As summer approaches you may be thinking about getting back on the court for a game of tennis.

Now is a good opportunity to look at some common tennis injuries and useful management tips.

Common Injuries:

  • Overuse shoulder Injuries
  • Lower Back Injuries
  • Tennis Elbow

Statistically, it is the overuse shoulder and lower back injuries that account for the most time spent off the court in our tennis population. Both lower back and shoulder injuries often occur as a result of excessive serving and/or poor service technique.

The rotator cuff muscles are crucial for the overall stability of the shoulder joint. With tennis serving (and other overhead sports), these muscles are forced to contract extremely quickly placing high loads on their respective tendons. The average first serve speed for professional male tennis players is 184.1km/hr. The fastest first serve ever recorded stands at 263.4km/hr. Those shoulders have to be very well conditioned. Muscle fatigue from overuse, a lack of conditioning and technique issues often lead to overuse tendon injuries.

Discomfort in the lower back is typically noticed on the opposite side to the server’s dominant arm. For example, a right-handed server will often have localised pain on the left side of their lower back. For most players, symptoms settle with sufficient rest and professional advice. However, if the stress exceeds part of the vertebrae’s ability to withstand serving loads overtime, a stress reaction in the lumbar vertebrae can develop, particularly in our younger players. These require substantially more time away from playing and regular medical surveillance in order to prevent progression to a potential stress fracture (spondylolysis) and more time off the court.

Tennis elbow (an overuse extensor tendon injury), which we have addressed in a previous blog, is not as common nowadays, particularly at competitive levels. This is largely due to increasing use of the double-handed backhand in the tennis world. Therefore, it is typically social tennis players that use a one-handed backhand and have limited coaching exposure that are at greater risk of developing tennis elbow.

The reasons for obtaining these tennis-related injuries can be quite complex. However, insufficient knee bend during the serve and a lack of thoracic spine mobility are often key contributors.

Key warm-up stretches:

Posterior shoulder release – Use a foam roller and place it just behind your shoulder (in-line with your armpit). Slowly roll up and down the back of your shoulder whilst lying on the roller in a side-lyingposition.

Resisted shoulder external rotation – Tie a theraband  or elastic tubing just above head height. Maintain your shoulder and elbow at a 90-degree angle throughout the motion. Pull the band so that your arm ends up just behind you.

Side-lying thoracic rotations – Lay down on your side with both knees bent at about 90 degrees. Keep both arms extended and out in front. Slowly rotate your top arm by twisting the middle aspect of your spine until you feel a slight stretch. Try not to allow your hips to rotate whilst twisting.

Medicine ball throws – Use a light (1kg) medicine ball and replicate both forehand and backhand motions by throwing it against a wall. Try and keep the ball behind your body to achieve maximal rotation.


The management of these injuries has similarities and key differences. Apart, from addressing technical aspects of certain tennis shots or equipment changes all these injuries will require specific strengthening programs.

Overuse shoulder injuries typically require specific strengthening exercises of the rotator cuff complex. Training these muscles to produce high amounts of power with enough control over many repetitions is vital. Often professional tennis players will make subtle adjustments to string type, racquet frame weight and weekly serving volume to manage these injuries in-season.

Lower back injuries often need not only a core stabilisation program but also mobility exercises that target the middle aspect of your spine (thoracic spine). Generating enough rotation in your thoracic spine during a serve is critical for reducing excessive stress on both your lower back and shoulder.

Nevertheless, anyone looking to play tennis (at any level) should have these essentials ticked off to help with reducing their chance of injury:

  • Basic lessons on serving and backhand groundstrokes
  • Favour learning and playing with a double hand bank-hand
  • Avoid playing with polyester strings at first
  • Always include thoracic (middle back) mobility exercises in your warm-ups
  • Progressive loading allowing your body to adapt over a structure period of time

Tennis is a great sport that offers plenty of health benefits, but it can also lead to injuries if you’re not careful. If you are experience pain or discomfort when playing tennis, it’s important to seek medical attention. The team at Symmetry Physiotherapy can help diagnose the injury and provide treatment options to get you back on the court as soon as possible. Have you sustained an injury while playing tennis? Book an appointment with us today.

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