Tennis

Tennis is an explosive, asymmetrical sport that combines power, agility, and endurance. It demands rotational core strength, shoulder stability through extreme ranges of motion, and rapid directional changes. The sport creates significant muscular imbalances due to dominant arm overdevelopment and requires careful attention to injury prevention, particularly for the shoulder and elbow.

Quick Reference

Aspect	Details
Primary Muscles	Rotator cuff, deltoids, pectoralis major, latissimus dorsi, core (obliques, rectus abdominis), quadriceps, calves
Secondary Muscles	Forearm flexors/extensors, triceps, biceps, glutes, hip abductors/adductors
Energy Systems	Mixed: ATP-PC for each point (5-15 seconds), glycolytic for long rallies, aerobic for recovery between points
Common Injuries	Tennis elbow (lateral epicondylitis), rotator cuff tendinopathy, wrist injuries, ankle sprains, lower back pain

Muscles Trained

Primary Muscles - Upper Body

Rotator Cuff

Role: Stabilize shoulder joint during extreme rotational demands of serving and stroke production

Activation Level: Very High (75-95% during serve and groundstrokes)

Movement-Specific Notes:

• Serve: Maximal activation during cocking phase and deceleration; external rotators eccentrically control internal rotation
• Forehand: High internal rotation velocity (up to 2,000 degrees/second); subscapularis heavily loaded
• Backhand: More balanced rotator cuff activation; external rotators more active than forehand
• Overhead: Similar to serve, extreme deceleration demands on posterior cuff

Training Implications: Dominant arm rotator cuff becomes significantly stronger but also highly susceptible to overuse injuries. Internal rotators typically overdeveloped relative to external rotators, creating 2:1 or 3:1 strength ratios (should be closer to 3:2).

Deltoids

Role: Control racket position, generate power through shoulder abduction and flexion, stabilize during rapid arm movements

Activation Level: Very High (80-90% during serving and groundstrokes)

Movement-Specific Notes:

• Anterior deltoid: Dominant in forehand and serve during acceleration phase
• Medial deltoid: High activation during serve trophy position and overhead shots
• Posterior deltoid: Critical for backhand and deceleration phases; often underdeveloped relative to anterior deltoid

Training Implications: Dominant shoulder deltoid significantly larger than non-dominant side. Anterior deltoid overdevelopment can contribute to forward shoulder posture and internal rotation bias.

Pectorals

Role: Generate power during serve and forehand through horizontal adduction and internal rotation

Activation Level: High (70-85% during serve and forehand)

Movement-Specific Notes:

• Serve: Peak activation during acceleration phase as arm drives forward and internally rotates
• Forehand: High activation during contact and follow-through
• Backhand: Minimal activation, pecs are relaxed
• Overhead smash: Similar to serve, explosive contraction

Training Implications: Dominant side pec significantly more developed. Contributes to rounded shoulder posture when combined with lat overdevelopment.

Latissimus Dorsi

Role: Generate power during serve, contribute to shoulder internal rotation and extension

Activation Level: High (65-80% during serve and forehand)

Movement-Specific Notes:

• Serve: High activation during acceleration and contact
• Forehand: Assists with arm extension and internal rotation
• Backhand (two-handed): Moderate activation from non-dominant side
• Overhead: Assists with powerful downward motion

Training Implications: Dominant side significantly more developed. Contributes to internal rotation bias and rounded shoulder posture.

Forearm Muscles

Role: Control racket angle, absorb shock, generate spin through wrist action

Activation Level: Very High (80-95% sustained during play)

Key Muscles:

• Wrist extensors (extensor carpi radialis, extensor carpi ulnaris): Maintain wrist extension during contact, prevent flexion collapse
• Wrist flexors (flexor carpi radialis, flexor carpi ulnaris): Generate topspin, control racket face angle
• Finger flexors: Maintain grip tension throughout stroke
• Supinator/pronator: Control racket face rotation for spin generation

Training Implications: Dominant forearm dramatically more developed. Wrist extensors prone to overuse (tennis elbow). Grip strength endurance is critical - fatigue leads to compensatory mechanics and injury.

