See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/364122528

Injury Surveillance and Training Load Methods Used by Health Professionals in

Tennis: An Online Multinational Survey

Article  in  Journal of Sport Rehabilitation · October 2022

DOI: 10.1123/jsr.2022-0044

CITATIONS READS

0 106

3 authors:

Diego H. Méndez Pablo Oscar Policastro

Favaloro University Hospital Durand
5 PUBLICATIONS   3 CITATIONS    30 PUBLICATIONS   62 CITATIONS   

SEE PROFILE SEE PROFILE

Danilo De Oliveira Silva

La Trobe University, Melbourne - AU
113 PUBLICATIONS   1,466 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Back Beliefs and Low back pain. View project

Development and evaluation of the effectiveness of a preventive program in reducing the impact of injuries in elite junior tennis players. View project

All content following this page was uploaded by Diego H. Méndez on 03 October 2022.

The user has requested enhancement of the downloaded file.

Journal of Sport Rehabilitation, (Ahead of Print)
https://doi.org/10.1123/jsr.2022-0044
© 2022 Human Kinetics, Inc. ORIGINAL RESEARCH REPORT
First Published Online: Oct. 3, 2022

Injury Surveillance and Training Load Methods Used by Health

Professionals in Tennis: An Online Multinational Survey
Diego H. Méndez,1,2 Pablo O. Policastro,1,2,3 and Danilo De Oliveira Silva4
1
Sports Physiotherapy Specialty, Universidad Favaloro, Buenos Aires, Argentina; 2Research Committee, KINÉ—Sports Clinic, Buenos Aires, Argentina;
3
Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil;
4
La Trobe Sport and Exercise Medicine Research Center, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia

Context: Injury surveillance and training load monitoring are both essential for the development of preventative strategies for
gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players
on whether and how they monitor injuries and training load. Design: A cross-sectional multinational online open-survey.
Methods: The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels,
a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020
to April 2021. Results: 72 health professionals from 27 different countries working with elite tennis players responded to the
survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-
recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to
injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is
performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly
differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring
are injury prevention (94%), training planning (81%), and player feedback (53%). Conclusions: Despite a high percentage of
health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health
professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers
reported for adequately monitoring injuries.

