A SIX-WEEK NEUROMUSCULAR TRAINING PROGRAM
FOR COMPETITIVE JUNIOR TENNIS PLAYERS
SUE D. BARBER-WESTIN, ALEX A. HERMETO, AND
Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio
ABSTRACT
Barber-Westin, SD, Hermeto, AA, and Noyes, FR. A six-week
neuromuscular training program for competitive junior tennis
players. J Strength Cond Res 24(9): 2372–2382, 2010—This
study evaluated the effectiveness of a tennis-specific training
program on improving neuromuscular indices in competitive
junior players. Tennis is a demanding sport because it requires
speed, agility, explosive power, and aerobic conditioning along
with the ability to react and anticipate quickly, and there are
limited studies that evaluate these indices in young players after
a multiweek training program. The program designed for this
study implemented the essential components of a previously
published neuromuscular training program and also included
exercises designed to improve dynamic balance, agility, speed,
and strength. Fifteen junior tennis players (10 girls, 5 boys;
mean age, 13.0 6 1.5 years) who routinely participated in local
tournaments and high-school teams participated in the 6-week
supervised program. Training was conducted 3 times a week,
with sessions lasting 1.5 hours that included a dynamic warm-
up, plyometric and jump training, strength training (lower
extremity, upper extremity, core), tennis-specific drills, and
flexibility. After training, statistically significant improvements
and large-to-moderate effect sizes were found in the single-leg
triple crossover hop for both legs (p , 0.05), the baseline
forehand (p = 0.006) and backhand (p = 0.0008) tests, the
service line (p = 0.0009) test, the 1-court suicide (p , 0.0001),
the 2-court suicide (p = 0.02), and the abdominal endurance
test (p = 0.01). Mean improvements between pretrain and
posttrain test sessions were 15% for the single-leg triple
crossover hop, 10–11% for the baseline tests, 18% for the
service line test, 21% for the 1-court suicide, 10% for the
2-court suicide, and 76% for the abdominal endurance test. No
athlete sustained an injury or developed an overuse syndrome
as a result of the training program. The results demonstrate that
this program is feasible, low in cost, and appears to be effective
in improving the majority of neuromuscular indices tested.
Address correspondence to Sue D. Barber-Westin, sbwestin@csmref.org.
24(9)/2372–2382
Journal of Strength and Conditioning Research
Ó 2010 National Strength and Conditioning Association
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2372 Journal of Strength and Conditioning Research
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FRANK R. NOYES
We accomplished our goal of developing training and testing
procedures that could all be performed on the tennis court.
KEY WORDS speed, agility, dynamic balance, plyometrics
INTRODUCTION
T
ennis is a sport played by over 75 million
participants worldwide (37). The health benefits
of this activity are well recognized. In a recent
review, Pluim et al. (38) found strong evidence that
tennis players have superior aerobic fitness, a decreased risk
of cardiovascular disease, a lower body fat percentage, and
improved bone health compared to controls. Houston et al.
(19) followed 1,019 male collegiate athletes who had
participated in tennis, golf, football, baseball, and basketball
20–40 years after graduation. One-half of the tennis players
were continuing to participate in the sport at midlife,
compared to one-quarter of the golfers and none of the
other-sport athletes.
The elite adolescent player averages 2.3 hours of practice or
play per day, a mean of 6.1 days a week. The average point
requires 8.7 changes of direction, with each change creating
a load of 1.5–2.7 times the body weight on the knee (22). In
the junior player, intense participation in tennis alone or in
tennis combined with other sports significantly increases
the risk of injury (21). This is because of the heightened
frequency, intensity, and duration of participation, along with
the large biomechanical and physiological demands of
competitive play. These factors are especially problematic
in athletes who have not developed adequate strength and
aerobic conditioning to offset the tremendous forces placed
on both the upper and lower extremities. The incidence of
injury, which varies between studies, ranges from 0.05 to 2.9
injuries per player per year (39). The most common injuries
that occur during tennis are to the lower extremity, such as
muscle strains, meniscus tears, and ligament sprains, which
account for 39–59% of the total incidence of injuries (21).
This is followed by injuries to the upper extremity, occurring
in 20–45%, and then the central core, noted in 11–30%.
The effort to reduce injuries in tennis should promote
a decrease in loads or stresses placed on both the lower and
upper extremities by improving technique, strength, dynamic
balance, agility, and aerobic fitness. To date, no study exists in
the medical literature that we are aware of on the effects of
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a training program on neuromuscular indices (speed, agility,

