{"id":11956,"date":"2026-09-18T06:00:44","date_gmt":"2026-09-18T05:00:44","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11956"},"modified":"2026-09-03T16:28:38","modified_gmt":"2026-09-03T15:28:38","slug":"growth-matters-injury-risk-changes-with-biological-maturation-in-junior-tennis-players","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2026\/09\/18\/growth-matters-injury-risk-changes-with-biological-maturation-in-junior-tennis-players\/","title":{"rendered":"Growth matters: injury risk changes with biological maturation in junior tennis players"},"content":{"rendered":"<p><b>Keywords: <\/b><span style=\"font-weight: 400\">junior tennis, biological maturation, peak height velocity, injury prevention, youth athletes<\/span><\/p>\n<p><span style=\"font-weight: 400\">This blog provides a summary of our recent study published in the <\/span><i><span style=\"font-weight: 400\">British Journal of Sports Medicine <\/span><\/i><span style=\"font-weight: 400\">[1].<\/span><\/p>\n<p><b>Why is this study important?<\/b><\/p>\n<p><span style=\"font-weight: 400\">Junior tennis players are not simply \u201csmall adults\u201d. During adolescence, athletes experience rapid changes in height, body composition, muscle strength, flexibility and coordination [2]. These changes can affect how the body responds to tennis training and competition [3].<\/span><\/p>\n<p><span style=\"font-weight: 400\">In many youth sports, injury prevention is still often based on chronological age, such as under-12, under-14, under-16, or under-18 categories [4]. However, two athletes of the same chronological age may be at very different stages of biological maturation [5]. One player may be in the middle of a growth spurt, while another may already be several years past it.<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is especially important in tennis, where young athletes are exposed to repeated sprinting, stopping, changing direction, trunk rotation and high-volume hitting [6]. Despite this, little has been known about how biological maturation relates to injury risk in junior tennis players. We wanted to better understand when young tennis athletes may be most vulnerable to injury and whether these vulnerable periods differ between boys and girls.<\/span><\/p>\n<p><b>How did the study go about this?<\/b><\/p>\n<p><span style=\"font-weight: 400\">We retrospectively analyzed 15 competitive seasons of data from a tennis academy in Japan. The study included 100 junior tennis athletes, with 50 boys and 50 girls.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We estimated each athlete\u2019s biological maturation using age at peak height velocity (APHV), which is calculated from the longitudinal height data. APHV refers to the age when an athlete reaches their fastest rate of height growth during adolescence (Figure 1).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11957\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-1-300x199.png\" alt=\"\" width=\"423\" height=\"281\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-1-300x199.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-1.png 512w\" sizes=\"auto, (max-width: 423px) 100vw, 423px\" \/><\/p>\n<p><b>Figure 1<\/b><span style=\"font-weight: 400\">: An example of a growth velocity curve showing the identification of peak height velocity (PHV) and age at peak height velocity (APHV).<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u00a0This is a useful marker because it allows us to look at injury risk in relation to each athlete\u2019s own growth timing, rather than simply using chronological age [7].<\/span><\/p>\n<p><span style=\"font-weight: 400\">Each athlete\u2019s development was divided into five maturity phases:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">more than 18 months before APHV\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">18 to 6 months before APHV\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">around APHV\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">6 to 18 months after APHV\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">more than 18 months after APHV\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">We then examined injury incidence and injury burden across these phases. Injury incidence tells us how often injuries occurred, while injury burden also considers severity by including the number of days lost from sport [7].<\/span><\/p>\n<p><b>What did the study find?<\/b><\/p>\n<p><span style=\"font-weight: 400\">We found large individual differences in maturation timing. In both boys and girls, the difference between the earliest and latest maturing athletes was approximately 4.5 years (Figure 2). This means that athletes of the same chronological age may have very different maturation status.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We also found clear sex-based differences. Boys reached APHV at approximately 13.2 years of age, whereas girls reached APHV at approximately 11.5 years of age. Boys also had a higher peak height velocity than girls (Figure 2).