Viral illnesses and infections affect us all. Even though the treatment is similar amongst most individuals, there are special considerations for tennis athletes. The #1 reason that WTA athletes withdraw or retire from tournaments is illness, including returning too early after an illness! The WTA physicians have developed this guide to assist you in a safe and efficient return to training and competition, with the goal of reducing illness recurrence and decreasing days missed.


The most common type of illness among athletes is a viral upper respiratory tract infection. There are variations of viral illnesses and more serious infections, that include but are not limited to: the common cold, ear infections, influenza (the ‘flu’), mononucleosis, and acute gastroenteritis. Minor bacterial infections that may require a doctor’s visit for an antibiotic include pertussis (whooping cough), strep throat, sinusitis lasting more than two weeks, or community acquired pneumonia.


Although exercise has a beneficial effect on the immune system, the chance of a tennis professional contracting an illness is about the same as a non-athlete. Upper respiratory tract infections are generally self-limited, meaning that they resolve with an appropriate amount of rest and self-care, without any major medical interventions. Your immune system eventually rids the body of the infection!


If you have a history of recurrent illnesses, sleep disturbances, international travel, increased stress, poorly controlled asthma, and, perhaps most importantly, not enough time for recovery, you are at risk. While reasonable amounts of exercise can improve your immune system, extensive and intense training can lead to increased risk of illness!

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Many experts believe that upper respiratory infections negatively affect athletic performance more than all other diseases combined. Whereas regular moderate exercise enhances your immune system, studies done on professional athletes over the past decades have shown that repetitive INTENSE exercise without appropriate recovery, makes you, the elite athlete, more susceptible to an infection. This phenomenon is known as the ‘exercise-immune paradox’. Basically, the longer and harder you train can put you at more risk of getting sick. This happens because your respiratory mucosa is impaired for 1-2 weeks after intense exercise. Intense exercise also depletes Vitamin C and glutamine stores which weakens your immune system. As both illness and excessive training without effective recovery can reduce your immune system function and leave you more susceptible to getting sick, proper recovery is critically important! Fortunately, WTA physicians have done their homework and share their recovery protocol to assist you in a healthy return to court.


Antibiotics work only if the cause is a bacterial infection. As a professional tennis athlete, there are certain antibiotics that you want to avoid, as they have some unwanted side effects, which may take you out of play. While all medications have the potential for some side effects, adverse effects such as electrical changes in the heart, tendon ruptures, sun sensitivity, diarrhea and dehydration could slow your recovery and/or cause harm. Since most infections are viral and viruses do not respond to antibiotics, they are generally not recommended. If antibiotics are required, follow the instructions of your physician about the most suitable antibiotics, take the full course, exactly as prescribed. Some over the counter (OTC) medicines can help reduce symptoms. Guaifenesin and Dextromethorphan are common OTC cough remedies that and are safe and allowed under the Tennis Anti- Doping Program (TADP). Like all medicines, OTCs options may have side effects, including an increased risk of injury due to factors such as fatigue and sedation. Many OTC medications are not banned under the TADP, but some, such as decongestants, ARE prohibited. Consult your primary care physician before starting any medications.


Mononucleosis: Sore throat, fever, fatigue, and abdominal pain are potential signs of infectious mononucleosis (IM). If your physician has any suspicion of IM, further testing, including blood tests, is recommended. If IM is diagnosed, you will need to take some time off tennis due to the increased risk of a ruptured spleen with continued competitive tennis. If your doctor felt your spleen was large on exam, occasionally, they may want to evaluate your spleen size with an ultrasound. If you are feeling better, at least three weeks after the initial onset of symptoms, you may return to play through the iRTP (standard or accelerated based on physician discretion). Because IM is viral, treatment is generally supportive, such as bed rest, good hydration and nutrition and a graduated, medically supervised return to activity. Antibiotics will not assist and are not required. Antiviral medications have also been shown to be ineffective despite much research.

Influenza: Sudden onset of fever, weakness, dry cough, and body aches are potential signs of the flu. Your physician will determine if you need to be tested for the flu. If you are confirmed to have influenza, you are required to stay away from the tennis facility to prevent spread of infection to others, and refrain from playing until your symptoms (fever, chills, muscle and body aches, fatigue and discomfort) are completely resolved. You may receive antiviral treatment from your physician, if detected soon enough. The best way to avoid the flu is to receive your annual influenza vaccine!

Pertussis: Having an unexplained cough for over 2 weeks with associated coughing spells, an inspiratory “whoop”, or post-cough vomiting, may be signs of pertussis (whooping cough). Those who are unvaccinated (DTap or Tdap) are at increased risk. Pertussis is treated with antibiotics such as azithromycin (5 days), clarithromycin (7 days), or bactrim (14 days). This infection is highly contagious, so you need to stay away from the tennis venue, do not play and notify others with whom you have been in contact, as they may also need treatment. Infectious diseases will be evaluated and treated on a case by case basis to determine the appropriate safety measures.


For more information read “Cold Comfort”, “Boost your Immune System”, “Defeat Disease” and “Prevention is Protection”. Get the rest you need, without missing a swing!

Accelerated Protocol

  • Day 1: 15 minutes light physical activity, i.e. treadmill, stationary bike (begin on day of meeting iRTP criteria). Athlete's goal: Introduction of activity while maintaining hydration and staying out of the heat
  • Day 2: Moderate intensity jogging, running and non-racquet drills (15-30 minutes/day)
  • Day 3: Racquet drills and tennis rallying, no competition (30-60 minutes/day)
  • Day 4: Return to full tennis training and competition

Standard Protocol

  • Day 1: 15 minutes light physical activity, i.e. treadmill, stationary bike (begin on day of meeting iRTP criteria). Athlete's goal: Introduction of activity while maintaining hydration and staying out of the heat
  • Day 2: Moderate intensity jogging, running and non-racquet drills (15-30 minutes/day)
  • Day 3 to Return Day: Racquet drills and tennis rallying, no competition (30-60 minutes/day); gradually progress daily until final day of guidelines (based off equation above)
  • Return: Full tennis training and competition after last day determined by Standard Guidelines

How many days until you return to full training? Use the Recovery Time Formula, multiply the number of days of illness by 2 to determine the number of days following the Standard Guidelines iRTP.
To calculate the total days, begin from the first day of symptoms to the day that iRTP criteria is met. For example, if Wednesday is the first day of illness and the iRTP is met the following Monday, that equals 6 days. Multiply days of illness by 2 (6 days x 2 = 12 days); the athlete should strictly follow the standard guidelines for 12 days to return to competition in order to restore health and performance.

The contents of the Health site are for informational purposes only and should not be treated as medical, psychiatric, psychological, health care or health management advice.  The materials herein are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. Reliance on any information provided herein is solely at your own risk. A special thanks to the authors, Dr. Jeffrey Chen, DO; Dr. Stephen Steele, DO, and Dr. Geoffrey Lange, DO.