Journal of Clinical Sciences

: 2020  |  Volume : 17  |  Issue : 3  |  Page : 52--56

The relationship between grip styles and musculoskeletal injuries in table tennis players in Lagos, Nigeria: A cross-sectional study

Ayoola Aiyegbusi, Mayowa Oduntan 
 Department of Physiotherapy, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria

Correspondence Address:
Dr. Ayoola Aiyegbusi
Department of Physiotherapy, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos 02341


Background: Table tennis is a high skill sport that requires athletes to make accurate judgments. It involves explosive, repeated movements that involve hitting the ball, thus subjecting the musculoskeletal system to risks of overuse injuries. Grip styles in table tennis, which is the way players hold the racquet has been reported to affect injury predisposition. Aims: The aim of this study determine the dominant grip styles among table tennis players in Nigeria and how they predispose to musculoskeletal injuries. Setting and Design: This was cross-sectional study. Materials and Methods: This study involved 108 professional and recreational male and female (M = 71, F = 37) table tennis players with at least 6 months playing experience from selected sports clubs in Lagos state, Nigeria. An adapted questionnaire from the Badminton Injury Questionnaire and the Tennis Injury Questionnaire was used to collect data. Data were analyzed using descriptive statistics, and the association between variables was determined using Chi-square and the level of statistical significance was set at P < 0.05. Results: The Shakehand grip was the predominant style (90.7%) among the players and had the highest prevalence of injury (94.2%). Although other grip styles in relative terms predisposed less to injuries, they appear not to be popular among the players. There was no significant association (P > 0.05) between the different grip styles and the prevalence of injury. The personal grip style was, however, significantly (P < 0.05) associated with dislocation and bruises. Conclusion: The Shakehand Grip was the predominant Grip style among Table Tennis players in Lagos and had the highest prevalence of injury.

How to cite this article:
Aiyegbusi A, Oduntan M. The relationship between grip styles and musculoskeletal injuries in table tennis players in Lagos, Nigeria: A cross-sectional study.J Clin Sci 2020;17:52-56

How to cite this URL:
Aiyegbusi A, Oduntan M. The relationship between grip styles and musculoskeletal injuries in table tennis players in Lagos, Nigeria: A cross-sectional study. J Clin Sci [serial online] 2020 [cited 2020 Aug 6 ];17:52-56
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Full Text


Table tennis is a high skill sport that requires athletes to make accurate judgments and explosive hitting-the-ball movements in a very short period.[1],[2] Professional tennis sports involve powerful movements repeatedly subjecting the musculoskeletal system to heavy mechanical load, thereby increasing the risk for most acute and overuse injuries.[3]

Table tennis is unique among racquet sports in that it supports a large variety of different styles among players, and even at the very top of international table tennis, there are a large number of dramatically different grip styles to be found.[4],[5] Grip style in table tennis is the way a player holds the racquet, and it is of importance because of issues as simple as where the thumb rests make a lot of difference. These Grip styles include the Shakehand Grip [Figure 1], in which the index fingers are on the side of the paddle directly facing the body, and the thumb rests on top of the other fingers, which are encircled around the blade handle. For the shallow shakehand Grip, the thumb rests or relaxes on the blade while for the deep shakehand Grip, the thumb rests or relaxes on the rubber.[6] While the shallow shakehand Grip gives the player the freedom to move the wrist, the deep shakehand Grip prevents excessive movement of the paddle in the player's hand, which ensures a firm grasp and so does not allow for wrist flexibility.{Figure 1}

The second most popular type of Grip is the penhold Grip [Figure 2], which allows free movement of the wrist, much more than shakehand Grips.[6] Aside from the shakehand and penhold Grips, there are also a few more unusual and rare Grips that rarely make it to international scenes due to their unproven effectiveness in matches. Some examples of these are the V-Grip [Figure 3], in which the blade is held between the index and middle finger, spread apart at first to form a letter V and the Seemiller Grip which can be observed to be a variation of the V-Grip, but the tip of the forefinger is placed near the edge of the paddle, or around the edge of the paddle.[6] The disadvantages of the V-Grip are that balls shot towards the player's elbow are difficult to return without fast footwork. The advantage of the Seemiller Grip is free wrist movement, while the disadvantages are that backhand side wrist movement is hampered, limiting heavy topspin and powerful returns for the player.{Figure 2}{Figure 3}

From the foregoing, it is seen that different Grip styles have different effects on the musculoskeletal system and by inference, susceptibility to injury. This study, therefore, aimed to determine the prevalence of the different Grip styles and their association with musculoskeletal injuries in both amateur and elite table tennis players in Lagos Nigeria.

 Materials and Methods

Participant selection

This was a cross-sectional study that involved both male and female Table Tennis players with at least 6 months playing experience from selected sports clubs in Lagos State, Nigeria. Excluded were players that had prior fracture or surgery to any part of the upper limb. The participants were recruited using a sample of convenience, and those that met the inclusion criteria were included in the study.


An adapted questionnaire from the Badminton Injury Questionnaire[7] was used to collect data. The questionnaire consisted of 28 questions, which were divided into four sections. Section A comprised the socio-demographic information of the athlete, which included age, gender, ethnicity, and dominant arm, while Section B collected information on the table tennis history, training, and playing information. Section C comprised of information on the Grip style adopted when holding the table tennis racquet and Section D gave information on any past or present injury sustained during table tennis-related activities, including the location, nature, and cause of injury and the treatment options, if any, used to manage the injury. The survey questionnaire had closed and open-ended questions.

Ethical approval was sought and obtained from the Institutional Health Research and Ethics Committee (CMUL/HREC/07/17/221) before the commencement of the study. Informed consent was sought from each of the participants before their participation in the study. Consent was also sought from the parents/guardians of the underage participants.

