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

Emory Tennis 10+ warm up/cool down on court program

The Tennis 10+ is a tennis specific warm-up/cool down program created and researched by the Emory Tennis Medicine team to reduce injury and optimize performance on the court for competitive adult (and high level) tennis players. The program was developed to target common areas of tennis-related injury including the shoulder, elbow, wrist, hip, gastrocnemius/Achilles, spine, and knee.

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  • The Tennis 10+ was developed using an evidenced-based approach which accounts for known tennis-related injury patterns.
  • The Tennis 10+ is a 10-minute, 10-step warm up and cool down on court program that guides players through a dynamic warm-up prior to practice and match play followed by a cool-down/stretching progression following play.
  • The “+” are extra exercises to target specific prior areas of injury recommended by your doctor, therapist, athletic trainer or healthcare provider.
  • The United States Tennis Association (USTA) recognizes that dynamic warm-up and flexibility training is an essential element of any pre-activity and post-activity routine, but no standardized, tennis-specific program had been previously been studied.
  • The Tennis 10+ is the first researched and evidence-based warm up/cool down program shown to be associated with lower rates of injury and reduced severity of injury in adult tennis players who are compliant with the program.

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 more information or to make an appointment, please call 404-778-3350 or email tennismedicine@emoryhealthcare.org.

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