Primary Muscles - Core

Obliques

Role: Generate rotational power through kinetic chain, transfer force from legs to upper body

Activation Level: Very High (75-90% during groundstrokes and serve)

Movement-Specific Notes:

• Forehand: Dominant side obliques generate explosive rotation; non-dominant side decelerates and stabilizes
• Backhand: Opposite pattern from forehand; non-dominant obliques generate rotation
• Serve: Sequential activation from legs through trunk rotation to shoulder
• Recovery: Constant anti-rotation demands during directional changes

Training Implications: Asymmetric development common - dominant side rotation typically stronger. Core endurance critical for maintaining stroke mechanics through long matches.

Rectus Abdominis

Role: Stabilize trunk, contribute to forward trunk flexion during serve and overhead shots

Activation Level: Moderate to High (60-75% during dynamic movements)

Function: Provides anti-extension stability during rapid direction changes and explosive rotations. High activation during serve as trunk flexes forward from trophy position.

Training Implications: Core endurance more important than maximal strength. Fatigue leads to excessive lumbar extension and lower back pain.

Primary Muscles - Lower Body

Quadriceps

Role: Generate power for explosive first step, decelerate during direction changes, provide stability during split-step

Activation Level: High (70-85% during explosive movements)

Movement-Specific Notes:

• Split-step and first step: Explosive eccentric-concentric action
• Wide shots: Massive eccentric load to decelerate lateral movement
• Low balls: Deep knee flexion demands during recovery
• Serve: Drive upward force from legs through kinetic chain

Training Implications: Eccentric strength critical for injury prevention. Fatigue increases knee injury risk and reduces movement efficiency.

Calves (Gastrocnemius & Soleus)

Role: Generate push-off power, maintain balance on balls of feet, absorb landing forces

Activation Level: Very High (80-95% sustained)

Function: Tennis played almost entirely on balls of feet. Constant split-step landings create high-repetition eccentric loading. Essential for explosive first step and directional changes.

Training Implications: High injury risk from overuse. Calf endurance as important as strength. Achilles tendon experiences massive cumulative load.

Glutes & Hip Muscles

Role: Generate lateral movement power, stabilize pelvis during rotation, control deceleration

Activation Level: High (65-80% during movement)

Key Muscles:

• Gluteus maximus: Hip extension during push-off and serve
• Gluteus medius: Lateral stability and control during side-to-side movement
• Hip abductors: Prevent hip drop during single-leg loading
• Hip adductors: Control deceleration during wide lateral movements

Training Implications: Hip abductor and adductor strength critical for injury prevention. Weak hip stabilizers increase knee valgus risk and ankle sprain susceptibility.

Stabilizers

Scapular Stabilizers

Role: Provide stable base for shoulder joint during high-velocity arm movements

Activation Level: Moderate to High (60-80% sustained)

Key Muscles:

• Serratus anterior: Protraction during serve and forehand
• Rhomboids: Retraction during backhand; often weak relative to serratus
• Lower trapezius: Scapular depression and upward rotation; critical for overhead mechanics
• Upper trapezius: Elevation during serve trophy position; often overactive

Training Implications: Scapular dyskinesis extremely common in tennis players. Lower trap and rhomboid weakness with upper trap dominance creates shoulder impingement risk. Non-dominant side typically weaker.

Deep Neck Flexors

Role: Stabilize cervical spine during rapid head movements tracking ball

Activation Level: Moderate continuous (40-60%)

Function: Constant head tracking of fast-moving ball requires sustained neck stabilization. Upper trap dominance often inhibits deep neck flexor activation.

Training Implications: Neck pain common in players with poor posture and weak deep flexors. Forward head posture exacerbates upper trap dominance.