core strength and endurance, and single-leg function and
balance) in adolescent competitive tennis players. We be-
lieved that, with the tremendous number of junior players
participating in tournament and school competition and the
high rate of injuries, a training program should be developed
and assessed first for its effectiveness in improving these
indices and second, for its effectiveness in decreasing the rate
of injuries. A program that does not improve these factors
would not be expected to have a significant impact on re-
ducing injuries in competitive athletes, and therefore, the
measurement of the change in specific neuromuscular indices
was the primary goal of this investigation.
In this manner, we took into account our prior experience in
training athletes with an anterior cruciate ligament (ACL)
prevention program, Sportsmetrics (17) (Cincinnati Sports-
medicine Research and Education Foundation, Cincinnati,
OH, USA). This program has been shown to be effective in
improving neuromuscular indices in female athletes, because
studies have reported improved overall lower limb alignment
(from excessive valgus to neutral) on a drop-jump test (34),
increased hamstrings isokinetic peak torque (17,34,49), increased
knee flexion angles on landing (17,40), and reduced abduction
and adduction moments and ground reaction forces on landing
(17). This training program was also reported to significantly
reduce the risk of noncontact ACL injuries in female athletes
participating in basketball, soccer, and volleyball (16). Figure 1. Left, single-leg hop test. Right, single-leg triple crossover hop test.

We developed a tennis-specific training program for com-

petitive junior players, implementing the essential components
of Sportsmetrics along with other exercises designed to improve
dynamic balance, agility, speed, and strength. The additional
exercises were implemented in an effort to improve indices not
previously studied by knee injury prevention programs (such as
agility and speed). Because compliance with injury prevention
programs has been shown to be problematic (15), we believed
that these additional tennis-specific drills and tasks would be
beneficial in both improved performance and compliance of

Figure 2. Baseline forehand and backhand test.

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 Neuromuscular Training in Junior Tennis Players

Figure 3. Service box test.

the players in attending the majority of the training sessions.
Third, our experience has shown that athletes, parents, and
coaches are more willing to participate in a performance-
enhancement program that contains injury prevention com-
ponents compared to just an injury-prevention program alone.
The purpose of this study was to determine the effective-
ness of this new training program using a battery of tests on
improving specific neuromuscular indices. The goal was to
conduct all training and testing on the court, with limited
equipment required so that this program could be offered at
any tennis facility regardless of financial limitations.
We hypothesized that this
training program would signif-
icantly improve speed, agility,
core strength and endurance, and
single-leg function and balance.
All testing and training were conducted on clay courts
(Har-Tru). Players selected were those who routinely played
in local tournaments and high-school teams. Before each
testing and training session, the subjects completed approx-
imately 5–8 minutes of dynamic warm-up exercises. The
subjects underwent a single hop for distance test, a triple
crossover hop for distance test, a baseline speed and agility
forehand test, a baseline speed and agility backhand test,
a service box speed and agility test, a single-court suicide run,
a 2-court suicide run, and an abdominal endurance test. Three
days later, the subjects were placed into the supervised

METHODS
Experimental Approach to the
Problem
This study was undertaken to
develop a training program for
competitive junior tennis play-
ers using the components of a
previously published training
program proven to improve
neuromuscular indices in ath-
letes, along with additional
sport-specific exercises and
drills. A battery of tests was con- Figure 4. The 1-court suicide is run a straight line; the figure depicts the 8 segments individually for illustrative
ducted to determine the effec- purposes only.
tiveness of this training program.
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TABLE 1. SportsmetricsTM tennis training program.*

