- Tennis frequently causes injuries to the shoulder, elbow, and spine.
- Knowledge of pathologies and prevention strategies is essential.
- Strengthen shoulder, stretch, and correct serve technique to prevent injury.
- Use correct backhand technique and proper equipment to prevent elbow pain.
Table of Contents
- Epidemiology of Tennis Injuries
- Shoulder Injuries
- Impingement and rotator cuff tendinopathy
- SLAP lesion and instability
- Elbow Injuries
- Lateral epicondylitis (tennis elbow)
- Medial epicondylitis (golfer’s elbow in tennis)
- Spinal Injuries
- Low back pain from hyperextension-rotation
- Lower Limb Injuries
- Ankle sprain
- Plantar fasciitis and Achilles tendinopathy
- Patellar tendinopathy
- Tennis Player Prevention Program
- Pre-match warm-up (10-15 minutes)
- Specific strengthening (2-3 times/week)
- Post-match cool-down (5-10 minutes)
- Equipment Management
- Frequently Asked Questions (FAQ)
- Does tennis damage joints?
- Can I play tennis with epicondylitis?
- Does a two-handed backhand protect the elbow?
- How many times a week can I play without risking injury?
- Does the surface influence the risk of injury?
- Related articles
Tennis injuries
Tennis is a sport that intensely stresses the musculoskeletal system through repetitive high-speed movements, explosive changes of direction, and ball impacts that generate significant forces on the joints. It is estimated that competitive and amateur tennis players suffer 1-3 injuries per 1000 hours of play, with a characteristic distribution predominantly involving the upper limb (shoulder and elbow), spine, and lower limb (ankle and knee). Knowledge of the most frequent pathologies and prevention strategies is essential to practice this sport safely and for a long time.
Epidemiology of Tennis Injuries
| Site | Frequency | Main pathologies |
|---|---|---|
| Shoulder | 20-30% | Impingement, rotator cuff tendinopathy, instability, SLAP |
| Elbow | 25-35% | Epicondylitis (tennis elbow), epitrochleitis |
| Wrist and hand | 10-15% | Extensor tendinitis, stress fractures |
| Spine (lumbar) | 15-20% | Low back pain, spondylolysis, disc herniation |
| Knee | 10-15% | Patellar tendinopathy, chondropathy |
| Ankle and foot | 10-15% | Sprain, plantar fasciitis, Achilles tendinitis |
Shoulder Injuries
Impingement and rotator cuff tendinopathy
Tennis player’s shoulder is the most frequent upper limb pathology. The serving motion involves internal rotation speeds of up to 2500°/second, generating enormous forces on the rotator cuff.
Mechanism: During the cocking and acceleration phases of the serve, the cuff tendons (especially the supraspinatus and infraspinatus) are compressed under the acromion (impingement) and subjected to eccentric stress during the deceleration phase.
Symptoms: Shoulder pain during and after play, especially during serve and smash, nocturnal pain, loss of power.
- Eccentric strengthening of external rotators with resistance band: 3 sets of 15
- Exercises for scapular stabilizers (rhomboids, middle and lower trapezius)
- Posterior capsule stretching (sleeper stretch)
- Correction of serving technique (avoid hyperabduction)
SLAP lesion and instability
In tennis players with a high volume of serves, repeated traction of the biceps can cause a superior glenoid labrum lesion (SLAP). Micro-traumatic anterior instability is common in young competitive tennis players.
Elbow Injuries
Lateral epicondylitis (tennis elbow)
Lateral epicondylitis is the most iconic tennis injury, although it more frequently affects amateur and recreational players (40-50% of amateur tennis players suffer from it at least once) than professionals.
Mechanism: Overload of the wrist extensors, particularly the extensor carpi radialis brevis, due to an incorrect backhand technique (especially a one-handed backhand with an unstable wrist).
Technical risk factors:
- One-handed backhand with a “loose” wrist
- Racket too heavy or with an inadequately sized grip
- Strings too tight
- Heavy or wet balls
- Excessive playing volume
Prevention:
- Correct backhand technique: hit with a stable wrist and slightly flexed elbow
- Appropriate racket: correct grip size, strings not too tight (50-55 lbs), racket not too stiff
- Eccentric strengthening of wrist extensors: 3 sets of 15
- Stretching of wrist flexors and extensors before and after play
Medial epicondylitis (golfer’s elbow in tennis)
Less frequent than epicondylitis, it affects the wrist flexor-pronators. Associated with serving with strong pronation and forehand with a lot of topspin.
Spinal Injuries
Low back pain from hyperextension-rotation
The serve and smash require hyperextension combined with rotation of the lumbar spine, which can cause:
- Acute muscular low back pain
- Spondylolysis (stress fracture of the vertebral pars interarticularis) — common in young tennis players
- Disc herniation (less common, but possible due to torsional stresses)
Prevention:
- Core stability: plank, dead bug, pallof press
- Thoracic mobility: dorsal stiffness forces the lumbar spine to compensate
- Adequate hip rotation: if the hip does not rotate enough, the spine compensates
- Correct serving technique: use the full kinetic chain (legs-trunk-arm)
Lower Limb Injuries
Ankle sprain
Frequent due to rapid changes of direction on hard surfaces. Clay courts are slightly protective (the foot slides), while concrete and synthetic courts increase the risk.