Joints Involved

Shoulder (Glenohumeral Joint)

Demand Level: Extreme - highest stress of any joint in tennis

Primary Movements:

• Serve: Extreme external rotation (up to 170-180 degrees) followed by explosive internal rotation (up to 7,000 degrees/second angular velocity)
• Forehand: Horizontal abduction followed by horizontal adduction with internal rotation
• Backhand: More external rotation bias, particularly one-handed backhand
• Overhead: Similar to serve, extreme range and velocity demands

Mobility Requirements:

• Exceptional external rotation range (often 100-120 degrees in dominant shoulder vs 60-80 degrees non-dominant)
• Good internal rotation, though often limited in dominant shoulder due to adaptive changes
• Full overhead flexion and abduction

Common Issues:

• GIRD (Glenohumeral Internal Rotation Deficit): Dominant shoulder loses internal rotation range as adaptation to sport; increases injury risk when excessive (over 20 degree deficit)
• Posterior capsule tightness: Contributes to GIRD and anterior shoulder migration
• Humeral retroversion: Bony adaptation in young players; humeral head sits in more externally rotated position
• Microtrauma accumulation: Serves in a match can approach 100-200; practice serves add thousands weekly
• Labral stress: Extreme range and velocity create shear forces on glenoid labrum

Elbow Joint

Demand Level: Very High - second most injured joint in tennis

Primary Movements:

• Extension: Forceful elbow extension during serve and forehand
• Flexion: Control during backhand and defensive shots
• Pronation/Supination: Racket face control and spin generation

Stress Points:

• Lateral epicondyle: Wrist extensor origin; massive overuse during backhand and gripping
• Medial epicondyle: Wrist flexor origin; stress during serve and forehand
• Posterior elbow: Triceps insertion stress during serve

Common Issues:

• Tennis elbow (lateral epicondylitis): Overuse of wrist extensors, particularly extensor carpi radialis brevis
• Golfer's elbow (medial epicondylitis): Less common but occurs with excessive topspin and serving
• Hyperextension stress: Rapid deceleration creates posterior compression

Wrist Joint

Demand Level: High - critical for racket control and spin

Primary Movements:

• Extension: Maintained during contact to prevent flexion collapse
• Flexion: Generates topspin through "wrist snap"
• Radial/Ulnar Deviation: Fine racket angle control

Common Issues:

• Wrist extensor tendinopathy: Overuse from maintaining extension under load
• TFCC injuries: Triangular fibrocartilage complex stress from rotational forces
• Extensor carpi ulnaris tendinopathy: Common from extreme wrist extension and ulnar deviation

Hip Joint

Demand Level: High - critical for movement and power generation

Primary Movements:

• Flexion/Extension: Explosive movements and recovery
• Abduction/Adduction: Lateral movement control
• Internal/External Rotation: Core rotation and power transfer

Mobility Requirements:

• Good hip flexion for low ball recovery
• Adequate hip extension for power generation
• Strong rotational control in both directions

Common Issues:

• Hip flexor tightness: From constant split-step position and explosive movements
• Femoroacetabular impingement: Repetitive rotational stress
• Hip abductor weakness: Increases knee valgus and ankle injury risk

Ankle Joint

Demand Level: Very High - most commonly injured joint in tennis

Primary Movements:

• Plantarflexion/Dorsiflexion: Push-off and landing control
• Inversion/Eversion: Critical for movement on uneven surfaces and rapid direction changes

Stress Factors:

• Constant split-step landings (100-300 per match)
• Rapid lateral movements with cutting
• Playing on balls of feet creates sustained calf and ankle demand
• Clay court sliding requires unique ankle control

Common Issues:

• Lateral ankle sprains: Most common acute injury in tennis
• Chronic ankle instability: From recurrent sprains
• Achilles tendinopathy: Overuse from repetitive push-offs
• Peroneal tendinopathy: Lateral ankle stabilizer overuse