Component Day # Exercise Duration

Dynamic warm-up 1–18 1 Lap around 2 courts/side step/arm circles 2 Courts

1 Lap around 2 courts carioca 2 Courts
Straight leg march Baseline–net–baseline
Forward lunge Baseline–net–baseline
Lateral lunge Baseline–net–baseline
Jump training 1–18 Wall jump 20–25 s
1–18 Tuck jump 20–25 s
1–18 Squat jump 10–20 s
1–3 Barrier jump side to side 20 s
1–3 Barrier jump forward–backward 20 s
1–6 180° Jump 20–25 s
1–6 Broad jump 5–10 Reps
7–12 Triple broad jump, vertical 5–8 Reps
7–12 Single-leg triple hop 3 Reps on each leg
13–15 Scissors jump 20 s
13–18 Backward broad jump 5 Reps
16–18 180° scissors jump 20 s
4–18 4-Square, various patterns 25 s
Strength training 1–18 (exercises Medicine ball forehand 2 Sets of 6–16 reps
progressed Medicine ball backhand 2 Sets of 6–16 reps
gradually) Medicine ball overhead 2 Sets of 6–16 reps
Medicine ball backwards, between legs 2 Sets of 6–16 reps
Backward lunge, add hand weight day 7 1–2 Reps, baseline–net–baseline
Single-leg toe raise, add hand weight day 7 3 Sets of 10–20 reps
Seated press-ups 10–20 Reps
Wall push-ups (girls) 3 Sets of 10–20 reps
Regular push-ups (boys) 3 Sets of 10 reps
Biceps and triceps, free weights 3 Sets of 10 reps
Mini–arm circles, tennis ball against wall 2 Sets, 60 s
Wall sits 3 Sets, 45–60 s
Wall sits, ball pressed between legs 3 Sets, 45–60 s
Abdominals: crunches 30–60 s
Abdominals: bicycle 30–60 s
Abdominals: crunches, twisting 30 s
Abdominals: plank, alternate leg raise 60–90 s
Abdominals: superman, alternating 2 Sets of 10 reps
Agility/speed/ 1–18 (5–6 Drills Crossshadow, singles sideline–sideline 2 Sets of 8 reps
cardiovascular performed Net zigzag, baseline–net–baseline 2 Sets of 9 cones
during each Shadow swing baseline 2 Sets, 10 s
session) Forehand with resistance belt 2 Sets, 20 s
Backhand with resistance belt 2 Sets, 20 s
Forehand/backhand baseline reaction 30 s/30 s, rest/2 min
Short/deep ball reaction: forehand 2 Sets of 8 reps
Short/deep ball reaction: backhand 2 Sets of 8 reps
Forehand/backhand alternating reaction 2 Sets of 8 reps
Sprints: baseline–net 10 Reps
Ladder: various patterns 2 Reps
1-Court suicide 4 Reps
2-Court suicide 1 Rep
Return of serve continuous feeds: 2 Sets of 8 reps each side
forehand/backhand

