how to prevent the most common tennis injuries

Sports Physiotherapy  ·  9 min read

The six most common tennis injuries are tennis elbow, rotator cuff strain, lower back pain, ankle sprains, patellar tendinopathy (jumper's knee) and wrist tendonitis. You can reduce your risk of all six by completing a sport-specific dynamic warm-up before play, building progressive forearm and rotator-cuff strength, choosing a correctly-sized racquet, and increasing your playing volume gradually rather than in sudden jumps.

Reducing Risks for Most Common Tennis Injuries

A West London Chartered Physiotherapist's guide to the six injuries we see most often — and the evidence-based ten-minute routine that helps you avoid them.

BK

Bryan Kelly

Chartered Physiotherapist, CK Physio  ·  Updated 12 May 2026

Tennis in Britain is booming. According to the Lawn Tennis Association, adult participation grew by 44% between 2019 and 2023, with around 5.6 million British adults now playing at least once a year — roughly 10% of the population. The International Tennis Federation's Global Tennis Report ranks Britain first among all 199 contributing nations for tennis participation per head of population, ahead of the United States, France, Spain and Australia.

That is wonderful news for our health, our social lives and our local courts. But more racquets on more courts also means more rotator cuffs, elbows and lower backs getting sore. At CK Physio in Hanwell, we see a clear seasonal spike in tennis-related complaints from April through September, with a smaller second wave each January as New Year resolutions meet under-prepared bodies.

This guide explains the six injuries we treat most often in West London tennis players, why they happen, and — most importantly — what the evidence says you can do to stay on court rather than visit our clinic.

How common are tennis injuries, really?

Tennis injuries are far more common among recreational adult players than most people realise. A longitudinal study from Emory University's Tennis Medicine Program reported that injury prevalence among adult recreational players can exceed 50% in a single year, with the elbow, shoulder and lower back the most frequently affected sites. Around 80% of these injuries are overuse rather than acute — they build gradually rather than appearing from a single dramatic moment.

Sources: LTA / ITF, NHS Mersey Care, Emory Tennis Medicine, Render et al. 2026.

The good news is that the modifiable risk factors are well understood. Most tennis injuries follow predictable patterns linked to sudden increases in playing volume, gaps in strength or mobility at key joints, poor stroke mechanics, ill-fitting equipment and inadequate warm-up. Address those, and you reduce your odds of becoming a statistic.

Tennis elbow (lateral epicondylitis)

The most common racquet-sport injury

Tennis elbow — known medically as lateral epicondylitis — is an overuse injury affecting the extensor tendons on the outside of the elbow, particularly the extensor carpi radialis brevis. Despite the name, only a small minority of cases occur in tennis players; the condition has a population prevalence of 1–3%, with peak incidence between ages 45 and 54.

For tennis players, the culprit is usually repetitive gripping combined with wrist extension during backhand strokes, particularly when the racquet grip is too small, string tension is too high, or technique relies on the wrist rather than the whole kinetic chain. Early symptoms include weakness when gripping, and a localised ache on the bony outside edge of the elbow that worsens with handshakes, lifting kettles or twisting jar lids.

The evidence on prevention and early treatment is strong. A 2025 review reported that eccentric strengthening combined with manual therapy produced up to a 42% reduction in pain scores and a 35% improvement in grip strength. According to NHS data, almost 90% of people report their symptoms significantly improved or resolved within twelve months. For stubborn cases that have not responded to loading exercises, shockwave therapy has a growing evidence base and is something we offer at CK Physio. For a guided exercise programme, see our companion guide on tennis elbow rehabilitation exercises.

Rotator cuff strain

The serve injury

The rotator cuff is a group of four small muscles that stabilise the shoulder during overhead movement. In tennis, every serve and every overhead smash demands controlled, repeated effort from these muscles, and the asymmetry of the sport — almost all power generated on the dominant side — makes the rotator cuff one of the most commonly injured structures in adult players.

Typical symptoms include a dull ache deep in the shoulder, pain when reaching overhead or behind the back, and weakness when lifting a kettle from a high shelf. Sleeping on the affected side often becomes uncomfortable. Players sometimes describe a sense that the arm "does not feel connected" during serves.

