Epidemiological profile of beach tennis practitioners in Florianopolis region – Santa Catarina/BrazilABSTRACT
Considering the growing number of practitioners and the low evidence regarding the characteristics of injuries in beach tennis, this work aims to describe the prevalence of injuries related to the practice of beach tennis in the Florianópolis. A retrospective cross-sectional epidemiological study was carried out from September to October, 2022. In total, 140 beach tennis practitioners were evaluated regarding the locations, types, and chronicity of injuries, as well as information about sporting experience and weekly practice volume. A total of 108 injuries were identified in 44 athletes (30.7%), 62 of which were chronic injuries (57.4%) and 46 were acute (42.6%). The upper limbs were the most affected, with the elbow (26.8%) and shoulder (13%) standing out. Tendinopathies (34.2%) and muscle injuries (25%) were the main types of injuries reported. The main elbow involvement was lateral elbow tendinopathy, comprising 90% of total elbow injuries. The predominant profile encompassed females, recreational practitioners, with some chronic soft tissue injuries, predominantly in the upper limbs, mainly elbows and shoulders. The shorter practice time and the amateurism of practitioners were found to influence the incidence of reported injuries.
Keywords
Beach Tennis; Injuries; Epidemiology; Athletes
RESUMO
Tendo em vista o crescimento de praticantes e a baixa evidência a respeito das características das lesões no beach tennis , este trabalho visa descrever a prevalência de lesões relacionadas à prática desse esporte na região de Florianópolis. Foi feito um estudo epidemiológico transversal retrospectivo entre setembro e outubro de 2022. Cento e quarenta praticantes de beach tennis foram avaliados quanto aos locais, tipos e cronicidade das lesões, bem como informações sobre a experiência esportiva e volume semanal de prática. Foi identificado um total de 108 lesões em 44 atletas (30,7%), sendo 62 lesões crônicas (57,4%) e 46 agudas (42,6%). A incidência média de lesões foi de 1,43 por 1.000 horas de exposição. Os membros superiores foram os mais acometidos, sendo o cotovelo (26,8%) e o ombro (13,%) as regiões mais acometidas, respectivamente. Tendinopatias (34,2%) e lesões musculares (25%) foram os principais tipos de lesões relatadas. O principal acometimento no cotovelo foi a epicondilalgia lateral do cotovelo, compreendendo 90% do total de lesões desse complexo articular. O perfil identificado após a análise foi o predomínio de mulheres, praticantes recreativas, com algumas lesões crônicas de partes moles, com predomínio em membros superiores, principalmente cotovelos e ombros. O menor tempo de prática e o amadorismo dos praticantes demonstraram influenciar na incidência de lesões relatadas.
Keywords
Beach Tennis
; Lesões; Epidemiologia; Atletas
RESUMEN
Teniendo en cuenta el aumento del número de practicantes y la baja evidencia sobre las características de las lesiones en el beach tennis , este trabajo busca describir la prevalencia de lesiones relacionadas con la práctica de este deporte en la región de Florianópolis. Se realizó un estudio epidemiológico transversal retrospectivo entre septiembre y octubre de 2022. Se evaluaron ciento cuarenta practicantes de beach tennis en cuanto a la localización, tipos y cronicidad de las lesiones, así como las informaciones sobre la experiencia deportiva y el volumen de práctica semanal. Se identificó un total de 108 lesiones en 44 atletas (el 30.7%), de las cuales 62 fueron lesiones crónicas (el 57.4%) y 46 fueron agudas (el 42.6%). La incidencia media de lesiones fue de 1.43 por 1000 horas de exposición. Los miembros superiores fueron los más afectados, siendo el codo (el 26.8%) y el hombro (el 13.%) las regiones más afectadas, respectivamente. Los principales tipos de lesiones relatadas fueron tendinopatías (el 34.2%) y lesiones musculares (el 25%). La principal afectación en el codo fue la epicondilalgia lateral del codo, representando el 90% del total de lesiones de este complejo articular. El perfil identificado tras el análisis fue el predominio de mujeres, practicantes recreativas, con algunas lesiones crónicas de tejidos blandos, con el predominio en miembros superiores, principalmente codos y hombros. Se demostró que el tiempo de práctica más corto y el amateurismo de los practicantes influyen en la incidencia de lesiones relatadas.