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 Neuromuscular Training in Junior Tennis Players
Flexibility 1–18 Hamstrings
Quadriceps
Iliotibial band
Hip flexor
Gastrocnemius/soleus
Deltoid
Triceps
Pecs/biceps
Low back
*Modified from Barber–Westin and Noyes (3).
neuromuscular training program conducted 3 sessions per
week for 6 weeks. The sessions lasted 1.5 hours and consisted
of a dynamic warm-up, jump training, strength training, speed
and agility drills specific for tennis, and flexibility. All training
sessions were supervised by a certified Sportsmetrics in-
structor and a tennis professional certified by the United
States Professional Tennis Association. Then, the subjects
underwent all of the previously described tests within 1 week
of conclusion of the training program in an identical manner
as that done before the training program was initiated.
Subjects
All testing and training procedures were fully explained, and
written informed parental consent was obtained for each
subject, all of whom agreed to participate. The study was
approved by the Internal Review Board for use of human
subjects. Fifteen junior tennis players (10 girls, 5 boys, mean
age 13.0 6 1.5 years, range, 11–16 years) voluntarily
participated in this study. All subjects had no history of knee
injury or pathology and had no symptoms of pain, patella
instability, or visible joint effusion. All subjects had partici-
pated in competitive tennis for a minimum of 2 years before
this study was initiated. Training was conducted just before
the start of the middle- and high-school tennis season
(November, December) and at a time period when none of
the players were peaking for important tournaments.
No subject participated in other sports or training programs
during the course of the study. The subjects participated in
routine tennis practice on 2 off-days a week (Tuesday,
Thursday).
Procedures
Single-Leg Hop for Distance Test (2,33). A tape measure was
secured to the ground for a distance of approximately 0.5 m.
The subjects began by standing on the designated leg to be
tested with their toe just behind the starting line. They were
instructed to hop as far as possible forward and land on the
same leg, holding that position for at least 2 seconds
(Figure 1). The subjects were allowed to use their arms for
balance as required. After a series of 3–5 trials, the subjects
completed 2 single-leg hops on each limb. The distance
hopped was recorded, the data from the 2 tests for each leg
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20- to 30-s, repeat 2 times
each side
averaged, and limb symmetry calculated by dividing the
mean distance hopped of the right leg by the mean distance
hopped of the left leg, and then multiplying the result by 100.
Research previously conducted by the authors (2) demon-
strated that a limb symmetry index of 85% or greater is
present in the majority (93%) of athletes. This test has
acceptable reliability, with intraclass correlation coefficient
(ICC) . 0.85 (14,42).
Single-Leg Triple Crossover Hop for Distance Test (33). The
subjects began by standing on the designated leg to be tested
with their toe just behind the starting line. Then, they hopped
3 consecutive times on that leg, crossing over the measuring
tape on each hop. The subjects had to be in control and hold
the landing of the third hop for 3 seconds for the test to be
considered. The subjects were allowed to use their arms for
balance as required. After a series of 3–5 trials, the subjects
completed 2 single-leg hops on each limb. The total distance
hopped was measured and the right-left leg limb symmetry
index calculated as described above. This test has acceptable
reliability, with ICC . 0.85 (42,46).
Baseline Speed and Agility Forehand and Backhand Tests (10). A
cone was placed in the center of the baseline and on the
singles sideline of the subjects’ forehand side, 0.9 m inside the
court (Figure 2). The subjects began on the starting position
(center of the baseline) and, upon command, ran to the cone
on the sideline, completed a forehand swing with the racquet,
ran back to the starting position, and continued back and
forth for a period of 30 seconds that was timed with a digital
stopwatch. One repetition equaled 1 full run from the center
to the swing cone and back to center cone or a distance of
5 m. The number of repetitions completed in the 30-second
time period was recorded and converted to the total distance
covered. If a subject reached the swing cone at the end of the
30 seconds, half of a repetition was added to the total count.
The test was also done with the swing cone placed on the
singles sideline of the subjects’ backhand.
Service Box Speed and Agility Test (10). The subjects began in
the middle of the service box in an athletic position. Upon
command, they ran and touched the center service box line
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and then the singles sideline with their racquet, back and
forth, as many times as possible within 30 seconds, which was
timed with a digital stopwatch (Figure 3). Each time the
subject touched a line counted as 1 repetition. The distance
between the 2 lines was 1.1 m. Each subject performed this
test twice, with a 5-minute rest between tests. The mean
number of repetitions was calculated and converted to the
total distance covered. This test has acceptable reliability,
with an ICC of 0.85 calculated in this investigation.
Suicide Tests. Each subject completed a single-court suicide run
(Figure 4). Beginning on the doubles sideline, the subject
moved forward and touched the singles sideline, ran backward
and touched the doubles sideline, ran forward and touched
the center of the baseline, ran backward and touched the
doubles sideline, and so on until all lines were touched for
a total of 46.6 m. The racquet was used to touch the lines. The
time to complete the test was recorded with a digital stop-
watch in one-hundredths of a second. Two subjects performed

TABLE 2. Results of SportsmetricsTM tennis training program*.

