Injury Risk Factors of the Tennis Serve: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>A key stroke in tennis is the serve. It is the most strenuous stroke in the game and has the greatest potential for injury. The serve has been broken down into a number of key stages to allow analysis of the movements involved.<h4>Objective</h4>The aim of this study was to conduct a systematic review of all injuries related to the stages of the tennis serve and to assess their relative impact on the risk of injury using a meta-analysis.<h4>Methods</h4>A systematic search was conducted across 8 electronic databases, supplemented with searches of grey literature. Eligible studies presented data from injured (injury group) and uninjured (control group) tennis players in a form that allowed further analysis of each risk factor for comparison. All results were presented as effect sizes (Cohen's <i>d</i>) to allow comparison of each risk factor and to identify the most important risk factors associated with injury. Overall study quality was assessed using an adapted Downs and Blacks checklist.<h4>Results</h4>A total of 29 studies were included in the meta-analysis, identifying 130 risk factors. 36 risk factors had an effect size suggesting a large or significant association with injury in tennis players (<i>d</i> ⩾ 0.8 or ⩽-0.8). These were divided into general risk factors and those associated with the preparation, acceleration and follow-through phases of the tennis serve. Seven of the risk factors were from 3 or more studies allowing meta-analysis, 3 were from 2 studies and 26 were from a single study. Downs and Black checklist scores ranged from fair to good for the studies included in this review. There was no evidence of publication bias.<h4>Conclusion</h4>Meta-analysis identified dominant shoulder rotation strength, internal rotation range of movement, weekly tennis volume, age, body mass and height as risk factors for injury in the tennis serve.