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It is the most strenuous stroke in the game and has the greatest potential for injury. The serve has been broken down into a number of key stages to allow analysis of the movements involved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The aim of this study was to conduct a systematic review of all injuries related to the stages of the tennis serve and to assess their relative impact on the risk of injury using a meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A systematic search was conducted across 8 electronic databases, supplemented with searches of grey literature. Eligible studies presented data from injured (injury group) and uninjured (control group) tennis players in a form that allowed further analysis of each risk factor for comparison. All results were presented as effect sizes (Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      ) to allow comparison of each risk factor and to identify the most important risk factors associated with injury. Overall study quality was assessed using an adapted Downs and Blacks checklist.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 29 studies were included in the meta-analysis, identifying 130 risk factors. 36 risk factors had an effect size suggesting a large or significant association with injury in tennis players (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009\u2a7e\u20090.8 or \u2a7d\u22120.8). These were divided into general risk factors and those associated with the preparation, acceleration and follow-through phases of the tennis serve. Seven of the risk factors were from 3 or more studies allowing meta-analysis, 3 were from 2 studies and 26 were from a single study. Downs and Black checklist scores ranged from fair to good for the studies included in this review. There was no evidence of publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Meta-analysis identified dominant shoulder rotation strength, internal rotation range of movement, weekly tennis volume, age, body mass and height as risk factors for injury in the tennis serve.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/27536351251374616","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T13:52:11Z","timestamp":1759326731000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Injury Risk Factors of the Tennis Serve: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4808-1869","authenticated-orcid":false,"given":"John","family":"Bradley","sequence":"first","affiliation":[{"name":"Faculty of Wellbeing, Education and Language Studies, School of Education, Childhood, Youth &amp; Sport, The Open University, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9440-4764","authenticated-orcid":false,"given":"Ben L.","family":"Langdown","sequence":"additional","affiliation":[{"name":"Faculty of Wellbeing, Education and Language Studies, School of Education, Childhood, Youth &amp; Sport, The Open University, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bowmaker","sequence":"additional","affiliation":[{"name":"Life Fit Wellness, Falkirk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart","family":"Kerr","sequence":"additional","affiliation":[{"name":"Life Fit Wellness, Falkirk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"International Tennis Federation. 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