Keywords: surveys and questionnaires, consensus, athletic injury

Sport injury surveillance is the process of collecting and
recording data on sport injuries, which is considered a key step
toward injury prevention.1,2 Implementation of prevention strate-
gies without knowing the epidemiological context of sport-
related injuries could lead to overspending and mismanagement
of resources.3 Training load also appears to be related with the
development of sport-related injuries.4 Therefore, monitoring and
adjusting these variables could contribute to injury prevention in
recreational and elite sport.5 The incidence of musculoskeletal
injuries in both recreational and professional tennis players range
from 0.04 injuries/1000 hours to 3 injuries/1000 hours.6 Elite tennis
players are 2.81 times more likely to have an injury than recrea-
tional players.7
Overuse injuries are predominant in tennis,8 and this forms one
of the major obstacles for injury surveillance because players are
still able to practice and play despite the presence of pain, often at
the expense of a decreased performance.9 Aiming to facilitate
injury surveillance adoption, a tennis-specific extension of the
International Olympic Committee (IOC) consensus statement
was published suggesting methods for recording and reporting
of epidemiological data on injury and illness in sport.10 The
incorporation of tools such as the Oslo Sports Trauma Research
Center questionnaire (OSTRC) was recommended, which consists
of 4 questions that add up to a final severity score ranging from 0 to
Policastro https://orcid.org/0000-0003-0434-2844
De Oliveira Silva https://orcid.org/0000-0003-0753-2432
Méndez (dmendez@favaloro.edu.ar) is corresponding author, https://orcid.org/
0000-0001-5164-7662
100 (100 being the inability to train and/or compete).11 This
questionnaire seems to address some barriers to injury surveillance
including (1) the infrequent contact between the players and the
medical staff, (2) the capture of symptoms and functional con-
sequences of injuries, (3) the fidelity of the data entered, and (4) the
reporting bias of third-party data collectors.11–13
The association between training loads and sports injuries in
tennis is conflicting.14–17 One of the reasons for these conflicting
results could be the lack of consistency in the training load
monitoring methods. Attempting to overcome this issue, a consen-
sus statement provided recommendations to help coaches, sport
science and health professionals to adopt training load monitor-
ing.18 The main topics covered in this consensus included the
methods and objectives of training load monitoring, how to analyze
the data, and the challenges experienced when performing this
task.18 Regarding injury prevention and training load association,
the acute:chronic workload ratio could be a feasible option.18–21
However, the association between acute:chronic workload ratio
with injury prevention has recently been under debate.22–24 Despite
this, the acute:chronic workload ratio provides a method of pro-
gressing training load relative to the athlete’s capacity, and there-
fore may be an option to avoid over or underloading tennis players.
Recording injury surveillance and training load data is essen-
tial to improving preventive strategies of overuse injuries in
tennis.1,2 However, there is no data exploring whether or how
health professionals record injury surveillance and training load
data as part of their practice managing elite tennis players. The
primary aim of our study was to survey health professionals
working with elite tennis players on whether and how they monitor
1
2 Méndez, Policastro, and De Oliveira Silva
injuries and training load. The secondary aim was to explore
whether demographics (eg, sex, language, and years of clinical
experience) are related to health professionals recording injury
surveillance and training load data.
Methods
Study Design
This cross-sectional multinational online open-survey was reported
according to the Checklist for Reporting Results of Internet E-
Surveys guideline recommendations.25 An informed online consent
of each participant was requested, and we ensured the confidentiality
and anonymity of the data entered. The online consent process
provided participants with the study’s purpose, researchers’ contact
details, estimated completion time, and storage of identifiers. Online
consent and data collection were approved by a Human Research
Ethics Committee “Fundación Favaloro” (Ref. 3118).
Procedure
The online survey (Google Forms®) was initially developed in
English language by the research team and informed by key injury
surveillance, training load, and tennis literature.10,12,13,18 The initial
version of the survey was reviewed by 2 international content
experts (both clinician-researchers with more than 15 y of experi-
ence) external to the research team. Content experts had approxi-
mately 4 weeks to provide comments on each item of the survey
and general comments on potential missing items.
Amendments were completed after content experts’ revision,
then the survey was piloted with 4 health professionals working
with elite tennis players, recruited from the clinical network of the
research team. Amendments were completed after health profes-
sionals’ revisions, and a final version of the survey was translated to
Spanish and Portuguese in order to achieve a higher number of
people including nonnative English speakers. The translations were
completed by certified translators, fluent speakers in both lan-
guages (English-Spanish; English-Portuguese).
All questions were nonrandomized and close ended (multiple
choice), except for the last 2 questions that included the partici-
pants’ opinion on what should be done to improve injury and
training load monitoring and the main barriers for injury surveil-
lance. The questionnaire (Supplementary Material [available
Figure 1 — Survey flow chart.
(Ahead of Print)
online]) consisted of 16 pages with a total of 37 questions taking
approximately 5 minutes to be completed and covering the follow-
ing topics:
(1) Injury surveillance
(2) Training load monitoring
(3) Wellness monitoring
(4) Other tennis exposure monitoring
We used adaptative questioning to increase time efficiency
during survey’s completion (Figure 1). All key truncated questions
required responses.
Participants
A final multilanguage survey was advertised on social media (Twit-
ter, Facebook, Instagram, and Linkedin), Tennis Medicine Academic
Journal, professional tennis associations (eg, Argentinian Tennis
Association, Society for Tennis Medicine and Science), health
professionals associations (eg, Argentinian Sport Physiotherapy
Association, Brazilian Sport Physiotherapy Society, American Soci-
ety of Shoulder and Elbow Therapists, International Federation of
Sports Physical Therapy, etc), and clinical networks of the research
team as an electronic version (Google Forms®). Responses were
accepted from December 2020 to April 2021.
The target population was health professionals who work with
elite, male or female tennis players. Health professionals were
included if they were the primary professional or involved in a team
of health professionals managing injuries of elite tennis players
(eg, physicians, physiotherapists, athletic trainers). The definition
of an elite tennis player used by our study was any individual
whose main life activity is tennis regardless of age (junior players
were included).
A convenience sample was used without any financial or
professional incentive. The completion of the survey was
completely voluntary. Demographics obtained were age, sex,
country of work, and years of clinical experience.
Statistical Analyses
Data from all participants were electronically converted from
Google Forms® to Excel for data analysis using the R software
(4.1.2 version, R Core Team, 2022). Continuous variables nor-
mally distributed were reported as mean (SD), while nonnormally
 Injury and Training Load Monitoring in Tennis 3

