Racquet Sports (Care of the Young Athlete)

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Racquet sports (tennis, racquetball, squash,
badminton, and paddle tennis) are sports of speed and agility and involve
athletes of all ages.

As in many sports, the risk of injury increases with
age due to the style of play, contact forces, and size of athletes. However, the
risk of injuries can be reduced.

The following is information from the American
Academy of Pediatrics (AAP) about how to choose a racquet and prevent racquet
sports injuries. Also included is an overview of common injuries and

How to choose a racquet

Racquet choice can affect an athlete’s
performance. The appropriate head and handgrip size are important. Athletes may
need to test out different string tensions before deciding what is right for

  • Racquet head size. The head
    size refers to the hitting area. The following are general racquet sizes
    based on age:

    • 21-inch—4 to 6 years of

    • 23- to 25-inch—5 to 8
      years of age

    • 25- to 26-inch—8 to 11
      years of age

    • 27- to 29-inch (adult
      size)—11 years of age and older

  • Handgrip size. Handgrip
    size ranges from 3 to 5 inches (measured in eighths of an inch). There
    are many ways to assess proper grip size. One way is to measure the tip
    of the ring finger to the last palmar crease, or one “shakes
    hands with racquet.” And one finger breadth should fit between
    the thumb and second digit. The following are average handgrip sizes. If
    you measure between sizes, buy the racquet with the smaller grip and use
    an overgrip to increase grip size.

    • Smaller than 4

    • 41/8 to
      43/8 inches—women 18 years and

    • 41/2 and
      43/4 inches—men

  • String tension. Average
    string tension runs anywhere from 55 to 65 pounds. A good rule of thumb
    to remember: higher tension equals more power and less control; lower
    tension equals less power and more control.

Injury prevention and safety tips

  • Sports physical exam.
    Athletes should have a preparticipation physical evaluation (PPE) to
    make sure they are ready to safely begin the sport. The best time for a
    PPE is about 4 to 6 weeks before the beginning of the season. Athletes
    also should see their doctors for routine checkups.

  • Fitness. Athletes should
    maintain a good fitness level during the season and off-season.
    Preseason training should allow time for general conditioning and
    sport-specific conditioning. Also important are proper warm-up and
    cool-down exercises.

  • Technique. Athletes should
    learn and practice safe techniques for performing the skills that are
    integral to their sport. Examples of poor technique include not fully
    extending the elbow on forehands or backhands, hitting the ball too
    late, and serving behind one’s head. Athletes should work with
    coaches and athletic trainers on achieving proper technique.

  • Training. A good rule of
    thumb is not to increase training by more than 10% per week. That
    means if an athlete is playing 10 hours per week, the following week
    could be 11 hours not 20 hours.

  • Exercises. Some young
    athletes are weak in their shoulder, trunk, or leg muscles. It is wise
    to do appropriate strengthening exercises for these muscle groups.
    Others are inflexible in the hamstrings, hips, or shoulders and need
    appropriate stretching exercises. A certified strength and conditioning
    coach or athletic trainer can demonstrate appropriate exercises.

  • Equipment. Safety gear

    • Protective eyewear.
      Glasses or goggles should be made with polycarbonate or a
      similar material. The material should conform to the standards
      of the American Society for Testing and Materials (ASTM).

    • Sun protection (ie,
      sunscreen, lip balm with sunblock) when outdoors

  • Environment. Athletes used
    to playing on a soft surface (clay or grass) should gradually change to
    a hard surface. For example, 10 hours per week on soft surface; 1 hour
    per week on hard surface. Also, extra balls on the playing surface
    should be cleared away so that no one steps on them.

Common injuries

Shoulder injuries

Shoulder injuries result from too many
serves or overheads in a short period. The result is that the muscle
fatigues and then doesn’t function properly. Treatment consists of
strengthening the muscles that support the shoulder. Athletes are advised to
avoid the serving or overheads until the activity is pain-free.

Elbow injuries

Tennis elbow (lateral epicondylitis) is not
common in children and teens. However, irritation of the growth plates in
the elbow can occur. This is often the result of a new service motion
involving topspin. Treatment consists of rest from painful activities
(hitting or throwing), ice, medicines, and stretches.

Wrist injuries

Wrist injuries often result from hitting too
late, changing grip, or ground strokes. Athletes may have pain with use and
loss of range of motion.

Treatment begins with rest, ice,
compression, and elevation (RICE). Athletes should see a doctor if their
wrists are swollen or painful the next day. X-rays may be needed.

Low back pain

Spondylolysis, stress fractures of the bones
in the lower spine, are usually the result of too many serves (particularly
topspin) or overheads in a short period. Symptoms include low back pain that
feels worse with hyperextending the spine (doing back bends). Treatment of
spondylolysis includes rest, physical therapy to improve flexibility and low
back and core (trunk) strength, and possibly a back brace. Athletes with low
back pain for longer than 2 weeks should see a doctor. X-rays are usually
normal so other tests are often needed to diagnose spondylolysis. Successful
treatment requires early recognition of the problem and timely

Hip and groin injuries

Hip and groin injuries are common in tennis.
They usually result from quick side to side changes of direction. They can
be muscle injuries or avulsion fractures (when muscles or tendons pull away
from the bone). If the athlete is limping or hears a pop, or there is
immediate swelling, an x-ray should be done. Treatment consists of RICE
along with hip strengthening and flexibility exercises.

Heat-related illness

Many tennis athletes suffer from muscle
cramps. This may be due to fatigue and excessive sweating, which causes salt
loss and dehydration. Athletes who are dizzy, confused, or complain of a
headache are most likely suffering from heat exhaustion or heat stroke.
These athletes must be taken to a shaded area, cooled, and evaluated by
emergency medical services (call 911).

Heat-related illnesses can be prevented when
athletes are given time to get used to exercising in the heat (usually takes
1 to 2 weeks). Drinking water or a sports drink before, during, and after
training, and avoiding stimulants including caffeine, can also help.

Ankle sprains

Ankle sprains are some of the most common
injuries in racquet sports. They can prevent athletes from being able to
play. Ankle sprains often happen with quick side to side changes of
direction, causing the ankle to roll in (invert). An ankle sprain is more
likely to happen if an athlete had a previous sprain, especially a recent

Treatment begins with RICE. Athletes should
see a doctor as soon as possible if they cannot walk on the injured ankle or
have severe pain. X-rays may be needed.

Regular icing (20 minutes) helps with pain
and swelling. Weight bearing and exercises to regain range of motion,
strength, and balance are key factors to getting back to sports. Tape and
ankle braces can prevent or reduce the frequency of ankle sprains. Tape and
an ankle brace can also support the ankle, enabling an athlete to return to
activity more quickly. However, athletes should not return too quickly or
more serious ankle injuries can occur.

Eye injuries

There are reported cases of retinal injury
and blindness in the eye secondary to the ball striking the eye, especially
in squash and racquetball. Any injury that affects vision or is associated
with swelling or blood inside the eye should be evaluated by an
ophthalmologist. The AAP recommends that all children involved in organized
sports wear appropriate eye protection.


Injuries from racket sports can be prevented
when fair play is encouraged and the rules of the game are enforced. Also,
athletes should use the appropriate equipment and safety guidelines should
always be followed.