Palabras clave
Beach Tennis; Lesiones; Epidemiología; Atletas
INTRODUCTION
Beach tennis was created approximately in 1987 in Ravenna, Italy. This sport began to be professionalized in 1996 and is currently regulated by the International Tennis Federation (ITF). According to the ITF, more than 500,000 people practice this sport worldwide. The modality arrived in Brazil in 2008, in Rio de Janeiro, spreading to coastal cities in other states and even some inland areasshortly after. Today, according to the ITF, Brazil is the second “greatest sport power” in the world, behind only Italy 1 - 3
The success of beach tennis in Brazil and worldwide is due to the fact that it is a sport practiced by individuals of different age groups and levels of physical fitness/competitiveness, in addition to requiring only two or four people to play a match 1 , 2 . Due to this high acceptance by the world population for the sport, beach tennis seems to emerge as an enjoyable option for individuals looking to start some physical activity 1 , 2 .
Despite being a “noncontact” sport and, thus, being considered a safer sport, it is known that all types of physical activity carry a certain risk of injury 4 . Notably, injuries can lead to physical disability, which, in turn, may lead to absence from work, need to use public healthcare resources, and personal expenses 4 . Moreover, it has already been proven that lower injury incidence rates are strongly correlated with better results in the competitive season, as, for example, evidenced by Eirale et al. 5 in professional soccer teams.
Despite the considerable increase in the number of practitioners and the growing popularity of the sport, there is only one published study on beach tennis injuries, carried out with 206 practitioners, on the French island of Réunion, in the Indian Ocean 6 . Therefore, the literature still lacks studies on the most prevalent injuries in beach tennis practitioners, as possibly the latter French study does not represent the same findings in other “great power” in the sport.
Thus, determining the prevalence of injuries in TB practitioners from different locations, as well as to describe anthropometric and sociodemographic characteristics and their habits related to sports practice is significantly important. so that we can carry out comparisons of injury rates with other locations and analyze any causal factor that could influence a greater occurrence of these. Information about musculoskeletal injuries is fundamental to provide the best treatments, guidelines, and strategies for injury prevention. Thus, the objective of this study is to describe the incidence of injuries related to BT in the Greater Florianopolis region via a cross-sectional retrospective study.
METHODOLOGY
This retrospective cross-sectional epidemiological study included beach tennis practitioners in the Florianopolis region to verify the prevalence of injuries in professional and amateur practitioners. All participants signed an informed consent form before answering the questions.
Participants and inclusion criteria
Individuals aged over 18 years who practiced beach tennis regularly (at least once per week) and who lived in Florianopolis were included. Individuals who did not complete the questionnaire and those aged under 18 years were excluded.
Research development and data collection
The data collection was conducted via an online questionnaire, developed by the researchers, on the Google Forms ® platform. The first section of the questionnaire consisted of the sociodemographic and personal characteristics of the practitioners, such as sex, age, municipality of residence, handedness, and schooling level. The following section addressed factors related to the practice of beach tennis such as practice time, category classification following the 2022 Brazilian Tennis Confederation (CBT) regulation, frequency of practice, frequency of “extra beach tennis” physical training, and average time for each workout. The third section dealt with the investigation of the reported presence of pain and injury related to the practice of beach tennis, namely: pain intensity and location, investigation of previous injuries, type of injury, measures taken to deal with or treat the injury, time absent from practice, and level of return to sport. Finally, the fourth section focused on “extra beach tennis” physical activities, such as other sports and activities that the individual practiced regularly for leisure, competitiveness in other sports, place, and time of practice.
