The most common tennis injuries in adult players are tennis elbow, shoulder overuse problems, lower back strain, calf strains, ankle sprains and knee pain. Many develop gradually from overuse, while others, such as ankle sprains and calf strains, happen suddenly during quick movements. Common risk factors include increasing playing time too quickly, skipping warm-ups, limited strength and mobility, flawed technique and unsuitable equipment or footwear. The good news is that many tennis injuries can be reduced with sensible training habits. This guide explains each common injury, its typical signs and risk factors, prevention strategies, a step-by-step injury-prevention routine and when to seek professional help.
Health note: This article is general information, not medical advice, and cannot diagnose an injury. See a doctor, physical therapist or other qualified professional for pain that is severe, persistent, worsening or that affects how you move, and seek urgent care for major swelling, deformity, inability to bear weight, numbness or chest pain. Follow professional advice on returning to play.
Common injuries at a glance
| Injury | Typical signs | Main prevention |
|---|---|---|
| Tennis elbow (lateral epicondylitis) | Pain on the outer elbow, worse with gripping | Good backhand technique, suitable racquet and strings, forearm strength |
| Shoulder overuse | Ache or pain with serving and overheads | Rotator cuff and shoulder blade strength, smooth serve mechanics |
| Lower back strain | Stiffness or pain, often after serving | Core and hip strength, good serve technique |
| Calf strain | Sudden pain in the calf when pushing off | Warm-up, calf strength, gradual increases in play |
| Ankle sprain | Pain and swelling after rolling the ankle | Balance training, proper tennis shoes |
| Knee pain | Pain around the kneecap or with bending | Leg and hip strength, gradual loading |
| Wrist pain | Pain with topspin shots or gripping | Technique, forearm strength, suitable grip size |
Tennis elbow
Tennis elbow, or lateral epicondylitis, is an overuse condition affecting the tendons on the outer side of the elbow. It often causes pain with gripping, lifting or hitting backhands. Although it is named after tennis, many people who develop it do not play tennis. In players, risk factors can include late or wristy one-handed backhands, a grip size that is too small or too large, very stiff racquets or high string tension, and sudden increases in playing time. Prevention includes working with a coach on technique, choosing equipment suited to your level and gradually strengthening the forearm and wrist muscles.
Shoulder overuse
Serving and overheads place repeated stress on the shoulder, especially the rotator cuff muscles and tendons. Shoulder problems often develop gradually, starting as a dull ache after play. Weakness in the rotator cuff and the muscles around the shoulder blade, limited mobility in the upper back and serving with too much arm and too little leg drive can all contribute. Prevention includes regular shoulder and upper back strengthening, mobility work, a smooth serve motion that uses the legs and trunk, and managing serve volume, particularly when returning after time off.
Lower back strain
The serve involves arching, rotating and bending the spine, while groundstrokes involve repeated rotation. Lower back pain in tennis players can come from muscle strain or, less commonly, more serious structural issues. Weak core and hip muscles, limited hip mobility and excessive arching during the serve can increase stress on the back. Core and hip strengthening, mobility work and technical guidance on the serve can help reduce risk. Persistent back pain, especially with leg symptoms, should be assessed by a professional.
Calf strains and tennis leg
Calf strains are common in adult players, especially middle-aged players. They often happen suddenly when pushing off or lunging, with players sometimes describing a feeling like being hit in the calf. The term tennis leg is often used for a strain of the inner part of the calf muscle. Inadequate warm-up, fatigue, reduced calf strength and sudden increases in activity may raise the risk. A thorough warm-up, regular calf strengthening and gradually building playing time can help prevent these injuries.
Ankle sprains
Ankle sprains happen when the foot rolls, often during quick changes of direction, landing awkwardly or stepping on a ball. Previous sprains increase the risk of future ones. Prevention includes wearing proper tennis shoes with good lateral support, replacing worn shoes, keeping the court clear of loose balls and doing balance and ankle-strengthening exercises. Some players with a history of sprains use braces or taping, ideally on professional advice.
Knee pain
Tennis involves repeated bending, lunging, stopping and changing direction, which loads the knees. Pain around the kneecap and tendon problems are common overuse complaints. Weak thigh and hip muscles, sudden increases in play and hard court surfaces may contribute. Strengthening the quadriceps, hamstrings and hip muscles, building up playing time gradually and wearing supportive shoes can help. Sudden knee injuries with swelling, locking or instability should be assessed promptly.
Step-by-step: an injury-prevention routine
- Warm up for 10 to 15 minutes with light cardio and dynamic movements before playing.
- Start hitting gently, building pace gradually, including a few easy serves.
- Increase playing time gradually, especially after a break or when adding matches.
- Strength train two or more days a week, focusing on legs, hips, core, back, shoulders and forearms.
- Include balance and mobility work, such as single-leg balance and hip and upper back mobility.
- Check equipment: a suitable racquet, grip size and string tension, and supportive tennis shoes.
- Cool down with light movement and gentle stretching after playing.
- Rest and recover, with adequate sleep, hydration and rest days.
The role of equipment
Equipment can influence injury risk. Racquets that are very stiff or heavy, grips that are the wrong size and strings that are very stiff or strung at high tension may increase stress on the arm for some players. Softer strings, such as multifilaments or natural gut, and slightly lower tensions are often recommended for players with arm pain, although individual needs vary. Tennis shoes are designed for lateral movement and provide support that running shoes do not. Replace shoes when the tread or support wears down. A coach or knowledgeable stringer can help you choose suitable equipment.
Returning after an injury
Returning too soon is a common cause of re-injury. Follow professional advice, and return gradually. Start with gentle hitting, short sessions and limited serving, then build up volume and intensity over time. Pain that returns or worsens is a sign to slow down. Continuing strength and mobility exercises after recovery helps reduce the chance of the same problem returning.
Common mistakes
- Skipping the warm-up, especially before matches.
- Increasing playing time too quickly.
- Playing through pain instead of getting it checked.
- Wearing running shoes on the tennis court.
- Ignoring strength training.
- Using unsuitable equipment, such as the wrong grip size.
- Returning from injury too soon.
Frequently asked questions
What is the most common tennis injury?
Tennis elbow and shoulder overuse problems are among the most common in adult players, along with calf strains, ankle sprains and lower back pain.
How can I prevent tennis elbow?
Work on backhand technique with a coach, use a suitable racquet, grip size and string setup, strengthen the forearm and increase playing time gradually.
Should I play tennis with pain?
Mild soreness after playing can be normal, but pain that is sharp, persistent or affects how you move should be assessed by a professional before continuing.
