups in active condi-
   stretching program. No significant differ-        stretch (thick line). The stiffness (E) of the    tions, it is unclear how the passive stiffness
   ences in serve speed or percentage were           muscle group in these stretches, however, is      and active stiffness of muscles are related.
   observed and this lack of an effect of            not different.                                    In summary, there is little clinical or basic

                                                        MEDICINE   & SCIENCE    IN   TENNIS 22
   science evidence to show that stretching         imbalances related to the repetitive                      7 Knudson D. Stretching during the warm-up: do
                                                                                                                we have enough evidence? J Phys Ed Rec
   prior to physical activity like tennis           motions of tennis play.14,16 Potential trou-                Dance 1999;70(7):24-27, 51.
   decreases the risk of muscular injury.7,15,17    ble areas that should be routinely                        8 Knudson D, Magnusson P, and McHugh M.
   Most studies show that stretching can            stretched in tennis players are the ham-                    Current issues in flexibility fitness. Phys Fit Res
   increase range of motion but will have a         strings, low back, calf, hip adductors and                  Dig 2000;3(10):1-8.
   negligible effect on the stiffness of            internal rotators, shoulder internal rota-                9 Knudson D, Noffal G, Bahamonde R, Bauer J,
                                                                                                                and Blackwell J. Stretching has no effect on ten-
   muscle.8 This combined with the epidemi-         tors, and hip flexors. Based on the biome-                  nis serve performance. J Strength Cond Res (in
   ological literature suggests that the com-       chanical and clinical studies of stretching,                press).
   mon belief that stretching prior to activity     Knudson8 has recommended that 4-5 stat-                  10 Nelson AG, Guillory IK, Cornwell A, and
   reduces the risk of injury is likely false.      ic or PNF stretches be performed for each                   Kokkonen J. Inhibition of maximal voluntary iso-
                                                                                                                kinetic torque production following stretching is
   Stretching following physical activity,          muscle group. Each stretch should be held                   velocity specific. J Strength Cond Res
   however, may be appropriate to maintain          at ‘with low levels of force’ for 15-30 sec-                2001;15:241-246.
   normal levels of range of motion. More           onds. These general guidelines are appro-                11 Noffal G, and Knudson D. Effect of stretching
   prospective studies are needed to docu-          priate for most tennis players.                             on throwing speed and isokinetic shoulder
   ment the normal or desirable ranges of                                                                       torques (submitted).
                                                                                                             12 Pope RP, Herbert RD, and Kirwan JD. Effects
   motion that are associated with lower risks      References                                                  of flexibility and stretching on injury risk in
   of muscular injury, and on the effect of         1 Amako M, Oda T, Masuoka K, Yokoi H, and                   army recruits. Aust J Physiother 1998; 44:165-
   musculotendinous stiffness on risk of vari-        Campisi P. Effect of static stretching on preven-         172.
                                                      tion of injuries for military recruits. Military Med   13 Pope RP, Herbert RD, Kirwan JD, and Graham
   ous injuries.                                      2003; 168:442-446.                                        BJ. A randomized trial of pre-exercise stretch-
                                                    2 Avela J, Kyrolainen H, and Komi PV. Altered               ing for prevention of lower-limb injury. Med
   Stretching for Tennis Players                      reflex sensitivity after repeated and prolonged           Sci Sports Exerc 2000;32:271-277.
   Although there is an incomplete under-             passive muscle stretching. J Appl Physiol              14 Roetert EP, Ellenbecker TS, and Brown SW.
   standing of the effects of stretching on per-    3 Cornwell A, Nelson AG, Heise GD, and
                                                                                                                Shoulder internal and external range of motion
   formance and injury risk, the data can be                                                                    in nationally ranked junior tennis players. J
                                                      Sidaway B. Acute effects of passive muscle                Strength Cond Res 2000;14:140-143.
   used to suggest general guidelines appro-          stretching on vertical jump performance. J Hum         15 Shrier I. Stretching before exercise does not
   priate for tennis players. Most tennis play-       Mov Stud 2001;40:307-324.                                 reduce the risk of local muscle injury: a critical
   ers should perform static stretching exer-       4 Fowles JR, Sale DG, and MacDougall JD.                    review of the clinical and basic science litera-
                                                      Reduced strength after passive stretch of the             ture. Clin J Sports Med 1999; 9:221-227.
   cises in the cool-down following matches           human plantar flexors. J Appl Physiol 2000;            16 Vad VB, Gebeh A, Dines D, Altchek D, and
   or conditioning. The goal should be to             89:1179-1188.                                             Norris B. Hip and shoulder internal rotation
   maintain normal ranges of motion for all         5 Jones BH and Knapik JJ. Physical training and             range of motion deficits in professional tennis
   the major muscle groups. Sports medicine           exercise-related injuries. Sports Med                     players. J Sci Med Sport 2003;6:71-75.
   professionals can assist players by monitor-     6 Kokkonen J, Nelson AG, and Cornwell A. Acute
                                                                                                             17 Weldon SM, and Hill RH. The efficacy of
   ing ranges of motion for problem joints,                                                                     stretching for prevention of exercise-related
                                                      muscle stretching inhibits maximal strength per-          injury: a systematic review of the literature.
   especially in the joints with common               formance. Res Q Exerc Sport 1998;69:411-415.              Man Ther 2003; 8:141-150.

