The Effect of A Neuromuscular Vs Dynamic Warm Up.9

Original Research
The Effect of a Neuromuscular vs. Dynamic Warm-up

on Physical Performance in Young Tennis Players
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Jaime Fernandez-Fernandez,1,2,3 Vicente Garcı́a-Tormo,1 Francisco Javier Santos-Rosa,4

Anderson Santiago Teixeira,5,6 Fábio Yuzo Nakamura,7,8,9 Urs Granacher,10 and David Sanz-Rivas3
CX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 01/05/2024
1
Department of Physical Activity and Sport Sciences, University of Léon, León, Spain; 2AMRED, Human Movement and Sports
Performance Analysis, University of Léon, León, Spain; 3Spanish Tennis Federation, Madrid, Spain; 4Faculty of Sport, Pablo de Olavide
University, Seville, Spain; 5Physical Effort Laboratory, Sports Center, Federal University of Santa Catarina, Florianópolis, Brazil;
6
Research Group for Development of Football and Futsal, Sports Center, Federal University of Santa Catarina, Florianópolis, Brazil;
7
Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy; 8The College of Healthcare
Sciences, James Cook University, Townsville, Australia; 9UPE/UFPB, João Pessoa, Brazil; and 10Division of Training and Movement
Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
Abstract
Fernandez-Fernandez, J, Garcı́a-Tormo, V, Santos-Rosa, FJ, Teixeira, AS, Nakamura, FY, Granacher, U, and Sanz-Rivas, D. The
effect of a neuromuscular vs. dynamic warm-up on physical performance in young tennis players. J Strength Cond Res 34(10):
2776–2784, 2020—The aim of this study was to examine performance-enhancing (i.e., training) effects of a neuromuscular warm-
up (NWU) compared with a dynamic WU (DWU) in young tennis players. Twenty-eight well-trained male tennis players with a mean
age of 15.09 6 1.16 years participated in this study and were assigned to either a training group performing NWU (n 5 14), or
a group that followed DWU (n 5 15) before tennis-specific training, for 8 weeks. Pretest and posttest included: speed (5, 10, and
20 m); modified 5-0-5 change of direction (COD) test; bilateral/unilateral countermovement jump (CMJ); 2 kg overhead, forehand,
and backhand-side medicine ball throw performance (MBT); serve velocity, and shoulder strength and range-of-motion (ROM)
performance (i.e., internal [IR]/external [ER] rotation). Results showed that both groups, NWU and DWU, significantly improved their
sprint performances (5–20 m; [p , 0.05; d 5 0.83–1.32]), CMJ (bilateral and unilateral [dominant side] [p , 0.005; d 5 1.27–1.59]),
overhead MBT (p 5 0.014; d 5 1.02), and some shoulder strength (i.e., IR dominant side [D], ER D, ER/IR ratio [p , 0.05; d 5
0.86–1.59]) and ROM (i.e., ER D, total ROM D [p , 0.05; d 5 0.80–1.02]) values. However, the interaction effects revealed that NWU
compared with DWU produced greater performance gains in most of the analyzed parameters (i.e., 5–10 m sprint, CMJ, overhead
MBT, serve speed). The inclusion of an NWU characterized by a relatively low volume (;20–35 minutes), including general mobility,
core, and shoulder strength exercises, combined with neuromuscular-related exercises (e.g., plyometric and acceleration/
deceleration/COD drills), can be recommended to obtain positive effects in tennis performance-related variables.
Key Words: athletic performance, intermittent sport, mobility, neuromuscular qualities
Introduction Andersson et al. (1) examined the effects of a shoulder-injury

