Don’t let injury affect your tennis participation

Tennis is a highly popular year-round sport which can be played by all, requires a small amount of equipment and embraces many attributes, such as agility,  athleticism, tactical awareness, resilience and hand-eye coordination.

Tennis has been ranked the 5th most popular sport in the world, by participation. During a tennis session, a player may hit the ball over 1000 times, often repetitively playing the same shot and many players will play more than once per week. It is therefore no surprise that like all sports, tennis is not without its injury risks, which can broadly be split into traumatic or overuse injuries.

The most well-known tennis injury is probably Tennis Elbow and so it may come as a surprise that tennis isn’t the biggest cause of tennis elbow! Whilst the incidence of tennis elbow is certainly higher in older and less experienced tennis players, at both junior and elite levels Tennis Elbow is actually less common, probably due to increased tissue resilience, better joint stability, control and technique.


What is known (research-proven) about tennis injuries?

  • Injury incidence in both men and women varies from 0.05 to 2.9 injuries per player per year, or 0.04 to 3.0 injuries per 1000 hours played (much lower than some contact sports!), so this article is relevant to everyone who plays tennis!


  • Overuse injuries are more likely to occur than traumatic injuries and most commonly affect the upper limbs. Injuries include tendinopathy, rotator cuff tear, stress fracture and vascular emboli.


  • Less experienced tennis players are more likely to suffer upper limb overuse injuries.


  • Lower limb injuries are more likely to be traumatic (such as ligament sprains) but have a more variable presentation, including muscle tears, stress fractures, knee meniscal injuries.


  • Trunk injuries (including the lower back) account for between 5-25% of injuries.


  • Playing more than 6 hours/week (specifically in junior tennis) increases the risk of lower back injury.


  • Reduced shoulder internal rotation, reduced total shoulder motion or reduced external/internal rotation strength ratio increases the risk of injury.


  • Previous spinal injury has been shown to increase the risk of re-injury in tennis.


  • Tennis coaches have similar levels of injury to players, so experience alone isn’t the answer.


  • In one study, the most common causes of Tennis Elbow were found to be occupational stresses 35% and ‘other leisure activities’ 27%. Tennis only accounted for 8% of all tennis elbow cases!


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What does this mean for the average tennis player?

  • Tennis is a relatively safe sport, but all players and coaches should be aware of common injuries and the best way to reduce the risk of these. Physiotherapists are well placed to help with this.


  • Those starting out, improving their game or increasing their participation frequency are at increased injury risk and should include injury prevention strategies within their tennis schedule (flexibility, strength, technique coaching etc). Tennis-knowledgeable physiotherapists and tennis coaches are well-placed to help players reduce injury risk, particularly when working in partnership.


  • Overuse injury risk can be reduced by addressing range of motion discrepancies, muscle imbalance, joint stability and tennis technique. Physiotherapists can help players to improve these elements. These strategies are also recommended to help resolve injuries such as tennis elbow.


  • The risk of traumatic injury can be reduced by correct equipment use, sensible training and playing practices and by improvements in strength, balance, proprioception, agility and footwork.


  • Tennis elbow, rotator cuff injuries, muscle tears, ligament injuries and stress fractures can often be successfully managed by working with a physiotherapist knowledgeable in tennis, without the need for onward referral. Only a small number of patients will require referral or further investigation.


  • Training and match frequency should be scheduled to allow for tissue recovery. Session content should be adapted to reduce prolonged repetition (unless technique when fatigued is the goal).


  • Tennis coaches have similar risk levels as other players and can benefit from working closely with a physiotherapist knowledgeable in tennis injuries. This may include reducing injury risk for the coach but also provides an opportunity to share ideas and strategies, for the benefit of players.



Did you know:

Bevan Wilson’s Team of Chartered Physiotherapists specialise in treating tennis injuries and treat both elite and amateur tennis players of all ages and abilities.

Our Managing Director James Avery has worked in professional tennis, for the LTA National Tennis Centre, Aegon Championships at Queen’s Club and The Boodles, treating some of the world’s best players for over 15 years. He’s also been interviewed about tennis injuries by Sky Sports at Wimbledon (available on our website).

Physiotherapy isn’t just about ‘hands-on’ treatment in clinic (although this is often important) but also rehabilitation and restoration of joint and tissue mobility; strength, muscle timing and muscle balance; balance, agility and proprioception; and the development of self-help maintenance, personal improvement and injury-prevention programs.

Bevan Wilson are delighted to support local tennis clubs, coaches and players via education sessions, open day attendance, screening clinics, E-mail injury advice and physiotherapy assessment and treatment.







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