How to handle injury

Daniil Medvedev receiving treatment for an injury.

Injury is a professional athlete’s worst fear, but it is also a virtual certainty that every tennis player will have to face it at some point in their career. Dan Lewindon, the LTA’s head of high performance science and medicine, is putting in place a structure which will help our tennis players cope with the physical and mental aspects of rehab and recovery, as he told Rob Clark.

The large number of injuries at the top end of the men’s game this season has brought into stark relief the question of rehab, and how elite tennis players work their way back to form, both physically and mentally.

Not only our own Andy Murray, but fellow Grand Slam winners Novak Djokovic and Stan Wawrinka, along with top 10 players Kei Nishikori and Thomas Berdych, all called an early halt to their seasons this year with varying knee, back, elbow and wrist problems. As Dan Lewindon, head of high performance science and medicine at the LTA, points out: “If you look at the demographic of players who have been injured this year, theyre guys in their late 20s and early 30s and we know that across all sports the risk of injury does start to increase with increasing age.”

That’s a depressing thought for us all, particularly those of us who are some way past that mark, but at least the top players can take heart, and inspiration, from the way that Roger Federer and Rafa Nadal have come back from injury woes this year. The two most successful male players in Grand Slam history each added two titles to their collection in 2017; in addition, between them they won five of the nine Masters titles (three for Federer and two for Nadal).

Nevertheless, professional tennis is an incredibly relentless pursuit. “The physical demands of the game are definitely increasing, there’s no doubt about that,” says Lewindon. “One of our strategic aims is to look not just at what it takes to be resilient and win now, but what we think it will take to do so in 5-10 years’ time and then develop athletes who have the tolerance to thrive in that future environment, and to contrive schedules and structures which will not put them at increased risk of injury.

“Tennis is a punishing game and rather than competing on a weekly basis through a six to nine-month season, the players can play for 11 or 12 months; it’s possible to play across the globe most days of most weeks of the year,” he continues. “That level of exposure comes with risk.”

Climbing the ladder

For younger players attempting to make their way in the game and garner sufficient rankings points to get into the bigger events, the temptation to compete continuously must be hard to resist. “I think that’s exactly right,” agrees Dan. “Trying to get yourself to a point where you’re financially solvent and have enough rankings points that you can make more strategic decisions about building recovery periods into your schedule is a real challenge.

“Part of our responsibility is to have a strong sense of duty of care to our players in how we manage and monitor them, give them appropriate advice at the right times and provide support when it is needed. These days instead of telling them that they have to gain x number of ranking points each year if they are to stay in our programme, we look at two-to-five-year projects for our players, which will really give them the kind of breathing room to make better decisions for longer periods.”

Getting your head right

Physical recovery from injury is only part of the process, however. There is also the mental aspect, which can include factors such as negative feelings (which could potentially even spiral into depression), worry about loss of rankings points, financial concerns and, of course, whether you will ever be as good as you once were.

“Its a very uncertain period of time for athletes,” agrees Lewindon. “Theres uncertainty about the outcome, the prognosis and the timeline. Then there are financial elements, contractual elements and, at a neuro-physiological level, I guess theres brain disturbance and you get that kind of fight, flight or freeze response from any injury you get. Recognising all that and providing context and positive, objective language to the player is, in my experience, the best way to overcome some of the concerns they have.”

Comunication builds confidence

For any performance-level athlete, being injured and out of the sport you love can be scary, and being bombarded with medical terminology, or getting complex, difficult-to-understand information does nothing to placate those fears.

“Making sure that the language used is simple, direct and understood by the athlete is a big issue,” confirms Lewindon. “We want our athletes to feel they are driving their own rehab ship when it’s appropriate so that they feel empowered to lead the direction in which their rehab is going. At the same time we have to be resolute if and when they are doing things they shouldn’t be doing, and that’s where the checks and challenges need to come in.

“If you’re an elite athlete performing at the top of your game, you’re in complete control of your domain. Strip that away and that loss of control can be part of the fear factor [when you’re injured].”

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