MELBOURNE, Australia — Casey Dellacqua, a former top-10 player and major finalist in women's doubles and a Grand Slam champion in mixed doubles, is returning to tennis this week at the Australian Open after nine months away because of a concussion.
While concussions have become a hot topic in recent years in contact sports like football, hockey and rugby, the injury is much rarer in tennis, even if it is a sport where balls can whiz past the head at speeds around 100 mph. Doubles players, in particular, take hits all the time, but not usually to their heads.
Concussions in tennis gained attention when Eugenie Bouchard, the former Wimbledon runner-up from Canada, sustained a concussion after a fall in the locker room at the U.S. Open in September 2015, an episode that is the subject of an ongoing lawsuit.
A few weeks later, at the China Open, a WTA Tour event in Beijing, Dellacqua, playing with Yaroslava Shvedova, took a fall that ended up costing her a place in the season-ending WTA Finals, the 2016 Olympics and most of last season.
"Slava took a ball that I thought I might take," Dellacqua said in Melbourne on Saturday, referring to Shvedova. "To cut a long story short, I ran backwards, fell over and knocked my head.
"There were only a couple of points to finish the match, but I still have no recollection of that 10 minutes post-falling. The first thing that comes back to me is actually being in the hospital in Beijing."
What followed was a now familiar story of postconcussion recovery. Dellacqua, a 31-year-old Australian, will play doubles and mixed doubles at the Australian Open, was kept in the hospital overnight. After a few days of rest, she was allowed to fly home, and she expected to be ready for the season-ending finals in Singapore at the end of October.
But any hope of a quick comeback vanished when she began to feel side effects.
"The doctor kind of made the call for me and said, 'It's actually not safe for you to go away and think you can play,'" she said. "I spent the next few months at home, recovering. I couldn't do anything, couldn't focus, couldn't read, watch TV, wasn't on my phone. I couldn't focus having a conversation with anyone. I was in this constant world of drowsiness.
"Then I started not being able to sleep properly. I kept asking the doctor, 'When am I going to feel better?' They said it was all normal, all part of concussion. It was a really hard injury for me to understand mentally, because it wasn't like I had a sore shoulder, it was just to do with concussion."
Bouchard was back on tour regularly about three months after suffering the concussion, but Dellacqua shelved a brief comeback attempt in early 2016. She found day-to-day life frustrating.
"I never felt sad, feeling like I don't want to get out of bed, but I just really struggled and felt like I couldn't cope with anything," she said. "We had the two kids at home, and I felt quite debilitated just being me not tennis or anything just not being able to do the small things in life. It had really affected me."
Dellacqua — who has a young son and daughter with her partner, Amanda Judd — said she drew comfort from speaking to Sarah Borwell, another tennis player who had sustained a concussion. A British doubles player, Borwell was struck in the back of the neck by a ball hit from about 6 feet away during a match in July 2010.
"I felt like I could connect with her and she could understand," Dellacqua said. "It was good because she made me feel like it was going to be okay, it was just going to take time. She kept telling me, 'It's okay, your brain will eventually reboot and you'll eventually get there.'
"It was difficult, but she was right, the doctors were right, and you do feel fine, eventually. But it was a horrible experience, concussion, and I'm glad I play a sport where you don't get multiple ones, because I don't know how those footballers go back on the field."
Borwell suffered serious bruising to her brain, and though she returned to the tour in 2011, she retired in early 2013.
"I couldn't speak very well," said Borwell, who now runs Tennis Smart, a program that helps promising junior players choose the right college in the United States. "If I was walking in a straight line and tried to talk to someone, I would veer off if someone was on my left and I talked to them, I would veer off to the right. It took me about a year to feel normal again."
Both the WTA and the ATP have protocols in place when a concussion is suspected, including a gradual return to play and consistent monitoring and testing. Elaine Brady, director of the WTA's sports science and medicine department, said the tour averaged one concussion per year between 2006 and 2010, but the count had risen to two a year since then.
"We have annual physicals which the athletes go through, across the domains of sports medicine, and we do the SCAT 3 — the sports concussion assessment tool — so every athlete on the WTA has a baseline SCAT test," Brady said. "So should they have any concussion issues in the future, they've had a baseline SCAT, and they're educated on the purpose of it and the symptoms to look for."
Dellacqua, a former top-30 player in singles, considered quitting tennis on several occasions while she was struggling to recover, but a feeling of unfinished business kept her going. She is undecided about playing singles in the future, but plans a full schedule in doubles. She will partner with Ashleigh Barty, who is amid a comeback of her own after taking more than a year off to play professional cricket.
"There were plenty of times I'd thrown away my tennis bag, my sweatbands, my rehab stuff because I knew it was a long way back," Dellacqua said. "I feel very unique to a lot of other players. I know that my life at home is great, and 110 percent when I finish, I'll be so happy. But you're a long time retired. I have had a great career, things I can be proud of, but from now on in, it's not about how many Grand Slam finals I make or my ranking. I'm out here to make my family proud and set a good example, and enjoy my tennis and go from there."