In Tennis, Hip Injuries Are the New Wrist Injuries Are the New Elbow Injuries

As has been written elsewhere many times before, we are in the power-baseline era of men's professional tennis, where extended baseline rallies spent trying to break down the opponent's defense are the norm, and with some of the best practitioners of that strategy—Andy Murray, Rafael Nadal, Novak Djokovic—standing at or near the top of the rankings.

While Nadal has had a resurgent 2017 after an injury-marred 2016, it's been a down season so far for the other two: Murray's won only one tournament so far, Djokovic two. Earlier this year, both men had to skip the ATP Masters 1000 tournament in Miami, where they've historically found success, due to elbow injuries. And at the exhibition event before Wimbledon in Hurlingham, England, Murray withdrew from his two matches, citing a sore hip, although he appears to be managing just fine at the All England Club so far.

It's a question that comes up whenever the tennis world watches a wave of injuries plague its biggest stars, from Nadal and his knees to Juan Martin del Potro and his wrists to, more recently, Nick Kyrgios and his hip: Is the sport's embrace of that punishing baseline style catching up with its players?

As tennis has evolved into a more physically demanding sport, today's players face the same injury risks as they have for years, along with new challenges, said Todd Ellenbecker, vice president of medical services for the ATP World Tour.

"Some of the same injury patterns continue to be seen in male professional tennis players: more acute traumatic injuries in the lower body and overuse injuries in the upper body and core," he told VICE Sports, but a few notable trends have emerged in recent years, too.

"One uptick in injuries in this generation of tennis players is in the hip. Right-handed players often injure their right—called ipsilateral—hip," Ellenbecker said, which he attributed at least in part to "an increased understanding in the medical community of evaluation and treatment of hip injuries coupled with the baseline game with repetitive side-to-side loading from the groundstrokes." From running out wide along the back of the court to setting up to hit the shots with the necessary amount of pace, players are putting more stress on their hips, over and over and over.

Ellenbecker also noted that more research needs to be done on the causes of injuries, and on the best strategies to prevent them. Historically, there haven't been many studies on injuries at the professional level. To that end, both the ATP and the WTA started compiling an online database to track every player injury for all World Tour events.

"We now have five years of complete seasons of injuries in the system," Ellenbecker said. "Since most of the musculoskeletal injuries are overuse in nature—i.e., they occur over weeks and weeks of continued play—definitive conclusions on surface and other specific factors relating to that injury are difficult and must be studied further."

While it may be too early to definitively state how much the power baseline game affects players' bodies in terms of injuries, other changes are clear.

"I think both men's and women's games have gotten more physical as the years have gone by," said Todd Martin, a former two-time Grand Slam finalist and world No. 4 in the 1990s. Today he serves as the CEO of the International Tennis Hall of Fame. "In the 90s, if you couldn't finish a point at the net, you were causing yourself troubles. The sport has become much more, as everyone knows, a back-and-forth, 95-feet-away-from-your-opponent game."

Comparing tennis to boxing, Martin explained how that distance from the opponent makes a difference.

"If you're going to try to beat somebody over the course of time, being away from them, it's going to be a longer fight if you dance around with each other," he said. "And for tennis, the further two guys are away from each other, the longer the points, the stronger they have to be and also, the more advantage the stronger one will have."

And that, at least in part, has pushed tennis players to be fitter and stronger than ever before. Like any other elite athlete, they are constantly looking for an edge over their competition, and have been aided by advancements in areas like fitness, nutrition, and sports medicine.

"Sports science was starting when I started and bought into by the time I stopped," said Martin, who retired from the professional tour in 2004. "It almost trumps tennis in some ways and that's evident when you look at the way the guys play; when you look at the way the guys look; and, I think, when you see them recover from injury, they recover quicker."

"In earlier decades, players trained by playing tennis," Ellenbecker said. "While this is, of course, still true—you have to play tennis to obtain elite levels of performance—off-court fitness and strength and conditioning is imperative for injury prevention and performance enhancement. Players in today's game have had a generous utilization of off-court training techniques throughout their career."

From Djokovic's use of a hyperbaric chamber the past few years to dynamic Frenchman Gael Monfils taking dance classes, pro athletes are embracing a wide variety of methods to stay in shape for the grueling men's tennis schedule.

"The modern tennis player has exceptional levels of flexibility, strength and endurance leading to longer periods of career performance at elite levels," Ellenbecker said. All of the top five players currently on the men's side—Djokovic, Murray, Stan Wawrinka, Nadal and Roger Federer—are on the north side of 30, which has never happened before in the history of the sport.

"The training has changed so much; they are so much more focused," Martin said of today's players. "It's like education now, the discussion about the 'whole child.' It's a good thing. You look at the tennis player and it's about the 'whole athlete.'"