To reach as many practitioners as possible, the questionnaire was sent to arenas, gyms, and private beach tennis courts in the city of Florianopolis, in addition to being disseminated via social networks (Instagram® and WhatsApp®). Data collection was conducted over a two-month period, during September and October, 2022.
The study was conducted following the tennis-specific extension of the International Olympic Committee (IOC) consensus statement on methods for recording and reporting epidemiological data on injuries and illnesses in sports 7 . The use of the standard established by the IOC for tennis was considered valid due to the proximity between these tennis modalities, in addition to the absence of specific evidence for beach tennis.
Definition of injury
This study followed the definition of injury by the IOC consensus. This definition characterizes injury as any condition that affects an athlete’s normal state of health, regardless of its consequences on the athlete’s participation or sport performance, or if the individual sought care from a health professional 8 .
Statistical analysis
Data were tabulated and stored in Google Sheets® for later analysis using the SPSS v17.0 software (SPSS, USA). A descriptive analysis of the sociodemographic and professional data of the participants was performed. Questionnaire responses were expressed as frequency, mean, and percentage. To estimate the total incidence of injuries per 1,000h, the model proposed by Minghelli et al. 9 (2019) was employed. The total number of injuries among the individuals studied was multiplied by the total number of training hours of the injured individuals. Then, the total value was adjusted to a proportion per 1000h. To estimate hours, a weekly practice time of 7h and a month equals 4.34 weeks were assumed. The association between nominal qualitative variables was assessed using the Chi-squared test (χ 2 ). A 5% significance level was used.
RESULT
The survey was conducted with 143 beach tennis practitioners. Females represented most of the study sample (69.2%). Table 1 shows the anthropometric and sociodemographic characteristics of these practitioners.
“Recreational” athletes, that is, those who do not participate in official competitions, represented 49.6% of the total sample, as shown in Table 2 . We classified as “free-time physical activity” all physical activities and sports practiced, excepting beach tennis.
Location, type, and severity of lesions
A total of 108 injuries were reported in 44 athletes (30.7% of participants). The overall incidence of injuries was 1.78 per 1,000h of exposure. Among the reported injuries, 46 (42.6%) were acute and 62 (57.4%) were chronic. These injuries occurred in the upper limbs (47.2%), lower limbs (44.4%), and axial region (8.3%). Elbows showed the highest frequency of injuries, followed by shoulders and hips ( Table 3 ). The main types of injuries reported were tendinopathies and muscle injuries. Table 3 shows data on time off and performance in sport upon return.
Association of variables with injuries
A descriptive analysis of the sociodemographic and professional data of the participants was carried out. Questionnaire responses will be expressed as frequency, mean, and percentage. The association between nominal qualitative variables was assessed using the Chi-squared test (χ 2 ). The significance level used was 5% ( Table 4 ).
Shoulder and elbow injuries
The main injuries reported in the shoulder were tendinopathies, totaling 41% of all shoulder injuries ( Table 5 ). Among the 14 individuals with shoulder injuries, 13 underwent some type of intervention to treat or deal with the condition, with “physical therapy” and the combination of “physical therapy, massage, and medication” being the most common, both representing approximately 21% of the treatment options. Only one individual did not undergo treatment.
Regarding elbow injuries, most participants reported lateral elbow tendinopathy (tennis player’s epicondylitis), with 90% of all elbow injuries reported, against 10% of elbow ligament injuries ( Table 5 ). Most of those affected by epicondylitis stayed one to two weeks away from the beach tennis practice. Among the treatment options reported by athletes, “physical therapy” and the combination of “physical therapy and medication” were the most listed (37.5% and 18.7%, respectively). In total, two practitioners did not undergo intervention.
DISCUSSION
This study aimed to describe the prevalence of injuries in beach tennis. We found a predominance of female and recreational practitioners. Moreover, an incidence rate of 1.78 injuries was observed per 1,000h of exposure, and it seems that the shorter practice time and the amateurism of practitioners may influence the incidence of injuries. Among the injuries, chronic ones predominate, and the upper limbs are the most affected, especially shoulders and elbows. Berardi et al. 6 found similar results, with 178 injuries in 206 players (with a predominance of male players), totaling 1.81 injuries per 1,000h of play. The authors found that shoulders were the most frequently injured, as well as that most upper limb injuries were chronic tendinopathy in recreational players.
