Tennis- and squash- related injury (all ages)

July 2008

There were 1392 emergency department presentations and a further 576 hospitalisations in Victoria over the four-year period from January 2003 to December 2006 for tennis-related injuries. This represents an average of 348 emergency department cases and 144 admissions to hospital per year. For squash-related injury, during the same period there were 186 admissions and 306 ED presentations: an average of 47 and 77 cases per year respectively.

Age: Tennis-related ED presentations were highest among 10-14 year olds and generally high among all 5-year age groups from 5 to 49 years. Approximately one-third of presentations occurred among school-age children, and two thirds among adults of working age. Less than 5% of presentations were pre-school children or adults of retirement age. Hospital admissions followed a similar trend but with the bulk of cases aged in the mid-thirties to mid-fifties.

Squash-related ED presentations were most common among 30-34 year olds and 40-44 year olds. Less that 4% of cases occurred in children 14 years old or younger. Admissions showed a similar trend, with the bulk of cases occurring among 30-44 year olds and less than 1% in children under 14.

The large number of cases among teenagers and middle-aged persons and the few among preschoolers and the elderly are probably due to the relative popularity of racquet sports in these age groups. However, is should be noted that in each sport the younger people tended to be treated in the emergency department, while admissions to hospital were more common amongst older persons. For all ages above 55, admission to a hospital ward was more likely than treatment in the emergency department only. This suggests that tennis and squash injuries in older people are typically more severe and require more complex treatment that those of younger individuals.

Sport: Overall tennis-related injury cases were more common than squash-related cases. Emergency department presentations related to tennis outnumbered squash at a ratio of 4.5 to 1, and hospital admissions at 3 to 1. While this may simply reflect that tennis is more popular than squash, the higher proportion of squash injuries among admissions than presentations indicates that squash injuries may tend to be more severe and require a longer period of treatment than those that are tennis related.

Gender: Males were more commonly treated for tennis injuries than females, representing 59% of ED presentations and 55% of hospital admissions. For squash-related cases, the over representation of males was much more pronounced: males accounted for 82% of squash-related presentations and 84% of admissions.

Table 1: Gender division of tennis and squash related injuries

Source: VEMD & VAED, Jan 2003 - Dec 2006

Body region: The pattern of tennis injury by body region was similar for emergency presentations and hospital admissions. The lower extremity (leg, knee, ankle and foot) was the most affected region in both presentations and admissions, accounting for 40% and 57% of cases respectively. Next most affected was the upper extremity (including the shoulder, arm, wrist and hand) at 28% of presentations and 32% of admissions and the head, face and neck with 12% of presentations and 5% of admissions. Injuries to the trunk were less common, representing 2% and 4% respectively.

Among squash cases the pattern was slightly different. Injury to the lower extremity was most common (35% of presentations and 74% of admissions), followed by the head, face and neck (22% presentations, 11% admissions), upper extremity (10% of each) and the trunk (4% and 3% respectively).

The ankle was the most common specific injury site among persons presenting to emergency departments. With 260 tennis-related cases and 47 due to squash, these accounted for 19% and 15% of the total number of tennis and squash cases respectively.

Squash-related injury	Tennis-related injury

Source: VEMD & VAED, Jan '03 - Dec '06
Figures 1&2: Tennis and squash related presentations and admissions by age group

Injury prevention: All players should routinely warm-up, cool-down and stretch before and after every game and training session. Both competitive and recreational players are advised to undergo a graduated development and training program based on consultation with an accredited tennis or squash coach. Players should seek professional assistance when selecting a racquet and choosing string tension. Players should also choose their shoes carefully, preferably with professional advice on the most appropriate shoe for their foot type and usual playing surface. Limit play with used balls and avoid play with dead balls. Contact as sports medicine professional for advice on injury prevention and management.

Further information: For further information on tennis related injuries and injury prevention.

Data source: Victorian Emergency Minimum Dataset (VEMD) and Victorian Admitted Episodes Dataset (VAED) January 2003 to December 2006 (4 years).

Search Strategy: [Presentations]: A search was conducted for the text terms 'tennis' and 'squash' in the 250 character 'Description of Injury Event' field of the VEMD. Narratives were manually checked and irrelevant cases excluded. Cases subsequently admitted to hospital were excluded as they are captured in the VAED. [Admissions]: Cases in the VAED were selected if the activity code was 'U59.4: Tennis' or 'U59.2: Squash'.