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11958\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-2-300x106.png\" alt=\"\" width=\"583\" height=\"206\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-2-300x106.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-2.png 512w\" sizes=\"auto, (max-width: 583px) 100vw, 583px\" \/><\/p>\n<p><b>Figure 2: Growth velocity curves for boys (A) and girls (B)<\/b><\/p>\n<p><span style=\"font-weight: 400\">APHV: age at peak height velocity; PHV: peak height velocity. Boys: n=50, Girls: n=50. *Significant sex difference (p &lt; 0.05)<\/span><\/p>\n<p><span style=\"font-weight: 400\">A total of 256 injuries were recorded over the study period. Lower limb injuries were the most common in both boys and girls, followed by upper limb and trunk injuries. Tendon injuries were the most frequent injury type in both sexes, contrasting with the predominance of muscle injuries often reported in adult tennis players. This finding may reflect the unique mechanical demands placed on the developing musculoskeletal system [8].<\/span><\/p>\n<p><span style=\"font-weight: 400\">The timing of highest injury risk differed between boys and girls. In boys, injury incidence and injury burden were highest around APHV (Figure 2 and Figure 3). This suggests that the period of rapid growth may be a key window of vulnerability for boy tennis players. In girls, the highest injury incidence and injury burden occurred after APHV (Figure 2 and Figure 3). This suggests that injury prevention in girl tennis players may need to continue beyond the growth-spurt period, especially as training exposure and sport-specific demands increase.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11959\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-3-300x96.png\" alt=\"\" width=\"591\" height=\"189\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-3-300x96.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-3.png 512w\" sizes=\"auto, (max-width: 591px) 100vw, 591px\" \/><\/p>\n<p><b>Figure 3<\/b><span style=\"font-weight: 400\"> Injury incidence (number of injuries per year) plots for boys (A) and girls (B). Boys: n=114 injuries and girls: n=142 injuries. *p=0.016, **p=0.004, ***p=0.003, ****p=0.002, *****p&lt;0.001. Error bars indicate 95% CIs.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11960\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-4-300x91.png\" alt=\"\" width=\"599\" height=\"182\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-4-300x91.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/tennis-4.png 512w\" sizes=\"auto, (max-width: 599px) 100vw, 599px\" \/><\/p>\n<p><b>Figure 4 <\/b><span style=\"font-weight: 400\">Injury burden (days absence per year) plots for boys (A) and girls (B). Boys: n=114 injuries and girls: n=142 injuries. *p=0.038, **p=0.036. Error bars indicate 95% CIs.<\/span><\/p>\n<p><b>What are the key take-home points?<\/b><\/p>\n<p><span style=\"font-weight: 400\">Our study suggests that junior tennis injury prevention should consider biological maturation, not just chronological age.<\/span><\/p>\n<p><span style=\"font-weight: 400\">For boys, the period around APHV may be a particularly important time to monitor training load, flexibility, trunk function and growth-related symptoms. For girls, clinicians and coaches should remain alert to injury risk after APHV, when tennis-specific exposure and physical demands may continue to increase.<\/span><\/p>\n<p><span style=\"font-weight: 400\">A practical message is that growth should be tracked routinely. Regular height measurements can help identify when an athlete is approaching or passing through their growth spurt. This information can support more individualized decisions about training volume, recovery, conditioning and injury prevention.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The main message is simple: in junior tennis players, injury risk changes with maturation, and the timing of risk differs between boys and girls. To protect young athletes and support long-term development, clinicians, coaches and parents should look beyond age categories and pay attention to each athlete\u2019s biological growth stage.<\/span><\/p>\n<p><b>Authors information<\/b><span style=\"font-weight: 400\">: Dr Yoshimasa Saigo and Daichi Morikawa, Department of Orthopaedics, Faculty of medicine, Juntendo University, Tokyo, Japan.<\/span><\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li><span style=\"font-weight: 400\">1<\/span><span style=\"font-weight: 400\">.<\/span> <span style=\"font-weight: 400\">Saigo, Y., et al., <\/span><i><span style=\"font-weight: 400\">Injury risk and its relationship with biological maturation among 100 junior tennis athletes: a 15-year retrospective analysis.<\/span><\/i><span style=\"font-weight: 400\"> Br J Sports Med, 2026.