Note: For the fifth year in a row, I am serving as Chief Tournament Physician of the Family Circle Cup. Each day of the tournament, I am writing an article for The Post and Courier and Family Circle Cup.

Recently I did an interview with Douglas Robson of USA Today about the evolution of professional tennis into more of a power and endurance sport. Robson’s article makes the case that today’s professional tennis players are elite athletes competing in a grueling sport.

I think that most people who don’t play tennis on a regular basis assume that tennis is more of a skill rather than a sport. I don’t know if this is due to the perception that tennis is a country club sport or doesn’t involve tackling or other forms of physical contact. In the article, three-time major champion Maria Sharapova argues, “I don’t have to tell anyone (how tough it is) if they’ve played the sport themselves.”

Over the last 10 years or so, tennis has evolved into a sport of incredible athletic ability. While I don’t want to be critical of the tennis played by the likes of Rod Laver, Arthur Ashe, Billie Jean King, or Chris Evert, in many ways the sport currently played barely resembles that which was played by former champions. Tennis today, at least at the professional level but also in the youth ranks, has evolved into a sport requiring incredible strength, agility, flexibility, endurance, stamina, and hand-eye coordination. The speed of the serves, the power in the groundstrokes, and the foot speed to chase down attempted winners screaming over the net is as great as it ever has been.

Caroline Wozniacki injures her ankle at the Family Circle Cup
Caroline Wozniacki injures her ankle at the Family Circle Cup

This increased athleticism of the sport unfortunately can take a toll on its best players. Injuries have unfortunately become a major factor in the outcomes of tournaments and can change the careers of many stars. Just look at some of the major stars and the different body parts these athletes have injured – ranging from Maria Sharapova’s shoulder, Justine Henin’s elbow, Juan Martin del Potro’s wrist, Rafael Nadal’s knee, and Caroline Wozniacki’s ankle. It is a unique sport in that top athletes endure overuse issues such as tendinitis and stress fractures but also risk traumatic injuries. The power of the serves and groundstrokes and the repetitive nature of these booming shots can lead to overuse injuries of the shoulder, elbow, and wrist while the speed and frequent change of direction can lead to falls and lower body injuries. In the article, Serena Williams’ trainer, Mackie Shilstone, describes tennis as, ‘…one of the most grueling sports you will ever encounter.”

My home away from home for the next 9 days

As a sports medicine physician and the chief tournament physician of the Family Circle Cup, I often hear people criticize tennis players who withdraw from tennis tournaments for what they perceive as mild injuries. What I think most casual fans of the sport don’t realize is that on top of the increasingly physical nature of the sport, these athletes are playing almost nonstop throughout the year. By the time the players reach Charleston in early April, many of them are already exhausted and need a break. There is very little time at the end of the season to fully recover. The nature of the tournaments week after week, the around–the–world travel schedule, and the change of court surface several times throughout the year, all contribute to the fatigue these players face. While withdrawals from tournaments are unfortunately common due to injury, I would argue that some, if not most, of the players at any given tournament are playing through some degree of pain.

Fortunately the increased athleticism of the players can be beneficial as well. The strength and conditioning regimens and meticulous attention to proper nutrition that has helped these players excel has probably helped to prevent injuries from occurring. Programs teaching rehabilitation exercises to prevent overuse injuries, especially to the shoulder and elbow, core strengthening, and rigorous attention to proper mechanics should help decrease the injury rate even further. I hope that these programs work their way down into the youth levels. Unfortunately in the youth and high school elite tennis players that I’ve seen for injuries in my practice, it seems that these players emulate the professional stars and try to hit with the same power. The problem is that these athletes don’t have the same muscle strength, and their bones and joints haven’t fully matured. Their bodies are not capable of withstanding the same stresses, and injuries occur.

As you watch the Family Circle Cup this week, take a moment to admire the physicality of these top athletes. Professional tennis has truly become a showcase of athleticism.

Tweet about the athleticism in women’s tennis.

Read my daily posts from the 2011 Family Circle Cup!

Day 2: Do our clay courts decrease injuries?
Day 3: What’s on the menu for pro tennis players?
Day 4: Best Tennis Town in America
Day 5: Wind hurts more than players’ games
Day 6: Is kinesio taping hype or helpful?
Day 7: The sun can be dangerous for tennis players
Athletes must take meds, supplements with caution
Day 9: Medical aspects of professional tennis