Common Tennis Injuries and Why They Happen

Tennis injuries often affect the shoulder, elbow, wrist, ankle, calf, and lower back because tennis combines repeated overhead strokes, fast court coverage, lunging, and sudden braking. For a broader overview, visit our Sports Injuries guide. You can also explore racquet sports injuries, sports injury physiotherapy, and our similar squash injuries page for related loading patterns.

Tennis can cause both acute and overuse problems. Some happen suddenly, such as a sprained ankle during a wide ball or awkward landing. Others build over time, such as tennis elbow, rotator cuff pain, wrist tendinopathy, Achilles tendinopathy, or lower back pain.

In French Open surveillance from 2011 to 2022, 750 injuries were recorded in 687 players, averaging 62.5 injuries per tournament, with the thigh-hip-pelvis region, ankle-foot region, and spine most affected.¹

Physiotherapy may help identify the main pain driver, guide early management, and build a graded return-to-court plan. It may also help reduce recurrence by improving strength, movement control, recovery habits, and workload planning.

Where Do Injuries Occur?

• Shoulder — repeated serving and overhead loading may contribute to rotator cuff injury or shoulder impingement.
• Elbow — repetitive gripping, backhand load, and racquet transmission may aggravate tennis elbow.
• Wrist and hand — topspin, serve acceleration, and off-centre contact may irritate the wrist and hand, including wrist tendinopathy.
• Ankle and foot — fast lateral movement, deceleration, and recovery steps increase the risk of sprained ankle; ankle-foot injuries were among the most common regions in tournament surveillance.¹
• Calf and Achilles — repeated push-off and change of pace can overload the calf complex and Achilles tendinopathy or a calf strain.
• Hip, groin, and trunk — lunging, rotation, and repeated recovery steps can stress the adductors, trunk, and spine, leading to problems such as groin strain or lower back pain.^1,4

Why This Sport Causes Injuries

Tennis loads the body in a way that is both repetitive and explosive. Serves and overheads place high demand on the shoulder, trunk, and wrist. Meanwhile, groundstrokes, split steps, sprints, and recovery steps load the hips, knees, calves, ankles, and feet.

Fatigue also matters. When players lose timing, lower limb control, or trunk strength, load often shifts to smaller structures such as the elbow, wrist, or shoulder. Court surface, footwear grip, string tension, racquet grip size, and sudden spikes in match or training volume can all add to the problem.^2,3

Who Gets Injured?

Both recreational and competitive players get injured, but the pattern can differ. Recreational players often run into trouble after doing too much too soon, returning after a break, or pushing through pain. Competitive players usually face higher cumulative load, more serving volume, and tighter tournament schedules.

Players with a previous injury, recent load spike, poor recovery, or repeated pain in the same area are at higher risk of recurrence. Junior and younger competitive players can also pick up shoulder, elbow, and lower limb issues when growth, training, and competition loads all rise together. Performance often drops before players stop completely, so reduced serve speed, poor footwork, or slower recovery between sessions should not be ignored.^3,4

Most Common Tennis Injuries

• Tennis Elbow
  A common overuse problem involving the outer elbow, often linked to gripping load, backhand mechanics, and repeated hitting volume.
• Rotator Cuff Injury
  Overhead serving and repeated high-speed strokes can irritate or overload the rotator cuff and surrounding shoulder structures.
• Wrist Tendinopathy
  The wrist can become sore with heavy topspin, off-centre ball contact, and repeated acceleration through the racquet.
• Sprained Ankle
  Wide balls, awkward landings, and sudden direction changes can overload the ankle ligaments.
• Calf Strain
  Repeated push-off, braking, and court movement can overload the calf, especially during sharp acceleration and recovery steps.
• Lower Back Pain
  Serving, trunk rotation, repeated extension, and fatigue can irritate the lower back during both training and match play.

How Physiotherapy, EP & Massage Can Help

Physiotherapy for tennis injuries usually starts with a clear assessment of pain behaviour, stroke demands, court movement, recent workload, and strength deficits. Your physiotherapist may assess shoulder strength, trunk rotation, landing control, calf capacity, ankle stability, and how symptoms behave the next day after loading.

Treatment may include exercise rehabilitation, movement retraining, strength testing, load planning, and a staged return-to-sport progression. If appropriate, an sports injury physiotherapy plan can also help guide serving volume, court drills, gym loading, and return to match play.

