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Spring is here, the sun is beginning to shine (sort of…), Nadal has just won his fifth Madrid title and the tennis season is getting into full swing. With Wimbledon looming just around the corner, many of us are feeling inspired and are reaching for our rackets.  However, even the top tennis players get injured, so it’s no wonder many of us hobble off the court with some kind of tennis-related injury.

Tennis is played on a variety of surfaces: grass, artificial grass, hard court surfaces and clay.  All of these require variations of speed, balance, power, co-ordination and proprioception.  And, due to the high speed impact, repetition and use of your whole body, they predispose us to ankle, knee, hip, spine, shoulder and wrist injuries.

Let’s take a look at some of the most common tennis injuries and the top tips for preventing them.

Common Tennis Injuries

Lower Limb Injuries

Ankle, knee and thigh/calf injuries, are the most common injuries seen in tennis players, usually caused by the stop-start nature of the game, involving sudden sprinting/stopping, pivoting, jarring and pounding.

  1. Ankle Sprain

Sprains occur when a ligament is stretched or torn. Most commonly in ankles, this happens when an ankle is “twisted” and the ankle rolls inwards, spraining the ligaments on the outside. Any instability or weak muscles can increase the risk of spraining your ankle.

In tennis:

The fast paced, quick direction changes and jumping involved in tennis, predispose you to a higher risk of going over on your ankle.

Tips to avoid this injury:

  • ensure your muscles are adequately strengthened and properly warmed up before playing, to reduce the risk of injury
  • integrate balance, co-ordination and proprioceptive exercises into your training, to reduce the chance of ankle sprains and improve control
  • wear appropriate, supportive footwear
  • wear ankle supports or tape for extra support, if you have a history of spraining your ankle
  1. Muscle Strain

Muscle strains can occur from over-use or from quick, sudden movements, that cause an over-stretch or tear in the muscle.

In tennis:

The quick, stop-start nature of tennis with sudden sprinting, stopping and jumping, means that hamstrings and calves are susceptible to being strained or “pulled”.

Tips to avoid this injury:

  • Make sure you do a thorough warm-up before playing, as well as an appropriate cool-down, including stretches afterwards, to prevent muscles from being at risk of a strain
  • Include sudden movement, plyometric training and jumping, into your training regime
  • Use taping techniques to give support to previously strained/weak muscles
  • Play in warmer weather – acute muscle strains are more common when it’s cold because the muscles are stiffer, so make sure you do an extra-long warm-up or play in the warm weather!
  1. Stress Fractures

Stress fractures are usually an over-use injury.  When muscles fatigue and are unable to absorb added shock, most stress is transferred to the bone. This can cause tiny cracks, known as stress fractures. These are most commonly seen in the weight-bearing bones of the lower leg and foot, although they have been known to occur in the spinal vertebrae too.

In tennis:

Stress fractures are a common injury in amateur players and are usually a result of increasing the training or the intensity of the activity, too rapidly.  The repetitive stress of the foot striking the ground can cause trauma. They can also be caused by switching court surfaces (eg. soft clay court to a hard court) or wearing improper footwear.

Tips to avoid this injury:

  • Ensure that you have sufficient rest periods between playing, to allow time for your bones to recover and reduce the risk of fracture
  • Set incremental goals to gradually build up your training – do not increase the intensity of your training too rapidly
  • Include specific strengthening training to ensure as much shock as possible is absorbed by your muscles and not your bones
  • Include calcium and vitamin-D rich foods into your diet to promote healthy bones
  • Wear appropriate, supportive footwear
  • Recognise symptoms early – if pain and swelling occurs, rest and ice for a few days until this subsides. If it does not improve consult a healthcare professional


Upper Limb Injuries

Elbow, shoulder and wrist injuries are commonly seen in tennis players, as a result of the high-velocity and high-repetition arm movements required.

  1. Tennis Elbow

“Tennis elbow” is a condition characterised by pain and tenderness on the outside of the elbow. It usually results from repetitive-strain or over-use of the wrist extensor muscles, most commonly the extensor carpi radialis brevis (ECRB) muscle, which causes micro-trauma to the tendons.

