There are almost 30 million tennis players in the United States, who benefit from improvements in aerobic fitness, cholesterol profiles, and improved bone health through particpation¹.   Tennis can be played at junior, adult, junior competitive, and professional levels. Injuries and injury prevention differ depending on the age of the athlete, competitive level and amount of time playing for fun or competition.

Junior competitive players tend to play 11-15 hours/week. The most competitive players may participate in up to 25 tournaments per year.  Junior players tolerate higher volumes of play than the adults¹.  They are more susceptible to acute injuries during tournament play.   Risk of serious overuse injury increases with year round intense training and competition, an excess of 5 or more matches in a tournament, and early single sport specialization¹.

Recreational adult tennis players can range from beginners, developing their skills, to high-level former college or professional players with advanced skills.  Adults may commonly play 6 or more hours/week.  Adults tend to have overuse and degenerative conditions, with half of adults, over 40 years of age, having some elbow symptoms. As the level of play increases, the number of acute injuries increases, with the greatest number of injuries noted in
tournament play¹. 

Tennis Injuries and Causes
Due to the running and quick direction changes in tennis, both adult and junior players are prone to ankle sprains and patellofemoral (kneecap) pain. Shoulder pain due to rotator cuff problems also affects players regardless of age. Other injuries are more specific to players of certain ages.

Junior Competitive Players:  Lumbar spine hyperextension (arching of the lower back backwards) while serving may put junior players at risk for stress fractures in the low back.  Topspin (kick) serves may result in greater arching of the lower back.  Slice serves and extreme topspin (western) grips on forehands may contribute to inner elbow injuries.  Heavy topspin strokes may also cause pain on the pinkie side of wrist. Junior competitive players rarely get tennis elbow (lateral epicondylosis), and should be evaluated for more serious problems.

Recreational Adult Players:  Wrist extension during one-handed backhands and forearm rotation on topspin forehands and serves may contribute to tennis elbow (outer elbow) pain.  If players under-use their trunk strength while hitting and serving, extra stress can be placed on the shoulder and elbow. This may lead to tendinosis in the rotator cuff (shoulder) or elbow tendon problems (tennis elbow).

Injury Prevention Recommendations:
Each tennis session should start with warm ups that recreate tennis-specific movement patterns. Players should stretch at the end of a workout.  Tennis-specific evaluations by a sports medicine physician to identify high-risk areas (shoulder, elbow, low back) early in symptom development may reduce long-term absences from tennis. 

Adults:  Caution with >6 hours/week and particularly over 10 hours/week.

Junior:  Play multiple sports prior to adolescence to limit injury, burnout, and improve long-term performance.  Limit practicing kick serves until at least 13 years old.  Consider playing less hours/week then age, and participate in less tournaments/year then age. 

AMSSM Authors: 

Cassidy M. Foley, D.O. and Edited by Neeru Jayanthi, M.D

References

¹Jayanthi N, Esser S. Racket Sports. Current Sports Medicine Reports. 2013;12(5);1-8.