Preventing Tennis Injuries with Physical Therapy

Tennis is a popular, dynamic sport that requires significant speed, agility, endurance, coordination, and cardiovascular fitness of the tennis player. Due to the intensity and repetitive motions of tennis, tennis players can suffer chronic overuse injuries like tennis elbow and rotator cuff tendinitis and acute injuries like ankle sprains. Physical therapists can help tennis players prevent injury through a strength and conditioning program tailored to their needs and abilities and provide targeted treatment for specific injuries to help tennis players return to competition with restored strength and mobility.

Common Tennis Injuries

Tennis is a dynamic sport that requires speed, agility, endurance, coordination, and cardiovascular fitness to run, position your body, swing, and hit the tennis ball. However, due to the intensity and repetitive motions of tennis, tennis players can experience injuries in the upper and lower extremities, particularly the shoulder, elbow, wrist, knee, and ankle. Two-thirds of tennis injuries are related to chronic overuse and are the primary factor for shoulder, elbow, and wrist injuries in tennis. The remaining 1/3 of injuries are acute or traumatic events to the knee or ankle.

The six most common tennis injuries include:

1.     Tennis Elbow: Tennis elbow is one of the most common tennis injuries involving inflammation of the tendons joining the forearm muscles to the outside of the elbow. Tennis elbow is a repetitive motion injury caused by swinging the tennis racquet over and over and improper backhand technique. It causes pain, a burning sensation on the outside of the elbow, and weak grip strength.

2.     Rotator Cuff Tendinitis & Tears: Rotator cuff tendinitis involves inflammation of the rotator cuff tendons, causing shoulder pain and swelling and can lead to a partial or full tear of the rotator cuff tendons. This injury is often caused by excessive overhead serving and serving with the arm at 90 degrees.

3.     Patellar Tendinitis: Patellar tendinitis involves inflammation or injury to the patellar tendon, which connects the kneecap to the top of the shinbone and helps to extend the knee. This injury is common in tennis players as tennis places immense stress on the knee due to jumping and landing repetitively during the game, frequent side-to-side quick movements of the knee, and playing on hard surfaces like a synthetic or cement tennis court.

4.     Ankle Sprains: Ankle sprains result from the multi-directional nature of tennis and due to frequent running, jumping, and landing that could cause a player to turn the ankle. Playing on an uneven court can also contribute to an ankle sprain, in which the ligaments of the ankle are overextended due to the foot twisting or turning beyond its normal range of motion.

5.     Low Back Pain: Low back pain in tennis players can develop from twisting and side-bending during play, hyperextension of the back (bending the back), and playing on hard courts. Hyperextending and quickly rotating the back can place stress on the vertebrae and strain the muscles of the low back. Playing on a hard surface also contributes to a greater impact on your low back.

6.     Wrist Tendinitis: Wrist tendinitis is inflammation of the tendons of the wrist that develops over time. In tennis players, this can result from swinging the racket, especially if there is excessive wrist motion with each swing. Pain can be felt on either side of the wrist or the palm or clicking may be heard when moving the wrist.

Preventing Tennis Injuries

Physical therapists can help tennis players prevent injury through a strength and conditioning program tailored to their needs and abilities and provide targeted treatment for specific injuries to help tennis players return to competition with restored strength and mobility.

Often, athletes focus on perfecting the techniques and particular skills needed for their specific sport and neglect training off the court. However, off the court training is critical to improve the athlete’s overall performance and prevent injury. A physical therapist can design a strength and conditioning program tailored to the tennis player’s specific condition and abilities. The program includes targeted strengthening of weak muscles or correcting muscular imbalances; functional movement training such as balance training, sprinting, and side lunging; and aerobic conditioning for improved endurance.

Strength training of the legs, core, and shoulders is essential as these areas are placed under significant strain during tennis. Your rotator cuff muscles in the shoulder need to be strong and have the endurance to stabilize shoulder muscles during serves, forehands, and single-handed backhands, while the core needs to be flexible and strong to handle power shots. Strong legs, knees, and gluteal muscles provide the athlete the dynamic strength to run, jump, land safely, and side-step during a match.

Functional movement and aerobic conditioning can include both balance training, short sprints, and endurance training. Short sprints, such as shuttle runs and agility runs, train the tennis player to change direction quickly with speed and power. Endurance training allows the player to play at a higher intensity for a longer period of time as the muscles are able to perform without tiring as quickly.

Physical therapists are trained to provide targeted treatment for specific injuries like rotator cuff, wrist, and patellar tendinitis or ankle sprains and back pain. Physical therapists use a variety of treatments: stretching and strengthening exercises of specific muscles around the injured area, pain management, manual therapy soft tissue and joint mobilization techniques, body mechanic instruction, and dry needling.

Injuries can be minimized or prevented by proper strength and conditioning of the tennis player, correct technique, appropriate equipment, and targeted medical attention to treat injuries early and effectively. 

Here are a few tips to avoid tennis injuries:

• Do a dynamic warm-up before practice and games. A dynamic warm-up has been shown to reduce injuries as it warms up the muscles and improves range of motion. Cold muscles are more prone to injury.

• Don’t overtrain. Overtraining means that an athlete compromises their recovery time and engages in practice and competition without sufficient rest time. Muscles and tendons will fatigue, become inflamed, and are more prone to injury.

• Use proper tennis techniques. Don’t arch the back too much when serving and balance your upper body weight by bending the knees and raising your heels. Avoid landing on the balls of your feet when jumping as this can result in an ankle injury

• Engage in a targeted strength and conditioning program with a physical therapist.

• Wear a tennis shoe that offers good support and stability to the foot and tennis socks (or a double pair of regular socks) for extra padding to support the ankle.

• Ensure you have a racquet with the correct grip size and string tension which can reduce stress on the elbow and shoulder.  A grip that is too large can force you to squeeze the racket more tightly and tire your arm, while a small grip can make you whip the racket, both of which places additional strain on the wrist, arm, and elbow.

• Avoid playing on synthetic or asphalt courts and play on clay or grass courts instead to reduce the impact on your body.