Exercise physiology can support conditioning, strength, and longer-term load tolerance, especially when rebuilding from time away from the court. Massage may help as a supportive option for muscle tension, recovery, and comfort, but it is not a standalone fix for most tennis injuries.

When to See a Physiotherapist

You should consider an assessment if pain is persistent, swelling is present, your symptoms keep returning, or you cannot tolerate normal tennis load. It is also sensible to get checked if pain changes your serve, backhand, footwork, or confidence on court.

Prompt review is worthwhile if you felt a pop, lost strength suddenly, cannot bear weight properly, or have repeated shoulder or elbow pain after matches. Recurrent ankle giving way, stubborn calf or Achilles pain, or ongoing back pain should also be assessed early. Early assessment often leads to a safer and faster return to sport.

Injury Prevention Tips

• Warm up with progressive movement, activation, and rally-specific hitting drills before harder serving.
• Build calf, leg, trunk, forearm, and shoulder strength across the week, not just on match day.
• Progress serving, drilling, and match volume gradually after time off.
• Use shoes that match the court surface and still provide grip and support.
• Review racquet grip size, string set-up, and technique if elbow or wrist pain keeps returning.
• Monitor next-day soreness rather than judging load tolerance only during the session.
• Address recurring pain early instead of waiting for it to settle on its own.

Returning Safely to Tennis

A safe return to tennis usually means graded exposure. Start with controlled hitting, movement drills, and conditioning that your body tolerates well, then build toward harder serves, wider court coverage, and match-specific demands. Next-day symptom response, strength recovery, and technique quality all help guide progression.

What To Do Next

If tennis injuries are limiting your training, matches, or recovery, our physiotherapists can assess movement, guide load management, and support a safe return.

Related Articles

1. Racquet Sports Injuries
2. Tennis Elbow
3. Sports Injury Physiotherapy
4. Rotator Cuff Injury
5. Lower Back Pain
6. Injury Prevention Essentials

References

1. Montalvan B, Decatoire A, Rousset P, et al. Epidemiology of Musculoskeletal Injuries in Tennis Players During the French Open Grand Slam Tournament From 2011 to 2022. Orthop J Sports Med. 2024;12(4):23259671241241551. https://pubmed.ncbi.nlm.nih.gov/38617888/
2. Bradley J, Langdown B, Coker B, et al. Injury Risk Factors of the Tennis Serve: A Systematic Review and Meta-Analysis. Adv Rehabil Sci Pract. 2025;14:27536351251374616. https://doi.org/10.1177/27536351251374616
3. Amor-Salamanca MS, Rodríguez-González EM, Rosselló D, de Lluc-Bauza M, Hermosilla-Perona F, Martín-Castellanos A, Herrera-Peco I. Risk Factors and Prevention of Musculoskeletal Injuries in Adolescent and Adult High-Performance Tennis Players: A Systematic Review. Sports. 2025;13(10):336. https://doi.org/10.3390/sports13100336
4. Layouni S, Dergaa I, Ghali H, et al. Epidemiology of Tennis-Related Injuries Among Competitive Youth Players in Tunisia: Frequency, Characteristics, and Management Patterns. Medicina. 2025;61(8):1478. https://doi.org/10.3390/medicina61081478

Tennis Injury FAQs

What are the most common tennis injuries?

Common tennis injuries include tennis elbow, rotator cuff pain, wrist pain, ankle sprains, calf strains, Achilles tendon problems, and lower back pain. The pattern depends on your playing load, technique, footwear, and previous injury history.

Why do tennis injuries keep coming back?

Tennis injuries often recur when players return too quickly, keep training through pain, or miss strength and load progressions. Ongoing technique, workload, and recovery issues can also keep reloading the same area.

Can physiotherapy help tennis injuries?

Yes. Physiotherapy may help by identifying the main source of pain, improving strength and movement control, guiding load management, and building a gradual return-to-court plan.

How can I reduce my risk of tennis injuries?

You can lower injury risk by warming up properly, progressing court and serve loads gradually, improving strength, using suitable shoes, and getting recurring pain assessed early.

When should I see a physiotherapist for tennis pain?

You should consider an assessment if pain is lasting, keeps returning, affects your serve or footwork, causes swelling, or stops you training and competing normally.