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Tennis is one of the most popular sports in the world — fast, fun, and a great way to stay fit. Unfortunately, it also carries with it a number of common tennis injuries.

If you play tennis regularly, you know the game is about more than powerful serves and forehands — it’s also about quick footwork, lunges, and constant change of direction. These movements place a lot of stress on the muscles of shoulder, forearm and inner thigh, and joints like the wrist, knee and ankle. When these muscles and joints are pushed beyond their limit, a muscle or ligament strain can occur.

These injuries are common among tennis players of all levels, from beginners to professionals, but with the right knowledge you can recover well and reduce your risk of future problems.

The good news? Most tennis related injuries are preventable, and when they do occur, recovery is usually straightforward with the right care and rehabilitation. This guide covers the most common tennis injuries — what they are, how they happen, and what you can do to recover from them. 

Need additional support? We’re here to help: give us a call on +61 02 9875 3760 or book online for a comprehensive physiotherapy assessment and plan tailored to your injury.

Groin Strain (Adductor Injury)

A strain or tear of the inner thigh muscles, often from lunging or stretching wide for a shot.

Symptoms

  • Sharp pain in the groin or inner thigh.
  • Pain when squeezing legs together or lunging.
  • Possible swelling or bruising.

Treatment

  • Early rest, ice, and compression (Tubi grip or sports compression tights).
  • Manual therapy including soft tissue release, heat, TENS and therapeutic ultrasound.
  • Gait aid prescription, such as crutches, to aid in mobility.
  • Gradual adductor strengthening prior to stretching (static adductor holds to lateral lunge pulses before opening the hip with deeper stretching).
  • Hip and knee stability strengthening (glute sets to bridges, lunges to step ups).
  • Balance and agility drills including lateral change of direction, whilst progressively increasing training intensity. Assessment of potential underlying deficits such as poor ankle stability or knee control.
  • Home exercise prescription and education on return to sport loading including warm up programs (dynamic movements without load) and continual strengthening to keep hip muscles strong and balanced.

Tennis Elbow (Lateral Epicondylitis)

Overuse of the forearm extensor muscles, leading to tendon irritation at the outside of the elbow. Tennis elbow injuries are not only specific to tennis, but this condition also happens in office workers (poor mouse ergonomics) and the weekend gardener (mowing and power tool use fresh after a quiet winter).

Symptoms

  • Pain on the outside of the elbow or forearm muscle belly (just below the elbow).
  • Grip weakness or pain with gripping tasks (like chopping vegetables).
  • Pain worsens with backhand strokes (or more gardening!).

Treatment

  • Rest from aggravating play (or gardening or domestic tasks).
  • Ice packs after play.
  • Manual therapy including soft tissue release, heat, TENS and therapeutic ultrasound.
  • Physiotherapy-guided eccentric loading exercises. Both excessive gripping and wrist extension actions contribute to this condition, so rehabilitation requires separating these movements. We want to gradually load the tendon without flaring it up. As the tendon recovers, we can re-combine actions to simulate sport and work scenarios in preparation for return.
  • Braces for short-term relief (should you HAVE to return to play or those necessary domestic tasks) and during rehabilitation to spread the load over a larger muscular surface area to aid in recovery. These braces can be for the wrist or elbow, depending on your injury.
  • Modifications to the grip size of the racket, power tool or chopping knife. Strengthening to reduce the level of grip required for control and ensuring wrist is kept neutral (power comes from the arm, not a flick of the wrist, which is a common compensation we may not be aware of).
  • Strengthening the opposite side of the forearm (how is your forearm stroke?) and shoulder (are you a regular volleyer or smasher?)

Rotator Cuff Injury (Shoulder Pain)

A rotator cuff injury involves irritation or small tears in the shoulder’s stabilising tendons, usually from repetitive serving or a powerful return.

Symptoms

  • Pain during serves, overhead shots, or extending the arm out for a wide forehand.
  • Weakness or reduced range of motion.
  • Night pain when lying on the shoulder, a dull ache that persists throughout the day or sudden pain on particular movement.

