How to Avoid Injuries on the Tennis Court

New York Times

29-05-2025

The first game of tennis after a long break can feel like a revelation. The birds sing, the air is crisp and your serve isn't half bad after three months off. The day after, however, is a different story.
If you took the winter off, you can expect some aches and pains when you get back onto the court. But compared with contact sports like soccer and basketball, recreational tennis poses a fairly low risk of acute injury, said Dr. Tiana Woolridge, a sports medicine physician at the Hospital for Special Surgery in New York City who has worked with collegiate players.
Even so, games like tennis and pickleball are full of repetitive and high-impact movements, such as lunging for balls and swinging the racket, and that can put a lot of stress on the body.
A five-year analysis of 449 Austrian recreational tennis players found that acute injuries spiked in the summer months, especially in June. The most common involved falls or twisted joints, especially ankle sprains, usually caused by missteps.
The spine and upper extremities are also particularly susceptible to chronic wear-and-tear injuries, said Dr. David Dines, the medical director of the Association of Tennis Professionals.
Here is an overview of the most common tennis injuries and tips on how to treat and prevent them.
Lower Back Injuries
During a serve, the back is hyperextended, and every stroke requires rotation. The damage can be subtle. In a small British study from 2007 involving competitive adolescent players, none of the 33 participants complained of back pain, but 28 of them had signs of spinal damage after M.R.I. imaging, a proportion you might expect in people over 60.
Back pains and strains become more frequent after 40, when the cushioning tissues between the vertebrae can start to deteriorate, Dr. Dines said. If you feel lower back pain, the first course of action should be rest, he said. If the pain returns, see a physical therapist or have a tennis professional assess your technique.
When you hit a tennis ball, most of the force is generated from the legs up. If the body's powerhouse muscles — the core, glutes, hamstrings and quads — are weak, the lower back pays the price. Dr. Dines recommended adopting a routine of core exercises, such as planks, and lower-body exercises, such as Romanian dead lifts and squats.
Upper Body Injuries
The ball-and-socket joint of the shoulder is secured by the four muscles and tendons of the rotator cuff, which can become irritated, torn or overstretched, particularly when playing overhead sports like tennis.
As we age, tissue in the body naturally starts to break down, causing small, often painless microtears, said Dr. Elizabeth Matzkin, an orthopedic surgeon at Mass General Brigham in Boston. But if the rotator cuff muscles are weak, the tears can worsen as you forcibly extend your arm going for a shot, she said.
Rotator cuff injuries cause pain when rotating the arm or extending it overhead and a dull ache in the shoulder that worsens at night. Minor irritation usually disappears after one or two days of rest, Dr. Woolridge said. If it persists, see a physical therapist; M.R.I. imaging may be required to rule out a full tear, which can require surgery.
Tennis elbow is a repetitive stress injury that affects up to 50 percent of tennis players annually and feels like a persistent pain on the outside of the elbow. It occurs when the muscles and tendons along the forearm that help extend the wrist are taxed from actions such as over-gripping the racket or hitting backhand with poor technique, Dr. Matzkin said.
Dr. Woolridge said that shoulder-strengthening exercises, like scapular rows and shoulder extensions with a resistance band, should be a staple in every tennis player's routine. These exercises can also ward off tennis elbow, as can wrist-strengthening drills like wrist curl flexion and extension exercises. For both drills, work up to 30 reps and then add a light dumbbell of no more than five pounds.
The grip size of your tennis racket and the tension of its strings can also contribute to tennis elbow and shoulder aches, Dr. Matzkin said. If you play more than once a month, she said, ask a pro to assess your equipment.
Lower Body Injuries
Ankle sprains are a hazard of any sport with intense side-to-side movement and sudden stopping or pivoting, Dr. Woolridge said. Most ankle sprains do not require surgery. While the standard advice has been rest, ice and compression, many experts now prefer movement and heat. However, research suggests that once you sustain an ankle sprain, you're at greater risk of sustaining another.
Calf muscle tears are common enough that many doctors call them 'tennis leg.' 'When players are quickly changing directions, they might feel a pop in the back of the mid-calf,' Dr. Matzkin said. The injury rarely requires surgery, but the calf will be sore and swollen and will require rest.
Tight calf muscles can also contribute to Achilles tendinitis, an inflammation of the tendon that connects the calf to the heel.
'If the calf is too tight and unable to contract, the Achilles takes the force and can rupture,' Dr. Matzkin said. 'That is a rough injury with a very long recovery.'
The fast-paced cutting and pivoting motions in tennis also put knees, particularly aging ones, at risk for injuries like ACL and meniscus tears.
The muscles in your feet and legs play an important role in ankle stability. You can strengthen them with exercises, such as resistance-band foot drills and lunges forward, backward and sideways. Balance drills, such as single-leg toe touches or lunges performed on an unstable surface, like a pillow, can improve proprioception, or body awareness.
Protect your knees with a regiment of squats and lunges, which strengthen the muscles that keep the knee stable and firm up the tendons and ligaments around the joint, Dr. Matzkin said.
To stretch and strengthen the calves and Achilles' tendon, she recommended calf raises with heels hovering off a step.
Playing Smart to Play Strong
A pregame dynamic warm-up for tennis or pickleball should be nonnegotiable, Dr. Woolridge said, especially if you're a weekend warrior or you're going from a desk to the court. If pain arises, don't ignore it. Continuing to play can aggravate it or cause you to make compensations that put other joints and muscles at risk, Dr. Matzkin said. Managing pain when it starts can shorten the time it will take to subside.
In your 20s and 30s, tennis is the workout, Dr. Woolridge said. But as we age, we start needing to work out to keep playing. Complementing your game with strength and mobility exercises can make tennis a sport you can play for a lifetime.