16 Common Tennis injuries (Prevention & Treatment)

Tennis injuries explained in detail: tennis elbow, ankle sprains, rotator cuff tendinitis, plantar fasciitis, stress fractures and tennis toe.

Serving and hard-court movement also cause calf and quadriceps strains, wrist trouble, hip flexor and groin strains and elbow bursitis, each with causes, symptoms and prevention pointers.

Smash through pain barriers, and step up your tennis game with confidence.

Get ready to serve up some knowledge and take control of your athletic health.

Injury Rates and Numbers

The figures below come from injury surveillance data and peer reviewed studies. Each row names the population it was measured in, because rates from elite athletes and from recreational players are not comparable.

Finding	Measured in	Source
The overall injury rate in NCAA women’s collegiate tennis was 4.16 injuries per 1000 athlete exposures from 2014-15 through 2018-19.	NCAA women’s tennis players (NCAA Injury Surveillance Program), 2014-2015 through 2018-2019	Journal of Athletic Training (NCAA Injury Surveillance Program)
In NCAA women’s tennis, 32.1 percent of all recorded injuries were time-loss injuries and about 30 percent of diagnoses were inflammatory conditions.	NCAA women’s tennis players (NCAA Injury Surveillance Program), 2014-2015 through 2018-2019	Journal of Athletic Training (NCAA Injury Surveillance Program)
Ankle sprains were the most frequently reported injury in collegiate tennis, accounting for 144 of 615 total injuries logged by team coaches.	NCAA/NAIA collegiate tennis players (111 teams: Division I, II, III, NAIA), published 2022 (survey covering the prior competitive year)	Sports (Basel), coach survey on injuries and strength training in collegiate tennis
Among tennis players who reported elbow pain, 64.7 percent localized it to the lateral epicondylar region, the site of classic tennis elbow.	tennis players with elbow pain (n=190 of 445 surveyed players, mean age 35.1, 73.9% male), published 2026	Cureus, study on backhand technique and elbow pain in tennis players
Most people who develop tennis elbow are between the ages of 30 and 50, though anyone with risk factors can be affected.	general population / recreational and competitive tennis players, current (AAOS patient education page, accessed 2026)	American Academy of Orthopaedic Surgeons, OrthoInfo

Overview

Injury	Body area	Typical time out
Tennis Elbow	Elbow	2 to 8 weeks, months if chronic
Ankle Sprain	Ankle	1 to 3 weeks, up to 3 months
Muscle Strains (including Calf Strains and Quadriceps Strain)	Leg muscles	1 to 8 weeks, 3+ months if severe
Knee Injuries (including Patellofemoral Pain Syndrome)	Knee	4 to 12 weeks, longer if tendon
Shoulder Injuries (including Tendinitis and Rotator Cuff Pain)	Shoulder	6 to 12 weeks, 6+ months post surgery
Wrist Injury	Hand and wrist	3 to 12 weeks, 3+ months post surgery
Plantar Fasciitis	Foot	6 to 12 weeks, months if chronic
Stress Fracture	Foot and lower leg	6 to 8 weeks, 3 to 6 months high risk
Back Injury	Lower back	Days to 3 weeks, months if bone
Groin Strains	Groin and hip	1 to 8 weeks, 3+ months if severe
Hip Flexor Strains	Hip	2 to 8 weeks, 3+ months if avulsion
Tennis Toe	Toe	Days to 2 weeks, up to 3 months
Hamstring Strains	Thigh	1 to 8 weeks, 3+ months if tendon
Elbow Bursitis	Elbow	1 to 3 weeks, longer if infected
Neck Strain	Neck	Days to 2 weeks, longer with nerve
Finger Volar Plate Injury	Finger	2 to 6 weeks, stiffness for months
Thumb Ulnar Collateral Ligament Sprain	Thumb	4 to 6 weeks, 3 to 4 months post op
Head Impact and Concussion	Head	1 to 3 weeks, longer if symptoms stay
Metatarsalgia	Foot	2 to 6 weeks, longer if bone
Hook of Hamate Fracture	Hand	6 to 12 weeks

Tennis Elbow

Tennis elbow is a degenerative change in the common extensor tendon on the outside of the elbow, most often in the tendon of the extensor carpi radialis brevis where it attaches to the lateral epicondyle. The tendon is loaded every time you grip the handle and stabilize the wrist against ball impact, so a late one handed backhand, a heavy racquet head or a grip that is too small drives the load up. It is a tendinopathy, not a true inflammation, which is why it responds to loading rather than to rest alone.

Symptoms

• Pain on the bony point at the outside of the elbow, often radiating into the forearm.
• Grip feels weak: a kettle, a door handle or the racquet slips.
• Backhand and shaking hands hurt more than serving.
• The elbow feels stiff and sore in the morning and loosens with movement.
• Pressing on the outer epicondyle is clearly tender.

How serious it is: The mild form hurts only during and after play and settles within a few weeks once load is adjusted. The stubborn form hurts during everyday gripping, has been present for months and takes far longer, because the tendon tissue itself has remodeled.

Typical time out: Two to eight weeks back to tennis if you catch it early and reduce load, six to twelve months to full comfort in long standing cases. The spread is wide because outcomes depend far more on how long the pain existed before treatment than on the treatment itself.

See a doctor if: See a clinician if the forearm or fingers go numb or tingly, since that points to a nerve problem rather than a tendon problem.

