Racquet sports injuries can develop through repeated serving, smashing, gripping, lunging, jumping and rapid changes of direction. They may affect recreational players, competitive athletes and people returning to court after a break.

Tennis, squash, pickleball, badminton, padel, table tennis and racquetball each place different demands on the body. However, common problem areas include the elbow, shoulder, wrist, knee, calf, Achilles tendon and ankle.

The action that triggers pain can help a physiotherapist narrow the assessment. However, one playing action can load several structures and does not confirm a diagnosis by itself.

Racquet sports injuries usually involve a combination of gradual overload and sudden court-based trauma. Repeated strokes may irritate muscles and tendons over time. Meanwhile, twisting, lunging, landing or abrupt stopping can produce an acute injury.

The pattern varies according to the sport, age, playing level, court surface, equipment, previous injuries and recent training load.

• Elbow pain with gripping, lifting or backhand strokes
• Shoulder pain during serving, smashing or overhead shots
• Wrist pain when striking the ball or shuttle
• Knee pain with lunging, jumping or pushing off
• Ankle pain, bruising or swelling after twisting
• Calf or Achilles pain during rapid acceleration
• Pain that builds during play and persists the following day
• Loss of speed, confidence or movement control on court

Players repeatedly transfer force from the legs and trunk through the shoulder, arm and racquet. Efficient movement requires coordinated footwork, balance, trunk rotation, shoulder control, grip endurance and rapid deceleration.

When one part of the movement chain contributes less than required, another area may absorb additional load. For example, limited trunk rotation or reduced leg drive may increase the work performed by the shoulder and elbow during a serve or overhead smash.

Lower-limb demands also vary. Squash, badminton and pickleball often involve repeated lunging and short accelerations. Tennis and padel require lateral court coverage, braking and rotational force. Table tennis involves less court distance but high repetition through the wrist, elbow, shoulder, neck and trunk.

Elbow and shoulder pain often develops when stroke volume, serving load or gripping demand rises too quickly. Technique changes, fatigue, unsuitable grip size and inadequate shoulder or forearm capacity may also contribute.

The shoulder must produce and control rapid rotation during serves and smashes. Meanwhile, the forearm muscles stabilise the wrist and racquet through impact. Repetition without adequate recovery can gradually reduce tissue tolerance.

Racquet sports require repeated stopping, side-stepping, pivoting and lunging. These movements place substantial force through the knee, calf, Achilles tendon and ankle.

Sudden injuries may occur during a poorly controlled landing, slip or unexpected change of direction. Gradual pain may develop when match volume rises before the legs have adapted to the extra workload.

No single factor explains every injury. However, several modifiable issues may increase stress on the body:

• A sudden increase in matches, court time or intensity
• A rapid rise in serving or smashing volume
• Returning to play too quickly after illness, injury or time away
• Reduced shoulder, forearm, trunk, hip or calf capacity
• Reduced balance, landing control or court movement
• Playing through persistent or worsening pain
• Inadequate warm-up, sleep or recovery
• Worn court shoes or unsuitable footwear
• A racquet grip that is too large or too small
• Racquet weight, balance or string tension that does not suit the player

Injury prevention should prepare you for the repeated strokes, lunges, stops and changes of direction required by your sport.

Respond to warning signs: Modify training when pain begins to affect technique, confidence or next-day function. Early changes may prevent a manageable problem from becoming more persistent.

Many racquet sports share similar injury mechanisms. However, court dimensions, equipment, stroke patterns and match demands create different areas of emphasis.

Less Common Racquet Sports

Platform tennis, real tennis, soft tennis and other regional racquet sports share many of the same injury principles. Assessment should still consider the exact movement, equipment, playing surface and competition demands of the sport.

Consider a physiotherapy assessment when pain keeps returning, changes your stroke or footwork, or prevents normal training. Assessment is also appropriate when symptoms persist into the following day or fail to improve after reducing activity.

Seek prompt medical or physiotherapy advice after:

• A twist, pop or tearing sensation
• Marked swelling or bruising
• Inability to bear weight or use the arm normally
• Repeated giving way or instability
• Significant loss of movement
• A direct blow to the head, eye or face
• Headache, dizziness, confusion or other possible concussion symptoms

Physiotherapy starts by identifying the likely injured tissue and determining why the problem developed. The assessment may include movement, strength, joint mobility, tendon loading, balance, court footwork or stroke-related tasks.

Management depends on the diagnosis and the demands of the sport. It may include:

• Advice on activity and match-load modification
• Pain-relieving or hands-on treatment where appropriate
• Joint mobility and movement exercises
• Progressive strength and tendon loading
• Balance, landing and change-of-direction training
• Shoulder and forearm conditioning
• Footwear, grip or equipment discussion
• A staged return to serving, smashing and match play

A safe return requires more than settling pain. Players should regain enough movement, strength and confidence for their sport’s repeated demands.

Later rehabilitation may include serving or smashing progressions, repeated lunges, lateral court movement, reaction drills and match-specific conditioning. The final workload should reflect how often the player trains, how long matches last and whether tournaments involve repeated games over several days.

Tennis elbow is one of the best-known racquet sports injuries. However, shoulder pain, ankle sprains, knee pain, calf strains and tendon problems are also common. The pattern varies between tennis, squash, pickleball, badminton, padel and table tennis.

Yes. Beginners may increase court time too quickly, use inefficient technique or start without enough strength and conditioning. Equipment that does not suit the player can also add unnecessary load.

Both occur. Gradual problems may develop through repeated gripping, serving, smashing or lunging. Sudden injuries may occur during a twist, fall, awkward landing or rapid change of direction.

Mild discomfort does not always require complete rest. However, pain should not progressively worsen, alter technique or persist strongly into the next day. Stop and seek advice when pain is sharp, function declines, or swelling and instability develop.

An unsuitable grip may increase gripping effort or change wrist and forearm mechanics. Grip size is only one possible factor, so persistent elbow pain still requires assessment of stroke load, technique, strength and other contributing issues.

Recovery time depends on the injured tissue, severity, symptom duration and sporting demands. A mild muscle strain may improve relatively quickly, while significant tendon, ligament or joint injuries may require a longer progressive rehabilitation period.

Physiotherapy may help identify the main pain source, improve strength and movement quality, modify training load and guide return to play. Rehabilitation can also address stroke-related overload, balance, landing mechanics and repeated court movement.

Consider an assessment when pain affects your grip, serve, overhead stroke, lunging or ability to move confidently around the court. A physiotherapist can assess the painful area, identify contributing factors and explain the most suitable next step.

Your plan may include treatment, progressive exercise, load modification, equipment advice and a staged return to training and competition.

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