    ARCH     Viscosupplementation not effective for the treatment of
                    posttraumatic osteoarthritis of the elbow

                               he treatment of      popular modality for safe and effective
                          T    posttraumatic
                           osteoarthritis of the
                                                    treatment of osteoarthritis of the knee. It
                                                    consists of a series of intra-articular injec-
                                                                                                                           ABOUT THE AUTHORS
                                                                                                               Richard van Brakel is Registrar at the
                                                                                                               Department of Orthopaedic Surgery in the
                           elbow in young           tions with hyaluronic acid or its deriva-                  Sint Maartenskliniek, a specialised hospital
                           patients remains a       tives. Hyaluronic acid is an endogenous                    for orthopaedic surgery in the Netherlands.
                           challenge. Due to        proteoglycan which can be found in syn-
                                                                                                               Denise Eygendaal is orthopaedic surgeon in
                           pain and functional      ovial fluid and also serves as a backbone                  the Sint Maartenskliniek and is specialised
                           limitation of the        for proteoglycans in cartilage matrix. Being               in Upper Limb Surgery and Sports
                           joint it can cause       a major constituent of synovial fluid, it has              Medicine.
                           great impairment in      visco-elastic properties by which it can act
                           every day function       as a lubricant during slow movement and
        Dr. Denise
                           and sports activities.   as a shock absorber during rapid move-                   viscosupplementation. Other parameters
                           In order to reduce       ment.                                                    were not influenced by treatment with vis-
   pain and hence maintain or restore func-                                                                  cosupplementation at any time. Systemic
   tion, the current conservative options of        In this prospective cohort study, we evalu-              or local adverse effects did not occur.
   treatment are analgetics and intra-articular     ated the effect and safety of viscosupple-
   injection of corticosteroids. Both options       mentation in 20 elbows with posttraumat-                 Because the use of viscosupplementation
   have important limitations. Intra-articular      ic osteoarthritis of 19 patients (9 male, 10             for the treatment of posttraumatic
   injection with corticosteroids are only indi-    female, average age 47,1 years, SD: 15,8                 osteoarthritis of the elbow provides only
   cated for patients with synovitis and joint      years). Three injections with sodium                     slight (but not significant) short-term pain
   effusion. They provide quick relief but          hyaluronate were given within four weeks                 relief while other parameters were not
   only of short duration and can cause ‘flare-     with regular intervals. Evaluation took                  modified, we believe that viscosupplemen-
   up’ of the joint and systemic side-effects.      place just before the first injection as well            tation is not suitable for this indication.
   Whether intra-articular injection with cor-      as after three and six months and consisted
   ticosteroids may induce extra deterioration      of the Elbow Function Assessment Score,                  The deformity of the joint as a result of
   of cartilage remains uncertain due to the        the Functional Rating Index by Broberg                   trauma and the possibility that the syn-
   fact that it has not been studied in             and Morrey and the Modified Andrews                      ovial fluid of posttraumatic osteoarthritic
   humans. Experimental data from animal            Elbow Scoring System. Pain was also                      joint is superior to synovial fluid of joints
   studies are contradictory.                       assessed by means of Visual Analogue                     with degenerative osteoarthritis regarding
                                                    Scales.                                                  rheological properties may explain the
   In recent years, intra-articular viscosupple-    Only pain showed a slight (but not signifi-              ineffectiveness of intra-articular injections
   mentation has become an increasingly             cant) decrease three months after starting               with sodium hyaluronate.