Test Pretrain Posttrain Difference p Value Effect size

Baseline forehand (# reps) 8.1 6 1.0 9.0 6 0.7 0.9 6 1.1 0.006 1.04
(6.5–10) (8–10) (20.5 to 1.75)
CI: 7.6–8.7 CI: 8.6–9.4
Total distance (m) 40.6 6 4.7 45.3 6 3.6 4.6 6 5.6 0.007 1.10
(32.6–50.3) (40.2–50.3) (22.5 to 15.3)
CI: 38.0–43.2 CI: 43.3–47.3
Baseline backhand (# reps) 8.2 6 0.8 9.0 6 0.6 0.8 6 0.7 0.0008 1.13
(7–10) (8.25–10) (20.5 to 1.75)
CI: 7.7–8.7 CI: 8.7–9.4
Total distance (m) 41.3 6 4.3 45.4 6 3.0 4.1 6 3.8 0.0009 1.11
(35.2–50.3) (41.4–50.3) (22.6 to 10.1)
CI: 38.9–43.7 CI: 43.8–47.1
Service line (# reps) 20 6 1.8 23.6 6 2.5 3.6 6 3.3 0.0009 1.84
(17–23) (18–28) (22 to 10)
CI: 18.9–21.0 CI: 22.2–25.0
Total distance (m) 80.7 6 8.1 94.1 6 21.1 13.4 6 14.6 0.003 1.30
(67.9–92.6) (69.9–113.2) (28.2 to 45.3)
CI: 76.1–85.2 CI: 87.4–100.8
1-Court suicide (s) 20.02 6 1.48 16.30 6 1.14 3.73 6 0.80 ,0.0001 3.04
(18.28–23.60) (15.12–19.06) (24.54 to 21.97)
CI: 18.96–21.08 CI: 15.48–17.11
2-Court suicide (s) 100.03 6 15.31 90.35 6 10.05 9.68 6 10.24 0.02 0.78
(80.00–129.00) (73.89–101.40) (229.69 to 7.94)
CI: 89.08–110.98 CI: 83.16–97.54
Abdominal endurance test (s) 92.3 6 59.0 145.2 6 62.1 52.9 6 59.3 0.01 0.87
(24–208) (45–223) (214 to 159)
CI: 54.8–129.8 CI: 105.6–184.7
Single-leg triple crossover hop
Right leg (cm) 330.4 6 71.7 366.7 6 59.8 36.3 6 67.5 0.05 0.54
(193.0–482.6) (290.1–525.8) (236.8 to 228.6)
CI: 290.7–370.1 CI: 333.6–399.8
Left leg (cm) 325.7 6 81.6 361.8 6 66.2 36.1 6 59.7 0.03 0.50
(152.4–467.4) (236.2–516.9) (261.4 to 177.8)
CI: 280.5–370.9 CI: 325.1–398.5
Single-leg hop
Right leg (cm) 133.8 6 17.5 139.5 6 21.1 5.7 6 19.0 0.27 0.29
(94.0–170.2) (109.7–200.7) (227.5 to 48.2)
CI: 124.2–143.5 CI: 127.8–151.2
Left leg (cm) 131.2 6 23.2 132.9 6 24.5 1.7 6 11.8 0.59 0.08
(72.4–165.1) (78.7–189.2) (215.2 to 24.1)
CI: 118.4–144.1 CI: 119.3–146.5

*Mean 6 SD, range, 95% confidence intervals.

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 Neuromuscular Training in Junior Tennis Players
the test at the same time as described by Delextrat et al. (5,6) to
encourage them to provide maximal effort.
The subjects also completed a 2-court suicide run on a bank
of 2 courts which were adjacent to each other. Beginning on
the doubles sideline of court-1, they ran a standard forward–
backward suicide, touching every line on both courts.
Abdominal Endurance Test. The subjects were positioned on
a mat or cushion on their back with their arms by their side
while sitting on their hands. Upon command, both legs were
lifted together approximately 15 cm off the ground, and the
player was instructed to maintain this position for as long as
possible. The amount of time that the subjects were able to
maintain this position (keeping both legs off the ground) was
recorded with a digital stopwatch.
Neuromuscular Training Program (3). The training program
consisted of the essential components of Sportsmetrics,
including a dynamic warm-up, plyometric and jump training
instruction, strength training (lower extremity, upper extrem-
ity, core), and flexibility (Table 1 [3]). Other strength, speed,
and agility exercises and drills were added based on a review
of published tennis instruction materials (12,25,27,28,44), the
authors’ experience, and materials from the Etcheberry
Certification for Tennis program (10). The program entailed
a gradual progression of the components to avoid overuse
problems and injuries. A trial training program involving
4 female players was conducted first to determine player
compliance and satisfaction with the program.
All training sessions were supervised by a certified Sports-
metrics instructor and a tennis professional certified by
the United States Professional Tennis Association. The
instructors kept written records of all exercises performed
by each athlete for each training session. There were 3 ses-
sions conducted per week (Monday, Wednesday, Friday) for 6
weeks. Each session lasted 1.5 hours. During the jump training
Figure 5. Single hop for distance video screening allows a qualitative assessment of an athlete’s ability to control the upper and lower extremity upon landing,
which may be rated as either A) good, B) fair to poor, or C) complete failure, fall to ground (from Barber-Westin and Noyes [3]).
the
2378 Journal of Strength and Conditioning Research
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and speed and agility drills, players were encouraged to
maintain a neutral alignment by reinforcing the knees and
ankles to be placed hip distance apart with exaggerated knee
and hip flexion on landing from a jump, decelerating, and
cutting. The trainers and tennis professionals gave constant
feedback on body mechanics during all training drills.
Instructional terms and cues such as ‘‘land softly,’’ ‘‘ keep
your knees and feet directly under hips,’’ and ‘‘bend your
knees deeper’’ were repeatedly used to aid in the education
process. Proper stroke instruction and footwork were also
continually emphasized. Strength training placed an empha-
sis on hamstring, quadriceps, gastrocnemius, soleus, hip
flexion and abduction, and core to aid in proper lower
extremity alignment and muscle recruitment patterns. Upper
body strengthening was accomplished with a medicine ball,
hand weights, and body exercises such as wall push-ups and
seated press-ups. Core strengthening involved a series of
exercises, beginning with 150 repetitions and progressing up
to 300 repetitions. Static flexibility exercises were performed
at the end of each training session.
Statistical Analyses
All data were normally distributed (Kolmogorov–Smirnov
test), and therefore, a 2-tailed paired t-test was used to detect
differences for each test between the pretrain and posttrain
periods. Effect sizes were calculated and interpreted accord-
ing to Cohen’s standards (4). A level of p # 0.05 was
considered to be statistically significant.
RESULTS
No athlete sustained an injury or developed an overuse syn-
drome as a result of the training program. All athletes
completed at least 14 of the 18 training sessions; 3 players
completed 14 sessions, 2 completed 15 sessions, 4 completed
16 sessions, 3 completed 17 sessions, and 3 completed 18 sessions.
TM