Energy Systems

ATP-PC System (Phosphagen)

Primary System: Dominant during individual points

Time Domain: Each point typically lasts 5-15 seconds (average ~7 seconds in professional tennis)

Characteristics:

• Explosive efforts: Serve, first step, powerful groundstrokes all rely on immediate ATP availability
• Point structure: 3-5 explosive efforts per point (serve/return, 1-3 shot exchanges)
• Recovery: 20-25 seconds between points allows partial ATP-PC restoration (80-90%)
• High power output: Maximum velocity serves (120-140+ mph) require maximal power

Training Implications: Sprint training, plyometrics, and Olympic lifting develop ATP-PC system. Practice point structure (work:rest ratios) should match competition.

Glycolytic System (Anaerobic)

Contribution: Significant during long rallies and tiebreaks

Time Domain: Extended rallies lasting 15-60+ seconds

Characteristics:

• Long rallies: 10+ shot exchanges, particularly on clay courts
• Tiebreaks: Continuous high-intensity points with minimal recovery
• Training sets: Long practice points tax glycolytic system
• Lactate accumulation: Muscle burn during extended rallies, particularly in legs

Training Implications: Interval training with longer work periods (30-90 seconds) and incomplete rest. On-court conditioning drills with extended rallies.

Aerobic System (Oxidative)

Role: Recovery between points and baseline endurance

Time Domain: Entire match duration (best of 3: 90-180 minutes; best of 5: 180-300+ minutes)

Characteristics:

• Between-point recovery: Aerobic system clears lactate during 20-25 second rest periods
• Between-game recovery: 90-second changeovers allow deeper recovery
• Match endurance: Ability to maintain power output through 3-5 sets
• Heat tolerance: Aerobic fitness improves thermoregulation during long matches in heat

Training Implications: Base aerobic fitness critical for recovery capacity. Long, steady-state cardio builds aerobic base. However, excessive slow aerobic work may reduce power - balance is key.

Energy System Integration

Match Structure Energy Demands:

• Work-to-rest ratio: Approximately 1:2 (point duration vs rest between points)
• Point energy: 70% ATP-PC, 20% glycolytic, 10% aerobic
• Recovery between points: 90% aerobic, 10% glycolytic (clearing lactate)
• Overall match: ~20% ATP-PC, ~10% glycolytic, ~70% aerobic (when accounting for all rest periods)

Surface-Specific Variations:

• Hard courts: Faster pace, shorter points, more ATP-PC dominant
• Clay courts: Longer rallies, higher glycolytic demand, extended matches
• Grass courts: Fastest surface, shortest points, highest ATP-PC emphasis

Common Imbalances

Dominant Arm Overdevelopment

Muscles Affected: Entire dominant upper extremity - shoulder, arm, forearm significantly larger and stronger

Mechanism:

• All stroke production from dominant arm
• Thousands of repetitions per training session
• High-intensity contractions during serve and groundstrokes
• Minimal bilateral training in sport-specific work

Manifestation:

• Visible muscle size difference (1-2 cm arm circumference difference common)
• Dominant shoulder sits lower at rest due to muscle mass
• Strength imbalances of 30-50% between arms in tennis-specific movements
• Scapular position asymmetry

Performance Impact: Not directly limiting for tennis performance, but creates aesthetic asymmetry and may increase injury risk if imbalance becomes extreme. Difficulty with bilateral activities requiring equal arm strength.