prevention program, implemented 3 times per week, during a 7-
Tennis is an intermittent sport in which players require a mix-
month handball season. The results of this study showed that the
ture of physical components, such as speed, agility, muscle
intervention compared with the control group experienced
power, and cardiovascular fitness, to achieve high levels of
a 28% lower risk of sustaining shoulder problems and a 22%
performance (20). Because of the demands placed on the body
lower risk of substantial shoulder problems.
during training and competition, tennis players are susceptible
Before sport-specific training and competitions, tennis players,
to a range of injuries including chronic overuse conditions and
like most athletes from different sports, perform warm-up rou-
acute traumatic injuries (25). There is limited evidence that total
tines with the goal to achieve high levels of explosive force and
body and lower-extremity warm-up (WU) programs have the
potential to acutely enhance performance and prevent injuries power before a competitive activity (48). These acute
(2,36). This injury-preventive effect has particularly been shown performance-enhancing effects can be caused by increases in in-
for WU programs such as FIFA 111 and Harmoknee in amateur tramuscular temperature, nerve conduction velocity, and meta-
soccer (2,4). By contrast, there is a lack of research on the use of bolic reactions (10,35). A previous study showed that a dynamic
WU exercises to prevent upper-body injuries. Based on a pre- WU (DWU) protocol (i.e., cardiovascular activation followed by
vious systematic review analyzing warm-up in a population of dynamic stretching [DS] and tennis-specific exercises) compared
sport athletes (i.e., from youth to adult ages) (36), there is evi- to traditional WU strategies (i.e., including static stretching)
dence that dynamic, high-load upper-body WU has the potential resulted in improvements (3.9–11%) in jump and sprint per-
to enhance strength and power outcomes. More recently, formances as well as in serve speed in elite junior tennis players
Address correspondence to Dr. Vicente Garcı´a-Tormo, [email protected]. (3). Similarly, other studies that incorporated DS within a warm-
Journal of Strength and Conditioning Research 34(10)/2776–2784 up routine also showed enhancements in physical qualities (e.g.,
ª 2020 National Strength and Conditioning Association vertical jump height, 20-m sprint times, serve speed (26,53,54)).
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The Effect of a Neuromuscular vs. Dynamic Warm-up (2020) 34:10 | www.nsca.com
As previously mentioned, there is evidence that WU programs years and participated in 18–20 hours of tennis training per week.
have positive acute to long-term effects on selected performance The main focus of tennis training was the development of on-
measures in some team sports (i.e., football, netball) court technical/tactical tennis skills, as well as the enhancement of
(2,4,29,37,57). However, to the best of our knowledge, no pre- tennis-specific fitness. Players were eligible to be included in this
vious research analyzed the long-term effects of a neuromuscular study if they were free from any severe injuries, did not have
WU (NWU) program (i.e., including a combination of funda- surgeries, or did not conduct any sport-related rehabilitation
mental movements and specific strength and conditioning activ- programs during the 12 months before the start of the study.
ities [e.g., dynamic stability, core focused strength, plyometrics, Study subjects were randomly assigned to either a training group
and agility]) on physical performance in youth tennis. Although performing the NWU (n 5 14) or an active control group that
the main purpose of NWU is injury prevention (41), it is timely to followed a DWU (n 5 15). Tennis-specific training was always
examine WU-related training effects (e.g., changes in upper-body conducted after the WUs. Baseline tests were used to control for
and lower-body strength) to identify the potential mechanisms the initial fitness status of the players. All players were ranked
underlying the injury-preventive effect in a short-term or long- among the 250 top players in their respective national singles
term perspective. Thus, the aim of this study was to examine ranking category (U16). Before the start of this investigation,
performance-enhancing (i.e., training) effects of DWU compared written informed consent was obtained from both subjects and
with a DWU in young tennis players. We hypothesized that NWU their parents/legal guardians. All subjects were fully informed
would result in significant performance gains after an 8-week about the testing and training protocols. The procedures were
training period. approved by the Spanish Tennis Federation (RFET19/1) ethics
review committee (RFET19/1) and in agreement with the ethics
code of the World Medical Association (Declaration of Helsinki).
Methods
Experimental Approach to the Problem Testing Procedures: Maturity Status. Body height was measured
using a fixed stadiometer (60.1 cm; Holtain Ltd., Crosswell, United
A 2-group, matched for age and maturity status, experimental Kingdom), sitting height using a purpose-built table (60.1 cm; Holtain
design was used in this study. Study subjects were randomly Ltd.), and body mass using a digital balance (60.1 kg; ADE Electronic
assigned to either a training group performing NNWU (n 5 14; Column Scales, Hamburg, Germany). Pubertal timing was estimated
