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Ask the High Performance Lab -- Mar. 7

May 25, 2008 12:25 PM

PLEASE NOTE: The medical opinions in USTA.com's Ask the High Performance Lab are responses intended for the average player. Please consult with your primary physician before beginning any new exercise program.

At the 2005 Competition Training Center Workshop (CTC) held in January 2005, USTA Sport Science Committee members Kathleen Stroia, Carol Otis, and Page Love gave brief presentations on medical, developmental, and nutritional issues facing young female players.

Following the presentations they were joined by Jean Nachand, Director of Women’s Coaching for the USTA, in a panel discussion, fielding questions posed by the audience. While many of the questions came directly from information given in the presentation, the answers are applicable to all coaches who work with female players.

Additional information on the panelists is included below.

Kathleen Stroia, MS, PT, ATC – Vice President of Sport Sciences and Medicine and Professional Development of the WTA.
Carol Otis, MD – Physician and expert on women’s issues in sport. Dr. Otis has also served as a medical consultant to the WTA.
Page Love, MS, RD, LD, CSCS – Nutritionist who has worked with many tennis players in the USTA, WTA as well as other professional sports organizations.
Jean Nachand – Director of Women’s Tennis for the USTA in the High Performance Division.

These questions represent Part II of a two-part series: The Developing Female Tennis Player.

Q: One of the difficult issues that face coaches, particularly male coaches, is talking to players about “female issues”, like menstruation. What recommendations do you give to a coach to broach the subject, of say menstruation, to find out if the player is having her period and discuss female issues? What should a coach do? (Having a regular menstrual cycle is important for female tennis players. Irregular menstruation, or lack of a menstrual cycle, is commonly associated with the female athlete triad – disordered eating, abnormal menstrual cycle, and osteoporosis).

Carol Otis: I think the main thing is not to not be afraid of bringing up the issue. Treat both your female and male players with respect. You are going to give them privacy, if you are bringing up something that might be sensitive, and you are going to handle everything with confidentiality. Use the same principles you are already use when approaching males when it comes to talking with female players about issues like their menstrual cycle. I think you can have a way of indicating you are aware women have a menstrual cycle and at a certain time of the month they may be having a more difficult time, and that you understand that. If there is a conversation taking place that goes into more detail, always have the conversation in privacy – you do not want to embarrass the young woman. They can become very easily embarrassed about this, so if you can do his in a private setting or a private office, that is probably the best way. Also, you may have to take any issues about the menstrual cycle on to the next level – which is to a health care provider. Have those referrals ready and available to provide the player or know who in your community that player has access to and say “I am not the expert when it comes to this, but I do want you to see and expert to get it managed. Because my understanding is that we can help you with this if it is interfering with you performance and/or your life.”

Q: Do you notice a higher incidence of lower body injuries (in the leg, hip, foot, knee) in females compared to what other people are reporting for males, and if so why do you think that is the case.

Kathleen Stroia: I think what we notice are a higher number of low back sacro-iliac joint (SI joint) injuries. Some of that is related to the kinetic chain, so it can go down to the feet, like stress fractures in the feet, being the weight bearing joint. What we are really seeing is a lot of rotational injuries in the lower back and I think that is due to poor core stability and the need for strengthening of the core. On the men’s side they are seeing a higher number of hip injuries which is more prevalent with the loading in an open stance.

Q: What are some guidelines with regards to training and competition that coaches can use to protect the health of the young female player and also promote great tennis development?

Kathleen Stroia: Unfortunately, we do not have solid information on this topic for young players, but we are looking into it. The information I have comes from some studies done on the WTA tour. We started to look at injuries and when they occur. I think it is important to adhere to periodization principles and incorporate all four phases of the periodization cycle into training and competition - which are critical - and really apply that approach. It is also important to monitor the players as to what training they are doing. I spoke with some coaches earlier today about injuries they were seeing and we related them back to what the players are doing off the court and in the gym. Not just how much they are playing, and working out, but what are they doing. Players really net to be ggetting into the core stability types of exercises - emphasizing strengthening the core, and the trunk, and the shoulder - rather than doing something more aggressive, like plyometrics – even modified plyometrics - at the younger ages. What we really need to be looking at what they are doing and asking is their technique proper, whether they are in the gym or on the court, in addition to looking at the frequency of what they are doing.

Jean Nachand: I think #1, as a coach you want to pay attention to each player individually and specifically what they are doing. If you have a player who loses in the first round every week, she may be able to compete in more tournaments on the road because she in only playing 3 matches in three weeks, versus 7, 8, or 9 matches in three weeks. Things like that need to be taken into account. I think also, as Kathleen indicated, you are looking at what the players are doing off the court. When they have a schedule, each individual does respond differently to travel. If the player is a “home body,” maybe 3-4 weeks is too much for them to be on the road. It may not be so much physical as it is emotional. You need to take into account all of the elements of the individual as you put the schedule together. I think you have to continue to monitor it. For example, if a player is not doing well at the beginning of the year when they are playing 1-2 matches each week and they start progressing and doing better, you may need to reassess things when they are playing 4-5 matches each week. You may not be able to go 3-4 week back-to-back.

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