distributed data were reported as median and interquartile range. Sport Injury Surveillance
Categorical variables were reported as number and percentage.
Sample distribution was determined by the Kolmogorov–Smirnov Regarding injury surveillance, 7 (10.3%) respondents used the
test. Chi-square test or Fisher exact tests was used as appropriate for OSTRC. All of them had more than 8 years of experience managing
independence (α set at .05) to determine whether years of clinical elite tennis players indicating a significant positive association
experience (the cutoff was defined by the median value in our cohort between years of experience and OSTRC implementation (P < .001).
<7 y, >7 y), sex (male and female), and the language of the survey Although 71.4% of the health professionals using the OSTRC are
respondents (English and non-English) were associated with health English speakers, there was no significant association between the
professionals’ injury surveillance outcomes. We used the Fisher language of the survey answered and the OSTRC implementation
exact test when more than 20% of results had expected frequencies (P = .249). There was no significant association between sex of the
lower than 5 as the chi-square would be inaccurate in these cases.26 health professional and the use of the OSTRC (P = .388).
Regarding injury classification, Sport Medicine Diagnostic
Coding System or Orchard Sports Injury Classification System
Results were used by 19.1% of the respondents, and 84.6% of those are
English speakers, indicating a significant association with the
Seventy-two health professionals from 27 different countries re- implementation of these injury classification systems (P < .05).
sponded to the survey (Table 1). We received 40 responses in There was no significant association between years of experience
English, 28 in Spanish, and 4 in Portuguese language. (P = .780) or sex (P = .494) with the use of valid injury classifica-
tion methods.
Injury data collection, registration, and analysis performed by
the respondents are detailed in Table 2.
Table 1 Participants Demographics Main barriers to perform injury surveillance in tennis players
Characteristics 72 participants identified by the respondents are presented in Figure 2. Health
professionals’ suggestions on what should be done to overcome
Age, n (%)
these barriers are:
Under 29 17 (24)
(1) Coaches and players education to improve adherence.
30–39 32 (44)
40–49 19 (26) (2) Create a software or mobile app specific for tennis injuries
and easy to use.
50–59 3 (4)
+60 1 (1) (3) Increase the role of national tennis associations supporting
and training health professionals on sport injury surveillance.
Gender, n (%)
Male 52 (72) (4) Knowledge translation in order to improve understanding of
the latest evidence and worldwide consensus.
Female 20 (28)
Years of experience, median (IQR 25–75) 7 (4–14.25)
Sport sex, n (%) Training Load
Both 57 (79) Training load monitoring of elite tennis players was performed
Male 9 (13) by 50% of the health professionals working with elite players.
Female 6 (8) Training load was monitored by 60% of the English survey
Players age, n (%)
respondents, and 37.5% of the professionals that answered the
non-English versions (χ2 = 2.76; P = .097). There was no signifi-
Both junior and adult tennis players 57 (79) cant association in training load monitoring rate with sex (P = 1) or
Only adult tennis players 7 (10) years of experience of health professionals (less than 7 y 54.1% vs
Only junior tennis players 8 (11) more than 7 y 45.7%; P = .637).
Country of residence, n (%) Details regarding training load monitoring carried out by
Argentina 19 (26) health professionals working with elite tennis players are presented
in Table 3 and Figure 3.
United Kingdom 6 (8)
United States 5 (7)
Spain 5 (7) Discussion
India 5 (7)
This is the first survey to investigate injury surveillance and
Australia 3 (4) training load monitoring practices performed by health profes-
Brazil 3 (4) sionals working with elite tennis players worldwide. Our results
Portugal 3 (4) provide an overview of current practices and the perceived barriers
Italy 2 (3) to implementing injury surveillance and monitor training load in
France 2 (3) elite tennis players.
Despite the high proportion of health professionals monitor-
Netherlands 2 (3)
ing injuries in our study (94%), there seems to be very low
Switzerland 2 (3) consistency regarding the methods used. The last tennis-specific
Other countries with 1 response 15 (21) extension of the IOC consensus statement proposed a specific
Abbreviation: IQR, interquartile range. Note: Adult = tennis players aged 18 years injury definition and surveillance methods to improve this con-
and older. sistency and allow data comparison across players worldwide.13
(Ahead of Print)
Table 2 Injury Surveillance Methods
Variables 72 participants
Data collection, n (%)
On field data collection (face-to-face) 45 (66)
Virtually (online survey or questionnaire) 20 (29)
Both 3 (4)
Data collection frequency, n (%)
Every time an athlete reports any complaint 40 (59)
Every day 15 (21)
At least once a week 10 (15)
Between once a week and once a month 2 (3)
Other 1 (2)
Data registration, n (%)
Self-designed system 55 (81)
Oslo sports trauma research center questionnaire 7 (10)
Other 6 (9)
Definition of injury, n (%)
Any player complain regardless of decreased performance, time-loss, or medical attention 25 (37)
Any event which decreases performance regardless of time-loss or medical attention 13 (19)
Any event which required medical attention regardless of time-loss 10 (15)
Any event which prevented the player from partaking in at least 1 training, match or competition 14 (21)
Any event which prevented the player from partaking in at least 1 match or competition 6 (9)
Codification of injury, n (%)
Clinical diagnosis 52 (77)
Sport medicine diagnostic coding system 7 (10)
Orchard sports injury classification system 6 (9)
Another diagnostic coding system 5 (7)
I do not diagnose injuries 3 (4)
Mechanism of injury recording, n (%)
Differentiate between acute, repetitive (sudden onset), and repetitive (gradual onset) 43 (63)
Differentiate between acute and repetitive 16 (24)
No 8 (12)
Other 1 (2)
Injury severity registration, n (%) 60 (88)
Acute injuries
Nature of injury 47 (78)
Decrease in performance or training load 30 (50)
Time-loss 29 (48)
Self-reported questionnaires 8 (13)
Overuse injuries
Nature of injury 43 (72)
Decrease in performance or training load 36 (60)
Time-loss 32 (53)
Self-reported questionnaires 7 (12)
Player injury rates, n (%) 46 (68)
Acute injuries
Incidence 18 (39)
Prevalence 7 (15)
Both 21 (46)
Overuse injuries
Incidence 17 (37)
Prevalence 9 (20)
Both 20 (44)