age 14.96 6 0.88 years, body mass 60.34 6 9.13 kg, height according to the biological maturation of each individual using the
172.50 6 7.08, estimated age at peak height velocity (PHV) 14.03 predictive equation described by Mirwald et al. (38). Calculating the
6 0.61 years), or a group that followed a DWU ( n 5 15; age biological maturation of each subject (years) was achieved by sub-
15.21 6 1.40 years, body mass 59.50 6 10.90 kg, height 172.57 tracting the chronological age at the time of measurement from the
6 7.90 cm, estimated age at PHV 14.38 6 0.90 years). The study chronological peak-velocity age (51). Therefore, a maturity age of 2
was conducted during the second part of the preparatory period 1.0 indicates that the player was measured one year before their PHV;
(January–March). Both WU programs were conducted before the a maturity of 0 indicates that the player was measured at the time of
tennis-specific training sessions. After an appropriate familiar- their PHV; and a maturity age of 11.0 indicates that the subject was
ization period, physical fitness tests were completed one week measured 1 year after their PHV (51).
before and after the 8-week training period. Test time during the
day was similar during pretests and posttests to avoid perfor- Speed Test. Time during a 20-m dash (with 5- and 10-m split times)
mance fluctuations due to the circadian rhythm. Preintervention in a straight line was measured by means of single-beam photocell
and postintervention tests were conducted for the assessment of gates that were placed 1.0 m above the ground level (DSD Sport
20-m sprint performance, with 5- and 10-m split times, counter- system, León, Spain). Each sprint was initiated 50 cm behind the
movement jump (CMJ) performance, 5-0-5 change of direction photocell gate. The digital timer started after the player crossed the
(COD) test, 2 kg overhead, forehand, and backhand-side medi- gate. Each player performed 2 maximal 20-m sprints with at least 2
cine ball throw performance (MBT), serve velocity (SV) perfor- minutes of passive recovery in between the 2 trials (55). The best
mance, shoulder strength, and range-of-motion (ROM) performance was recorded and used for offline analysis. The
performance (i.e., internal/external rotation). All fitness tests were intraclass correlation coefficient (ICC) for this test was 0.96.
performed on an outdoor synthetic court (pretests vs. posttests).
Between the last training session and the posttests, only light on- Modified 5-0-5 Change of Direction Test. The abilities of the
court training combined with injury-preventive exercises (e.g., athletes to perform a single, rapid 180° change of direction over
core training, shoulder strengthening, and flexibility) were a 5-m distance was measured using a modified version (stationary
scheduled. To reduce interference from uncontrolled variables, all start) of the 5-0-5 test (43). Players started without a racquet in
athletes were instructed to maintain their habitual lifestyle and a standing position with their preferred foot 1 m behind the
normal dietary intake before and during the study. They were told timing gate (DSD Sport system). After they crossed the photocell,
not to exercise on the day before a test and to consume their last the digital timer started and they accelerated at maximal effort.
(caffeine-free) meal at least 24 hours before the scheduled test One trial pivoting on both left and right feet was completed and
time. the best time recorded to the nearest 0.01 seconds (Figure 1). A
2-minute rest was allowed between trials. The ICC was 0.92.
Subjects
Vertical Jump Test. A CMJ without arm swing was performed on
Twenty-nine well-trained male tennis players aged 15.09 6 1.16 a contact-time mat (Ergojump, Finland) according to the proce-
years participated in this study (mean 6 SD:body mass 59.90 6 dures as described by Bosco et al. (11). Each player performed 2
9.91 kg, body height 172.53 6 7.38 cm; 6 age at PHV 0.88 6 maximal CMJs interspersed with 45 seconds of passive recovery.
0.94). Twenty-seven players were right-handed and 2 were left- The best jump height was recorded for each athlete and used for
handed. Subjects had a mean training background of 5.0 6 1.2 further analysis. The ICC of the CMJ was 0.96.
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The Effect of a Neuromuscular vs. Dynamic Warm-up (2020) 34:10
Serve Velocity Test. Serve velocity was measured using new tennis
balls (Babolat Team) with a radar gun (model SR3600, Homo-
sassa, FL; range 80–232 km·h21). In accordance with the man-
ufacturer’s specifications, the radar gun was calibrated before
each test session. In line with previous research (22), the radar was
positioned on the center of the baseline, 3 m behind the server,
aligned with the approximate height of ball contact (;2.2 m) and
pointing down the center of the court. Each Subject performed 3
sets of 10 maximal flat serves (i.e., slice was not allowed) to the
advantage court with a 30-second rest between each set and ap-
proximately 10 seconds between each serve. To be eligible for
analysis, serves had to fall into the service box within 1 m of the
center service line. Direct feedback of the respective SV was
provided to encourage maximal effort. Before testing, a specific 5-
minute serve warm-up time was allowed that included upper-
body mobility and 2 sets of 8 first and second serves. Finally, the
average velocity of the 8 best trials was used for further analysis.
The ICC for this test was 0.88.
Medicine Ball Throw Test: Overhead, Forehand, and Backhand.

