Why are so many top tennis players suffering injuries, and what can be done?

Charlie Eccleshare
Andy Murray, Novak Djokovic and Serena Williams have all missed the Miami Open through injury - getty images/epa

The promotional poster for the Miami Open, which continues this week, was telling. 

"Federer, Serena, Nadal, Venus Williams, Novak Djokovic, Andy Murray, Juan Martin del Potro" it screamed in capital letters, celebrating the stars who would be competing. 

In the event however, Serena Williams, Djokovic and Murray pulled out injured, while Venus has been suffering from problems with her left thigh and right elbow. 

Of the others, Roger Federer missed most of last year with a knee issue, Del Potro is still recovering from multiple wrist surgeries, and Rafael Nadal has been plagued by injury for the last eight years. 

There have always been injuries in tennis, but it is a concern when the top two male players, as well as a string of others in the top 30, and the dominant female player are on the sidelines. Simona Halep, Garbine Muguruza and Madison Keys meanwhile have been battling injury for much of the last year, and all of the men's top 10 have withdrawn from tournaments or retired hurt from matches in the last 12 months. 

A number of these players have now withdrawn from the Miami Open

What's behind the recent rash of high-profile injuries?

The jam-packed schedule is part of the reason why a number of the top players have been suffering this early in the year. Murray for instance theoretically finished his 87-match 2016 season on 20 November, but he was back competing on 30 December, meaning his 'off-season' was shorter than six weeks. 

That he is now battling an elbow injury and the flu, having already contracted shingles in February, points to a desperately overworked body. 

The American surgeon Dr Richard Berger, who has operated on Del Potro and Laura Robson, says: "There are too many events, and on both the WTA and ATP tours there’s very little down time. ​ 

"There's not enough healing time because of the intensity of the matches, and in most tournaments outside the slams there's not even a day's rest.

"Players need to have superhuman abilities to stay fit."

Murray has had a number of fitness concerns this year

Michael Davison, the managing director of the sports medicine and rehabilitation group Isokinetic, says: "The issue is the squeeze on the off-season followed by intense training to get ready for extreme conditions at the Australian Open. This acute spike in workload puts them at risk. 

"Other factors are previous injury, cumulative fatigue, workload, and poor communication with coaches and the medical team. Playing on three different surfaces throughout the year is another issue."

The absence of a proper off-season makes players especially vulnerable to injury in the first three months of the year. The rash of players currently out follows the pattern of the last few years, including 2016 when Milos Raonic, Muguruza, Petra Kvitova, and Agnieszka Radwanska were among those who suffered injuries between January and March. 

How the mens top 10 have all been laid low in last 12 months

If players are lucky enough to come through the first few months unscathed, the rest of the year is scarcely less demanding. Any fitness concerns players have are likely to be compounded by the non-stop stream of events that take place until November, many of which are mandatory (for all but an elite few) and have financial inducements too good to miss for most players. 

A bulging calendar and minimal off-season are made worse by the relentless drive of the players to fulfill their potential, making them resistant to proper rest. 

Murray is one such player, and there is a growing belief that his injury troubles this year have partly been a consequence of an even more brutal than usual training camp in December

Former world No 1 Jelena Jankovic said last year: "We don’t want to miss out too much. We don’t want to lose our rankings. We just want to come back, and sometimes it’s really too soon."

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Once a player has suffered an injury, there is then a serious risk of recurrence, according to Dr Berger. "The fitness of athletes is greater today than it ever has been," he says. "But once they get an injury it can be very hard to get the individual back to their best because of the forces their bodies endure.

"The demand they are placing on the joints and the high level of performance makes them more vulnerable to a recurrence, and they don’t have enough recovery time once injured.

"It’s amazing how much it erodes the confidence of a player because they worry that if they have continued pain, they may be causing damage."

Isn't this just a normal part of sport?

It is important though to keep the latest injuries in perspective. Davison suggests that Djokovic and Serena Williams's setbacks may not be severe, and it's more a case of them not wanting to take any risks before the French Open. 

Davison believes Djokovic is effectively enjoying a "winter break" as he recovers from the cumulative fatigue of five years where he missed very few events. 

The Serb will be aware that missing the odd tournament can prove prudent in the long run, as Federer and the Williams sisters have demonstrated. 

Djokovic rests during his match against Nick Kyrgios earlier this month

What's the solution? 

Fewer matches and an extended off-season would be a good starting point to reduce the number of tennis injuries. 

The ATP has been proactive previously in reducing the number of tournaments per year and changing Masters finals from best of five sets to best of three, so it is not out of the question to hope for further reforms.

Another solution is a tweak to the preventative measures taken by the players. Dr Berger and many of his colleagues are recommending proprioceptive training, which promotes a better understanding of how joints and limbs interact with one other, thereby reducing the risk of pushing too hard and causing injury. 

But even with medical advances and a greater understanding by the players of how their bodies work, there is only so much that can be done if the schedule remains so unrelenting. As Davison points out, tendons, particularly when they are subject to repetitive forces, are harder to protect, no matter what preventative measures players take.

Next up on the tennis gravy train is the gruelling clay-court season, which Federer says he may miss chunks of to preserve his body for Wimbledon. Hopefully the majority of the top players will be available next month, but a rash of withdrawals would not be a surprise. 

The tennis calendar is reaching breaking point, and so are the players. 

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