Upon completion of training, statistically significant
improvements were found for the baseline forehand and
backhand tests, the service line test, the 1-court suicide, the
2-court suicide, the abdominal endurance test, and the single-
leg crossover hop for both legs (Table 2). Large effect sizes
were noted for the majority of these tests, except the single-
leg hop.
Highly significant improvements were noted for both
baseline tests, because 67% improved the forehand test score
and 80% improved the backhand score. In the service line test,
all but 1 player improved. In the 1-court suicide run, all players
improved, and in the 2-court suicide, all but 1 player improved
their time to complete the test. The greatest average percent
improvement was noted in the abdominal endurance test
(76%), with all but 2 players demonstrating better times.
Normal limb symmetry ($85%) was detected in the single-
leg triple crossover hop in 87% during both test sessions.
A mean improvement of 36 cm was detected in both legs (p #
0.05). Normal limb symmetry was recorded in the single-leg
hop test in 87% of the players during the pretrain test and in
93% at the posttrain test. The mean distance hopped did not
significantly improve between test sessions. Sixty-seven
percent of the players did show some improvement in the
distance hopped on the right leg, whereas 47% had improve-
ment in the left leg.
DISCUSSION
Tennis is a demanding sport for the competitive athlete
because it requires a combination of technique, speed, agility,
explosive power, and aerobic conditioning along with the
ability to react and anticipate quickly and cope with fatigue
and pressure throughout a match (11,43). These attributes
have been demonstrated to correlate with tournament
performance in elite players (24,45). Our training program
is unique in that it comprises a blend of neuromuscular
training and sport-specific enhancement tasks to specifically
improve dynamic balance, agility, speed, and strength. We
were unable to find a similar multiweek program designed
specifically for adolescent competitive female and male
tennis players in the literature to compare our results to,
because most studies provide a single-time physiological
profile of players (1,7,9,13,18,35,36,48).
The neuromuscular training principles and exercises
chosen for this study were derived from a previously
published training program (3,16,17) that was shown to be
effective in improving neuromuscular indices and reducing
the risk of noncontact knee ligament injuries in adolescent
athletes. Our program requires a dedicated tennis pro-
fessional who understands the basis for the neuromuscular
training elements to instill them into the tennis-specific drills,
along with proper stroke and footwork instruction. Super-
vision of training of competitive tennis players is essential for
continued improvement in both the physical and mental
aspects of the game. Kovacs et al. (29) found that just a
5-week period of unsupervised tennis training resulted in
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significant reductions in speed, power, and aerobic capacity
in collegiate nationally ranked players.
The neuromuscular training component included strategies
to enhance dynamic balance and agility during both jump
training and sport-specific drills. The players were taught
to control the upper body, trunk, and lower body position;
lower the center of gravity by increasing hip and knee flexion
during running, jumping, landing; and land with smaller
ground reaction forces. These strategies were also encouraged
during the agility and speed drills that involved straight
running, lateral movements, and backwards jogging with and
without hitting a ball. The plyometric component was used to
not only train for power and explosive movements but also to
enhance the players’ ability to decelerate quickly in a safe
manner (26). The ability to efficiently decelerate in tennis is
just as important as the ability to accelerate, because the
player must be able to stop and change direction in the time
period required to make optimal ball contact and be in
position to continue the rally. The ability to control the body
during both acceleration and deceleration translates into
superior dynamic balance and ultimately, performance.
Malliou et al. (32) recommended that balance training be
incorporated into tennis training programs after noting
a fatigue-induced decline in balance performance in 36 elite
tournament players. In addition, it is believed that many
lower extremity injuries occur because of poor balance and
deceleration techniques or an overabundance of acceleration
training that is not balanced with deceleration training (26).
Salonikidis and Zafeiridis (47) assessed the effects of
3 training programs on 64 novice tennis players aged 21.1 6
1.3 years on speed, reaction time, tennis-specific movements,
and power of the lower limbs. The programs comprised either
plyometric training (6 plyometric exercises), tennis-specific
drills training (6 running drills), or a combination of both and
were conducted 3 times a week for 9 weeks. The authors
reported that the combined training program appeared to be
the most advantageous because it resulted in a significant
improvement in most of the tests conducted including reaction
time, 4-m side steps, 4-m and 12-m sprint runs, drop jump, and
lower extremity maximum isometric force. This program was
only tested in novice players, and the results are thus unknown
for more experienced, competitive players.
Agility in tennis represents the ability of the player to
produce a rapid, reactive change of direction in response to
the motion or pathway of the tennis ball (50). Competitive
tennis players perform countless agility movements during
match play. The mechanics of the movement of the entire
body during the change in direction must be controlled and
efficient and incorporate a high level of dynamic balance. Our
program included both preplanned and reactive tasks in
forward, backward, sideways, and diagonal patterns to
improve agility. Both the dominant and nondominant lower
limb sides were stressed equally. For instance, in the ladder
drills, players completed the patterns in a nonrandomized
order where the drill was initiated with either the right or left
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 Neuromuscular Training in Junior Tennis Players
foot. The results of the 3 agility tests indicated improvements
