Here we look at some of the most common injuries in the game of Tennis, as well as what you can do to try to prevent tennis injuries. Tennis injuries are often in the upper body, especially due to the forces required to hit the ball over and over again, especially on shots like serves and smashes! Rotator cuff injuries are common, as are wrist and elbow injuries.
Most common Tennis injuries
Iliotibial band syndrome
IT syndrome or runners knee as it is sometimes called is a gradual onset injury causing pain on the outside of the knee. Over time the pain gets progressively worse until the player must stop. Typically they will rest for a period of time until symptoms go only for it to return again as soon as they go back to playing tennis or running. Treatment is based around reducing the pain and inflammation along with stretching, foam roller use and strengthening exercises. Read more about IT band syndrome.
Patellofemoral Pain Syndrome (PFPS) also known as runners knee, chondromalacia patella is a generic term used to describe kneecap pain at the front of the knee. Symptoms include an aching pain in the knee joint, particularly at the front of the knee around and under the patella. Treatment includes rest, applying ice or cold therapy to reduce pain and inflammation along with a full rehabilitation program of specific exercises along with knee taping. Read more on patella pain.
Low back pain
Back pain can be acute (sudden onset back pain) or chronic back pain (gradual onset or persistent). It can be difficult to diagnose due to the complexity and the number of structures and tissues in the lower back that can cause pain. Pain radiating down the leg is known as Sciatica. Read more on lower back pain.
Also known as lateral epicondylitis it is more of a generic term for pain on the outside of the elbow of which there can be a number of causes. A poor backhand technique where the player as a soft or bent wrist can cause tennis elbow although it is even more common through the repetitive strain in daily activities such as typing on a keyboard, using a screwdriver or gripping heavy objects. Read more on Tennis elbow.
Should I seek professional treatment?
If you have any of the following symptoms you should seek further medical assistance.
- Severe pain, especially on walking
- Severe swelling (oedema)
- Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anesthesia).
- Unable to complete normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a podiatrist, physiotherapist, sports therapist, osteopath or chiropractor. If you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment.
Secondly, if you have applied for P.R.I.C.E principle and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your foot or heel, you are highly recommended to seek advice from a specialist expert - such as a podiatrist or physiotherapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.
Immediate first aid for acute injuries
The PRICE principles are the gold standard set for treating acute sports injuries. The acronym stands for Protection, Rest, Ice, Compression and Elevation and should be applied as early as possible and continued for at least the first 24-72 hours.
Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is by using a support or splint.
In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.
An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
If an injury is sustained during sporting activity some athletes have a tendency to 'run it off'. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases, this is not true and is not advisable.
Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare.
The application of ice to an injury, in the acute phase, can substantially decrease the extent of the damage. It achieves this in a number of different ways:
Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
Reduces pain (pain gate theory)
Reduces muscle spasm
Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collarbone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.
Applying compression to an injured area minimises the amount of swelling that forms after an injury in two ways and should be applied for the first 24 to 72 hours from the onset of injury. Compression can be applied through a number of methods. The most effective of these is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.
Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid away from the injured site. This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).
Read more on PRICE principles
Preventing tennis injuries
A warm-up is a vital part of sporting participation in order to prevent injury and perform at your optimum level from the start. It helps to get the cardiovascular system functioning at a higher level, warms and stretches the muscles ready for action and prepares the mind for competition.
‘How to warm-up’ is a commonly covered topic, but many of these routines are aimed at either team sports like soccer which focus more on the legs, or are a very general routine where the upper body is glossed over.
A warm-up for racquet sports such as Tennis, Badminton, Squash, and Racquetball needs to get the heart pumping, the muscles of the arms and legs warm and stretched and allow the participant to practice some of the moves they will be performing in competition.
Start with any form of pulse-raising activity. A jog around the court for 3-5 minutes is usually sufficient. Alternatively, take a skipping rope with you! After this, try some shuttle runs, gradually increasing your speed. Around 8-10 lengths of the court is enough. After all, you don’t want to tire yourself out before the game!
Dynamic stretches are sometimes also known as active stretches. The aim of these exercises is to stretch the muscles in the ways they will be used during competition.
Again, using the length of the court, perform these movements, getting gradually larger with the stride length and increasing the movement velocity:
- Side steps – Moving from one end of the court to the other in a sideways fashion – 2 lengths
- Skipping – Skip (as a child would do!) from one end to the other to warm the calf muscles – 2 lengths
- Carioca – A common warm-up pattern which involves crossing one leg in front of the other as you cross the court sideways – 2 lengths
- High knees – Lift the knees as high as you can as you run across the court – 2 lengths
- Heel flicks – Kick the heels back to touch the buttocks – 2 lengths
- Walking lunge – Perform a lunge then swing the back leg forward and walk the length of the court this way – 2 lengths (see image below)
- Side squat – Stand side on and squat with the feet wide apart. Then rotate on the lead leg to face the opposite direction, squat again and repeat for 2 lengths.
- Double leg hops – with the feet together, hop forwards, making sure you stay on your toes throughout and gradually increase speed and height jumped.
By now your legs should be nice and warm. You can choose to perform static stretches at this point, but this is purely optional as research shows this is unlikely to reduce the risk of injury. You may wish to just focus on areas which you personally find tight. Calf stretches and hamstring stretches are commonly performed.
Upper body dynamic stretches can be performed standing in one spot. Stand with your feet hip-width apart and knees slightly bent. Ensure the back is straight and the tummy pulled in.
- Trunk rotation – Hands on the hips, rotate the upper body from one side to the other, gradually making larger and faster movements – 10-15 reps.
- Trunk bend – Arms above the head, bend over to the side, reaching over your head with the opposite hand, then swap sides – 10-15 reps
- Neck circles – Slowly rotate the neck through its full range of motion, looking to the floor, over the right shoulder, the ceiling and over the left shoulder – 3 times.
- Shoulder rolls – Arms by the sides, roll the shoulder joints forwards 5 times and then backward 5 times.
- Arm circles – Swing both arms around in circles, firstly forwards 5 times and then backward 5 times. Then try one backward and one forwards for coordination!
- Straight arm clap – Start with both arms out in front, elbows straight and palms touching. Move the hands apart, out to your sides at chest level, and then bring back to the centre. Speed up the movement gradually. You can also bend the elbows when pulling them back.
- Rotator cuff rotation – Start with the arms at shoulder height and the elbows bent to 90 degrees, palms facing down. Rotate the shoulder joint so the fist points to the ceiling and then back the other way so it points to the floor (maintaining a horizontal upper arm). Repeat 10 times each arm, gradually getting faster.
- Wrist rotations – With the elbows straight, rotate the wrists around in circles, gradually increasing the size of the circle and speed of the movement. Perform 5 in each direction, per wrist.
Tennis specific exercises
Next up is your sports specific warm-up. This should focus on the movements you will be performing in order to continue the physical warm-up, but also to help hone your technique and ‘feel’ for the actions before your game.
Always start with gentle underarm shots like net shots in tennis and badminton. Gradually move back from the net/wall and increase the power you use until you are at the baseline performing full underarm lobs and backhands etc.
Next, move onto some gentle overhead shots such as drop shots. Again, start close to the net and move back. Finally, progress onto clears and smashes in badminton and serves in tennis. You should now be fully warmed up and ready to play!