Footage from this year’s French Open shows Nicolás Almagro in agony on the court. An hour and a half into his match against Juan Martín del Potro, he hunches over, drops his racket to the ground and buries his face in his hands.
Medical attendants run to his side. It’s his knee. A worsening injury had grown beyond his control throughout the match, forcing Almagro to resign.
Almagro isn’t the only player who has experienced pain during play. Tennis is a physically demanding sport. According to the American Orthopaedic Society for Sports Medicine, roughly two-thirds of tennis injuries to overuse and the remaining third to traumatic or acute events.
The most common injuries include:
- Tennis elbow: This is an overuse of the muscles that extend and bend the wrist. The muscles are most impacted when the tennis ball hits the racquet.
- Shoulder injuries: Typically due to poor strengthening of the rotator cuff muscles, these injuries often irritate shoulder tissues, such as the tendon and the bursa.
- Stress fractures: Stress fractures result from training too fast, which tires the muscles and puts more pressure on the bone. They affect 7.5 percent of professional players and 20 percent of junior players.
- Muscle strains: These happen due to quick, sudden movements and are avoidable through stretching and proper warm-ups.
Thankfully, through dedicated rehabilitation, most players work through their injury and return to the court. It just takes time, effort and attention to proper technique.
Common Types of Tennis Injuries
Here’s a closer look at a few common injury types, the famous tennis players who have experienced them, and how you can prevent injury in your own play.
Arm and Shoulder Injuries
Wrist strains, fractures, and carpal tunnel syndrome are all common among tennis players. They can result from gripping positions, falls, and overuse.
Even more common than wrist injuries, though, is tennis elbow. In fact, Venus Williams, Bjorn Borg, Aleksandra Wozniak, Andy Murray and Juan Martin Del Potro have all suffered from it. Over time, if players overuse their forearm muscles or don’t follow proper hitting techniques, they’ll experience tennis elbow pain.
Tennis players also run the risk of shoulder pain, which happens due to repeated stress during tennis strokes. Overuse of rotator cuff muscles can impinge the fluid-filled sac known as a bursa between the shoulder’s bones and muscles. This causes inflammation and pain when the player raises an arm—a condition called shoulder bursitis.
The good news is you can avoid tennis elbow and other arm injuries by staying in good overall shape, as well as stretching and strengthening arm and back muscles. This ensures that the muscles are strong and flexible enough to handle your playing.
Consider training with a tennis expert to learn proper techniques and movements. The trainer can share which equipment best fits your ability and body size. You can also ask about arm and shoulder braces that will best support your movements.
Consider what tennis players do in a match: They run and jump, over and over again. As a result, they risk developing patellofemoral pain syndrome, which happens when the underside of the kneecap rubs against the bones of the leg.
Another common injury is jumper’s knee, or patella tendonitis. In this case, knee tendons are damaged from repetitive strain. Knee bursitis also may develop from overexertion. When Serena Williams had to withdraw from Indian Wells in March 2017, she stated she hadn't been able to train due to her knees.
Additionally, tennis players’ knees may become sprained or strained, or the player may tear a ligament or cartilage. As a result of any of these conditions, arthritis can set in, potentially leading to pain, stiffness, and—in Billie Jean King’s case—new knees.
To prevent knee injuries, warm ups that include stretching and muscle strengthening are key. Proper running, stopping and jumping techniques will also help protect the knees.
Wear the right tennis shoes. Make sure the court is clean before you begin play, checking closely for slippery spots and debris that could cause a slip, trip or fall.
Low back pain – like Peter Sampras’ who had to withdraw from the US Open in 1999 due to it – is common for tennis players.
Potential causes include postural abnormalities, muscle dysfunction and overuse. These come from players’ constant rotations, flexions and extensions of the back during fast-paced matches.
Both front- and back-hand shots require twisting of the spine, while serves hyper-extend the lower back, compressing lumbar discs. The stress isn’t just on the spine, though. Back muscles have to support sudden movements that often start and stop quickly in all directions.
You can avoid back issues by using a tennis racket with tension and size fitted for you. For example, the more flexible the racket, the more trunk rotation it will require.
Some serve techniques also require less of a back arch, reducing pressure on the spine and surrounding muscles. Throughout play, make sure you keep your knees bent, and hold in the abdominal muscles to protect the lower back.
Preventing Pain While Playing Tennis
While every tennis player can take steps to avoid injury, many sports medicine experts advocate for broader changes to tennis in general. Fewer matches and extended off-seasons would put less stress on the body and give players more time to recover.
In the meantime, tennis players should make sure their equipment fits their body type and train thoroughly to learn proper form. Reserving adequate time to warm up and cool down before and after play is also crucial.
And if you have to take a break from the sport due to injury, it’s best to ease back into play. You’ll want time to re-learn physical limits and strengthen muscles—something that most tennis players learn at some point.