Internal Rotator Dominance (Dominant Shoulder)

Muscles Affected: Subscapularis, pectoralis major, latissimus dorsi, anterior deltoid

Mechanism:

• Serve and forehand emphasize internal rotation and horizontal adduction
• External rotators work eccentrically to decelerate but are overpowered
• Internal rotation velocities up to 7,000 degrees/second create massive training stimulus
• Thousands of serves and forehands weekly

Manifestation:

• Dominant shoulder sits in more internally rotated position
• Limited internal rotation range (GIRD - Glenohumeral Internal Rotation Deficit)
• Excessive external rotation range (compensatory adaptation)
• Forward shoulder posture on dominant side
• Posterior shoulder tightness

Performance Impact: Moderate GIRD (15-20 degrees) may be normal adaptation. Excessive GIRD (over 20 degrees) increases impingement risk and alters stroke mechanics. Limits non-dominant side backhand development.

Weak External Rotators (Dominant Shoulder)

Muscles Affected: Infraspinatus, teres minor, posterior deltoid

Mechanism:

• External rotators primarily work eccentrically to decelerate internal rotation
• Eccentric strength develops but concentric strength lags behind internal rotators
• Typical ratio should be 3:2 (internal:external); tennis players often 3:1 or worse
• Fatigue of external rotators during long matches reduces shoulder stability

Manifestation:

• Difficulty with external rotation against resistance
• Shoulder instability sensation when fatigued
• Positive impingement signs
• Scapular dyskinesis

Performance Impact: Primary risk factor for rotator cuff injuries and shoulder impingement. Reduces serve velocity when fatigued. Limits ability to train at high volumes.

Weak Scapular Stabilizers

Muscles Affected: Lower trapezius, rhomboids, middle trapezius (bilateral but worse on dominant side)

Mechanism:

• Tennis emphasizes scapular protraction (serratus anterior) during serve and forehand
• Limited retraction demands in stroke production
• Upper trapezius becomes dominant compensator
• Forward shoulder posture inhibits lower trap activation

Manifestation:

• Scapular winging, particularly on dominant side
• Upper trap overdevelopment causing neck tension and headaches
• Inability to maintain retracted scapular position
• Poor scapular upward rotation during serve

Performance Impact: Reduces force transfer from trunk to arm. Increases shoulder impingement risk. Contributes to neck and upper back pain. Limits serve power when scapula cannot provide stable base.

Core Asymmetry

Mechanism:

• Forehand rotation (dominant direction) practiced more than backhand
• Oblique strength imbalances favor dominant rotation direction
• Repeated asymmetric loading through thousands of strokes
• Modern open-stance forehand increases rotational demands

Manifestation:

• One direction of rotation significantly stronger (typically forehand direction)
• Spinal rotation mobility asymmetry
• Asymmetric core endurance
• Possible spinal alignment changes

Performance Impact: May limit backhand power development. Can contribute to lower back pain. Reduces efficiency of kinetic chain in weaker rotation direction.

Posterior Chain Weakness

Mechanism:

• Tennis played on balls of feet with constant forward posture
• Hip flexors and quads dominant over glutes and hamstrings
• Limited hip extension demands in typical stroke production
• Forward body position reinforces anterior chain dominance

Manifestation:

• Tight hip flexors
• Relatively weak glutes and hamstrings
• Anterior pelvic tilt
• Difficulty with hip extension exercises

Performance Impact: Reduces serve power (kinetic chain starts with ground force through posterior chain). Increases hamstring and lower back injury risk. Limits movement efficiency.

Complementary Training

External Rotation Strengthening

Purpose: Balance overdeveloped internal rotators, reduce shoulder injury risk, improve deceleration capacity

Key Exercises:

• Band external rotations at 90-degree abduction: Mimics serving position, 2-3 sets of 15-20 reps
• Side-lying external rotation: Isolates infraspinatus/teres minor, slow tempo
• Prone external rotation at 90-degree abduction: Strengthens in lengthened position
• Sleeper stretch: Address posterior capsule tightness contributing to GIRD

Programming: 4-5 times per week, year-round. Can be performed daily as prehab. Essential during high-serving volume periods.