4 (Ahead of Print)
 Injury and Training Load Monitoring in Tennis 5

method would help epidemiological data pooling and therefore

contribute to the development of tennis injury prevention
strategies.
Injury surveillance based on the time-loss definition may also
be problematic in tennis. Overuse injuries are 3 times more
prevalent than acute injuries in elite tennis players.8 At many
instances, overuse injuries may impact players’ performance but
do not lead to time-loss. Thus, only surveilling injuries based on the
time-loss definition may lead to a large underreporting of injuries in
tennis players.8,9 Findings from an epidemiological study suggest
that one in every 8 tennis players practice or compete with pain
every week, and one in every 12 had to modify their training
because of their pain.8 One of the possibilities recommended by the
Figure 2 — Barriers to include injury surveillance in elite tennis. IOC consensus statement to overcome this bias associated with the
time-loss definition, is using the OSTRC as a specific method to
collect overuse injuries.12 This questionnaire also allows practi-
Table 3 Training Load Monitoring Methods tioners to capture symptoms severity and functional impairments.11
Variables 72 participants Our findings suggest that only 10.3% of health professionals use
the OSTRC for injury surveillance. Based on these findings and the
Type of load, n (%) fact that this tool is mostly used by the more experienced and
Both 22 (61) English-speaking practitioners, knowledge translation strategies
Only internal load 9 (25) must be developed to increase awareness about this tool to health
Only external load 5 (14) professionals working in tennis, particularly the development of
Load-related metrics, n (%) resources for novice non-English speaking health professionals.27
Week to week difference 26 (72)
Similarly, language seems to be a barrier to the implementation of
the most recent recommendations of injury classification coding
ACWR 21 (58) systems.
Chronic training load 17 (47) Another interesting finding of our study was that 66.2% of the
Monotony 7 (19) health professionals only collect injury data when they are face-to-
Other 3 (8) face with the athlete. This is challenging because unlike team
Body load, n (%) sports, where professionals involved in data collection are present
Full body 30 (83)
at training and competition sites, elite tennis players do not usually
stay in their training place for long periods. Only a few elite tennis
Differentiate between upper and lower body 10 (28)
players can afford to travel with their health team throughout the
Differentiate between muscle and breathlessness 6 (17) season. Thus, for most of the season elite tennis players do not
Difference between tennis and strength and have daily contact with the health professionals that manage their
conditioning, n (%) health condition, which would also lead to an underreport of
Yes 33 (92) injuries.28 The implementation of self-reported tools like the
Abbreviation: ACWR, acute:chronic workload ratio. Note: External load indicates OSTRC would at least allow for a remote injury surveillance
the work performed and internal load refers to the physiological and psychological by health professionals.
responses to the external load. Only 50% of health professionals working with elite tennis
players monitor their training load. A possible explanation is that
monitoring training load could be the responsibility of strength and
conditioning coaches instead of health professionals. For example,
a recent study in rugby reported that training load was monitored by
the strength and conditioning coaches in 38% of the clubs, head
coaches in 12%, and 50% did not specify who was responsible.29
However, training load plays an important role in injury prevention
as suggested by previous studies that reported an association
between moderate to high chronic loads and a decrease in the