For the overhead MBT, the players held a 2-kg medicine ball, with
both hands, in front of their chest and they stood on a line facing
toward the throwing direction with their feet side-by-side and
shoulder-width apart. The throwing motion was started with
a countermovement behind the head. Thereafter, the ball was
Figure 1. Structure and dimensions of the 505 change of
direction test. m 5 meters.
vigorously accelerated until it left the hands. The players were not
allowed to cross the line. In addition, players performed a fore-
hand and backhand MBT throw, which was in accordance with
a previous study (55). For this purpose, players stood sideways to
Shoulder Range of Motion Test. The passive glenohumeral rota- the starting line and simulated a forehand-backhand stroke. They
tion was assessed following the methodology as previously de- tossed the ball as far as possible, using both hands, without
scribed using a manual inclinometer (ISOMED inclinometer, crossing the line with their feet. For all MBT trials, the distance
Portland, OR) (13). For this purpose, each subject was in supine was taken to the nearest 5 cm from the line to the point where the
position on a bench, with the shoulder 90° abducted and the elbow ball landed. The best performance out of 2 trials for each condi-
flexed to 90° (forearm perpendicular to the bench). From this tion was taken for further analysis. A 45-second rest period was
starting position, an examiner held the subject’s proximal shoulder granted between trials. The ICC of these tests ranged from 0.88
region (i.e., clavicle and scapula) against the bench to stabilize the to 0.93.
scapula, avoiding an overpressure. Another examiner rotated the
humerus in the glenohumeral joint to produce maximum passive Warm-up Programs. Both experimental groups (i.e., NWU and
external (ER) and internal (IR) rotation (39). Two attempts were DWU) exercised in an indoor facility, between 4 and 5 PM. The
performed for IR and ER as well as for the dominant and non- warm-up programs were scheduled before the tennis-specific
dominant sides. Performance in degrees (º) were averaged over training. For both groups, a 10-minute recovery period was
both repetitions, and then used to calculate both, total range of allowed between WU programs and the tennis training, during
motion (TROM), the bilateral difference in IR (side-to-side asym- which subjects were asked to consume water and a 6%
metry 5 dominant2nondominant) as well as the glenohumeral carbohydrate/electrolyte drink ad libitum. To ensure familiar-
internal rotation deficit (GIRD) (i.e., loss in dominant shoulder IR ization with the training and testing procedures, all subjects
that is greater than 18–20°, with a corresponding loss of TROM completed 2 familiarization sessions (i.e., ;1 hour each) 1 week
greater than 5° when compared with the nondominant shoulder) before baseline testing.
(15). Intraclass correlation coefficient ranged from 0.78 to 0.91. In addition to their regular tennis training (i.e., 4 sessions·wk21),
all subjects performed the WU protocols 3 times per week for 8
Shoulder Strength Test. Isometric internal and external shoulder consecutive weeks. Regular tennis training lasted on average 75.5
rotation strength levels of the dominant and nondominant limb 6 6.4 minutes. Tennis training started with an 8-minute WU that
were assessed with a portable handheld dynamometer (Nicholas included general mobility exercises, ground strokes, volleys, and
Manual Muscle Tester; Lafayette Indiana Instruments, Lafayette, low-intensity smashes. Thereafter, players performed technical
Indiana). Subjects were in supine lying position on a plinth with drills (i.e., service technique) for another 10 minutes. This was
the shoulder abducted at 90° and the elbow flexed at 90°. This followed by ;50 minutes of specific drills (i.e., mixed open/closed
procedure has been described previously (14). The average of 2 technical/tactical drills) (18). The tennis training portion was
maximal trials (5 seconds) was used for subsequent statistical designed by the tennis coaches with the goal to address the specific
analyses. There was a 30-second rest period between trials. A needs of each athlete, stressing technical/tactical drills
side-to-side difference higher than 10% was defined as bilateral (i.e., designed to focus on improvements to a specific quality in
asymmetry. Moreover, shoulder rotational strength values were stroke technique or tactical approach), and/or sessions including
additionally normalized to body mass and expressed as N·kg21 a more physical approach (i.e., relatively high volumes of open
(15). Intraclass correlation coefficient ranged from 0.78 to 0.88. and/or high-intensity drills (21)). Together with the tennis-specific
2778
sessions, players performed 1 to 2 sessions·wk21 of strength The training volume, in terms of duration, of the 2 warm-up
training. Due to the fact that only some of the Subjects had pre- programs was similar across the intervention period. Thus,
vious strength-training experience, guidelines for novices were players included in the DWU supplemented their programs with
chosen, based on previous research (16). Each session comprised more tennis-specific activities to balance the NWU group. Both
a 10-minute warm-up and approximately 30 minutes of machine- groups finished the routine with light stretching exercises for the
based exercises (i.e., low pulley dead lifts, leg-press, chest-press, plantar flexors (principally gastrocnemius and soleus), hip flexors
lat pull-down), with 2 sets of 12 repetitions each (9). The intensity (hamstrings), hip extensors (gluteals), hip adductors, quadriceps,
was related to the load that could be lifted 15 times with a proper posterior shoulder, triceps, shoulder external, pectoralis, deltoid,
technique throughout the full ROM (32), leaving at least 3 rep- biceps brachii, and forearm extensors and flexors. Exercises were
etitions aside to avoid fatigue (50). In terms of volume and in- selected based on previous literature and performed in similar
tensity, strength training was similar between the experimental order, repeated 2 times, and performed for 5–6 seconds (52). A
groups. 10-second recovery period was provided between each exercise.