Technique Notes:

• Keep intensity moderate - external rotators fatigue easily
• Perfect form essential - any compensation defeats purpose
• Focus on eccentric phase (deceleration training)
• Monitor GIRD monthly - should stay below 20-degree deficit

Scapular Strengthening

Purpose: Restore proper scapular mechanics, reduce impingement risk, improve force transfer

Key Exercises:

• Prone Y-raises: Lower trap emphasis, arms in Y position with thumbs up
• Face pulls with external rotation: Posterior deltoid, rhomboids, middle trap
• Wall slides: Scapular control through full range
• Scapular push-ups: Serratus anterior and lower trap coordination

Programming: 3-4 times per week, 2-3 sets of 12-20 reps, light weight, perfect form

Technique Notes:

• Focus on scapular movement, not just arm movement
• Avoid upper trap dominance (don't shrug shoulders toward ears)
• Emphasize scapular retraction and depression
• Both sides equally, even though dominant side weaker

Non-Dominant Arm Training

Purpose: Reduce asymmetry, improve two-handed backhand, enhance overall athleticism

Key Exercises:

• Non-dominant groundstrokes: 10-15% of practice strokes from non-dominant side
• Non-dominant medicine ball throws: Rotational and overhead variations
• Unilateral exercises starting with non-dominant: Dumbbell rows, single-arm presses
• Two-handed backhand emphasis: Engages non-dominant arm more

Programming: 2-3 times per week for strength work; daily inclusion of non-dominant stroke practice

Benefits:

• Reduces visible asymmetry
• Improves two-handed backhand (non-dominant arm provides power)
• Creates more balanced athletic development
• Emergency shot capability with non-dominant hand

Hip and Core Strengthening

Purpose: Improve movement efficiency, increase power transfer, reduce lower back and leg injury risk

Key Exercises:

• Hip thrusts: Glute development for explosive push-off
• Lateral band walks: Hip abductor strength for lateral stability
• Copenhagen planks: Hip adductor strength for deceleration
• Pallof presses: Anti-rotation core strength
• Rotational medicine ball throws: Power in both rotation directions

Programming: 3-4 times per week, emphasizing both rotation directions equally

Technique Notes:

• Train weak rotation direction (usually backhand) with extra volume
• Emphasize eccentric control for deceleration capacity
• Include single-leg variations for balance and stability

Lower Body Strength and Plyometrics

Purpose: Improve explosive first step, enhance deceleration capacity, reduce knee and ankle injury risk

Key Exercises:

• Bulgarian split squats: Single-leg strength and stability
• Lateral lunges: Specific to lateral tennis movement pattern
• Depth drops to lateral bound: Reactive strength for direction changes
• Single-leg box jumps: Explosive power development
• Eccentric calf raises: Achilles tendon resilience

Programming: 2-3 times per week, periodized by season

Technique Notes:

• Emphasize eccentric phase - this is where injuries occur
• Progress volume conservatively with plyometrics
• Include multi-directional movements (not just forward/back)
• Monitor for knee valgus - correct immediately

Mobility and Flexibility Work

Purpose: Maintain healthy joint ranges, prevent overuse injuries, counter sport-induced stiffness

Key Areas:

• Shoulder external rotation: Maintain balance with internal rotation development
• Thoracic rotation: Both directions, prevent compensatory lumbar rotation
• Hip flexor stretching: Counter constant forward posture and split-step
• Ankle dorsiflexion: Often limited in tennis players
• Posterior shoulder (sleeper stretch): Address GIRD

Programming: Daily, 10-15 minutes, especially pre-training and pre-match

Injury Patterns

Tennis Elbow (Lateral Epicondylitis)

Mechanism: Overuse of wrist extensor muscles, particularly extensor carpi radialis brevis, from repetitive backhand groundstrokes and gripping

Contributing Factors:

• Poor backhand technique (leading with elbow, wrist collapse)
• Excessive grip tension throughout stroke
• Late contact point causing increased wrist extensor demand
• Racket factors: heavy racket, high string tension, small grip size
• Inadequate forearm strength and endurance
• Sudden increase in training volume or intensity
• Aging (decreased tendon vascularity)

