Tennis Medicine Program
Wellness & Prevention
You can play tennis for a lifetime. It can help you meet American College of Sports Medicine exercise recommendations. Plus, players of all ages enjoy the physical, mental, social and emotional benefits of the game. But, too much of a good thing can cause problems. Some of our studies show that up to two-thirds of tennis injuries are due to overuse. These injuries most often affect the low back, elbow, shoulder, hip and wrist. They may be due to errors in training and competition volumes. Inefficient stroke mechanics can also be a factor. Train smart. Listen to your body. Identify pain and injury patterns early.
Tips to prevent tennis injuries
- Learn how to recognize injuries early, especially in high-risk areas like your shoulders, elbows, back and knees.
- Always include a dynamic warm up to before you exercise to activate the muscles you’ll be using (rather than static stretching).
Serve tips to prevent low back and shoulder problems
- Increase the amount of knee flexion (knee bend) to reduce shoulder and elbow torque.
- Increase the counter rotation of hips/trunk to increase force.
- Hit flat serves before adding spin.
Backhand tips to avoid elbow injuries
- Go through a proper evaluation to see if a one-handed or two-handed backhand works for your style of play.
- Avoid early forearm pronation on forehands and serves. Avoid terminal wrist extension on backhands.
- Do not lead with the elbow.
Forehand tips to avoid wrist injuries
- Limit excess movement of the following: Ulnar deviation, supination, wrist extension. In other words, do not extend and rotate the wrist to extremes.
- Limit early/excess topspin in the non-dominant wrist during a two-handed backhand. Also limit the same in the dominant wrist during forehand strokes.
- Use core muscles and lower extremities to generate force.
Prevent back pain
Junior tennis athletes should not ignore low back pain. As many as 40% of symptoms may be due to a low back stress injury and should be checked right away.
Young tennis players should limit heavy topspin (or kick serves.) They should be evaluated if they have extension-based low back pain.
Junior players should limit extension to less than 20 degrees on serve.
Adult players should try to maximize hip extension on serves. Avoid multiplanar (combined) motions on strokes when possible.
Tennis equipment tips
- Choose the heaviest racket that does not affect swing speed for style of play.
- The effect of vibration dampeners is negligible in reducing forces to the upper arm.
- Tennis elbow straps may reduce forces to the extensor carpi radialis brevis. (ECRB is the muscle in the forearm that extends and abducts the wrist.) But, they are not necessarily good for reducing injuries.
- If you have an arm injury, lowering string tension may increase power. That’s because it places less demand on your arm to generate force.
- If you have a leg or knee injury, consider clay court tennis. Clay is a slower playing surface and has better knee pain ratings.
Match and training volume recommendations
We developed the following evidence-based recommendations from several studies. These studies were performed on thousands of tennis players, including juniors, elites and adults. These may reduce risk of injury for junior players.
Note: recommendations should be individualized to players, based on tolerance.
- Consider training fewer hours in a week than your age to prevent overuse injuries. For example, a 12-year-old player should train 12 hours or less per week. Weekly training may increase the risk of injury if it exceeds 16 hours per week.
- Wait until middle or late adolescence to focus solely on tennis. Playing many sports may prevent injury and increase successful performance.
- Delay kick serve until after age 13 to reduce stressful loads.
- Use caution in the fifth match and beyond, when there’s a higher risk of medical withdrawal. Or, maximize rest periods to reduce risk.
- Elite players should not play more than three consecutive competitive weeks (tournaments).
- Consider having at least one to two hours between same-day matches. This allows you enough time to fully recover in between.
- When scheduling, consider the increased risks in match and tournament play for athletes with prior injuries.
- Add more off-court tennis-specific injury prevention and conditioning programs. This may help protect competitive juniors from injury.
- Reduce annual match volume. Juniors increase the risk of tournament medical withdrawal if playing more than 40 USTA singles matches a year.
For a non-medical on-court evaluation, please call 404-778-1831
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