Common Issues for Tennis Players
Tennis players most commonly experience rotator cuff tendinopathy, lateral epicondylitis (tennis elbow), ankle sprains, and lumbar spine injuries from repetitive overhead motions and high-impact movements, with treatment prioritizing conservative management through eccentric strengthening exercises, relative rest, and technique modification before considering surgical intervention. 1
Upper Extremity Injuries
Shoulder Pathology
- Rotator cuff tendinopathy is particularly common in tennis players due to repetitive microtrauma from overhead serving and groundstrokes, with the supraspinatus tendon being most vulnerable to impingement 1
- Athletes are especially vulnerable to overuse tears from repetitive overhead activities, with the dominant arm being more commonly affected 1
- Serving generates the highest peak muscle activity in the shoulder, placing supraphysiologic forces on the joint hundreds of times per match 2
- Internal impingement and superior labral tears occur from the repetitive overhead motion pattern inherent to tennis strokes 2, 3
Elbow Injuries
- Lateral epicondylitis (tennis elbow) is 7-10 times more common than medial epicondylitis and involves the dominant arm 75% of the time 4
- Activities requiring repetitive wrist extension during groundstrokes and serves contribute to extensor tendon degeneration rather than acute inflammation 4, 5
- Medial epicondylitis can occur from excessive forehand topspin and serving motions 6
- Ulnar collateral ligament insufficiency and valgus extension overload affect players with repetitive throwing-type motions 3
Wrist and Hand
- Extensor carpi ulnaris tendinosis and instability result from repetitive wrist loading during strokes 3
- Triangular fibrocartilage complex injuries occur from chronic loading and ulnar-sided wrist stress 3
- Hamate hook fractures may present as wrist soreness and require special radiographic views for diagnosis 7
- Carpal stress injuries can develop from repetitive impact forces 3
Lower Extremity Injuries
Ankle Injuries
- Lateral ankle inversion sprains are the most common acute injury in tennis, accounting for 20% of all sports injuries 1
- Previous ankle sprain history is a moderate risk factor for recurrent injury during play 1
- Tennis is among the sports with highest prevalence of ankle injuries alongside basketball and soccer 1
Lumbar Spine
- Spondylolysis and degenerative disk disease occur from repetitive rotational and torsional forces during serving and groundstrokes 1
- Tennis places different biomechanical stresses compared to other sports, with high rotational forces being characteristic 1
- Competitive athletic activity increases risk of lumbar spine injury, particularly in young players 1
Environmental Challenges
Heat-Related Issues
- Substantial sweat losses and body water deficits are common during prolonged matches in hot conditions 1
- Thermal strain considerably challenges physiology, perception of effort, and on-court performance 1
- Multiple same-day matches create cumulative physical activity and heat exposure that is particularly challenging 1
- Adequate hydration is notably difficult to maintain during successive days of competition in hot weather 1
Treatment Algorithm
Initial Conservative Management (3-6 months)
- Relative rest by reducing repetitive loading activities while avoiding complete immobilization to prevent muscle atrophy 8, 4
- Ice therapy through wet towel for 10-minute periods for short-term pain relief 8, 4
- NSAIDs (topical preferred over oral) for symptomatic pain relief, though they don't alter long-term outcomes 8, 4
- Eccentric strengthening exercises as the foundation of treatment to reverse degenerative changes and increase strength 8, 4
- Deep transverse friction massage to reduce pain 8, 4
- Technique modification to minimize repetitive stresses on affected tendons 1, 8
Adjunctive Treatments
- Tennis elbow bands and orthotics to reinforce and unload tendons during activity, though evidence is limited 1, 4
- Corticosteroid injections only for acute pain relief, used with caution as they may inhibit healing and reduce tensile strength 1, 8, 4
- Extracorporeal shock wave therapy (ESWT) for chronic tendinopathies that fail initial conservative management 8, 4
Surgical Intervention
- Surgery is indicated only after 3-6 months of failed conservative therapy in carefully selected patients 1, 8, 4
- Surgical techniques include excision of abnormal tendon tissue and longitudinal tenotomies 1, 4
Ankle Sprain Management
- PRICE protocol (Protection, Rest, Ice, Compression, Elevation) is well-established for acute ankle injury 1
- Semirigid or lace-up ankle supports are superior to elastic bandages for functional treatment 1
- Functional rehabilitation with motion restoration and strengthening exercises is preferred over immobilization 1
- Support devices provide protection against future sprains, particularly in those with recurrent injury history 1
Critical Pitfalls to Avoid
- Never completely immobilize affected joints as this accelerates muscular atrophy and deconditioning 8, 4
- Avoid injecting corticosteroids into tendon substance as this may predispose to spontaneous rupture 1, 4
- Do not rely solely on radiography for early spondylolysis detection as sensitivity is low without spondylolisthesis 1
- Recognize that joint effusions are uncommon with tendinopathy and should raise suspicion for intra-articular pathology 8
Kinetic Chain Considerations
- Any pathology affecting the groin, hip, or abdominal musculature increases risk of shoulder and upper extremity injury through disruption of the kinetic chain 2
- Prevention programs must address muscular imbalances throughout the entire kinetic chain, not just the symptomatic area 2
- Core muscle dysfunction can transmit abnormal forces to the upper extremity during stroke mechanics 2