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Terry A. Adirim, T.L.C., <\/span><i><span style=\"font-weight: 400\">Overview of Injuries in the Young Athlete.<\/span><\/i><span style=\"font-weight: 400\"> Sports Med, 2003. <\/span><b>33<\/b><span style=\"font-weight: 400\">: p. 75-81.<\/span><\/li>\n<li><span style=\"font-weight: 400\">DiFiori, J.P., et al., <\/span><i><span style=\"font-weight: 400\">Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine.<\/span><\/i><span style=\"font-weight: 400\"> Br J Sports Med, 2014. <\/span><b>48<\/b><span style=\"font-weight: 400\">(4): p. 287-8.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Rice, R.P., et al., <\/span><i><span style=\"font-weight: 400\">Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players.<\/span><\/i><span style=\"font-weight: 400\"> Sports Health, 2022. <\/span><b>14<\/b><span style=\"font-weight: 400\">(4): p. 466-477.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Katsunori Fujii, S.D., Jinzaburou Matsuzawa, <\/span><i><span style=\"font-weight: 400\">Optimum Onset Period for Training Based on Maximum Peak Velocity of Height by Wavelet Interpolation Method in Japanese High School Athletes.<\/span><\/i><span style=\"font-weight: 400\"> J Physiol Anthropol Appl Human Sci, 2005. <\/span><b>24<\/b><span style=\"font-weight: 400\">: p. 15-22.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Hjelm N, W.S., Renstrom P. , <\/span><i><span style=\"font-weight: 400\">Injury profile in junior tennis players: a prospective two year study.<\/span><\/i><span style=\"font-weight: 400\"> Knee Surg Sports Traumatol Arthrosc., 2010. <\/span><b>6<\/b><span style=\"font-weight: 400\">: p. 845-50.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Monasterio, X., et al., <\/span><i><span style=\"font-weight: 400\">The burden of injuries according to maturity status and timing: A two-decade study with 110 growth curves in an elite football academy.<\/span><\/i><span style=\"font-weight: 400\"> Eur J Sport Sci, 2023. <\/span><b>23<\/b><span style=\"font-weight: 400\">(2): p. 267-277.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Pluim, B.M., et al., <\/span><i><span style=\"font-weight: 400\">Tennis injuries: occurrence, aetiology, and prevention.<\/span><\/i><span style=\"font-weight: 400\"> Br J Sports Med, 2006. <\/span><b>40<\/b><span style=\"font-weight: 400\">(5): p. 415-23.<\/span><\/li>\n<\/ol>\n<p><b>AI policy<\/b><\/p>\n<p><i><span style=\"font-family: arial, sans-serif\">BMJ will consider content where\u00a0AI\u00a0technologies are used. Our approach is one of transparency. Where\u00a0AI\u00a0technology has been used this should be clearly described. Editors will consider the suitability of the use outlined. Our approach is in line with organisations including the\u00a0<a href=\"https:\/\/wame.org\/page3.php?id=106\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/wame.org\/page3.php?id%3D106&amp;source=gmail&amp;ust=1788535411777000&amp;usg=AOvVaw31DAd9f5K0x38QHSJvJlOd\">World Association of Medical Editors (WAME)<\/a>\u00a0and the\u00a0<a href=\"https:\/\/publicationethics.org\/cope-position-statements\/ai-author\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/publicationethics.org\/cope-position-statements\/ai-author&amp;source=gmail&amp;ust=1788535411777000&amp;usg=AOvVaw3q0jgE-hv2u1Pv9qtpQvJ7\">Committee on Publication Ethics (COPE)<\/a>.<\/span><\/i><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Keywords: junior tennis, biological maturation, peak height velocity, injury prevention, youth athletes This blog provides a summary of our recent study published in the British Journal of Sports Medicine [1]. Why is this study important? Junior tennis players are not simply \u201csmall adults\u201d. During adolescence, athletes experience rapid changes in height, body composition, muscle strength, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2026\/09\/18\/growth-matters-injury-risk-changes-with-biological-maturation-in-junior-tennis-players\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[8316,16068,16508,2894],"class_list":["post-11956","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-exercise-physiology","tag-featured","tag-growth","tag-tennis"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Growth matters: injury risk changes with biological maturation in junior tennis players - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/?p=11956\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Growth matters: injury risk changes with biological maturation in junior tennis players - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Keywords: junior tennis, biological maturation, peak height velocity, injury prevention, youth athletes This blog provides a summary of our recent study published in the British Journal of Sports Medicine [1]. 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Why is this study important? Junior tennis players are not simply \u201csmall adults\u201d. 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