It's no surprise that tennis courts become fully booked and tennis racket sales increase around this time of year, as amateur tennis players are keen to train harder and newcomers are inspired to start playing from scratch.

Although tennis can be an extremely fun sport to engage in, it is important prepare yourself before play. Two-thirds of tennis injuries are from overuse and a third of injuries are due to acute/traumatic events, all of which can be sustained during training or games.  

Following some simple steps can help protect you from injury if you are thinking of getting involved.

Common tennis injuries

Lateral Epicondylitis, more widely known as ‘Tennis elbow’ is perhaps the most common upper limb injury in tennis. This is caused after strenuous overuse of the forearm extensor muscles, where degenerative changes arise in the muscles and tendons, near the elbow joint. This injury can go on to cause significant pain in the arm, even when carrying out normal daily tasks.

How to avoid tennis elbow

Evidence shows that tendons do not respond well to ‘too much, too fast, too soon,’ which is a common mistake we make when taking up a new sport, such as tennis. It is sensible to start a gentle tennis training programme.

It is important to target the common extensor muscles/tendons of the wrist and elbow as these are the areas where micro tears and degenerative changes occur during injury.

Consider exercising your forearm muscles as a warm up, but also routinely throughout the week to maintain strength and flexibility:

• Gripping or squeezing on a stress ball or therapeutic putty
• Extending your wrist over the edge of a table whilst holding a weight
• Forearm rotation while holding onto a stick or resistance band
• Forearm stretches

Top helpful tip if in pain:  Taping or strapping to offload the tendon.

Shoulder pain

The most common injury site in the shoulder is not the rotator cuff themselves but the tendons that attach these muscles to the upper arm. The rotator cuff muscles are a small group of muscles, situated close to the ball-and-socket joint of the shoulder that provide stability.

What can be done to prevent shoulder pain?

With tennis players it is important to work on flexibility, strength and endurance of the shoulder muscles. A Chartered Physiotherapist can help with specific targeted rehabilitation addressing all issues including posture, scapular, rotator cuff strength, posterior capsular tightness (if present), and core stability, along with sport specific exercises.

What should you do if you suffer a shoulder injury?

First you need to reduce any inflammation, using an ice pack for up to 15-20 minutes can help. Never apply ice directly to the skin as you may develop an ice burn. Use anti-inflammatories as prescribed by the doctor.

Physiotherapy may involve advice and education on managing your injury, an exercise program to strengthen your muscles, acupuncture to alleviate pain, taping to support your shoulder and encourage muscle activation and manual treatments to address joint stiffness and soft tissue tightness. 

Spinal stress fractures

Spinal stress fractures can occur within the vertebral bones of the spine. These are common in tennis due to the repetitive nature of extending and twisting the back as we serve or reach for fast moving balls.

If these excessive forces aren’t counteracted by our core muscles that surround the spine, then we are more at risk of developing an injury.

Evidence shows that improving your core stability reduces the risk of sustaining a stress fracture in the spine. A great way to do this alongside your tennis training could be to engage in other activities such a swimming, Pilates or Yoga classes, which are great for challenging your core!

Here’s a few core stability exercises to try out before starting your tennis training:

• Tilting your pelvis back while laying on your back with your knees bent (think of your pelvis as a bucket, pouring water out of it as you flatten your lower back to the floor)
• Superman holds,  stretching opposite arm and leg out whilst kneeling on all fours
• Roll downs, lean against a wall and slide your hands down your legs to curl forwards into an arch (imagine you are peeling forwards off of the wall, starting with your head) then curl back up

Common risk factors and advice to reduce tennis injuries

• Incorrect footwear and racquet: It is important to wear comfortable tennis shoes with premium support and stability to prevent ankle injuries. Also having the right fit of tennis racquet, including the correct grip size and string tension can minimize the stresses placed on your elbow and shoulder. Speak with your coaches for advice on the correct racquet for you.
• No warm-up and cool-down: Warming up can improve performance as well reduce injuries. Always take time to warm up to elevate your heart rate and prepare for the task in hand.  Try replicating similar movements to ensure you warm up the whole body in a sports specific way. A cool down may involve a stretching program and gentle exercise, which can help reduce stiffness and soreness.
• Incorrect technique: An incorrect swinging action can be a result of relying on the arm to hit the ball, rather than using the body’s full strength.
• Time spent playing: Overexertion is the most common cause for injury.  The body needs to rest between matches. Ensure that you spread out the time spent on the court and in training sessions and mix high and low intensity sessions, ensuring adequate rest days.
• Previous injury: Follow the advice of your physiotherapist, and take time to rest or reduce training load to allow injuries to heal properly, avoiding an injury becoming chronic.