Fitness and Performance

Tennis injuries: The upper body

May 27 2019

It’s that time of year again, the sun is starting to shine (allegedly) and the tennis season is here with The French Open well underway!

The call to pick up a racket grows ever stronger. Making sure you stay injury free this year is a must so you can play till the sun goes down. In part one of James Ticehurst’s tennis blog series focusing on common tennis injuries, he discusses the upper body.

Tennis is a physically demanding sport which is played on a variety of surfaces including grass, artificial grass, hard court surfaces and clay. It comes with its fair share of tennis injuries.

Speed, balance, power

All of these require variations of speed, balance, power, coordination, proprioception and the ability for your musculoskeletal structures to tolerate high levels of load. This can predispose a variety of injuries on the tennis court.

In summary, I will be covering the most common tennis injuries and some hot tips to avoid them this summer.

Based on the most recent literature, tennis injuries have been found to have a higher prevalence during matches, rather than training sessions. The most common areas that are affected are the spine, shoulders, ankles, knees, hips, elbow and wrists. This first entry into the series will cover the upper body injuries that happen from tennis


Labral tear (SLAP lesion)

The labram is an area of cartilage that helps stabilise the shoulder and surrounds the joint and holds It in place. A labral tear can be quite serious and is managed typically through surgical intervention but can be managed conservatively as well through physiotherapy. The injury usually occurs during the early acceleration part of an overhead serve. When the arm is in this position the biceps muscle, that inserts at the labram, pulls on the structure.

As the labrum tears you typically hear a pop sound and the feeling of a dead arm.

Typical symptoms include: Pain, joint laxity, weakness, reduced range, inability to effectively throw/hit with a racquet and catching, clicking or popping.

Rotator cuff tear or tendinitis

The rotator cuff is a sling made up of 4 muscles and tendons that start in the shoulder blade and come around and insert into the arm. It is a main stabilising muscle of the shoulder and helps with rotation of the arm for example when backhanding or overhead serves or shots. The repetitive nature of tennis can overload the tendons of the rotator cuff and when load exceeds the tolerance of the tendon, the tendon can become sore and inflamed, resulting in tendonitis. Then rotator cuff tendon can also be injured traumatically by excessive forces which can cause the tendon to tear instead. Seeing a physiotherapist is usually the main path of treatment. This will allow them to reload and strengthen the shoulder.

Symptoms include: Reduced range of motion, pain, weakness and reduced effectivity of using the racquet.

Shoulder Bursitis

A bursa is a fluid-filled sac and prevents friction around joints and helps lubricate. Shoulder bursitis is when the bursa that sits in the shoulder joint becomes inflamed from the repetitive motion of the shoulder. This can be very painful. Typically this can be resolved through anti-inflammatories, ice, rest and a desensitisation and strengthening programme through physio treatment.

Symptoms include: Pain both during the day and at night, weakness, and reduced range of motion.

Tips to avoid this injury:

  • Most importantly, strengthen the rotator cuff and other shoulder muscles, to ensure that they can cope with the repetitive forces and impact of hitting the ball.
  • Stretch before and after play, to prevent tight muscles and inflammation.
  • Ensure your technique is correct, in order to reduce the force going through this joint and muscles during each stroke.


Tennis elbow

Clinically known as extensor tendinopathy or lateral epicondylitis, Tennis elbow is a condition in which the outside of your elbow becomes painful and weak. This is typically due to repetitive strain and impact from the racquet on the elbow extensor muscles in the forearm which become overloaded and inflamed. Physio treatment, anti-inflammatory meds, ice and rest are the typical treatment methods.

Symptoms include pain around the outside of the elbow, pain during or after activity, pain on gripping or grasping something and weakness.

Tips to avoid this injury:

  • Warming up before play will help reduce the risk of injury.
  • Additionally, ensure that the grip size is right for you and your technique is correct.
  • Thirdly, reduce the tension of the racket strings to minimise the impact on the forearm muscles.


Extensor carpi ulnaris strain

The ECU is a long thin muscle that is located on the inside of the forearm. It passes through the wrist and inserts into your little finger. Its main function is to bend your wrist during twisting of the forearm. The repetitive strains from the wrist bending during tennis can lead to the tendon of the muscle becoming inflamed or strained and results in wrist pain. Rest, ice and anti-inflammatories are the initial treatment followed by strengthening the muscle.

Wrist ligament sprain

The wrist ligaments help stabilise the wrist and prevent excessive motion. They are typically injured through sudden forces and may hear a pop sound. Pain and instability follow. Rest, ice and anti-inflammatories are used first then once the ligament has healed, can start to be strengthened and reintroduced to tennis.

Tips to avoid this injury:

  • Make sure these muscles are both adequately strengthened and warmed up before play to reduce the risk of injury.
  • Ensure that the grip size is right for you and your technique is correct.
  • Reduce the tension of the racket strings to minimise the impact on the forearm muscles.
  • Wear a wrist support to prevent excessive movements.

Below we will cover general ways to prevent the above injuries and keep you on the turf

How to Avoid Injury

Good preparation

  • Make sure you gradually build up your training and include specific strengthening, balance, coordination and proprioceptive exercises into your regime, to ensure that you are at your fittest


  • Ensure you use a tennis racket that is suitable for your size, style and level of play.
  • Check the court surface is in good condition and avoid playing on a wet surface.
  • Remember to use balls that are appropriate for the playing surface and avoid playing with old or “dud” balls.


  • Ensure the correct footwear is worn to support both feet and running style. If required, use orthotics or seek professional advice.


  • If there’s a history of a previous injury, correctly support it with either a brace or taping to prevent re-injury

Warm up, cool down, stretch

  • Get into the habit of doing this after every training session, to ensure that your muscles remain at their optimum condition

Maintain fitness

  • Tailor your training and conditioning to exercises specific to the physical demands of tennis

Good skills and technique

  • A good technique and practice will help to prevent injury. Seek advice from a qualified coach to refine and correct your technique


  • Finally, practice a variety of strokes and shots in order to avoid overly repetitive movements that can cause injury.

Want to read about common lower limb injuries? Stay tuned for the follow up covering the lower limb injuries.