As you are reading this, the first round matches at this year's Championships at Wimbledon will have started, setting the scene for two weeks of breath-taking tennis with the very best players in the world competing for this prestigious Grand Slam title. Dr Ian McCurdie ISEH Consultant in Sport, Exercise & Rehabilitation Medicine and Tournament Physician, at The Championships, Wimbledon gives an intriguing insight on the medical care at the Championships.
Looking after the players at The Championships provides a rare and privileged opportunity to see some of the world’s very best athletes in action. The medical support for players competing in the sport’s highest profile event is delivered by an experienced multi-disciplinary team that includes primary care and sports medicine specialist doctors, physiotherapists, soft tissue therapists and podiatrists. Together they aim to enable each player to achieve their full potential on the court.
The patterns of injury in professional tennis are wide ranging and have changed over recent years as the game has evolved. Players are now generally bigger and more athletic than their predecessors – elite male players are on average 1.5 inches taller and 3 years older than they were in 1990. Technique has changed with almost universal use of the ‘Western’ grip, predominantly double-handed backhands and open stance hitting with heavy top spin. Whilst sliding has long been seen on clay courts, players are now sliding on grass and even on hard courts to increase their coverage of the court. Although there is no clear evidence that court surface directly influences injury rates, there is a feeling that changing court surface (eg. moving from clay to grass) may pose an increased risk of injury.
The professional tennis season is almost year-long and combines global travel with regular changes in playing conditions and court surface. This punishing schedule allows few opportunities for rest, recovery and rehabilitation from injury. Although acute injuries such as torn muscles, ligament sprains and joint sprains are not uncommon, the majority of injuries are ‘overuse’. These result from repeated stress on tissues with insufficient time for recovery, such that damage occurs and the tissue begins to fail. Examples include patella tendon injuries at the knee, low back pain and shoulder joint overload and instability. The difficulty with such overuse injuries is that whilst they impact on function, they do not necessarily prevent the player from continuing to compete and thus tend to remain unresolved. The consequences of carrying an unresolved overuse injury are not just impaired performance on court, but also potential long term ill-effects on player health. The role of the tournament medical team is therefore to strike the right balance between helping the player to continue to play (if at all possible), whilst taking into account the long term consequences and health of the individual. The injured player must be given clear and accurate information out their injury before being able to consider their fitness to continue playing. Such decisions on fitness to compete can be difficult and stressful for all concerned and will be made following detailed discussion with both the player and their coaching team.
Ideal medical care requires a degree of continuity, a luxury that is rarely enjoyed by players on the professional circuit. The use of centralised electronic medical records, dedicated travelling ATP and WTA physiotherapists and experienced tournament physicians goes some way to securing continuity of care. In depth knowledge of the sport and its injuries is another critical factor that is required to be able to deliver high standards of medical care in such an unusual and demanding environment. Whilst tennis may be an individual sport, the delivery of medical care to support the players is very definitely a team event.