Tennis Injuries

With around 30 million tennis players in the United States, there is a vast difference in frequency and level of play. The injuries are different between youth to master athletes and between novice to professional athletes. Junior competitive players tend to play 11-20 hours per week and participate in up to 25 tournaments per year. Recreational players can range from beginners to former college/professional players with advanced skills and commonly play from 6-12 hours per week. There are some traumatic injuries in tennis but the vast majority are gradual onset or overuse injuries.

Traumatic Injuries:

• Ankle sprain- caused by quick change of direction. The outside of the ankle will become swollen and maybe discolored. If you are unable to take 4 steps regardless of pain then an X-ray may be indicated to rule out a fracture. Recurrent ankle sprains can happen but perhaps avoided with good rehab following the initial injury. If there is a long-term ankle instability, rehab will be helpful and a preventative ankle brace may be indicated for return to play.
• Hamstring strain- these injuries occur when leg is in a forced stretch position and a pop can be heard. It may swell or become discolored. Pain will be in the back of the thigh and hurt when walking, running, or bending the knee. Rehab for a hamstring strain is recommended because this injury is at high risk of becoming recurrent.
• ACL tear – There is a distinct movement pattern that causes this injury that can be avoided with proper training. A loud pop will likely be heard and the knee will feel unstable during cutting/planting while running forward may be fine initially. The knee will swell dramatically within 24 hours 90% of the time and it will be difficult to walk without a limp. Surgery is typically indicated to restore function especially for return to play. Prevention of these injuries is effective and improves performance. Check out our Jump to Perform course
• Achilles rupture or calf strain – these injuries are much more common in the 50+ yo. There will be a pop and generally it is reported “it felt like someone hit me from behind with a hammer.” If it is a full tear, you will be unable to point the toe down like you were pressing a gas pedal. There will be swelling and possibly bruising. Partial tears of the gastroc may heal but the achilles tear generally requires surgical repair.
• Concussion – falls on the hard court or a being hit by a fast moving ball can cause a concussion. Symptoms include dizziness, headache, confusion, light/sound sensitivity, nausea etc.. If you believe you have a concussion, you must stop play and get evaluated by a medical provider experienced in concussion care. See our page on Concussion management for more information.
• Dehydration/Heat exhaustion – Tennis is typically played outside in the elements including heat and humidity. Any aged athlete is at risk for dehydration or heat exhaustion. For more information on this, check out this article.

Overuse/Gradual onset injuries:

• Tennis elbow/lateral epicondylagia – Pain on the outside of the elbow with gripping, hand shaking, and playing tennis – usually the forehand, serve, and volleys. Very common injury among recreational players because of technical flaws in stroke and decreased leg drive and/or poor racket/string choice. This can be frustrating but it doesn’t have to be. Read the our blog part 1 and part 2 for more information.
• Hip pain/Femoral Acetabular impingement (FAI) – Pain/ache at the hip joint after playing and can pinch or have sharp pain in certain positions. More common in higher level male athletes but also seen in recreational players male and female. The treatment of FAI has come a long way in the last decade. Hip mobility is critical and you can have great success with PT. While PT should always be your first line option, if there is a boney contribution that PT can’t overcome then surgery can be an option.
• Spondylosis/Stress fracture of lumbar spine – More common among high level youth or college players. Low back pain primarily in the extended pattern but can ache as well. Muscles spasms are common with this injury. Primary issue is poor serve mechanics allowing too much back extension (or anterior tilt of the pelvis).
• Abdominal strain/Rectus abdominis (RA) strain – Pain in the abdominal area during serve, high ground strokes, or overheads. The rectus abdominis on the side opposite of serving arm is usually the involved muscle (left RA in a right hand dominant player). This can be a debilitating injury that sidelines a player recurrently if not handled properly – must include rehab for muscle but also correct the serve mechanics.
• Shoulder pain/tendonitis – Pain in shoulder that can be sharp with certain movements and leaves a dull ache. The shoulder endures a heavy load especially eccentrically – basically slowing the arm down during serve or ground stroke. While the rotator cuff is the site of pain, the problem is usually caused by poor stability from the shoulder blade muscles and/or poor mobility of the thoracic spine. This is a complex issue that requires some expertise of a PT who understands overhead throwing athletes.
• Wrist pain/TFCC injury or ECU strain – Pain on the outside of the wrist especially during ground strokes and commonly affects the backhand of the player that hits with more spin – although this is not the only cause. More common in collegiate and professional ranks. Catch this early for success in rehab.

Knee pain:

• Patellofemoral pain – ache under knee cap especially after sitting for a long time but movement on court can also be painful with the stop and start motion. This is more common in the youth or recreational player and driven by poor core and hip strength and control. Great success with PT.
• Arthritis – stiff and achy in morning, better after moving around but can worsen with activity. This is more common in the senior population but a PT can help greatly with improving movement, strength of the joints at the hip, knee, and ankle. Arthritis does NOT mean you have to be sidelined – in fact, remaining active is key to keeping the knee healthy – you just have to do it the right way.

This list is not an exhaustive but gives a good idea about common tennis specific injuries. The key to remember with all of these problems, the cause of the injury is rarely at the site of pain. Tennis is a sport demanding a great deal from all four limbs and core. Depending on level of play, age, and training there can be different types of injuries. At BIA, we understand the tennis player and can help you get back on court feeling strong and pain free.