ArticleSports health
Association Between Spikes in External Training Load and Shoulder Injuries in Competitive Adolescent Tennis Players: The SMASH Cohort Study.
Article in Sports health. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Prevention strategies and modifiable risk factors for upper extremity injury: a systematic review and meta-analysis for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus.British journal of sports medicine · 2025Pooled it
- Risk Factors Associated with New Onset of Shoulder Pain and Injury Among the Athletic Population: A Systematic Review of the Literature.International journal of sports physical therapy · 2025Pooled it
- Methods of Monitoring Internal and External Loads and Their Relationships with Physical Qualities, Injury, or Illness in Adolescent Athletes: A Systematic Review and Best-Evidence Synthesis.Sports medicine (Auckland, N.Z.) · 2023Pooled it
- A Retrospective Weekly Rating of Perceived Exertion Measure May Assist Training Load Monitoring in Professional Tennis Players.Sports (Basel, Switzerland) · 2026Article
- Rethinking Warm-Up in Overhead Exercise: Acute Shoulder Responses to a Strength- and Mobility-Oriented Protocol in Youth Athletes.Sports (Basel, Switzerland) · 2026Article
- Tennis Serve Biomechanics, Joint Load Mechanics and Overuse Injuries: A Narrative Review.Sports medicine - open · 2026Review
- Racket Sports-Related Injuries in Youth Athletes: A Narrative Review.International journal of environmental research and public health · 2026Review
- Injury prevalence and characteristics among tennis coaches in the Netherlands: a cross-sectional survey.BMJ open sport & exercise medicine · 2026Article
- Risk Factors and Prevention of Musculoskeletal Injuries in Adolescent and Adult High-Performance Tennis Players: A Systematic Review.Sports (Basel, Switzerland) · 2025Review
- Epidemiology of Tennis-Related Injuries Among Competitive Youth Players in Tunisia: Frequency, Characteristics, and Management Patterns.Medicina (Kaunas, Lithuania) · 2025Article
- Range of Motion and Muscle Stiffness Differences in Junior Tennis Players with and without a History of Shoulder Pain.International journal of sports physical therapy · 2025Article
- Injury risk and epidemiology of pickleball players in South Korea: a cross-sectional study.Frontiers in public health · 2025Article
- Risk Factors for Injury in Border Collies Competing in Agility Competitions.Animals : an open access journal from MDPI · 2024Article
- Lower-Extremity Injuries Predominate in American High School Tennis Players.Arthroscopy, sports medicine, and rehabilitation · 2023Article
- Effectiveness of overuse injury prevention programs on upper extremity performance in overhead youth athletes: A systematic review.Sports medicine and health science · 2023Review
- Multicomponent stretching and rubber band strengthening exercises do not reduce overuse shoulder injuries: a cluster randomised controlled trial with 579 handball athletes.BMJ open sport & exercise medicine · 2022Article
- Effect of Fatiguing Wheelchair Propulsion and Weight Relief Lifts on Subacromial Space in Wheelchair Users.Frontiers in rehabilitation sciences · 2022Article
- Athletic Identity and Shoulder Overuse Injury in Competitive Adolescent Tennis Players: The Smash Cohort Study.Frontiers in sports and active living · 2022Article
- Injury Risk Factors of the Tennis Serve: A Systematic Review and Meta-Analysis.Advances in rehabilitation science and practiceArticle
- Training the Adolescent Athlete.Sports healthArticle
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFew studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics. HYPOTHESIS: Rapid increases in external workload are associated with the incidence of shoulder complaints and injuries. STUDY
designA cohort study. LEVEL OF EVIDENCE: Level 3.
methodsAt baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire).
resultsFor each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries.
conclusionAccumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players. CLINICAL RELEVANCE: Consistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.
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