An interdisciplinary approach to better understanding low back pain in elite adolescent tennis players

Connolly, Molly Ann (2020) An interdisciplinary approach to better understanding low back pain in elite adolescent tennis players. PhD thesis, Victoria University.


This thesis explores potential risk factors for low back pain in elite adolescent tennis players. Low back pain (LBP) is one of the most significant causes for loss of playing time in elite junior tennis players and can result in up to 4-5 months away from competition. Current research has explored lumbar spine abnormalities as well as serve and groundstroke biomechanics in tennis in an attempt to better understand the manifestation of LBP in the sport. However, the vast majority of this research has been cross-sectional and limited to male playing populations, meaning that the mechanisms of LBP remain unclear. To address the lack of knowledge on the mechanisms of LBP and to provide improved evidence-based prevention for players, this course of studies investigated multiple proposed causes for LBP; including lumbar spine abnormalities, serving biomechanics and workload in a sample of elite adolescent tennis players over a 12-month period. During this study, 19/25 players presented with lumbar spine abnormalities. The most common abnormalities were disc degeneration, pars abnormalities (including bone marrow oedema (BMO)) and facet joint degeneration. Interestingly, the presence of BMO did not influence LBP, with only 3/12 players who presented with BMO experiencing LBP. Further the severity of BMO did not appear associated with LBP, which is contrary to the findings in other sports such as cricket. Lastly, the link between pars abnormalities and facet joint orientation still remains unclear due to contradicting results at baseline and follow-up. The biomechanics of the adolescent serve, specifically peak leg, trunk and racquet kinematics and kinetics, were not related to the presence of pars abnormalities. However, there was evidence to suggest that the timing of these peak mechanics are. Players with pars abnormalities entered peak right knee flexion and peak lumbar right lateral flexion earlier than those without pars abnormalities. Also, the players with pars abnormalities entered the trophy position (racquet high point) and experienced peak lumbar posterior force later than those without pars abnormalities. Therefore, this provides cause for coaches to reconsider the importance of the timing of the tennis serve in the context of pars abnormalities and potentially LBP. Lastly, when referring to players who experienced LBP in this cohort, all players had a spike in workload with an acute chronic workload ratio (ACWR) ≥1.5. Previous research has flagged this ratio as a risk factor for LBP, yet the high frequency of these spikes in adolescent tennis players complicates their direct link with LBP. It is difficult to conclude the specific causes for LBP in elite junior tennis players. This thesis reveals that BMO is not linked to LBP as many players with diagnosed BMO remained pain-free. The order in which players perform key serving events (for example racquet high point) do appear related to the presence of pars abnormalities and potentially LBP. Lastly, the relationship between workload and LBP remains unclear and warrants further investigation. Overall, this thesis contributes to the small but growing research into LBP among tennis players and progressively increases our understanding of LBP risk factors.

Item type Thesis (PhD thesis)
Subjects Historical > FOR Classification > 1106 Human Movement and Sports Science
Current > Division/Research > Institute for Health and Sport
Keywords low back pain; adolescents; tennis; tennis players; lumbar spine; biomechanics; kinematics
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