Each warm-up intervention lasted from 20 minutes during No rest period was allowed when the limb was changed.
week one to 32 minutes during the last week. In both experi- Stretching intensity was held at the point of discomfort.
mental sessions (NWU and DWU), subjects started by performing
self-paced rope jumping for 4–5 minutes (i.e., including forward/
Statistical Analyses
backward movements, unilateral jumps, sidestepping, and double
jumps), followed by a group-specific WU exercises. Figure 2 Descriptive statistics were presented as mean values and SDs.
shows the schematic representation of both WU programs. Data normality and variance equality were assessed through the
NWU subjects performed the following exercises, always su- Shapiro-Wilk and Levene tests, respectively. When assumptions
pervised by an experienced S&C specialist: were violated, log-transformations were computed. To examine
c 5–8 minutes of general mobility, including arms and the effects of a structured tennis-specific warm-up protocol,
shoulder (i.e., wall slides), thoracic mobility exercises a two-way repeated-measures analysis of variance (ANOVA)
(i.e., 3 sets of different exercises such as the cat camel, with one between factor (training group: NWU vs. DWU) and one
extension with foam roller, trunk rotation 3 15 repetitions within factor (time: pre-training vs. post-training) was used for
each). each dependent variable. If a significant F value was identified for
c 5–8 minutes of core, hip, and shoulder strength exercises group-by-time interactions, Bonferroni corrected post hoc tests
(i.e., 3 sets of 3 exercises 3 15 repetitions: core (i.e., plank, were calculated to identify pairwise differences. The significance
side plank, and sit-ups); hip (i.e., abduction and adduction level was set at p # 0.05. In addition, effect sizes (Cohen’s d) were
with a mini-band); and shoulder (i.e., low-row, inferior calculated from eta-squared using the ANOVA output. More-
glide, “lawnmower,” ER using elastic tubbing). over, within-group effect sizes were computed using the following
c 5–8 minutes of neuromuscular-related exercises (i.e., 2–3 equation: Effect size 5 (mean_post2mean_pre)/SD. Threshold
sets 3 6–10 repetitions of upper-body and lower-body values for Cohen’s d statistics were 0.20, 0.60, 1.20, 2.0, and 4.0
exercises, including 1–2 kg MBTs; bilateral and unilateral for small, moderate, large, very large, and extremely large effects,
jumps [i.e., CMJs to 20-cm box; multilateral hops with respectively (28). The statistical analyses were performed using
hurdles; ankle jumps, line jumps], as well as ;10-second SPSS (SPSS 17.0 version, Chicago, IL).
acceleration/deceleration/COD drills) (18).
Subjects in the DWU performed a coach-selected and su-
Results
pervised warm-up program that consisted of 5–8 minutes of
dynamic movements (i.e., arm circles, leg kicks, multidirec- All subjects received treatment as allocated. No significant be-
tional skippings), some ballistic exercises (e.g., single-hop tween group baseline differences were identified for all analyzed
jumps [5 repetitions], alternate leg bounds (multidirectional 3 measures (p . 0.05).
5 repetitions), service motion throws without a tennis ball (5
repetitions each arm), and short (2–3 m) accelerations and
decelerations in different directions (3 repetitions forwards Physical Fitness Tests
and 5 repetitions side to side). A short protocol (5 minutes) of The analysis did not reveal a statistically significant main effect of
shoulder strength exercises (i.e., external/internal rotation; time nor a significant group-by-time interaction for the backhand
shoulder extension and rowing) was also included. The rest of MBT and 505 on the dominant and nondominant sides (p . 0.05;
this WU consisted on tennis-specific activities (e.g., on-court d 5 0.06–0.74). A significant main effect of time was observed for
hitting against an opponent performing ground strokes, vol- 20-m sprint time (F (1,27) 5 11.657; p 5 0.002; d 5 2.27),
leys, and serves). CMJ on the nondominant side (F (1,27) 5 23.497; p , 0.001;
Figure 2. Schematic representation of warm-up (WU) programs.
2779
d 5 1.87), and forehand MBT (F (1,27) 5 9.775; p 5 0.004; d 5 absolute (D 5 12.5% [p , 0.001; d 5 0.61] vs. 2.9% [p 5 0.149;
1.20). There was a significant group-by-time interaction for 5-m d 5 0.15]) and relative strength (D 5 12.2% [p , 0.001; d 5
(F (1,27) 5 10.560; p 5 0.003; d 5 1.25) and 10-m (F (1,27) 5 0.86] vs. 0.6% [p 5 0.868; d 5 0.02]), and ER/IR ratio (D 5 6.9%
4.683; p 5 0.039; d 5 0.83) sprint times, CMJ (F (1,27) 5 [p 5 0.002; d 5 0.51] vs. 1.1% [p 5 0.716; d 5 0.03]) on the
17.002; p , 0.001; d 5 1.59), CMJ on the dominant side (F (1,27) dominant side were greater in NWU compared with DWU. Fur-
5 10.832; p 5 0.003; d 5 1.27), overhead MBT (F (1,27) 5 thermore, the increases in shoulder IR relative strength (D 5 1.6%
6.951; p 5 0.014; d 5 1.02), and SV (F (1,27) 5 4.693; p 5 0.039; [p 5 0.019; d 5 0.11] vs. % [p 5 0.003; d 5 20.11]) on the
d 5 0.83). Post hoc tests revealed that improvements in 5-m (D 5 nondominant side was also superior in NWU compared
23.5% [p , 0.001; d 5 20.73] vs. 21.0% [p 5 0.069; d 5 2 with DWU.