Treatment

  • Rest from overhead strokes and aggravating positions.
  • Manual therapy including soft tissue release, heat, TENS and therapeutic ultrasound.
  • Physiotherapy to improve engagement of the rotator cuff in synergy with the scapula. If the injury is extensive the initial exercises movements are totally passive (no muscle engagement). Exercises then progress to active arm movements with a bend in the elbow to de-load the rotator cuff, and assistance comes from the other arm (known as ‘active assisted’ exercises). Progressively we load the arm in different directions before combining movement to simulate sport specific movements, including load and speed. Everyone is unique in their rehabilitation, so we highly recommend an individualised program to safely progress a rotator cuff injury.
  • Strengthening of the upper and lower back to cooperate with the shoulder for power and stroke control, so you are your best when returning to the court. Best not to overload your serve volume to prevent re-injury and warm up once on the court itself.

Ankle Sprain

An ankle injury is a ligament injury caused by rolling or twisting the ankle, common during rapid directional changes.

Symptoms

  • Pain, swelling, and bruising.
  • Difficulty bearing weight and moving the foot.

Treatment

  • Initially RICE (Rest, Ice, Compression, Elevation). More significant ankle rolls may require a crutch to aid in mobility.
  • Manual therapy including soft tissue release, heat, TENS and therapeutic ultrasound.
  • Physiotherapy to recover ankle range (Theraband press downs and pull ups, then light movements inwards and outwards). Often, the side movements require static holds for 10 seconds before progressing to short repetitions to aid tendon healing. Calf stretching and progressive strengthening, with the aim of achieving stable single leg calf raises, then balance tasks are added. 
  • Bracing/taping during return to play. The importance of upcoming game(s) and events is discussed as it is always a balance between early return to play versus allowing longer recovery time. We have a collaborative discussion about return to sport timelines.
  • Gait review and analysis of the medial arch of the foot. We have high quality sports orthotics to support people with less arch support that goes beyond the arch support in even the most supportive footwear. These can be moved between work and sports shoes and provide firm yet pliable support for impact activities.
  • Once you have had an ankle sprain you are more likely to have another, though this shouldn’t stop us returning to activities we enjoy. The opportunity is to continue to work on balance and proprioception beyond acute injury recovery to continue to enjoy the sport.

Knee Injuries (Patellar Tendinopathy / Meniscus Issues)

Stress on the knee from repetitive jumping, sprinting, or twisting.

Symptoms

  • Front-of-knee pain (jumper’s knee).
  • Swelling or catching if meniscus affected.
  • Pain with squats, running, or stairs.

Treatment

  • Rest and load management. Often our medial (inside) quadricep muscle is weak, causing poor loading across the patella tendon that runs over the knee. 
  • Eccentric quadriceps strengthening. Later in the rehabilitation phase we focus on strength control required during stepping downstairs and prevention of knee hyperextension
  • Taping or supports if needed. Like ankle injuries, these supports are used to speed recovery and graded return to activities.

Playing tennis is demanding on the body, but most common tennis injuries share a theme: they come from overuse, poor mechanics, or sudden, intense movements.

The key is to:

  • Warm up properly.
  • Strengthen supporting muscles.
  • Train movement patterns, not just strokes.
  • Listen to your body and rest before small pains become big problems.

If you do get injured playing tennis, early physiotherapy can speed recovery and reduce your risk of recurrence.

With the right approach, you can stay healthy, improve performance, and enjoy tennis for years to come.

Give us a call on +61 02 9875 3760 or book online for a comprehensive physiotherapy assessment, exercise program and plan tailored to your injury.

For more information, we have posted a blog about tennis injuries, shoulder injuries, and physiotherapy for a sprained ankle.

Tennis Australia in South Australia also posted information on common tennis injuries.

References

  1. Abrams GD, Renstrom PA, Safran MR. Epidemiology of musculoskeletal injury in the tennis player. Br J Sports Med. 2012;46(7):492–498.
  2. Serner A, van Eijck CH, Beumer BR, et al. Study methodology of groin injuries in athletes: a systematic review. Br J Sports Med. 2015;49(12):775–781.
  3. Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011;10(2):238–253.