risk of injury.30–32 This was also highlighted by the participants of
our study who suggested that monitoring the training load would be
useful for injury prevention (94.4%), training planning (80.6%),
and player feedback (52.8%). Training load is one of the compo-
nents that should be considered when managing elite tennis
Figure 3 — Objectives of training load monitoring. players’ health and performance. The health team from elite tennis
players should seek opportunities to integrate technology and
optimize training load monitoring of tennis players both in situ
Our findings suggest that only 36.8% of health professionals and remotely. Although sex and years of experience seems to not
registered injuries based on the consensus definition, while be related to health professionals monitoring training load, lan-
29.4% used a time-loss definition. While certain heterogeneity guage (non-English speaker) also seems to be a barrier to im-
is expected, having a consistent injury definition and surveillance plementing this practice.
(Ahead of Print)
6 Méndez, Policastro, and De Oliveira Silva
Limitations and Future Directions
Our survey was developed using the last IOC consensus statement
and the tennis-specific extension published in 2020 and piloted
with experienced health professionals in the field. Even so, a
more thorough consultation with other health professionals and
researchers could lead to further changes in the last version of the
survey. Although our cohort consists of health professionals from
27 different countries with a balanced proportion of English and
non-English versions respondents, it may not be representative
of all health professionals who work with elite tennis players. The
total number of health professionals working with elite tennis
players is unknown since there is no international professional
association where they have to be registered or any registry.
Additionally, our findings should not be generalized to the whole
population of health professionals working in professional tennis.
Another limitation is that we did not calculate the response rate
considering our methods of recruitment.
Our findings indicate that time constraints and lack of knowl-
edge are barriers to injury surveillance and training load monitoring
adoption. A clear limitation is that this data was obtained with
an open-ended question on our survey, a more formal qualitative
investigation would provide further insights on how to better
understand and overcome these barriers.
Conclusion
A large percentage of health professionals working with elite tennis
players report to implement injury surveillance. However, 6 out of
10 health professionals do not use the consensus injury definition
with 8 out of 10 health professionals using a self-designed surveil-
lance method. English speaking health professionals are more
likely to implement the latest evidence-based injury surveillance
recommendations. Only half of health professionals working with
elite tennis players monitor training load. Health professionals
indicate that time constraint, lack of knowledge, and technology
are the main barriers for adequately adopting injury surveillance
methods and monitoring training load.
Acknowledgments
The authors would like to acknowledge all the respondents in this survey
for their time and also Federico Villalba for his support in the statistical
analysis of our study.
References
1. Finch C. A new framework for research leading to sports injury
prevention. J Sports Sci Med. 2006;9(1–2):3–9. doi:10.1016/j.jsams.
2006.02.009
2. van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity,
aetiology and prevention of sports injuries. Sports Med. 1992;14(2):
82–99. PubMed ID: 1509229 doi:10.2165/00007256-199214020-
00002
3. Bolling C, van Mechelen W, Pasman HR, Verhagen E. Context
matters: revisiting the first step of the “sequence of prevention” of
