Why Tennis Injuries Often Start Before You Feel Pain

Tennis might look effortless when it's played well.

Behind every serve, sprint and change of direction, however, is a huge amount of force travelling through the body. Whether you're a recreational player, a regular club competitor or completely new to the sport, tennis places unique physical demands on muscles, tendons and joints.

While some injuries are unavoidable, many can be identified and addressed before they become a problem.

Why Tennis Has a High Injury Risk

Tennis is one of the most physically demanding sports from a biomechanical perspective. Players are constantly required to sprint, stop suddenly, change direction, jump, rotate and produce explosive power, all while repeating the same movements hundreds of times.

The serve is particularly demanding.

Force is generated through the foot and ankle, transferred through the legs and trunk, and ultimately delivered through the shoulder and arm. If there's a weakness, restriction or previous injury anywhere along that chain, another area may be forced to compensate.

That's often where injuries begin.

The Most Common Risk Factors We See

While every player is different, several factors consistently appear in tennis-related injuries.

Reduced Shoulder Mobility: limited shoulder internal rotation is one of the biggest risk factors for upper limb injuries in tennis players. Over time, reduced mobility can place additional stress on the shoulder, elbow and surrounding structures.

Poor Shoulder Blade Control: the shoulder blade plays a vital role in producing efficient movement. When it doesn't move effectively alongside the arm, other tissues may be overloaded.

Reduced Core Stability: the trunk acts as the bridge between the lower and upper body. Poor control through this area can increase stress elsewhere and reduce overall efficiency.

Sudden Increases in Playing Volume: this is one of the biggest causes of injury we see. Whether it's a summer league, holiday tennis camp or sudden return to playing, rapid increases in workload often result in overload injuries.

Tennis Elbow Isn't Just an Elbow Problem

One of the most common misconceptions is that tennis elbow is simply caused by the elbow itself.

In reality, almost every case we assess is linked to either workload increases, biomechanical imbalances and movement compensations.

Treating symptoms alone often isn't enough. Understanding why the tissue became overloaded is usually the key to long-term recovery.

How Physiotherapy Can Help

Physiotherapy isn't just useful once you're injured. It can help identify risk factors before they affect performance.

Through movement assessment, strength testing and load management advice, we can help players reduce injury risk, improve movement efficiency, manage workload, return to play safely and stay pain-free for longer.

Because the best way to improve your tennis isn't simply to play more.

It's to stay healthy enough to keep playing consistently.

Written by Polly Worrall, Lead Physiotherapist at Carter & George Windsor.