Prevention rests on three pillars: dedicated rotator-cuff strengthening (external rotation work with a light resistance band is the cornerstone), scapular stability training to support the shoulder blade, and gradual progression of serve volume. Research from the USTA suggests that increasing knee flexion during the serve helps reduce shoulder and elbow torque — a small technique tweak with a real biomechanical payoff. If you have pain that has not settled within two weeks of rest and self-care, it is time for a professional assessment before the tendon develops chronic changes.

Lower back pain

The rotation injury

Lower back pain is one of the most common reasons tennis players come through our clinic doors. The combination of rotation, side-flexion and extension during serves and overheads loads the lumbar spine in three planes at once, and players with limited hip mobility or poor core control end up borrowing range from their backs.

Symptoms range from a dull ache after long matches to sharp pain during specific movements — particularly the serve. Junior players need extra attention here: USTA research has shown that as many as 40% of low-back symptoms in young tennis players may reflect a stress injury to the bone, and pain that is worse in extension warrants prompt assessment rather than "playing through it".

For adults, prevention focuses on building genuine core stability (not just sit-ups), improving thoracic spine and hip mobility so the back does not have to compensate, and modifying serve technique to maximise hip extension rather than lumbar extension. A short, regular routine of glute, hamstring and deep abdominal work makes a measurable difference. Any back pain that radiates down the leg, causes numbness, or does not ease within a fortnight of self-care should be assessed by a healthcare professional — these can be signs of nerve involvement that require a different approach.

Ankle sprains

The acute injury

Tennis demands constant rapid changes of direction, lateral shuffles and unpredictable lunges. Even on a well-maintained court, a misjudged step or an awkward landing can roll the ankle inwards, stretching or tearing the lateral ligaments. The lateral ankle sprain remains the most common acute injury in racquet sports.

Symptoms are usually unmistakable: a sharp pain at the moment of injury, rapid swelling and bruising on the outside of the ankle, and difficulty putting weight through the leg. The reason this matters beyond the initial pain is that ankle sprains are notoriously recurrent — around 10% of first-time sprains recur, and that figure rises to 33% in players who develop chronic instability.

Prevention has three components: proprioception (balance) training such as single-leg stands progressing to wobble-board work, strength work for the calf and peroneal muscles, and court-appropriate footwear with proper lateral support. Fashion trainers do not belong on a tennis court. If you sprain an ankle, follow PRICE (protection, rest, ice, compression, elevation) for the first 48 hours and then begin guided rehab early — the days of immobilising for weeks are long gone.

Patellar tendinopathy (jumper's knee)

The jumping injury

Patellar tendinopathy — historically called jumper's knee — is inflammation and microscopic disorganisation in the tendon that connects the kneecap to the shin bone. The repeated jumping, sudden stops and explosive direction changes of tennis create exactly the type of load this tendon objects to, particularly in players who increase their training volume quickly or who play on hard courts without supportive footwear.

Early signs include a localised ache just below the kneecap when climbing stairs, getting up from a low chair, or kneeling. The tendon often feels stiff at the start of activity and eases as the joint warms up — a pattern that is deceptive, because it can encourage players to push through what is actually a degenerative tendon problem.

The cornerstone of both prevention and treatment is progressive loading: slow, heavy squats and step-downs build the tendon's tolerance better than rest does. Once tendon pain has settled, gradual return to plyometric work (jumping and bounding) prepares the knee for tennis-specific demands. Persistent knee pain — particularly anything that swells, locks or gives way — should always be assessed in person before returning to play.

Wrist tendonitis

The grip-and-snap injury

Wrist tendonitis is inflammation of the tendons controlling movement at the wrist and fingers. In tennis players, it typically results from repeated heavy gripping, racquet vibration through impact, and the snapping wrist action used (sometimes inappropriately) for power on serves and forehands.

Pain usually sits along the back or thumb-side of the wrist, often with localised swelling and a creaky sensation when moving the wrist through its full range. Grip strength can drop noticeably, and even routine tasks like opening doors or typing become uncomfortable. Many wrist problems in tennis are actually grip-size or technique problems in disguise — a racquet handle that is too small forces the wrist to do more work, and a heavily wristy stroke loads the small wrist stabilisers beyond what they are designed for.