Plantar fasciitis and Achilles tendinopathy
Rapid lateral movement and repetitive pushing stress the plantar fascia and Achilles tendon. More frequent on hard surfaces and with inadequate footwear.
Patellar tendinopathy
Braking movements and explosive changes of direction stress the patellar tendon, especially on hard surfaces.
- Tutore spalla regolabile (paid link) (Ortesi | 25-45€)
- Fascia elastica resistenza (set) (paid link) (Esercizi | 12-25€)
- Pallina massaggio miofasciale (paid link) (Auto-trattamento | 8-15€)
Lower limb prevention:
- Specific footwear for the playing surface
- Calf strengthening (eccentric calf raise)
- Ankle proprioception
- Quadriceps strengthening with eccentric exercises
Tennis Player Prevention Program
Pre-match warm-up (10-15 minutes)
- Light jogging with changes of direction (3 minutes)
- Dynamic mobilization: arm circles, trunk rotations, lunges with rotation
- Resistance band exercises for the rotator cuff (external/internal rotation)
- Progressive mini-tennis (rally from baseline, then light serve)
Specific strengthening (2-3 times/week)
Shoulder:
- External rotation with resistance band at 0° and 90° abduction
- Resistance band rowing for scapular retractors
- Push-up plus for serratus anterior
- Sleeper stretch for the posterior capsule
Elbow and wrist:
- Eccentric extensors: wrist flexed with dumbbell, slow extension. 3&215;15
- Pronation and supination with hammer
- Grip exercises with hand grip
Core:
- Plank (front and side): 30-60 seconds, 3 sets
- Russian twist with medicine ball
- Chop and lift with resistance band
Lower limb:
- Squats and multi-directional lunges
- Single-leg calf raise
- Agility exercises: shuttle run, side shuffle, carioca
Post-match cool-down (5-10 minutes)
- Static stretching of shoulder, wrist, quadriceps, calf, adductors
- Foam rolling of the iliotibial band and quadriceps
- Cryotherapy on any painful areas
Equipment Management
| Parameter | Recommendation |
|---|---|
| Racket weight | 280-310 g (intermediate) — too light transmits more vibrations |
| Balance | Slightly head-heavy for power, handle-heavy for control |
| Grip size | Ring finger should almost touch the palm when gripping |
| String tension | 50-55 lbs (less tension = fewer vibrations) |
| String type | Multifilament or synthetic gut (more comfortable than polyester) |
| Footwear | Specific for the surface, with lateral support |
Frequently Asked Questions (FAQ)
No, tennis played with the correct technique, adequate equipment, and a prevention program does not damage joints. On the contrary, regular physical activity keeps joints healthy. Problems arise from overload, incorrect technique, and inadequate equipment.
In acute phases, it is advisable to reduce or suspend play. After symptoms improve, the return must be gradual, with correction of technique and equipment. An epicondylitis brace can help during recovery. Physiotherapy with eccentric exercises is the most effective treatment.
Yes, a two-handed backhand significantly reduces stress on the lateral epicondyle compared to a one-handed backhand, because the non-dominant hand shares the load. For those suffering from epicondylitis, switching to a two-handed backhand can be an effective solution.
There is no universal number. For an amateur without problems, 2-4 sessions per week (1-1.5 hours each) are generally well tolerated if accompanied by warm-up, strengthening, and recovery. The important thing is gradual progression: do not double the volume from one week to the next.
Yes. Hard surfaces (concrete, synthetic) transmit more impact to the lower limb joints. Clay courts are generally “gentler” because the foot slides partially, reducing torsional forces. Grass is slippery and increases the risk of falls.
Frequently Asked Questions
What are the key components of an effective tennis injury prevention program?
An effective prevention program typically includes a pre-match warm-up, specific strengthening exercises performed 2-3 times per week, and a post-match cool-down. Proper equipment management and correct technique for strokes like the serve and backhand are also crucial.
Does using a two-handed backhand technique help prevent elbow injuries?
A two-handed backhand can distribute the forces across both arms, potentially reducing the strain on the dominant elbow compared to a single-handed stroke. However, proper technique for both types of backhands is essential to minimize injury risk.
What are common shoulder injuries in tennis players and how can they be mitigated?
Common shoulder injuries include impingement, rotator cuff tendinopathy, and instability. These can often be mitigated through targeted strengthening exercises for the shoulder musculature, regular stretching, and refining serve technique to reduce undue stress.
Is it advisable to continue playing tennis when experiencing epicondylitis?
Continuing to play tennis with epicondylitis may exacerbate the condition and delay recovery. It is generally recommended to consult a physical therapist or medical professional for an accurate diagnosis and to develop a tailored management plan, which may include activity modification.
Sources and Scientific References
- Landesa-Piñeiro L et al. (2022). Physiotherapy treatment of lateral epicondylitis: A systematic review. J Back Musculoskelet Rehabil. 35:463-477. DOI | PubMed
- Stasinopoulos D et al. (2004). Cyriax physiotherapy for tennis elbow/lateral epicondylitis. Br J Sports Med. 38:675-7. DOI | PubMed
- Lenoir H et al. (2019). Management of lateral epicondylitis. Orthop Traumatol Surg Res. 105:S241-S246. DOI | PubMed
- Viswas R et al. (2012). Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. ScientificWorldJournal. 2012:939645. DOI | PubMed
- Bonczar M et al. (2023). Treatment Options for Tennis Elbow – An Umbrella Review. Folia Med Cracov. 63:31-58. DOI | PubMed