In tennis:

The wrist extensor muscles are used regularly in tennis when the ball impacts on the racket. The swinging movement from the elbow, twisting of the forearm and gripping of the handle, can also influence these muscles and lead to them being overloaded when playing tennis, particularly if your technique isn’t quite correct.

Tips to avoid this injury:

  • make sure these muscles are adequately strengthened and properly warmed up before playing, to reduce the risk of injury
  • ensure that the grip size is right for you and your technique is correct
  • reduce the tension of the racket strings to minimise the impact on the forearm muscles


  1. Shoulder Pain (Rotator Cuff Tendonitis)

Most shoulder pain in tennis is the result of an inflammation of the rotator cuff muscle tendons – a group of four muscles that surround and support the shoulder joint and which help it to move in all directions. When these muscles are deconditioned or weak, there is greater “play” of the head of the joint in the socket, which can lead to irritation of the tendons and bursa , resulting in pain, stiffness and weakness in the shoulder.

In tennis:

The highly repetitive forces that go through the shoulder when hitting a tennis ball, can lead to irritation of these tendons over time. People with shoulder tendonitis commonly experience pain and difficulty when playing, especially when serving and in more severe cases can experience pain at night and in other activities of daily life.

Tips to avoid this injury:

  • Strengthen your rotator cuff and other shoulder muscles, to ensure that they can cope with the repetitive forces and impact of hitting the ball
  • Stretch before and after playing, to prevent tight muscles and inflammation
  • Ensure your technique is correct, in order to reduce the force going through this joint and muscles during each stroke


Back Injuries

Back injuries are less common and are usually caused by the rotation when hitting ground stokes and the combination of rotation, extension and lateral flexion involved in serving.

  1. Lower Back Pain

Lower back pain is very common and can range from a dull ache, to sharp, sudden pain. In tennis, this is commonly due to muscle spasm.

In tennis:

People tend to over-arch in their spine in order to increase the power of their shots and when serving people rotate, side-flex and extend their spine repeatedly.  These repetitive movements can put added pressure on the joints and muscles of the spine and can contribute to back pain.

Tips to avoid this injury:

  • Include an appropriate warm-up and cool-down with stretching, to increase the mobility in your spine and prevent muscle stiffness
  • Include deep core strengthening in your training regime, to support the spine
  • Wear good, supportive footwear with cushioning, to absorb some of the impact



Risk Factors for Injury

  • Court surfaces
  • Ball condition
  • Type of tennis racket
  • Tennis shot technique
  • Weather
  • Inappropriate footwear
  • Poor physical conditioning
  • Level of experience
  • Previous injury

How to Avoid Injury

Good preparation

  • Make sure you gradually build up your training and include specific strengthening, balance, co-ordination and proprioceptive exercises into your regime, to ensure that you are at your fittest


  • Ensure you use a tennis racket that is suitable for your size, style and level of play
  • Check the court surface is in good condition and avoid playing on a wet surface
  • Use balls that are appropriate for the playing surface and avoid playing with old or “dud” balls


  • It’s so important to make sure you’re wearing the correct footwear, so that you have appropriate support for your feet and style of running. Use orthotics or seek professional advice, if needed


  • If you have a history of a previous injury, make sure the area is correctly supported with either a brace or taping to prevent re-injury

Warm up, cool down, stretch

  • Get into the habit of doing this after every training session, to ensure that your muscles remain at their optimum condition

Maintain fitness

  • Tailor your training and conditioning to exercises specific to the physical demands of tennis

Good skills and technique

  • A good technique and practice will help to prevent injury. Seek advice from a qualified coach to refine and correct your technique


  • Practice a variety of strokes and shots in order to avoid overly repetitive movements, that can cause injury.

Article by Sally Dixson, Chartered Physiotherapist at Capital Physio

If you are suffering from a tennis injury, call us on 033 0333 0435 to see if one of our Physiotherapists can help.

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