Comparison with overhead sports
Main injuries
According to Posner et al. 10 , the main segment affected in pitching sports (overhead) are the shoulders, accounting for 31% of all injuries in professional baseball pitchers, followed by 26% of elbow injuries 10 . The main potentially harmful radiological findings in throwing athletes (tennis, volleyball, javelin throwing) are internal impaction, superior labrum anterior and posterior lesions (SLAP), and injuries to the supraspinatus and infraspinatus muscles. Despite the high prevalence of shoulder injuries in volleyball athletes, they were not as common as ankle, knee, and finger injuries 11 . It is believed that many of these injuries are caused by joint adaptations due to the great demand for powerful shoulder rotation movements 12 .
Risk factors
Similar to other overhead sports, beach tennis presents a repetitive demand for power in the shoulder and elbow joints, mainly in actions such as the serve, smash, and hook. In throwing sports such as baseball, tennis, and American football, it is common to identify adaptive changes in bone, capsuloligamentous structures, and muscles, in addition to pathological indications in image exams of the athletes’ shoulders 11 . Some of the main adaptive patterns in the dominant shoulder of throwing athletes that were previously interpreted as pathophysiological include the glenohumeral internal rotation deficit (GIRD) 13 - 15 , described by Burkart et al. 13 as greater than 25% compared to the contralateral limb. Moreover, a decrease in total range of motion (TROM) has been noted, described by Wilk et al. 15 as greater than 5% when compared to the contralateral shoulder 13 - 15 . However, according to Keller et al. 16 , the literature is still limited on chronic adaptations of glenohumeral rotation and its correlation with shoulder and elbow injuries, as results did not reach statistical significance, despite suggesting a higher incidence of injuries in athletes with GIRD and TROM deficits 8 , 16 - 18 .
Regarding external load, Matsuura et al. 1 found that training volume above 16 hours/week were associated with shoulder and elbow injuries when analyzing risk factors for upper limb injuries in young baseball players 1 . Similarly, Møller et al. 19 analyzed the impact of training volume on young handball athletes and its correlation with shoulder injuries. They found that athletes who underwent 60% increases in acute training volume were twice as likely to have a shoulder injury when compared to increases of up to 20% in the same week 19 . This greater exposure to activity is expected to be one of the risk factors for developing upper limb injuries, as they are typically caused by the accumulation of microtraumas from the repetition of throwing motion 20 .
Since evidence of risk factors in throwing sports remains limited, it is suggested that a general shoulder screening should be performed considering range of motion, strength, power, and other standardized measures, such as GIRD and TROM analysis, which can have an important role in the prevention and treatment of these injuries 21 , 22 .
Comparison with racket sports
Beach tennis is a sport that presents strokes similar to tennis such as forehand, backhand, serve, slice, lob and, smash. A descriptive study of professional tennis players identified that more than 50% of male and female withdrawals from competition can be attributed to injuries 23 . In another recent descriptive study, it was observed that university tennis injuries were more prevalent in matches than in training, and that they occurred significantly more in the lower limbs, followed by the upper limbs and trunk. In this same study, the main injuries reported were strains, sprains, inflammations, and tendinitis, with no significant differences between sexes 24 .
Tennis and beach tennis differ in terms of the flooring of the courts, as the latter is played on sand, whereas the former is played on clay, grass, concrete, or carpet. This condition leads to another divergence, as in tennis the ball is allowed to bounce once on the ground, thus stimulating greater displacements of the tennis player during points disputes. Another difference is the size of the courts and nets: in beach tennis, the court for doubles measures 16m × 8m and the net stands 1.70m above the ground. Meanwhile, the tennis court for singles measures 23.77m × 8.23m, for doubles, 23.77m × 10.7m, and the net height is 0.14m 1 .
