Tennis Injuries: The Six That Keep Players Off Court and How to Beat Them

Tennis is unusually demanding on the body and it hides that fact well. There is no collision, no scrum and no tackle, so it reads as a low risk sport.

But a competitive player serves hundreds of times a week with one arm above their head, changes direction several times in every point, and does all of it on one dominant side. The injuries that follow are almost entirely predictable, which is good news, because predictable means preventable.

Why tennis loads the body the way it does

Three features of the sport explain nearly every injury on the list. It is one-sided, which builds real asymmetry over years.

It is overhead, which puts the shoulder in its least stable position under high speed. And it is repetitive with constant deceleration, which means the same tissues absorb braking forces thousands of times a season.

Add the surface. Clay allows sliding and is generally kinder to joints.

Hard courts do not, and the leg has to absorb every stop. Ahmedabad players moving between the two often notice their knees and ankles complaining within a couple of weeks of the switch.

1. The shoulder

The most common serious complaint in tennis. The serve takes the shoulder into extreme external rotation at high speed and then decelerates it violently, and the structures that control that are relatively small.

Pain at the front or top of the shoulder during the serve, or a shoulder that aches for hours afterwards, usually points to the rotator cuff and the way the shoulder blade is moving. The fix is rarely rest alone.

It is control of the shoulder blade plus rotator cuff strength, which is exactly what our guide to shoulder impingement covers in detail.

2. The elbow

Tennis elbow is named after the sport and yet most sufferers have never played it. In actual players it typically comes from a late or poorly timed backhand, a grip that is too small, or strings that are too tight, all of which push load up into the forearm tendons.

Tendons do not respond to rest the way muscles do. They need graded loading to rebuild, which is the core point of tendon rehabilitation.

Our full guide on tennis elbow explains why the standard advice to stop and wait so often fails.

3. The wrist

Increasingly common as the modern game has moved to heavy topspin and extreme grips. Pain on the little finger side of the wrist during forehands or when the racquet twists in the hand should be taken seriously rather than taped over, because some wrist structures heal poorly once irritated.

4. The lower back

The serve asks the spine to arch backwards, rotate and side-bend all at once, then unload explosively. Repeat that a few hundred times a week and the lower back complains.

Young players going through growth spurts are particularly worth watching here, and persistent one-sided low back pain in an adolescent server should always be assessed rather than stretched.

5. The knee

Tennis knees suffer from braking rather than running. Every change of direction is a controlled crash, and the quadriceps and the tendon below the kneecap absorb it.

Pain at the front of the knee that is worse on hard courts, worse on stairs and worse the day after a long match is the classic pattern.

6. The ankle

The most common acute injury in the sport, and the one most casually dismissed. A rolled ankle damages the sense of joint position, not just the ligament, and that sense does not return on its own.

This is why players who "walked it off" go on to roll the same ankle every season, a point made in full in our guide to ankle sprains.

The prevention that actually holds up

Most injury prevention advice in tennis is stretching, and stretching alone has a poor record. What consistently works is less exciting and more effective.

• Strength training, twice a week, all year. The single most reliable protection available, and the one most club players skip. See strength training for injury prevention.
• A proper warm-up before hitting. Not two minutes of static stretching. A real ramp up, as in the RAMP method.
• Manage the jump in load. Most overuse injuries follow a sudden increase in hours, not a high total. Tournament weeks and coaching blocks are the danger points.
• Serve volume awareness. Serving is the highest cost shot in the sport. Counting them during heavy weeks is worth the small effort.
• Check the kit. Grip size and string tension change elbow and wrist load meaningfully, and both are cheap to adjust.
• Train the non-dominant side. Tennis builds asymmetry. Deliberate balancing work reduces the cost of that over a career.

Club player or competitor, the risks are different

A social player who hits twice a week has a very different injury profile from a junior training six days a week. The club player is usually undertrained rather than overtrained: the body simply is not conditioned for the demands of a hard three-setter, so a long weekend match causes trouble that a fitter player would absorb easily.

The competitor has the opposite problem. Their tissues are well conditioned but the volume is relentless, and their injuries cluster around spikes: a tournament block, a new coach, a technique change, a jump from clay to hard court.

For one group the answer is more conditioning. For the other it is smarter scheduling.

Treating both with the same generic advice is why so much injury prevention fails.

What to do between matches in a heavy week

Tournament weeks compress a month of load into a few days, and recovery stops being optional. The basics do most of the work: sleep, adequate food and fluid in Ahmedabad heat, and getting off the legs between rounds rather than walking the venue all afternoon.

Cold water immersion has a genuine place here. After a hard match, when the priority is being able to play again tomorrow rather than adapting to training, it helps.

That is a specific use case rather than a daily habit, and the reasoning is set out in our guide to ice baths and cold water immersion. Light movement the following morning, rather than complete rest, usually leaves players feeling better on court.

Shoes and surfaces matter more than players think

Tennis shoes are built for lateral movement and are not interchangeable with running shoes, which are designed to go forwards and offer very little sideways support. Playing tennis in running shoes is a genuine ankle risk, and it is surprisingly common at club level.

Worn out shoes are the other half of this. The outsole usually looks acceptable long after the cushioning and lateral support have gone, so players keep wearing them.

If your knees or ankles started complaining and nothing else changed, count how many months the shoes have been in use before assuming the problem is your body.

Young players deserve extra attention

Growing bodies have vulnerable points that adult bodies do not, particularly at the growth plates around the knee, heel and shoulder. Pain in a young player that is consistent and reproducible should never be written off as growing pains without an assessment.

Junior players also tend to increase training volume very quickly when they get serious, which is exactly the pattern that causes trouble.

Coming back after time off

The most dangerous fortnight in a tennis player's year is the one right after a break. Exams, travel, a minor illness or a busy month at work, and then a player returns and picks up exactly where they left off.

The skill is still there, which is precisely the problem, because the tissue tolerance is not.

A sensible return builds back over two to three weeks rather than one session. Shorter hitting sessions first, serving reintroduced deliberately and in small numbers, and match play last.

Almost every shoulder and elbow problem we see in club players can be traced to a return that skipped this.

When to stop playing and get it checked

• An ankle you cannot comfortably weight-bear on.
• Sudden sharp calf or Achilles pain, especially with a snapping sensation. See calf and Achilles pain.
• Shoulder pain with genuine weakness, not just discomfort.
• Back pain that travels down the leg, or comes with numbness.
• Any pain that has moved to hurting at rest.

Getting assessed in Ahmedabad

SattvaRig's performance clinic sits inside Altitude Tennis Academy on Shilaj Road, which means players can be assessed in the environment they actually play in rather than in a room with no context. Watching someone serve matters more than watching them lie on a table.

Every first appointment is a full strength and mobility assessment, and for players it includes the movements your game actually asks of you. You can read more about our sport-specific conditioning or the recovery zone for what happens between matches during a heavy block.