in 67–93% of the athletes in this study.
Core stability and strength are required for trunk rotation
that occurs during the serve and groundstrokes, especially the
open-stance forehand (23). These elements play an integral
role in tennis performance and are well-established require-
ments in tennis conditioning programs (8,44). The combi-
nation of trunk rotation and upper limb drive (shoulder
internal rotation, elbow extension, wrist flexion) are crucial
components that help bring about optimal racquet speed and
position at ball impact (30). Ellenbecker and Roetert (8)
established an isokinetic profile of trunk rotation strength in
109 elite male and female tennis players aged 11–54 years.
The men had symmetrical strength between the forehand
and backhand directions, and the women had only small (4–
8%) differences in strength between these directions. The
authors suggested that core-stabilization programs should
focus on both directions of trunk rotation to enhance muscle
strength and balance. Our program incorporated numerous
drills and exercises to improve core strength and stability in
both directions, such as twisting lunges with a medicine ball
and exaggerated forehand and backhand medicine ball
throws. Abdominal exercises on mats were performed at
the end of the training sessions, beginning with 150
repetitions the first week and progressing up to 300
repetitions, using a variety of exercises. The training program
appeared effective, because all but 2 players improved in the
abdominal endurance test.
Although the program included upper body strength
exercises, it is recommended that players perform additional
upper body strength training either during the program
sessions or on opposite days that training is conducted. It
is also suggested that this training program be conducted
during a 6-week time period in which the player is not
peaking for important tournaments or school competition. In
this manner, the player focuses on the goals of the program
and will be less likely to miss training sessions because of
travel or tournament scheduling conflicts.
There are many tests that are available to determine
alterations in neuromuscular indices. We choose a small
battery of tests to measure lower limb symmetry and balance,
agility and speed, and abdominal endurance. We avoided pre-
viously described tests that required equipment not normally
available in tennis facilities or that required advanced medical
knowledge. For instance, the United States Tennis Associa-
tion has a testing protocol in which many of the tests require
a physical therapist or athletic trainer to perform with tools
such as a goniometer, blood pressure cuff, grip-strength
dynamometer, and skinfold calipers (44). The tests described
in our study can be performed by any individual without the
need for expensive equipment. Our future assessments will
include the low-cost, established multistage fitness test to
determine VO2max (31,41) and medicine ball throws to
assess upper body strength (44). Girard and Millet (13) con-
ducted a study on elite male tennis players aged 13.6 6 1.4
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2380 Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
years and found asymmetry between the strength of both
upper and lower limbs. The authors suggested the importance
of continual monitoring these factors during puberty and
modification of training to reduce these imbalances and the
risk of injuries. Kovacs et al. (29) also recommended that
coaches assess on a regular basis strength, speed, agility, and
aerobic capacity of elite players to ensure better compliance
with training programs.
We videotaped the single-leg hop tests to show the athlete
and parents the player’s body position on landing to
determine if they had adequate control of the core, upper
extremity, and lower extremity. We found subjectively that
only approximately one-third of the players were able to
maintain an adequate body position on landing before train-
ing (Figure 5). The others demonstrated noteworthy medial–
lateral displacement at the knee joint, along with poor upper
body control and posture. Some athletes had exaggerated
trunk flexion that affected their ability to hold the landing
position. Twenty percent of the players were unable to hold
the landing and fell to the ground (Figure 5C). After training,
marked subjective improvements were noted in the neuro-
muscular control on landing in all but 2 of the players. The
improved technique translated into superior confidence and
significant increases in the distance hopped in the triple
crossover hop. We believe this test provides a measure of
dynamic balance in addition to limb symmetry, more so than
the single hop for distance task. There was no significant
improvement in the single hop for distance test for either the
right or left limb, which could have been because the training
program did not include single-hop training. The only single-
leg exercise was the triple hop, which was done during weeks
3–4. Still, we believe that these single-leg hop functional tests
are valuable in detecting lower limb asymmetry that typically
would not be depicted by the other testing procedures.
Unfortunately, tennis is associated with a unique profile of
injuries because of its demands and the tremendous range of
age and skill level of players. To date, there have been no
published injury prevention training programs designed
specifically for this sport. In a review of 119 articles, Pluim
et al. (39) concluded, ‘‘we were unable to identify measures
proven to prevent tennis injuries.’’ Kibler and Safran (21)
noted that specific alterations in mechanics, such as incom-
plete flexion of the knee (less than 10°) in the cocking phase
of the serve, increased loads in the shoulder and elbow by 23
and 27%, respectively. Overuse injuries are common, in-
cluding patellofemoral pain syndromes, patellar tendinitis,
bursitis, Achilles tendinitis, plantar fasciitis, rotator cuff
inflammation, lateral epicondylitis, and medial epicondylitis.
In a study of 4 United States National Association national
junior tournaments, the incidence of medical withdrawals
was calculated to be 11.7 per 1,000 athletic exposures in the
14 and under age group, which increased to 20.6 in the 16
and under group and 22.7 in the 18 and under group (20).
Our future goals are to determine if this program is effective
in reducing injuries in junior tennis players and to assess if

