Regular Screening Guards Against Injury

© ATPMilos Raonic is seen having his shoulder internal rotation measured during the ATP performance and injury prevention screenings in Indian Wells California in March.

We’re taught from a young age that prevention is better than cure. That’s particularly true when it comes to tennis injuries.

Since 2006 the ATP has conducted player performance and injury prevention screenings three or four times a year at key events like Indian Wells, Madrid and Cincinnati. At these selected events a physical therapist and orthopedic surgeon provide a 30-minute one-on-one voluntary evaluation with players in a screening programme to check for warning signs of injury. These ATP medical staff members look at a player’s injury history and run them through a series of measures and performance movements, including muscle and flexibility tests, to identify potential problems and, if needed, tailor an individualized training regimen. “It’s one thing to provide treatment for all these injuries, but the more important question is how do we try to prevent them in the first place,” says Todd Ellenbecker, Director of Sports Medicine for the ATP.

When looking for problems, one warning sign is if the right shoulder of a right-handed player is weaker than his left shoulder (and vice-versa for left-handers). “If the rotator cuff of the dominant shoulder is weaker than the non-dominant side that concerns us and we’d look to put that player on a shoulder-strengthening programme,” Ellenbecker says. “A player should have similar strength, if not more, on his dominant side.” 

Tennis players typically lose some internal rotation flexibility on their dominant shoulder, but if significant flexibility is lost, that may lead to closer monitoring and improvement can be made with specific stretches. The screening evaluation also involves up to five tests for core stability (stomach, back, muscles of the mid section). Almost all players have very good core stability, which is important for preventing back injuries.

If a player doesn’t have a really high level of core stability, a specific programme is given to strengthen these important muscles for both injury prevention and of course to enhance a player’s performance.

Shoulder tests have been an important part of the screening programme since it was launched in 2006. ATP medical staff measure the internal and external rotation range of motion to ensure flexibility is not limited. A device is also used to measure muscular strength of the rotator cuff in a very precise way. “If a player loses range of motion or strength in their shoulder we know they are susceptible to injury,” Ellenbecker says. “A player who is found to have shoulder weakness is given an exercise programme and a list of things he can do to improve these deficiencies. Free exercise equipment from Thera-band is provided for the players going through the programme as we are confident that these products provide a great training stimulus and very importantly, can be taken with the player as they travel around the world so they are never without the right equipment to get their workout done.”

Remedial work to increase shoulder strength typically involves the use of elastic tubes and bands, which players can easily throw in their bag to take on the road. Work with small medicine balls is also often recommended. Ellenbecker says, “If we find a deficiency during the screening it’s not enough for us to say, ‘Hey you’ve got problems, see you later.’ So we structure a self-sufficient training programme they can follow on the road where they may not have access for fancy equipment. And they can check in with an ATP physio at a tournament if they have any questions.”

Players are encouraged to be tested multiple times a year so improvement can be monitored. “One of the most rewarding parts of the programme is when we see the deficiencies identified through the screening phase have gone,” Ellenbecker says.