The 5 Most Common Tennis Injuries: What They Are and Why They Happen

Tennis is a physically demanding sport that requires repeated sprinting, rapid changes of direction, powerful strokes and endurance, often within a single point or rally. This combination means that injuries are a common reality for players at every level. Here's what you need to know about the most prevalent injuries in the sport.

1. Shoulder Pain

Tennis requires the arm to accelerate rapidly through a wide range of motion, performing high-force sequences repeatedly throughout every rally particularly in overhead serving. Inefficient technique, limited mobility, and weak shoulder muscles can increase this stress on the shoulder. This combination can lead to overload and fatigue of the muscles around the shoulder blade increasing the risk of rotator cuff related injuries and labral tears. 

2. Tennis Elbow

Tennis elbow occurs when the forearm muscles are overloaded through repetitive activities that involve gripping, causing irritation where the tendon attaches to the elbow. The injury manifests as pain localised to the outside of the elbow that is aggravated by everyday activities that involve gripping and lifting in addition to tennis strokes.

3. Muscle Strains

Muscle strains occur when muscle fibres are torn, often during explosive movements, sudden changes in speed and rotational movements. 

Thigh Strains 

Thigh strains often occur during sudden acceleration, chasing wide balls, or explosive movements from a stationary position. The most common muscles that experience strains are the adductors on the inside of the thigh, hamstrings and quadriceps. Fatigue, reduced range of movement, and insufficient strength can increase the likelihood of injury. Players may experience a sudden sharp pain, tenderness, and difficulty challenging to play.

Abdominal Strains

Less discussed but very common, abdominal strains can occur during overhead serves where the abdominals are stretched, then rapidly contracted. Due to this mechanism, abdominal strains tend to be more prevalent in competitive players that perform many serves in a match. The ab muscles are especially vulnerable late in a match or in long matches when fatigue sets in, and mechanics begin to break down. Pain often manifests on the side of the abdomen opposite to a player’s serving arm.

4. Knee Pain

Patellar Tendinopathy

It develops when the tendon is repeatedly overloaded without sufficient recovery. In tennis, frequent jumping, explosive pushing movements, and sudden increases in training volume can contribute to the condition. Players typically experience pain just below the kneecap, particularly during running, jumping, and squatting.

Osgood-Schlatter Disease

In young players aged 10–15, rapid bone growth during puberty creates vulnerability at where the patellar tendon attaches to the shinbone. Repeated pulling on this growth plate causes localised pain, swelling, and sometimes a bony lump below the kneecap. It generally resolves with maturity, but a physio can help manage load and keep young players active safely during this period.

5. Ankle Sprains

Ankle sprains are one of the most common acute injuries in tennis. The fast-paced nature of changes in direction, side-to-side movements, and recovery steps, challenge ankle stability. Additionally, clay and grass courts can be unpredictable and slippery surfaces (particularly when sliding) whilst hard courts can abruptly cause catching or sticking to the acrylic surface due to the friction. These movements can cause the ankle to roll over, leading to tears in the ligaments often on the outside of the ankle. Returning to tennis too quickly without proper rehab leaves the joint unstable and very prone to re-injury, often leading to chronic instability over time.

How a physiotherapist can help

• Manage your load to help protect the healing structures 

• Guide you through pain management strategies in the initial stages of injury that work for your injury 

• Provide a structured rehabilitation program that involves progressive loading to help get you back on the court and reduce the risk of future re-injury by restoring strength, stability and power 

• Recommend equipment modifications including string tension, grip size, racquet weight or weight distribution.