a difference exists between genders in changes in neuro-
muscular indices after training.
There exists a tremendous array of tennis instructional
materials, from books to videotapes to online sources.
Although many of these resources provide sound advice
based on medical and research experience, it is difficult to find
a specific training protocol in which the exercise progression
is provided in detail and is based on a program proven to
improve neuromuscular indices in young athletes. Therefore,
our purpose was to develop a tennis-specific training program
for competitive junior players that implemented the essential
components of Sportsmetrics and added exercises and drills
designed to improve dynamic balance, agility, speed, and
strength. The results of this study show that this program is
feasible, low in cost, and appears to be effective in improving
the majority of neuromuscular indices tested. One limitation
is that there was no control or comparison group in this
investigation, which will be included in future studies.
PRACTICAL APPLICATIONS
We devised a 6-week training program for competitive junior
tennis players. The program is unique in that it incorporates
jump training and other drills from a previously published
training program reported to improve neuromuscular indices
and reduce the risk of knee ligament injuries in adolescent
athletes. The supervised training sessions are conducted
3 times a week for 1.5 hours per session. The program
includes a dynamic warm-up, plyometric and jump training,
strength training (lower extremity, upper extremity, core),
tennis-specific drills, and flexibility. This program is low in
cost and appears to be effective in improving speed, agility,
abdominal endurance, and single-leg function and balance in
young tennis players. All training and testing procedures are
performed on the tennis court, and we recommend that this
program be conducted during a time period in which the
player is not peaking for important tournaments or school
competition. Further research is required to determine if this
training program can reduce the incidence of injuries in tennis
players.
ACKNOWLEDGMENT
The authors would like to thank Gateway Golf and Country
Club, Fort Myers, Florida.
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