sports injuries. Sports Med. 2018;48(10):2227–2234. PubMed ID:
29956077 doi:10.1007/s40279-018-0953-x
4. Foster C, Rodriguez-Marroyo JA, de Koning JJ. Monitoring training
loads: the past, the present, and the future. Int J Sports Physiol
Perform. 2017;12:2–8. doi:10.1123/IJSPP.2016-0388
(Ahead of Print)
5. Ekegren CL, Gabbe BJ, Finch CF. Sports injury surveillance systems:
a review of methods and data quality. Sports Med. 2016;46(1):49–65.
PubMed ID: 26423419 doi:10.1007/s40279-015-0410-z
6. Pluim BM, Staal JB, Windler GE, Jayanthi N. Tennis injuries:
occurrence, aetiology, and prevention. Br J Sports Med. 2006;40(5):
415–423. PubMed ID: 16632572 doi:10.1136/bjsm.2005.023184
7. Minghelli B, Cadete J. Epidemiology of musculoskeletal injuries in
tennis players: risk factors. J Sports Med Phys Fitness. 2020;59(12):
2045–2052. doi:10.23736/S0022-4707.19.09842-6
8. Pluim BM, Loeffen FGJ, Clarsen B, Bahr R, Verhagen EALM.
A one-season prospective study of injuries and illness in elite junior
tennis. Scand J Med Sci Sports. 2016;26(5):564–571. PubMed ID:
25944058 doi:10.1111/sms.12471
9. Bahr R. No injuries, but plenty of pain? On the methodology for
recording overuse symptoms in sports. Br J Sports Med. 2009;
43(13):966–972. PubMed ID: 19945978 doi:10.1136/bjsm.2009.
066936
10. Dvorak J, Pluim BM. Injury and illness surveillance in sports: how
golf, tennis, cycling and parasport extended the IOC consensus
statement to tailor injury and illness surveillance to specific sports.
Br J Sports Med. 2021;55(1):6–7. PubMed ID: 33122251 doi:10.
1136/bjsports-2020-102616
11. Clarsen B, Bahr R, Myklebust G, et al. Improved reporting of
overuse injuries and health problems in sport: an update of the
Oslo sport trauma research center questionnaires. Br J Sports Med.
2020;54(7):390–396. PubMed ID: 32060142 doi:10.1136/bjsports-
2019-101337
12. Bahr R, Clarsen B, Derman W, et al. International Olympic committee
consensus statement: methods for recording and reporting of epide-
miological data on injury and illness in sport 2020 (including STROBE
extension for sport injury and illness surveillance (STROBE-SIIS)).
Br J Sports Med. 2020;54(7):372–389. PubMed ID: 32071062 doi:
10.1136/bjsports-2019-101969
13. Verhagen E, Clarsen B, Capel-Davies J, et al. Tennis-specific exten-
sion of the International Olympic committee consensus statement:
methods for recording and reporting of epidemiological data on injury
and illness in sport 2020. Br J Sports Med. 2021;55(1):9–13. PubMed
ID: 33082146 doi:10.1136/bjsports-2020-102360
14. Moreno-Pérez V, Prieto J, del Coso J, et al. Association of acute and
chronic workloads with injury risk in high-performance junior tennis
players. Eur J Sport Sci. 2021;21(8):1215–1223. PubMed ID:
32877321 doi:10.1080/17461391.2020.1819435
15. Myers NL, Aguilar Kv, Mexicano G, Farnsworth JL, Knudson D,
Kibler WBEN. The acute: chronic workload ratio is associated with
injury in junior tennis players. Med Sci Sports Exerc. 2020;52(5):
1196–1200. PubMed ID: 31764467 doi:10.1249/MSS.00000000000
02215
16. Myers NL, Farnsworth JLII, Knudson Dv. Different external training
workload models show no association with injury in competitive
junior tennis players. Ger J Exerc Sport Res. 2021;52(1):97–104.
doi:10.1007/s12662-021-00751-5
17. Johansson F, Gabbett T, Svedmark P, Skillgate E. External training
load and the association with back pain in competitive adolescent
tennis players: results from the SMASH cohort study. Sports Health.
2022;14(1):111–118. doi:10.1177/19417381211051636
18. Bourdon PC, Cardinale M, Murray A, et al. Monitoring athlete
training loads: consensus statement. Int J Sports Physiol Perform.
2017;12:161–170. doi:10.1123/IJSPP.2017-0208
19. Bowen L, Gross AS, Gimpel M, Li FX. Accumulated workloads and
the acute: chronic workload ratio relate to injury risk in elite youth
football players. Br J Sports Med. 2017;51(5):452–459. doi:10.1136/
bjsports