A major sport in Asia, badminton is considered the fastest among racket sports, and at a competitive level, it requires excellent physical conditioning. It is played predominantly with overhead movements. The game is physically challenging and demands complex movements with dynamic postural changes in the form of lunges, displacements, reaches, and jumps. Furthermore, repetitive “forehand” and “backhand” blows performed above the head generate excess stress on the upper limbs. Despite the high demand, its characteristic injuries are rarely severe and affect the lower limbs more, especially the knees in cases such as ligament sprains and patellar tendinopathy. In the upper limbs, the shoulder was the most common region in which pain was reported, with rotator cuff tendinopathy being the most prevalent diagnosis. Most injuries were due to overload, considered chronic and more common in young athletes 25 .
Padel is a racket sport performed on a court that allows the ball to bounce off the walls and continue the game. Particularly popular in Spain, Argentina, and parts of Brazil, it features a professional circuit worldwide, bringing together the best athletes in the ranking. In recreational padel player, injuries were more prevalent in the lower limbs for 53.1% of the total injuries, followed by the upper limbs (37.5%) and trunk (9.4%). The most common type of injury was ligament sprains (43%) and unknown factors were the top perceived cause of injury (40%), followed by fatigue (19%) and poor technique (15%). Other variables such as racket type and court surface material were not associated with injury 26 .
Comparison with other beach or sand sports
Previous studies have reported incidence of injuries with longer recovery time in indoor sports (closed court, hard surface) than in their beach or sand version, as the case of beach handball. A possible reason for this lower incidence in beach sports is the reduced speed when changing direction 27 . This ratio of fewer severe injuries is also seen in beach soccer, which despite presenting a higher number of hallux contusions and abrasion injuries, ankle sprains were considered less frequent in its beach variant when compared to traditional soccer 2 . It is also interpreted that the soft surface of the sand softens erroneous landings and falls from heights.
The soft surface of sand sports also affects jumping mechanics when compared to the hard surface. On sandy soil, beach volleyball athletes present a greater propulsive phase of the jump and greater absorption of it. This finding may explain a lower incidence of patellar tendinopathy, which typically occurs in athletes who use many jumps and landings on rigid surfaces 6 .
This study is the first to consider the practice of other (extra) physical activities by beach tennis athletes, which proved to be an important factor to consider since 84.6% of beach tennis practitioners practice other physical activities regularly, with bodybuilding, walking, and running being predominant.
Study limitations include those typical of a retrospective study. There are confounding factors related to players’ memory, underestimation of possible injuries, and issues regarding the diagnosis of injuries, which was not always performed by a health professional. As this is a collection conducted via an online questionnaire, it is possible that interpretation errors occurred when filling out the questions. Despite the investigation of the practices of other physical activities, this study did not differ injuries as occurring during the beach tennis practice and occurring during other physical activities. Moreover, this study did not consider other components that could influence injuries (multifactorial), such as hours of sleep, stress, anxiety, and diet, suggesting further studies.
The information in this study is fundamental for health professionals to effectively screen and evaluate BT practitioners, aiming to provide the best possible therapeutic choice for these athletes. Moreover, we highlight that joint work can aid prevent and minimize the risk of injuries among BT practitioners.
CONCLUSION
This study found a predominance of female and recreational beach tennis practitioners. Chronic soft tissue injuries predominate over acute ones and the upper limbs are the most affected, especially elbows and shoulders. Most athletes affected by these injuries sought care from health professionals to treat their conditions, with the physical therapist being the main professional to be consulted. Finally, the shorter practice time and the amateurism of practitioners was found to impact the incidence of reported injuries.
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This study was carried out in Florianópolis (SC), Brazil.
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Financing source:
nothing to declare
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Approved by the Research Ethics Committee CAAE No. 42853720.0.0000.0118 approval opinion 4.631.512, via Plataforma Brasil.
