Vivian Grisogono

Injury prevention for young tennis players

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Ice baths and massage as injury prevention
Q: I train a group of young tennis players. After fitness training, we usually use ice baths and massage for injury prevention. Can you tell me how long the ice should be used for, and what is the best type of massage?
Male fitness trainer, 22, UK
A. The only way to prevent injuries in young sports players is to prevent them from over-playing or over-training. Don’t expect young players to fit into a set routine of playing and training. Even if they’re all the same age, each member of your group will have individual needs, and each will be developing physically and mentally at his or her own rate.

Ice and massage are usually used to help recovery after heavy training sessions, or overload training, where a lot of lactic acid has been produced, especially through eccentric muscle training . Examples might be after doing heavy weight-resisted squatting exercises, or running repetitively on slopes or stairs for endurance. These are not types of training which are appropriate for young tennis players. In any case, injuries in young players are more likely to affect the bones and their growth areas than muscles and tendons. Ice and massage will not prevent bone-related injuries. So although ice and massage might have a use for adult sports performers doing certain types of training, they are not likely to help prevent injuries in young tennis players.

To understand how to prevent children’s injuries, you have to know a little about how the body structures grow and develop. You should learn to recognize when and how a young player is more likely to get injured. A useful pointer is that injuries are most likely to occur in the mid-teen period (aged 14-16).

Vulnerable bones and growth spurts
With young players, you have to allow for growth phases. Throughout the growth period, which runs from childhood right through the teenage years, there will be times when the long bones grow and then strengthen. The muscles and soft tissues relating to those bones will be relatively weak and tight during those phases, until the bone growth stops and the soft tissues can develop strength and pliability.

It’s easy enough to see when this process is happening, as the youngster looks longer, leaner and ganglier for a time. Changes in shoe size can warn of an impending growth spurt. Following the bone growth, the muscles gain strength and they fill out. This is a natural process.  If you try to speed it up, for instance through more or harder strength or stretching exercises, you risk over-straining the muscles and placing excess stress on the bones.

In childhood, the body’s bones are relatively soft and pliable. If they get broken by accident, the fracture is usually known as a “greenstick” fracture, because the bone tends to bend and crack rather than snapping as an adult bone might. In the teen years, the bones grow, strengthen and harden up, and the separate parts of each major bone fuse together. Every bone has growth areas through which the bone develops until it reaches its final shape and hardness. Growth areas at the ends of the bones are called epiphyses. There are also special knobs, called apophyses, on the major bones where tendons are attached. These knobs also grow and strengthen until they become firmly attached to their bone. Bones develop and solidify individually. Growth and fusion activities happen at different ages in different bones.

It’s because there is so much activity going on in the bones throughout the teenage years that the bones themselves are more vulnerable to injury than a teenager’s muscles, tendons or other soft tissues. Stressing the bones through excessive repetitive activities can easily disrupt the growth points. Osgood-Schlatter’s condition is an example: the tibial tubercle, the apophysis to which the patellar tendon is attached below the front of the knee, becomes inflamed, irritated, or in the worst of cases detached, through too much kicking, hopping, jumping or running. This usually happens between the ages of about 12 to 15, and is very common among young footballers, especially if they are training with squads. Injuries involving the growing bones are most common in the legs, but they can happen in the arms and even in the spinal bones too. Young tennis players are especially prone to suffer bone stress injuries around the elbow or elsewhere in the arm if they play too much too often, especially if they do repetitive drills for each stroke.

Diet and rest: vital factors
Growth is a tiring process, and during growth phases it’s important for the youngster to eat well and to have sufficient rest. Without these, there is a strong risk of illnesses or injuries, due to the pressure on the immune system.  When someone is over-tired, the immune system is depleted, so it’s counter-productive for that person to try to maintain strenuous physical activities, never mind increase them. During growth spurts, teenagers may need to lie down once or even twice during the day, for ten minutes or as long as they need, which might be a couple of hours. Late nights are tiring, so the day after a late night should be a day of rest and recovery.

The healthier the diet , the better. The immune system will be stronger, and growth processes more efficient. Fresh fruit and vegetables should be the mainstays, and it is often a good idea for growing children and teenagers to eat healthy snacks at frequent intervals, as well as having full meals. Drinking plenty of plain water throughout the day is vital for proper hydration, especially in the case of pre-teen youngsters, who dehydrate extremely easily. Junk foods, prepared meals, refined sugar and refined flour should be minimized or preferably eliminated. Fizzy drinks should be excluded, as they can cause depletion of calcium from the body, and calcium of course is vital, especially for healthy teeth and bones. Alcohol is extremely bad for youngsters, especially sports players, as it acts on the liver, which is a vital organ for energy production among many other functions.

Teenage girls may need to take iron supplements when they start menstruating, especially if they have heavy periods. If they have problems in this respect, they should be encouraged to refer to their GP. If there are no particular problems, it’s still worth keeping the possibility of relative iron deficiency in mind. If someone’s urine turns pink when they’ve eaten beetroot, it can be an indicator of slight iron deficiency, and then a standard iron supplement, taken according to the instructions or the doctor’s directions, can help redress the balance and restore energy.

Avoid overdoing it
To prevent injuries in young players, remember the adage “less is more”.

When preparing and training for competitive sports, coaches and players (not to mention parents and managers) often think that practice makes perfect and the more practice the better. But a stress injury involving growing bones can easily put the player out of sport for three months, and in the worst of cases for a year or more. If the injury is not properly identified and treated, there can be an indefinite cycle of pain, apparent recovery, and then relapse with ever-increasing pain each time.

The sad thing is that practising sporting skills at a young age is of limited value. In tennis, for instance, the basic essential skill is the eye-hand coordination which enables efficient contact between racket and ball. However, a player’s techniques for hitting each stroke are very different during growth from what they will become when the player has reached full height and strength. At the age of about 19-20, the player will be approaching physical maturity, but I prefer to look towards 23 onwards as the time the player can begin to be in his or her prime - partly because the final growth phase of some of the fine spinal bones doesn’t happen until about this time.

Until maturity, playing and training should be geared to the player’s physical capacities at any given time. Exercise should be reduced or stopped at any time when the young player shows signs of ongoing fatigue or any aches and pains. At every age, daily repetitive activities should be avoided. The more variety there is in training and practice, the better for both body and mind. Even if a player wants to specialize, it’s always advisable to have at least one other sport or exercise activity as a counter-balance.