Tennis is an extremely enjoyable yet physical sport that requires agility, speed, strength, endurance, and coordination to play. Due to the multitude of physical requirements to play tennis, it is no wonder that injuries occur regularly. The most commonly thought of injury is “tennis elbow”, however, tennis can cause injury to many parts of your body including the spine, legs (hip, knee, and ankle), and dominant arm (shoulder, elbow, wrist, and fingers). This is due to the high speed of racket swing, the torque placed on the spine, and the repetitive impact and cutting required for quick court movements. Proper form, conditioning, stretching, and body mechanics are key for injury prevention. With these precautions in place and having an understanding of your body’s limitations, tennis can be a “lifetime” sport played at any age.

1. Tennis Elbow

How Does It Occur?

Lateral epicondylitis, known widely as tennis elbow occurs as a result of repetitive strain on the tendons joining the forearm muscles to the outside of the elbow. These tendons become inflamed and painful. Tennis elbow is typically caused by overuse and can present as elbow pain, burning on the outside of the elbow, and weak grip strength. The symptoms can worsen with the use of the forearm.

How Can I Prevent It?

Warm-up and cool down before you practice or play. It is also important to cross-train and condition to prevent injuries. Also making sure to alternate to your nondominant hand and most importantly, honor your body and stop when it hurts. If you are unsure about your form or technique, work with a professional trainer.

How Is It Treated?

Treatment includes rest, ice, compression, and elevation (RICE), anti-inflammatories (NSAIDs) such as ibuprofen and in some cases bracing. Alternating your grip can help alleviate pain as well.  It is advised that if you have tennis elbow you need to address it immediately to avoid it becoming chronic.

2. Rotator Cuff Tendonitis/Tears

How Does It Occur?

Damage to the rotator cuff (the group of muscles, tendons, and ligaments that supports the upper arm around the shoulder joint) often causes significant pain and disability. The rotator cuff is formed by four separate muscles and tendons that come together to support the shoulder and allow for mobility. The rotator cuff tendons can become inflamed, can tear gradually due to overuse, but can also tear due to an acute injury. Rotator cuff injuries often present with pain, tenderness, and weakness in the shoulder, difficulty lifting the arm, and snapping and crackling noises while moving the shoulder. Rotator cuff symptoms are often present in recreational players with improper serving or swing form.

How Can I Prevent It?

To prevent rotator cuff irritations and injuries it is important to always warm-up and cool down after playing. Utilizing rotator cuff exercises is essential for further injury prevention and rehabilitation. One such exercise you can begin doing is putting your back flat against the wall, forming 90-degree angles with your arms and pressing slowly upward, bringing your thumbs together. This promotes the shuttling of synovial fluids, which lubricate the impinged (pinched) joint. Make sure your serving technique and grip techniques are correct and if you are unsure it is important to get training to improve your form.

How Is It Treated?

Treatment is RICE, activity modification, light exercising of the rotator cuff muscles, and anti-inflammatory drugs. Persistent symptoms or extreme acute symptoms require medical evaluation as tears often require surgery.

3. Stress Fractures

How Does It Occur?

Stress fractures are small cracks in the bone that are a result of overuse and repetitive impact movements such as running and jumping during tennis. The courts are typically made from asphalt or concrete cured with an acrylic sealant; this material increased the impact on the body. The fractures cause pain, swelling, stiffness, that present slowly and the symptoms will worsen over time. These fractures can occur in several areas including the leg, foot, and lumbar spine (lower back).

How Can I Prevent It?

Warming up and stretching is always key in injury prevention as well as taking breaks regularly. Listening to your body and not forcing yourself to play through the pain is also important and be sure not to play through pain. When you increase your activity levels, do so slowly and in small increments. Be sure to alternate between low-impact activities like swimming and biking when you plan to participate in high impact activities like tennis.

How Is It Treated?