Symptoms:

• Pain on outside of elbow, especially with gripping or wrist extension
• Pain when lifting objects or shaking hands
• Weakness in grip strength
• Pain radiating down forearm
• Morning stiffness in elbow
• Pain that worsens after practice sessions

Prevention:

• Proper backhand technique (whole arm unit, stable wrist)
• Progressive volume increases (no more than 10% weekly)
• Regular forearm strengthening (wrist curls, reverse wrist curls, farmer's carries)
• Equipment check (proper grip size, moderate string tension)
• Adequate rest between training sessions
• Proper warm-up including wrist and forearm preparation

Treatment:

• Relative rest (reduce volume, eliminate aggravating activities temporarily)
• Ice after training sessions
• Eccentric wrist extensor exercises (Tyler Twist protocol)
• Address technique flaws with coach
• Consider counterforce brace during play
• Equipment modifications (larger grip, lower string tension, softer strings)
• Physical therapy for chronic cases
• Gradual return to full play over 6-12 weeks

Rotator Cuff Tendinopathy / Shoulder Impingement

Mechanism: Overuse of rotator cuff muscles from repetitive overhead serving and groundstrokes, combined with muscle imbalances and scapular dyskinesis

Contributing Factors:

• Excessive serving volume without adequate recovery
• Weak external rotators relative to internal rotators
• Scapular dyskinesis (poor lower trap and serratus anterior function)
• Excessive GIRD (over 20-25 degrees) with posterior capsule tightness
• Poor serve technique (elbow dropping, lack of leg drive)
• Inadequate core and lower body contribution to serve
• Fatigue leading to altered mechanics

Symptoms:

• Pain during serving motion, particularly during cocking and acceleration phases
• Pain with overhead shots
• Night pain when sleeping on affected shoulder
• Weakness and loss of serve velocity
• Pain during follow-through phase
• Clicking or catching sensation in shoulder
• Pain may start gradually and worsen over weeks/months

Prevention:

• Balanced strength program emphasizing external rotators and scapular stabilizers
• Monitor and address excessive GIRD (sleeper stretches, posterior capsule mobilization)
• Proper serve technique with full kinetic chain integration
• Progressive serving volume increases
• Adequate rest between high-serving sessions
• Regular assessment of shoulder range of motion and strength ratios
• Year-round maintenance program for shoulder

Treatment:

• Reduce serving volume temporarily (50-75% reduction)
• Aggressive external rotator and scapular strengthening
• Address posterior capsule tightness and GIRD
• Video analysis and serve technique corrections
• Improve kinetic chain sequencing (legs → core → shoulder)
• Physical therapy for persistent cases
• Gradual return to serving over 8-12 weeks
• May require 4-6 weeks of complete serving rest for severe cases

Wrist Injuries (Extensor Tendinopathy, TFCC Injury)

Mechanism: Repetitive wrist extension under load during groundstrokes, or acute/chronic stress to triangular fibrocartilage complex from rotational forces

Contributing Factors:

• Excessive wrist action during stroke production
• Late contact points forcing wrist compensation
• Heavy topspin technique requiring extreme wrist flexion/extension
• Weak forearm muscles unable to stabilize wrist
• Two-handed backhand with dominant hand in extreme extension
• Direct impact injuries (hitting ground or net post with racket)

Symptoms:

• Pain on top of wrist (extensor side) during or after play
• Pain with wrist extension, particularly under load
• Weak grip strength
• Pain during two-handed backhand
• Ulnar-sided wrist pain (TFCC injuries)
• Clicking or popping with wrist rotation
• Swelling on wrist extensor tendons

Prevention:

• Proper stroke mechanics minimizing excessive wrist motion
• Forearm and wrist strengthening program
• Adequate warm-up including wrist circles and stretches
• Appropriate racket selection and string tension
• Wrist tape or support during play if needed
• Early contact points reducing wrist compensation