Tennis is a great sport that requires speed, power, endurance, balance, and coordination. However it can cause injury to many parts of the body due to the high speed of racquet impact, as well as repetition and use of your dominant arm. The frequent stopping, pivoting and jarring can also contribute to lower limb injuries in your knees, ankles or hips. Back injuries can also occur due to the frequent rotation required during groundstrokes. In this blog we will talk about some of the most common tennis injuries.

Types of Tennis Injuries

Tennis elbow

Tennis elbow, also known as lateral epicondylitis, is a painful condition of the outside of the elbow. It is often caused by overuse of the muscles, which become inflamed and in some cases you can get microtears. This condition is quite slow to heal as the tendon has a poor blood supply. Symptoms develop gradually, and can worsen over weeks and months.

Physiotherapy treatment can help by promoting blood flow to the area with soft tissue massage to the muscles and tendon. Ultrasound, hot or cold packs, and TENS can also be used for pain relief. They will give you an exercise program to help strengthen your forearm muscles so that they can better cope with the demands of tennis. You should also have your coach analyse your swing technique to ensure your wrist is stable and that you have minimal pressure on the extensor tendons. If appropriate, you may be advised to wear an elbow guard in the short term to help take the pressure off the affected area. Your physio can fit you with the brace and advise you on when you should be wearing it.

Shoulder injuries

Shoulder injuries are common in tennis, often due to the forceful motion of serves or smashes. Performing a tennis serve can overload various structures around the shoulder, particularly if there is tightness or weakness causing muscle imbalances. This can occur with a muscle strain, or during growth spurts in children when the muscles become tight as the bones are lengthening. Frequent overuse of the rotator cuff muscles in the shoulder can also cause impingement of the bursa which can lead to inflammation and pain.

To reduce the risk of injury, a thorough assessment should be performed to identify any muscle imbalances or weaknesses. A physiotherapist can then prescribe you with an individually tailored exercise program to target your strength deficits as well as work on flexibility, stability, and endurance. They can also provide advice on training your training load. Any increases in the amount of training or competition must be gradual to avoid overloading the shoulder. Physiotherapy can also help to reduce pain and swelling with gentle massage and joint mobilisations, ultrasound, heat and TENS. The shoulder can also be taped if deemed appropriate.

Knee injuries

Tennis players can be affected by patella tendonitis, also known as jumper’s knee. Knee pain in tennis players most commonly occurs at the front of the knee, due to inflammation of the patellar tendon with repetitive jumping and stop/start motions. Landing on hard surfaces can also contribute to this injury.

Treatment should follow RICE principles (rest, ice, compression and elevation), as well as target strengthening to your quadriceps. Your physiotherapist can help devise an exercise program to suit your needs and target your weaknesses. Regular lower limb stretching is also important and can help prevent injury to your calf, Achilles, and hamstrings.

Lower back injuries

The motion of serving involves hyperextending the lower back with an added rotation and side bend. This places stress on the joints and soft tissues of the lower back. With too much repetition, this may result in a slipping forward of the vertebra (spondylolisthesis). Some cases can develop into a spondylolysis, which is a stress fracture in the pars interarticularis.

Treatment firstly involves a period of rest to allow for healing to occur. Your physiotherapist will then guide your lower back rehabilitation to help build up the strength, stability and flexibility in your muscles. This will mean your back is better supported and better able to cope with the demands of the sport. Your physio will incorporate sports specific exercises and will advise you on when you can return to training and competition.

Tips to prevent tennis injuries

  • Always remember to warm up, stretch, and cool down
  • Maintain adequate fitness
  • Ensure you have good technique. You should seek advice from a qualified coach to help develop or correct your skills
  • Avoid over-repetition of the same type of shot. You should be practising a range of strokes including groundstrokes, smashes, volleys and serves.
  • Wear appropriate footwear which have adequate foot support
  • Check that your racquet is suitable for your style of play, experience and size
  • Update your tennis balls regularly. Old or damp balls load the arm with unnecessary force

If you are suffering from a tennis injury or have any further questions, please contact us! Give us a call on +61 02 9875 3760 or book online. We would be more than happy to help.