Sample size determination

The minimum sample size for this study was calculated to be 81 with an attrition of 10%, giving a total minimum sample size of 89.[7],[8]

Procedure for data collection

Copies of the questionnaires were distributed to the participants at the table tennis clubs/centers, and explanations were provided as necessary. Data were collected, and the completed copies of the questionnaire were collected by the same researcher.

Data analysis

The data collected from the study were summarized using descriptive statistics of frequency, mean, standard deviation, percentage, charts, tables, and inferential statistics of Chi-square. Data were analyzed using the Statistical Package for the Social Sciences version 22 (IBM Corporation, North Castle Drive, Armonk, NY 10504-1785, U.S.A.). The level of significance was set at P < 0.05.


A total of 108 professional and recreational table tennis players participated in this study, made up of 37 (34.3%) females and 71 (65.7%) males. The tennis players were within the age range of 11–66 years with a mean age of 22.33 ± 9.897 years. Out of the 120 copies of questionnaires administered in this study, 115 were returned, and of these, 7 were not valid for analysis; because 5 of the returned questionnaires did not meet the inclusion criteria of having at least 6 months of playing experience and 2 were incompletely filled. Therefore, 108 copies of the returned questionnaires were valid for analysis, giving a response rate of 90%. A greater proportion; 93 (88.9%) of the respondents were right-handed in daily activities, whereas 15 (11.1%) of the respondents were left-handed.

[Table 1] shows the Grip style information of the players, whereas in [Table 2], a crosstab was used to determine if there were associations between the prevalence of injury and the age, level of play, time spent on warm-up exercise and the type of warm-up exercise. [Table 3] shows there is no significant association between the different Grip styles and injury prevalence, while [Table 4] depicts the relationship between the type of injury and the different Grip styles and it is seen that the personal grip style is significantly associated with dislocations and bruises.{Table 1}{Table 2}{Table 3}{Table 4}


The aim of this study was to investigate the relationship between the styles of Gripping the table tennis racquet and musculoskeletal injuries. The knowledge of this association is important as it would serve to influence the mode of training and prevent the various musculoskeletal disorders seen in tennis players. Tagliafico et al.[9] had reported that in nonprofessional tennis players with wrist injuries, different styles of Grip of the racquet are related to the anatomical site of the lesion: Eastern Grip with radial-side injuries and Western or semi-Western Grip with ulnar-side injuries. Some wrist injuries have been reported to be apparently related to the use of certain forehand Grip styles and the predominant use of the two-handed backhand.[10]

In this study, Shakehand Grip, known to be highly favored in the Western world was predominantly the most common Grip style (90.7%). This probably is because it is the most convenient Grip for most players in addition to its global acceptance and notable symbol of professionalism.[6] Expectedly, it was observed that the greatest prevalence of injuries occurred in players who used the Shakehand Grip, however, in relative terms, other Grip patterns predisposed less to injuries, though they appear not to be popular among the players.

Our findings also showed that Professional players recorded the highest prevalence of injury (78.6%) when compared with the recreational (34.4%) and amateur players (43.8%) probably due to the rigors of training even as it has been reported that increased hours and duration of play over time is linked to injury.[6],[11] In addition to these, most of the Professional players probably have adopted the Shakehand Grip, which is seen as a mark of professionalism.[6] The high injury prevalence seen in the players at all the levels could be due also to the fact that in addition to Grip styles, appropriate Gripping technique and right Grip size are equally important in injury prevention.[12] Expectedly, though soft -tissue injuries were common at the elite level of play because of physical demands as earlier enumerated, they have also been reported to be prevalent in amateur players.[13] These injuries have been attributed also to poor footwork and incorrect stretching and warm-up exercises, which predispose to joint injuries.[13]

Except for personal Grip styles which are unconventional styles that could easily predispose a player to injury, there was no significant association between the other Grip styles and types of injuries, though it is seen that most of the injuries sustained were muscle strain and pain predominantly found in players who used the Shakehand Grip. Both the V-Grip and the Seemiller Grip, which have been reported to be similar[14] reported no incidence of injury. This could be due to the fact that these grip styles were not popular among the participants in this study, as only very few of them used these styles. Future studies with large sample sizes of players who use these grip styles could give a better picture of their association with injury prevalence.

Our findings show significant associations between shuffle footwork and shadow play during warm-up with the prevalence of injury. Footwork has been reported to be very important in table tennis and, in fact, has been described as one of the fundamental techniques every player should first learn to increase the quality of shots.[15] Footwork drills during training is believed to assist in increasing the response of the muscle receptors and, ultimately, the response rate of muscles. However, faulty footwork could predispose to injury; hence, players are advised to move on the toes and not on the heels to allow for swiftness while reducing the risk of injuries[14] such that Lam et al.,[16] had suggested the use of foot orthothic designs on high-pressured areas to reduce injury incidence.

Although, beyond the scope of this study, an association between the grip style and footwork could also be responsible for injury predisposition even as it has been earlier reported that bad grip and foot positioning twists the entire body out of proper alignment and are the most common cause of technique problems. It was, thus, recommended that players use neutral grip variations of the Grip styles along with proper stance as nonneutral grip forces the player to adjust to awkward movements.[15]


Our findings show that the Shakehand Grip was the predominant Grip style in Table Tennis players in Lagos and had the highest prevalence of injury.


There was no significant association between the different Grip styles and the prevalence of injuries, probably because most of the players used the Shake-Hand Grip compared with other Grip styles such that the data collected for all the other types of Grips was relatively too small to create a significant comparison. This study presents preliminary investigations, so further studies with much larger sample sizes are recommended in order to adequately capture the other Grip styles.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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