                                                        MEDICINE    & SCIENCE      IN   TENNIS 23
          WTA Tour Age Eligibility and Professional Development
                           Ten Year Review
                                                                                                                            representatives of various facets of the

                                              PHOTO CREDIT GETTY IMAGES
2004 marks ten years since the WTA
Tour presented its ground- breaking                                                                                         tennis community: former players,
investigation into the entry age of                                                                                         agents, coaches, the media, tennis manu-
women players on the WTA Tour that                                                                                          facturers, the ATP, the Grand Slam com-
resulted in the formation of the Profes-                                                                                    mittee, the ITF Women’s Department,
sional Development Department and                                                                                           the ITF Juniors’ Department, Board
programs and the Age Eligibility Rule.                                                                                      members representing the players and
                                                                                                                            tournaments, and a research consultant.
As part of the WTA Tour’s ongoing com-                                                                                      This ‘steering committee’ provides a
mitment to the career fulfillment and                                                                                       wealth of information, expertise and
longevity of its players, the WTA Tour is                                                                                   varied perspectives to the review process.
commencing a ten-year review of the
Age Eligibility Rule and the Professional                                                                                   The purpose of the Los Angeles meeting
Development Department programs.                                                                                            was to facilitate input and ideas from
The current Age Eligibility Panel is con-                                                                                   each facet of the tennis world on what
ducting this review. The Panel consists of                                                                                  issues should be investigated and the
an international group of independent                                                                                       methods of researching and analysing the
group of sports sciences and medicine                                                                                       issues during the 2004 Professional
specialists, all with expertise and experi-                                                                                 Development review.
ence in elite tennis and many of whom
are members of the STMS.                                                                                                    Additionally the worldwide tennis com-
                                                                                                                            munity shared ideas and interest in creat-
• Carol L. Otis, M.D., FACSM (USA),                                                                                         ing programs to ensure the health and
  Chairperson, expert in internal medi-                                   During the WTA Tour season ending                 welfare of young promising professional
  cine and primary care sports medicine                                   Championships in Los Angeles, the Age             players. The Age Eligibility Panel will
  with an emphasis on women athletes;                                     Eligibility Panel conducted a preliminary         formulate the 2004 review process,
• Babette Pluim, M.D., Ph.D. (The                                         meeting, via teleconference and in per-           which will include surveys, in-person tes-
  Netherlands), expertise in sports                                       son, with a select group of tennis con-           timonials and extensive research and data
  cardiology, exercise physiology and                                     stituents regarding the proposed review.          analysis. The expected completion date
  sports medicine;                                                        The constituents included international           for this review is August 2004.
• Ann Quinn, Ph.D. (Australia), expert
  in sport psychology and fitness training,                                                        CALL FOR SUBMISSIONS
  elite coaching and coach education;
                                                                          For the WTA Tour Age Eligibility and Professional Development Ten Year Review
• Miguel Crespo, Ph.D. (Spain), expert in
  tennis psychology and elite coaching;                                   STMS members are asked to submit any relevant articles for the purposes of assisting the
                                                                          Age Eligibility Panel of the WTA Tour in the collection of data for the literature review.
• Jim Loehr, Ed.D., FACSM (USA),                                          Submissions can include articles from peer-reviewed journals, presentations from
  sports psychologist with an emphasis                                    conferences, and any current research that STMS members are or have undertaken.
  on tennis;                                                              Relevant material from the last ten years (1993-2003) in the areas of sport sciences and
                                                                          medicine in relation to the physical, mental and emotional effects of training and competi-
• Paul Roetert, Ph.D., FACSM (USA),
                                                                          tion for tennis players from juniors through elite level is requested.
  kinesiologist with an emphasis on
  tennis training;                                                        Submissions are requested from all disciplines: sports medicine; sports psychology; sports
• Kathleen Stroia, M.S., P.T., A.T.,C.                                    sociology; exercise physiology; physiotherapy; nutrition; strength and conditioning; bio-
  (USA), expertise in athletic training                                   mechanics; coaching; equipment /technology sciences; and any other relevant disciplines.
  and physical therapy with an emphasis
                                                                          The Age Eligibility Panel aims to complete a very comprehensive multidisciplinary literature
  on women’s professional tennis;                                         review as a critical component of the 2004 Age Eligibility and Professional Development
• Peter Terry, Ph.D. (Australia), sports                                  ten-year review.
  psychologist with an emphasis on
  tennis;                                                                 Please submit articles to:
                                                                          Kathleen Stroia
• Tandy O’Donoghue (Non voting legal                                      Associate Vice President, Sports Science and Medicine & professional Development
  advisor – USA), WTA Tour Chief                                          Departments,
  Legal Officer;                                                          One Progress Plaza, Suite 1500 – St Petersburg, Florida, 33701
                                                                          Phone: 1 727 895 5000 – E-mail:
• Bart McGuire (Non voting special
  advisor- USA), visiting professor of law                                Please search your libraries and submit relevant articles to assist the Age Eligibility Panel
  Northwestern School of Law, Lewis                                       and the WTA Tour in this very important review process. Thank you in anticipation!
  and Clark College                                                       Deadline is 5 February, 2004

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