Prevention focuses on a correctly sized grip (a useful rule of thumb: with your fingers wrapped around the handle, you should just be able to slip the index finger of your other hand into the gap between your fingertips and the base of your thumb), forearm and wrist strengthening, and using the whole body to generate power rather than snapping from the wrist.

The Tennis 10+ warm-up: an evidence-based ten-minute routine

One of the most welcome developments in tennis injury research has been the publication of the Tennis 10+ programme — the first standardised, peer-reviewed warm-up and cool-down protocol designed specifically for adult recreational players. Developed by the Emory Tennis Medicine team and endorsed by the United States Tennis Association, Tennis 10+ takes ten minutes, requires almost no equipment, and can be performed entirely on court.

A 2026 longitudinal study published in Sports Health followed 317 adult recreational players aged 18–75 for a full year. Players who maintained high compliance with Tennis 10+ for the full twelve months showed a significant reduction in overuse injury rates compared with low-compliance peers. The programme is structured as six minutes of dynamic warm-up before play, followed by four minutes of static stretching afterwards — the order matters, because stretching cold tissue before play does not reduce injury and may actually increase risk.

The four-minute cool-down adds triplanar core stability work, eccentric wrist flexion and extension (excellent for tennis elbow prevention), and standing quadriceps, calf and hamstring stretches once the tissue is warm. The "+" element of Tennis 10+ allows for additional exercises tailored to any pre-existing injuries, prescribed by a healthcare professional. Compliance is the real challenge: most adult league players in the Emory study had no routine warm-up before discovering the programme. Building it in habitually — every session, no exceptions — is what produces the injury reduction.

Equipment that genuinely matters (and what does not)

Equipment marketing often promises injury reduction that the evidence simply does not support. The items that genuinely make a difference are unsurprising:

A note for padel players

Padel is the fastest-growing racquet sport in Britain. The UK passed the 1,000-court milestone in 2025, and around 35 million people now play globally across more than 130 countries. Many of our tennis patients are now splitting their week between the two sports — which raises an important question: are the injuries the same?

Mostly, yes. The overall padel injury rate runs at roughly 3 per 1,000 training hours and 8 per 1,000 match hours, broadly comparable to tennis. The most common single padel injury is, perhaps unsurprisingly, tennis elbow — accounting for around 20% of all reported padel injuries according to a 2023 systematic review in BMJ Open Sport & Exercise Medicine. After the elbow, knees are the next most affected area, with the sport's compact court, constant changes of direction, glass-wall rebounds and frequent jumps placing significant rotational and compressive forces on the knee joint.

For dual tennis-and-padel players, the prevention strategy is essentially the same as for tennis: dynamic warm-up before play, progressive forearm and rotator-cuff loading, lower-limb strength, and gradual increases in training volume. The one additional area we would add for padel is eye protection — balls can travel at speeds that make reaction effectively impossible at close quarters near the net, and ocular injuries are documented in the padel literature in a way they are not in tennis.

If you are new to padel and your elbow is already starting to grumble, it is worth getting it assessed early. Tennis-elbow symptoms that have only been present for a few weeks respond far better to physiotherapy than ones that have been ignored for months.

When to see a physiotherapist for a tennis injury

At CK Physio, our team of Chartered Physiotherapists has been working with West London athletes since 2003. For tennis injuries, we typically begin with a thorough assessment of the painful area in the context of the whole kinetic chain — because shoulder problems often have a thoracic spine origin, elbow problems are often rooted in scapular control, and lower-back pain is often a hip mobility issue dressed up in different clothing. From there, we build you a personalised programme combining hands-on treatment with the progressive loading that the evidence shows works best.

For tendinopathies that have not responded to a structured loading programme, we may discuss shockwave therapy as an adjunct — a non-invasive treatment with a growing evidence base for chronic tendon problems. The aim, always, is to get you back on court with a body that is more resilient than when you left it.

Frequently asked questions

This article is for general information only and does not replace personalised medical advice. If you are experiencing tennis-related pain or injury, please consult a qualified healthcare professional. CK Physio's Chartered Physiotherapists are registered with the Chartered Society of Physiotherapy and the Health and Care Professions Council (HCPC).