0.18]) and 10-m (D 5 22.2% [p , 0.001; d 5 20.63] vs. 21.0%
[p 5 0.020; d 5 20.22]) sprint times, CMJ (D 5 11.2% [p ,
0.001; d 5 0.75] vs. 2.5% [p 5 0.103; d 5 0.18]), CMJ on the Shoulder Range of Motion
dominant side (D 5 19.3% [p , 0.001; d 5 1.23] vs. 5.5% [p 5 There was no significant main effect of time nor a significant
0.058; d 5 0.26]), overhead MBT (D 5 10.2% [p , 0.001; d 5 group-by-time interaction for shoulder IR and ER ROM on the
0.49] vs. 4.8% [p 5 0.004; d 5 0.16]), and SV (D 5 7.7% [p 5 dominant side, TROM on the nondominant side, and TROM
0.002; d 5 0.82] vs. 0.7% [p 5 0.734; d 5 0.06]) were larger for Diff and GIRD on both dominant and nondominant sides (p .
NWU than DWU, respectively (Table 1). 0.05; d 5 0.02–0.75). A significant main effect of time was
found for shoulder IR ROM on the dominant side (F (1,27) 5
12.257; p 5 0.002; d 5 1.35). There was a significant group-by-
Shoulder Strength time interaction for shoulder ER ROM (F (1,27) 5 4.277; p 5
0.048; d 5 0.80) and TROM (F (1,27) 5 7.067; p 5 0.013; d 5
The statistical analysis did not reveal a significant main effect of
1.02) on the dominant side. The analyses showed that the
time nor a significant group-by-time interaction for shoulder ER
increases in shoulder ER ROM (D 5 2.0% [p 5 0.037; d 5 0.16]
relative strength and shoulder ER/IR ratio on the nondominant
vs. 20.5% [p 5 0.484; d 5 20.07]) and TROM (D 5 4.2% [p ,
side (p . 0.05; d 5 0.06–0.76). A significant main effect of time
0.001; d 5 0.45] vs. 0.9% [p 5 0.336; d 5 0.13]) on the dom-
was observed for shoulder IR (F (1,27) 5 9.255; p 5 0.005; d 5
inant side for the NWU were greater than those observed in
1.17) and shoulder ER (F (1,27) 5 4.967; p 5 0.034; d 5 0.86)
DWU (Table 2).
absolute strength on the nondominant side. There was a signifi-
cant group-by-time interaction for shoulder IR absolute (F (1,27)
5 7.926; p 5 0.009; d 5 1.08) and relative strength (F (1,27) 5
10.226; p 5 0.004; d 5 1.23), shoulder ER absolute (F (1,27) 5 Discussion
12.368; p 5 0.002; d 5 1.35) and relative strength (F (1,27) 5 To the best of our knowledge, this is the first study that examined
16.947; p , 0.001; d 5 1.59), as well as for ER/IR ratio (F (1,27) the effects of a structured tennis-specific WU compared with
5 5.044; p 5 0.033; d 5 0.86) on the dominant side. There was a more traditional DWU on physical performance in young tennis
also a significant group-by-time interaction for shoulder IR rel- players. As was hypothesized, our results showed that NWU
ative strength (F (1,27) 5 16.207; p , 0.001; d 5 1.55) on the resulted in significant performance gains (i.e., 5-m and 10-m
nondominant side. Post hoc tests showed that the increases in sprint, CMJ, overhead MBT, serve speed, shoulder strength, and
shoulder IR absolute (D 5 5.1% [p , 0.001; d 5 0.31] vs. 1.9% ROM) after an 8-week training period. Moreover, although
[p 5 0.082; d 5 0.11]) and relative strength (D 5 4.8% [p , trivial to small improvements were also reported in the DWU,
0.001; d 5 0.37] vs. 0.3% [p 5 1.000; d 5 0.00]), shoulder ER several improvements were greater in NWU.
Table 1
Physical fitness parameters before (pretraining) and after (posttraining) the study period (8 weeks) with relative changes (D) and Cohen’s
d values for time effect, group effect, and interaction effect.*
NWU group DWU group Time effect Group effect Interaction effect
Pre Post D (%) Pre Post D (%) Cohen’s d Cohen’s d Cohen’s d
Physical fitness
505 D (s) 2.77 6 0.08 2.73 6 0.11 21.41 2.83 6 0.12 2.84 6 0.11 0.08 0.667 0.834 0.739
505 ND (s) 2.87 6 0.08 2.83 6 0.09 21.57 2.88 6 0.11 2.89 6 0.11 0.33 0.424 0.403 0.629
Sprint 5 m (s) 1.10 6 0.05 1.06 6 0.04 23.50 1.11 6 0.06 1.10 6 0.05 20.99 2.265 0.496 1.250†
Sprint 10 m (s) 1.87 6 0.06 1.83 6 0.05 22.21 1.91 6 0.08 1.89 6 0.08 20.98 2.158 0.606 0.834†
Sprint 20 m (s) 3.23 6 0.11 3.19 6 0.07 21.21 3.28 6 0.12 3.25 6 0.11 20.79 1.316‡ 0.598 0.293
CMJ (cm) 31.26 6 4.04 34.48 6 2.59 11.23 29.95 6 3.84 30.67 6 3.67 2.49 2.491 0.759 1.586†
CMJ D (cm) 16.04 6 2.14 18.85 6 1.12 19.25 16.73 6 2.96 17.56 6 2.69 5.52 2.326 0.142 1.266†
CMJ ND (cm) 15.25 6 2.22 16.16 6 1.61 7.04 14.51 6 1.80 15.15 6 1.74 4.61 1.865‡ 0.501 0.327
MBTo (m) 7.77 6 1.37 8.48 6 1.15 10.22 7.80 6 1.91 8.13 6 1.82 4.78 2.726 0.110 1.016†
MBTf (m) 10.51 6 0.88 11.09 6 0.78 6.00 10.57 6 1.41 10.78 6 1.37 2.06 1.204‡ 0.127 0.569
MBTb (m) 10.04 6 1.02 10.24 6 1.01 2.91 10.25 6 2.12 10.53 6 1.89 3.21 0.544 0.168 0.063
Serve speed (km·h21) 153.45 6 12.25 164.09 6 7.86 7.72 156.23 6 16.84 157.28 6 17.26 0.66 1.016 0.168 0.834†
*NWU 5 neuromuscular warm-up group; DWU 5 dynamic warm-up group; D 5 dominant side; ND 5 nondominant side; CMJ 5 countermovement jump; MBTo 5 medicine ball throw overhead; MBTf 5
medicine ball throw forehand; MBTb 5 medicine ball throw backhand.
†Significant group-by-time interaction effect (p # 0.05).
‡Significant main effect of time (p # 0.05).
2780
Table 2
Shoulder strength and range of motion (ROM) measures before (pretraining) and after (posttraining) the study period (8 weeks) with
relative changes (D) and Cohen’s d values for time effect, group effect, and interaction effect.*
Time Group Interaction
NWU group DWU group effect effect effect
Cohen’s
Pre Post D (%) Pre Post D (%) d Cohen’s d Cohen’s d
Shoulder strength
IR D (N·m21) 169.17 6 24.48 177.22 6 22.07 5.10 159.32 6 21.83 161.80 6 18.21 1.95 2.049 0.610 1.084†
IR D (N·m21·kg21) 2.83 6 0.35 2.96 6 0.38 4.80 2.72 6 0.40 2.72 6 0.34 0.33 1.232 0.496 1.232†
IR ND (N·m21) 150.99 6 26.80 152.79 6 26.13 1.31 142.19 6 18.49 142.57 6 18.36 0.30 1.170‡ 0.434 0.763
IR ND (N·m21·kg21) 2.51 6 0.35 2.55 6 0.37 1.62 2.46 6 0.47 2.41 6 0.45 22.10 0.168 0.238 1.549†
ER D (N·m21) 119.16 6 21.64 133.24 6 21.22 12.53 126.39 6 19.67 129.59 6 17.55 2.87 2.150 0.090 1.353†
ER D norm (N·m21·kg21) 1.99 6 0.29 2.24 6 0.38 12.18 2.18 6 0.45 2.19 6 0.42 0.63 1.674 0.191 1.586†
ER ND (N·m21) 113.74 6 22.91 125.03 6 30.10 10.77 112.44 6 20.44 114.79 6 18.84 2.36 0.857‡ 0.271 0.561
ER ND norm (N·m21·kg21) 1.89 6 0.26 2.06 6 0.41 9.95 1.94 6 0.46 1.91 6 0.43 21.13 0.553 0.127 0.756
ER/IR ratio D 0.71 6 0.08 0.75 6 0.09 6.87 0.80 6 0.13 0.81 6 1.11 1.11 1.062 0.770 0.863†
ER/IR ratio ND 0.76 6 0.09 0.82 6 0.17 9.49 0.80 6 0.17 0.81 6 0.16 20.21 0.625 0.063 0.663
Shoulder ROM
IR D (˚) 54.25 6 11.46 59.75 6 9.12 12.30 56.90 6 11.46 58.50 6 9.53 3.87 1.347‡ 0.063 0.739
IR ND (˚) 65.79 6 13.32 66.71 6 9.67 5.53 68.20 6 13.63 68.57 6 11.67 1.98 0.155 0.220 0.020
