The Difficulty of Coming Back From Serious Tennis Injuries

It didn’t take long for Alexander Zverev to realize his situation was dire.

After hours of scintillating shot-making, Zverev and Rafael Nadal were set to begin a second tiebreaker in their semifinal match at last year’s French Open.

But suddenly, Zverev ran wide for a forehand, rolled his right ankle on its side and let out a bellow. He stumbled to the ground, red clay caked to the back of his black sleeveless top, and cupped his ankle in his hands.

“I knew immediately that I was done because my ankle was basically three times the size it normally is,” said Zverev by phone of the injury that took him from tennis for the rest of 2022 and dropped his ATP ranking from No. 2 to outside the top 20. “It wasn’t a nice feeling.”

Zverev is hardly the first player to be forced into an extended layoff because of a serious injury.

His opponent that day, Nadal, hasn’t played a tour match since he hurt the psoas muscle between his lower abdomen and upper right leg during the Australian Open in January. After repeated attempts to rehab the injury over the last four months, Nadal — who has also suffered from chronic foot pain, a cracked rib and a torn abdominal muscle in the last 18 months — withdrew from the French Open on May 18. He is the 14-time Roland Garros champion and has played the tournament every year since 2005. He also indicated that he does not plan to play Wimbledon and that 2024 will likely be his last year on the professional tour.

Emma Raducanu, who won the 2021 United States Open, has been frequently injured ever since, and recently underwent surgery on both of her wrists and one ankle. Andy Murray, a Wimbledon and U.S. Open champion, announced before the 2019 Australian Open that he would retire after the tournament, only to come back, first playing doubles, then returning to singles following a successful hip resurfacing surgery.

Bianca Andreescu, who beat Serena Williams to win the 2019 U.S. Open, has suffered injuries to her adductor, ankle, foot, back, and right shoulder, causing her to question whether she should stop competing. And Stan Wawrinka, a three-time major champion, contemplated retirement following multiple surgeries on his knee and ankle. Once ranked world No. 3, Wawrinka is now fighting to stay in the top 100.

Injuries, surgery and rehab are dreaded words in any athlete’s vocabulary. For professional tennis players, who are not protected by a team sport’s comprehensive rehabilitation coverage but are instead treated as independent contractors, working their way back onto the ATP and WTA Tours can be grueling physically, mentally and even financially.

“I had never experienced an injury from the time I started, and I played with high intensity every day,” said Dominic Thiem by phone. Thiem, who beat Zverev to win the 2020 U.S. Open, suffered a debilitating wrist injury in June 2021 and was sidelined for months. Once ranked No. 3, Thiem lost seven straight matches when he first returned to the ATP Tour, and his ranking plummeted to No. 352, forcing him to play lower-level Challenger tournaments.

“With an injury, the whole system comes to a stop,” said Thiem, who is now ranked just inside the top 100. “You can’t do your job, and you no longer have a clear plan. After I returned, it was like never before. You have to lower your expectations, but that’s very tough because for all those years you set for yourself a certain standard, not only from the tournaments you play, but also how you feel the ball. Basically, everything changes.”

The process of returning from a layoff can be just as difficult as the injury itself. Readjusting to the rigors of constant travel and the pressure of playing matches at all hours of the day and night, along with worrying about the possibility of reinjury, can impact a player’s recovery.

Andreescu knows that. Plagued by back troubles through much of 2022, she had finally begun to rebound at the Miami Open in March. But during her fourth-round match against Ekaterina Alexandrova, Andreescu tumbled to the court, clutching her left leg and screaming in agony.

“I’ve never felt pain like that,” Andreescu said by phone as she prepared to return to the tour three weeks later in Madrid. “The next morning I knew what happened, but I was just hoping that I was waking up from a bad dream. Then I felt the pain, and I knew this was real.”

Andreescu has rehabbed her body many times before, but she is also convinced that the mind-body connection is just as important.

“I believe that everything starts in the head and that we create our own stress and, in a way, our own injuries,” she said. “There can be freak accidents, but if you can get your mind right, then it’s easier to come back from those injuries.”

The WTA takes injury prevention and rehabilitation seriously. The tour has programming and staff devoted specifically to athletes’ physical and psychological well-being. According to Carole Doherty, the WTA’s senior vice president, sport science and medicine, all its players receive comprehensive medical care, with services that include cardiology, checkups with dermatologists, bone-density exams, and nutrition and hydration advice.

When a WTA player is out injured, or pregnant, for at least eight consecutive weeks, she can apply for a Special Ranking, which means that upon her return she will be ranked where she left off and can enter eight tournaments over a 52-week span with that ranking. The ATP has a similar protocol called Protected Ranking.

Becky Ahlgren Bedics, the WTA’s vice president of mental health and performance, is keenly aware of the psychological toll an injury can take.

“Injuries take you out of training and competition and force you to regroup and prioritize your life differently,” said Bedics, who encourages players who are off the tour to delete WTA rankings from their phones, so they won’t see where they stand as compared with their peers. “It’s tough for an athlete whose only thought is, ‘How can I get back, and what happens if I don’t?’”

Bedics and her mental health team encourage players to manage their expectations upon their return to play.

“There are so many stressors in this game, including financial ones,” Bedics added. “Our athletes are typically very young and not going to be doing this for 50 years. Sometimes they are supporting their families. So, what we help them do is listen to ‘what is,’ not ‘what ifs.’ We want them to look forward, but also to look backward to see how far they’ve come.”

Daria Saville understands the play-for-pay nature of tennis. She has suffered from repeated Achilles’ tendon and plantar fasciitis issues since 2016. She had surgery after the 2021 Australian Open, which kept her from playing for nearly a year. Then, while competing in Tokyo last September, she tore her anterior cruciate ligament, requiring more surgery.

“Every time I get injured, I think about my life and wonder what it will be like without tennis,” said Saville, who also had ACL surgery in 2013. “On tour, life is not so hard. Everything is done for you, so you don’t have to overthink. The worst thing that happens is you play bad and lose a match.”

Fortunately, for Saville, the financial burdens have been lessened by the support she receives from her national federation, Tennis Australia, which pays for her physiotherapist and strength and conditioning coaches. She also gets pep talks from her coach, the former tour player Nicole Pratt.

When Thiem thinks back on his wrist injury, he connects the dots to when he won the U.S. Open. Having achieved that goal, Thiem said, he suddenly lost his passion and motivation to play, prompting him to practice with a decreased level of intensity, ultimately leading to the injury. Trying to come back has been difficult.

“I can’t forget,” Thiem said, “that all the time when I didn’t play, the other players were playing, they were practicing and improving and moving ahead of me. That makes it even harder to come back.”