20. Griffin A, Kenny IC, Comyns TM, Lyons M. The association
between the acute:chronic workload ratio and injury and its applica-
tion in team sports: a systematic review. Sports Med. 2020;
50(3):561–580. PubMed ID: 31691167 doi:10.1007/s40279-019-
01218-2
21. Maupin D, Schram B, Canetti E, Orr R. The relationship between
acute:chronic workload ratios and injury risk in sports: a systematic
review. Open Access J Sports Med. 2020;11:51–75. doi:10.2147/
oajsm.s231405
22. Impellizzeri FM, McCall A, Ward P, Bornn L, Coutts AJ. Training
load and its role in injury prevention, part 2: conceptual and meth-
odologic pitfalls. J Athl Train. 2020;55(9):893–901. PubMed ID:
32991699 doi:10.4085/1062-6050-501-19
23. Impellizzeri FM, Ward P, Coutts AJ, Bornn L, Mccall A. Training
load and injury: part 1. The devil is in the detail-challenges to
applying the current research in the training load and injury field.
J Orthop Sports Phys Ther. 2020;50(10):574–576. doi:10.2519/jospt.
2020.9675
24. Dalen-Lorentsen T, Andersen TE, Bjørneboe J, et al. A cherry,
ripe for picking: the relationship between the acute-chronic work-
load ratio and health problems. J Orthop Sports Phys Ther. 2021;
51(4):162–173. PubMed ID: 33472501 doi:10.2519/JOSPT.2021.
9893
25. Eysenbach G. Correction: improving the quality of web surveys:
the checklist for reporting results of internet e-surveys (CHERRIES).
J Med Internet Res. 2012;14(1):e8. doi:10.2196/jmir.2042
(Ahead of Print)
View publication stats
Injury and Training Load Monitoring in Tennis 7
26. Kim HY. Statistical notes for clinical researchers: chi-squared test
and Fisher’s exact test. Restor Dent Endod. 2017;42(2):152. PubMed
ID: 28503482 doi:10.5395/rde.2017.42.2.152
27. Silva DO, Taborda B, Pazzinatto MF, Ardern CL, Barton CJ. The
altmetric score has a stronger relationship with article citations than
journal impact factor and open access status: a cross-sectional
analysis of 4022 sport sciences articles. J Orthop Sports Phys Ther.
2021;51(11):536–541. doi:10.2519/jospt.2021.10598
28. Pluim BM, Fuller CW, Batt ME, et al. Consensus statement on
epidemiological studies of medical conditions in tennis, April 2009.
Br J Sports Med. 2009;43:893–897. PubMed ID: 19900956 doi:10.
1136/bjsm.2009.064915
29. Yeomans C, Comyns TM, Cahalan R, et al. Current injury monitoring
and player education practices in Irish amateur rugby union. Phys
Ther Sport. 2018;33:27–32. PubMed ID: 29982035 doi:10.1016/j.
ptsp.2018.06.008
30. Orchard JW, Blanch P, Paoloni J, et al. Cricket fast bowling workload
patterns as risk factors for tendon, muscle, bone and joint injuries.
Br J Sports Med. 2015;49:1064–1068. doi:10.1136/bjsports-2014
31. Drew MK, Finch CF. The relationship between training load and
injury, illness and soreness: a systematic and literature review. Sports
Med. 2016;46(6):861–883. PubMed ID: 26822969 doi:10.1007/
s40279-015-0459-8
32. Rasmussen CH, Nielsen RO, Juul MS, Rasmussen S, Sci M. Weekly
running volume and risk of running related injuries among marathon
runners. Int J Sports Phys Ther. 2013;8(2):111–120.