Treatment:

• Relative rest from aggravating activities
• Ice after sessions
• Wrist strengthening and stabilization exercises
• Technique modifications to reduce wrist stress
• Consider wrist brace or taping during play
• Address grip size and racket weight if contributing
• Physical therapy for chronic cases
• MRI if TFCC injury suspected (may require surgical intervention for severe tears)

Ankle Sprains (Lateral)

Mechanism: Inversion injury during lateral movement, direction changes, or landing from split-step

Contributing Factors:

• Rapid direction changes inherent to tennis
• Fatigue leading to reduced ankle stability
• Previous ankle sprains creating chronic instability
• Weak peroneal muscles (lateral ankle stabilizers)
• Poor footwork technique
• Playing on uneven or slippery surfaces
• Inadequate ankle mobility limiting controlled motion
• Worn-out tennis shoes with reduced lateral support

Symptoms:

• Immediate pain on outside of ankle
• Swelling and bruising
• Difficulty bearing weight
• Reduced ankle range of motion
• Tenderness over lateral ligaments (ATFL, CFL)
• Instability or "giving way" sensation

Prevention:

• Ankle strengthening exercises (calf raises, inversion/eversion resistance)
• Balance and proprioception training (single-leg balance, wobble board)
• Proper footwork technique with low center of gravity
• Quality tennis shoes with good lateral support, replaced regularly
• Ankle taping or bracing if history of instability
• Progressive return to play after previous injuries
• Plyometric training for reactive stability

Treatment:

• Acute phase (0-72 hours): RICE protocol (Rest, Ice, Compression, Elevation)
• Grade I (mild): 1-2 weeks recovery, progressive weight bearing and range of motion
• Grade II (moderate): 2-6 weeks, may benefit from temporary bracing, progressive strengthening
• Grade III (severe): 6-12 weeks, may require immobilization, aggressive rehabilitation
• Early controlled motion better than complete immobilization
• Progressive strengthening: range of motion → strength → balance → sport-specific drills
• Gradual return to tennis starting with straight-line movement, progressing to lateral and rotational
• Consider ankle bracing for 6-12 months after return to prevent reinjury

Lower Back Pain

Mechanism: Repetitive rotational stress, extension loading during serve, and asymmetric movement patterns

Contributing Factors:

• Excessive lumbar extension during serve (arching back)
• Repetitive asymmetric rotation through core
• Weak core musculature unable to stabilize spine
• Tight hip flexors causing anterior pelvic tilt and compensatory lumbar extension
• Poor serve technique (lack of leg drive, all power from back)
• Inadequate glute and hamstring strength forcing lower back compensation
• Playing through fatigue with deteriorating mechanics

Symptoms:

• Pain during serving motion, especially extension phase
• Pain during groundstrokes, particularly on one side
• Stiffness after training or matches
• Morning stiffness requiring time to "warm up"
• Pain with rotation or extension movements
• Possible radiating pain into glutes or legs if nerve involvement

Prevention:

• Core strengthening program emphasizing anti-extension and anti-rotation
• Hip flexor stretching and glute activation
• Proper serve technique with leg drive and sequential energy transfer
• Adequate warm-up including dynamic spinal mobility
• Address any leg length discrepancies or pelvic asymmetries
• Avoid excessive volume when fatigued
• Strengthen posterior chain (deadlifts, hip thrusts)

Treatment:

• Identify and address specific mechanical cause
• Core stabilization program (planks, bird dogs, dead bugs, Pallof presses)
• Hip flexor stretching and glute strengthening
• Serve technique correction (increase leg drive, reduce back arch)
• Temporary reduction in serving volume
• Address any rotational asymmetries in training
• Physical therapy for persistent cases
• Avoid complete rest - controlled movement aids recovery
• Consider assessment for structural issues if recurrent

Sources

References

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