ER D (º) 143.86 6 14.04 146.20 6 10.38 1.95 137.77 6 10.27 137.03 6 10.26 20.52 0.419 0.710 0.797†
ER ND (˚) 132.68 6 10.96 133.18 6 11.20 0.39 132.33 6 9.76 132.13 6 9.52 20.04 0.155 0.063 0.238
TROM D (˚) 198.11 6 16.57 205.95 6 13.35 4.19 194.67 6 11.79 195.53 6 10.53 0.87 1.549 0.532 1.022†
TROM ND (˚) 198.46 6 17.56 199.89 6 14.38 0.85 200.43 6 16.79 200.70 6 15.71 0.46 0.142 0.142 0.020
TROM diff (%) 20.36 6 10.01 6.06 6 15.42 259.44 25.77 6 20.59 25.17 6 19.94 9.25 0.752 0.544 0.606
GIRD (˚) 211.54 6 6.76 26.96 6 12.58 240.75 211.30 6 11.60 210.07 6 10.16 19.22 0.582 0.180 0.414
*NWU 5 neuromuscular warm-up group; DWU 5 dynamic warm-up group; D 5 dominant side; ND 5 nondominant side; IR 5 internal rotation; ER 5 external rotation; norm: normalized values; TROM 5 total
range of motion; GIRD 5 glenohumeral internal rotation deficit.
†Significant group-by-time interaction effect (p # 0.05).
‡Significant main effect of time (p # 0.05).
Because this is the first study analyzing the effects of an NWU a limiting factor to interpret the results. Both groups probably
compared with a DWU in tennis players, it is not possible to obtained positive benefits from this additional training stimulus be-
compare our results with previous studies. Both groups, NWU cause the connection between strength training and motor perfor-
and DWU, improved their sprint performances (5–20 m), CMJ mance skills is well known, especially at young ages (8,30).
(bilateral and unilateral [dominant side]), overhead MBT, and Moreover, if we analyze the age at PHV of the subjects, they were
some shoulder strength (i.e., IR D, ER D, ER/IR ratio) and ROM 0.9 6 1.1 and 0.82 6 0.8 years after the PHV, for the NWU and
(i.e., ER D, TROM D) values. With reference to our findings, we DWU, respectively. Thus, growth and maturation can be also linked
postulate that the inclusion of a regular and supervised WU to these strength and power improvements because it has been
program is capable of enhancing physical fitness in this group of suggested that after the onset of puberty, adolescents will undergo
young athletes, as previously reported for other sports a performance spurt in strength and power (33).
(4,37,45,57). However, the interaction effects revealed that NWU None of the groups significantly improved 505-test perfor-
compared with DWU produced greater performance gains in mance, for both, D and ND sides. Despite the relevance of COD
most of the analyzed parameters. ability in tennis (34), the NWU adopted in the current study in-
The observed small-to-moderate effects of NWU on sprint per- volved a relatively low volume of plyometric exercises (5–8
formance are in line with previous studies conducting neuromuscular minutes of 2–3 sets 3 6–10 repetitions of upper-body and lower-
training programs in different sports (6,12,40,42,49), including body exercises). In this regard, it was previously shown that, for
tennis (5,18,56). These studies showed moderate-to-large training- example, in young soccer players, COD performance is related to
related effects in sprint distances ranging from 5 to 20 m. Because one higher volumes of horizontal and vertical jumps (e.g., 5–8 sets and
of the main parts of the NWU included multidirectional plyometric 10–15 repetitions) (42). Accordingly, in previous tennis-specific
and acceleration/deceleration/COD drills, we can speculate that studies (18,23,56), a higher training volume (;40 minutes per
improvements are likely to be related to the neural component (e.g., session) led to significant COD improvements. Thus, the low
inter-lower-limb muscle coordination and stride frequency) (44,47). volume of plyometric stimuli incorporated to the NWU routine
Results also showed differences between groups in sprint perfor- seemed to be sufficient to induce positive changes
mance, which can be related to the lack of specific exercise drills in (i.e., improvements in stretch-shortening cycle mechanism (44)) in
DWU compared with NWU. In this regard, players in DWU per- the linear acceleration and sprint abilities of young tennis players,
formed some accelerations and decelerations together with tennis- which can be very effective for tennis as well as S&C coaches to
specific activities. However, DWU also improved in almost the same design their training schedules. However, enhanced linear sprint
sprint parameters than NWU, with trivial to small changes. It is speed did not translate into improved COD performance, thus
important to highlight that both groups conducted 12 strength- confirming that they are different abilities (31), and that the latter
training sessions during the present intervention, and this could be demands specific training strategies.
2781
Upper-body strength and power seem to be determinant in serve IR/ER ROM changes (.5%) after a 6-week intervention, including
performance of tennis players, since early ages (19,24,55), with a supervised stretching program, conducted 3 times per week (17).
MBTs as strong predictors of serve speed, together with the abso- Interestingly, a significant main time effect was observed for
lute IR and ER shoulder strength (19). Moreover, MBT and SV shoulder IR ROM of the dominant side and GIRD in both groups,
seem to be among the most important physical components related NWU and DWU, although increases in NWU (small ES) were
to tennis performance in adolescent tennis players (i.e., ranking) greater than those observed in DWU (trivial ES). Both groups in-
(24,55). Results of this study showed that NWU led to significant cluded some stretching exercises in their programs including
improvements in the SV, overhead MBT, IR, and ER of the dom- “problematic” muscles (i.e., stretching of the pectoralis minor,
inant side, with small to moderate ES (0.5–0.8), compared to the posterior capsule) (15), and this could be related to the improve-
DWU, although trivial changes were also found for this group. ments reported. Moreover, the NWU included shoulder and tho-
Previous studies conducted with young tennis players reported racic mobility exercises, which can be related to the greater
significant improvements in the SV (4–5%) after training inter- increases compared to the DWU. In this regard, recent findings
ventions, including plyometric training or combined strength provide evidence of thoracic spine movement contributing to
training (e.g., core stability, elastic tubing, and plyometric exer- upper-limb functional movement (1,27). More research is de-
cises) (9,17,23). In general, improvements in both groups can be finitively needed in this area, analyzing the effects of a shoulder-