Treating a stress fracture is multifaceted but the most important aspect is rest. Avoid the motion/ impact that caused the fracture in the first place to allow the bone time to heal and prevent further injury. If rest and other conservative treatments do not help your pain evaluation by an orthopedic specialist is the next step as more advanced stress fractures may require bracing or immobilization. As fractures exit the acute healing stage, physical therapy can help patients regain strength and stamina.

4. Ankle Sprain

How Does It Occur?

Tennis is a fast-paced game that requires a lot of multidirectional movement, especially lateral cutting. These abrupt sideways movements lead many tennis players to suffer from ankle sprains by stretching the ligaments too far. Twisting, overextension, changing direction quickly, and catching uneven ground can lead to a sprain. Clay courts provide a softer surface for impact but can pose a greater risk for an ankle sprain. the side of the foot can dig into the surface more easily, resulting in a turned ankle. These injuries lead to loss of range of motion, stiffness, swelling, pain, bruising, and sometimes instability.

How Can I Prevent It?

When playing tennis it is important to wear supportive footwear with ankle supports that can help prevent sprains. Also, you should be aware of uneven areas of your playing surface that are a pitfall for ankle injuries. As always it is also important to warm up and cool down properly.

How Is It Treated?

A sprained ankle responds well to rest, bracing, ice and NSAIDs (Nonsteroidal anti-inflammatory drug). An ankle sprain can range from mild to extremely severe and if you suffer an ankle injury  it is important to have it evaluated to make sure you receive proper treatment.

5. Jumper’s Knee

How Does It Occur?

Patellar tendonitis, also known as Jumper’s knee, is an inflammation of the tendon that attaches the patella (kneecap) to the tibia (shin bone). This tendon is responsible for supporting the body on impact and aids in the motion of the leg when walking, jumping, and other movements.  Tennis requires a lot of repetitive jumping which can increase the risk of small tears in the patellar tendon which will lead to tendonitis. This irritation can lead to pain, warmth, and swelling in the front of the knee. Increased activity levels including walking, kneeling, running, ascending and descending stairs.

How Can I Prevent It?

Avoiding overexertion is the first step in preventing Jumper’s knee and cross-training with non-impact exercises like swimming and biking.  Some players benefit from the use of a brace called achopat strap.

How Is It Treated?

Like most inflammatory conditions, Jumper’s knee responds well to RICE and NSAIDs. It is important to avoid aggravating activities while the tendon is healing. After the initial pain subsides there are some stretches and strengthening activities that can help prevent a recurrence that can be done at home or in formal physical therapy. If the pain does not respond to conservative treatments or reoccurs it is prudent to follow up with a medical professional.

How Can I Prevent Tennis Injuries

Tennis is a high impact sport which means cross-training with non-impact activities is imperative in the prevention of injury. Swimming, cycling, and strength-training will all strengthen the muscles and tendons while alleviating some of the excess stress. It is also important to be aware of your body’s limitations and avoid overuse, especially when starting a new sport or progressing your practice. Proper form is integral for tennis players as well due to the high velocity of swings and the unilateral nature of the sport.

Additionally here are a few more tips to help you avoid injury while playing tennis:

• Have The Right Equipment
  • Shoes should be sturdy, lightweight and have proper ankle support
  • Socks should be well padded
  • Additional ankle support may be beneficial
  • Purchase a racquet with the help of a professional to assure weight and size is appropriate
  • Make sure your grip fits well
  • Make sure your string tension suitable’
  • Ensure your clothing is non-restrictive and not a tripping hazard
• Focus on Improving Technique
  • Work with a coach who can make sure your serve, swing, and jumping techniques are safe and effective
  • Once you have been trained, practice the kinematics of the proper movements
• Warm-Up/ Stretch/ Cool Down

Create a routine for yourself with pre and post-game stretches

Continue your cross-training  with non-impact activity and strengthening of the core, shoulder, and spine

Icing problem joints after a workout can help prevent pain and further injury

• Take Breaks
  • It is important to allow your body time to recover from impact sports like Tennis, so allow yourself time to reset
  • If you develop pain, listen to your body and stop playing. Playing through pain can lead to more severe injuries