explained, as previously mentioned, by the combination of the specific training program to address the imbalances created by
strength-training program conducted and the associated gains in intensive tennis training and competition.
strength due to the maturation process. However, results high- In conclusion, an NWU resulted in significant performance gains
lighted significant differences between groups, with the NWU (i.e., 5-m and 10-m sprint, CMJ, overhead MBT, serve speed,
showing greater improvements, suggesting that the 12 strength- shoulder strength, and ROM) after an 8-week training period
training sessions undertaken by the players were not enough to compared to a DWU. Nevertheless, it is important to note that
induce better serve performance. Therefore, the inclusion of low- there are several limitations associated with this study. First, there
volume explosive exercises (e.g., upper-body PT) in the WU rou- were several factors that could affect the results obtained, including
tine, performed at relatively high speeds, seems to elicit movement- the parallel strength training program, or the maturation status of
specific adaptations (i.e., force-vector specificity) and possibly en- the players. Future studies should isolate the intervention more,
hanced intermuscular coordination, resulting in an improved force although it is true that in the present context, it was not possible to
transfer through the kinetic chain (23). cancel the additional training conducted by the players. Moreover,
Due to the importance of the shoulder complex in tennis (13), it the inclusion of a third group, acting as a control group, could bring
seems important to highlight that results showed significant more information to discuss the present results. However, we be-
improvements in shoulder strength and ROM values, with greater lieve that the present design has high levels of ecological validity
increases in the dominant shoulder IR and ER strength and ER/IR and may offer a starting point to suggest practical applications to
ratio, as well as in the dominant shoulder ER ROM and TROM. The the tennis professionals. As always, additional research is required
analyses showed that the increases in NWU (small ES) were greater to investigate how players respond to the inclusion of medium- to
than those observed in DWU (trivial ES). To the best of our knowl- long-term training protocols, including an analysis of the injury
edge, there is no previous study analyzing the effects of a structured prevention potential of the NWU.
WU in tennis, including a combination of shoulder mobility and
strengthening exercises. Regarding shoulder strength levels, intensive
Practical Applications
tennis practice and competition lead to an unbalanced shoulder
function profile, with higher IR strength compared to the ER on the Based on our results, it can be postulated that coaches and
dominant side (19). Present results showed that the inclusion of an strength and conditioning experts implement a tennis-specific
NWU maintained ER/IR ratios around 0.7, which can be considered WU for young tennis players before the start of regular tennis
as a “healthy” ratio (i.e., cut–off values ranged ,0.60–0.85) (14). training. NWU is characterized by a relatively low training
The NWU included shoulder-strengthening exercises aimed to an session duration, ranging from 20 to 35 minutes. The WU
increase in absolute strength values for shoulder rotators and greater program should include general mobility (e.g., arms, shoulder
muscle balance (15). In this regard, a recent study conducted with as well as thoracic mobility exercises), core (e.g., plank varia-
swimmers showed that a dry-land shoulder-strengthening program tions, sit-ups), hip (e.g., abduction/adduction with resistance),
led to an increase in shoulder rotator balance and ER endurance (7). and shoulder (e.g., exercises focused on the posterior rotator
Extensive research has shown that excessive or limited shoulder cuff and scapular stabilizers using elastic tubbing) strength
ROM may lead to shoulder injuries, such as instability and im- exercises. Furthermore, a combination of neuromuscular-
pingement, in overhead athletes (13,15,39). The current results related exercises (e.g., plyometric oriented exercises [1–2 kg
showed reductions in IR ROM in the dominant shoulder, which MBTs, bilateral and unilateral multidirectional jumps, with or
are in line with previous tennis-specific studies (13,19), and can be without hurdles, etc.], and acceleration/deceleration/COD drills
considered a normal adaptation of these athletes (15). In this (short sprints [15–20 m] with 2–3 COD, and short rest periods
regard, research has identified IR limitations and injury risk when [25 seconds]) is also introduced in the NWU. Moreover, al-
there is a loss of rotation greater than 18°–20°, with a corre- though there is not enough evidence to support that a stretching
sponding loss of TROM greater than 5° when compared bilaterally program reduces the incidence of recurrent shoulder injury
(15). In this study, players showed preintervention average values (15), the inclusion of active, passive, or manual therapy forms
of ;11° for both groups, which could be considered “normal,” of stretching at the end of the training sessions (e.g., physical
from a pathological point of view (15). However, individual values and tennis-specific sessions) is recommended. These routines
can be considered dangerous, with bilateral differences exceeding are recommended to improve posterior shoulder tightness and
more than 20° in some cases. Thus, the introduction of prevention GIRD in the short-term for asymptomatic young athletes who
measures to balance these shoulder deficits seems necessary. In this are active in overhead sports such as tennis.
regard, only a single previous study reported significant shoulder
2782
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Original Research

The Effect of a Neuromuscular vs. Dynamic Warm-up

Jaime Fernandez-Fernandez,1,2,3 Vicente Garcı́a-Tormo,1 Francisco Javier Santos-Rosa,4

Introduction Andersson et al. (1) examined the effects of a shoulder-injury

Medicine Ball Throw Test: Overhead, Forehand, and Backhand.

groups. 10-second recovery period was provided between each exercise.

Figure 2. Schematic representation of warm-up (WU) programs.

23.5% [p , 0.001; d 5 20.73] vs. 21.0% [p 5 0.069; d 5 2 with DWU.

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