What helps

• Progressive strength work for the wrist extensors, with slow eccentric and isometric loading into acceptable pain, is the core treatment.
• Reduce the aggravating load for a while instead of stopping everything: fewer backhands, softer strings, shorter sessions.
• Check the equipment: grip size, string tension, and a racquet that is not too head heavy all change the force at the elbow.
• Fix the late backhand. Hitting the ball in front of the body with the trunk turned takes load off the forearm.
• A counterforce brace or taping can reduce pain during play but does not heal the tendon, so use it alongside loading.
• Corticosteroid injection may calm pain for a few weeks but is associated with worse results later in tendinopathy, so it stays an exception, not a first step.

Ankle Sprain

An ankle sprain is a tear of the lateral ligaments, usually the anterior talofibular ligament and sometimes the calcaneofibular ligament, when the foot rolls inward under load. In tennis it happens on the hard split step and the sudden change of direction on the wide ball, and on clay it happens when the foot catches instead of sliding. Ankle sprains are the single most frequently reported injury in collegiate tennis.

Symptoms

• Sudden pain on the outside of the ankle at the moment of the twist.
• Swelling within an hour, often followed by bruising toward the foot.
• Limping or being unable to put full weight on the foot.
• The ankle feels unstable or as if it might give way.
• Pushing off sideways hurts more than walking straight.

How serious it is: Grade 1 is a stretch with mild swelling and normal walking, grade 2 a partial tear with clear swelling and painful weight bearing, grade 3 a complete tear with marked instability. A sprain that will not take any weight at all needs to be checked for a fracture.

Typical time out: One to three weeks for a grade 1, four to eight weeks for a grade 2, and two to three months or more for a grade 3 or when a fracture is involved. The range is wide because return depends on regaining balance and confidence in cutting, not only on the swelling going down.

See a doctor if: Get it examined if you cannot take four steps on it, if the bony back edge of either ankle bone is tender, or if the foot looks out of line.

What helps

• Start moving and loading early within the limits of pain, since protected early motion returns players to sport faster than immobilization.
• Short cooling in the first hours is fine for pain relief, but it is a comfort measure, not the treatment.
• Balance and proprioception training on one leg, progressing to unstable surfaces and then to cutting drills, is what lowers the chance of a repeat.
• A brace or taping for the first months back on court measurably reduces recurrence, especially if you have sprained the ankle before.
• Imaging is only needed when the clinical rules point to a possible fracture or when pain persists well beyond the expected timeline.

Muscle Strains (including Calf Strains and Quadriceps Strain)

A strain is a tear of muscle fibers at or near the junction where muscle becomes tendon, most often in the medial head of the calf or in the rectus femoris of the thigh. In tennis the calf tears on the explosive push off toward a wide ball, so often that a torn medial gastrocnemius is nicknamed tennis leg. The quadriceps takes its damage on hard deceleration and on the lunge to a low ball, when the muscle is lengthening while contracting.

Symptoms

• A sharp, sudden pain, often described as being hit or kicked from behind.
• Immediate difficulty pushing off, sprinting or climbing stairs.
• Swelling and later bruising that tracks downward under gravity.
• A tender spot you can find with one finger in the muscle belly.
• Stretching the muscle reproduces the pain.

How serious it is: Grade 1 is a minor fiber tear with pain but nearly full strength, grade 2 a partial tear with clear strength loss and bruising, grade 3 a complete rupture with a palpable gap and marked weakness. Tears close to the tendon take longer than tears in the muscle belly, whatever the grade.

Typical time out: One to three weeks for a grade 1, three to eight weeks for a grade 2, and three months or more for a complete rupture or a tear at the tendon. Calf tears in the muscle belly recover faster than tears involving the soleus or the tendon sheet.

See a doctor if: Seek help if you felt a pop and cannot push off at all, or if the calf becomes hot, tight and swollen out of proportion, since that can mimic or accompany a clot.

What helps

• Load the muscle early at a level that stays within acceptable pain rather than waiting for pain to disappear.
• Build strength through the full range, including lengthened positions, because that is where the tear happened.
• Progress speed last: jogging, then striding, then change of direction, then match play with a return criterion rather than a calendar date.
• Calf raises with a straight and a bent knee train both heads and the soleus, which carries most of the load in the push off.
• Get it looked at if strength and pain have not clearly improved after two weeks, since a tendon involvement changes the timeline.

Knee Injuries (including Patellofemoral Pain Syndrome)

Patellofemoral pain comes from overload of the joint surface between the kneecap and the groove of the femur, where the compressive force rises steeply as the knee bends under body weight. Tennis loads this joint on every split step, lunge and low volley, and the load is repeated hundreds of times per set. The related patellar tendinopathy sits in the tendon just below the kneecap and hurts most on jumping and deceleration.

Symptoms

• A dull ache around or behind the kneecap rather than a sharp point of pain.
• Worse on stairs, squatting, lunging and after sitting with the knee bent for a while.
• Pain builds through a session instead of appearing in one moment.
• Occasional grinding or a feeling of the knee giving way without true instability.
• Tenderness at the edges of the kneecap or on the tendon below it.

How serious it is: The mild form hurts only after long matches and settles with load management. The stubborn form hurts on stairs in everyday life and needs a structured strength program over months. Sudden swelling, locking or true giving way is a different problem and points to cartilage or ligament damage.

Typical time out: You can usually keep playing at a reduced level while it settles over four to twelve weeks. Tendinopathy of the patellar tendon and cartilage injuries take three months or longer, and surgical cases considerably more.

See a doctor if: See a clinician if the knee swells within hours of a single incident, locks in one position, or gives way so that you fall.

What helps

• Strengthen the quadriceps and the hip abductors and external rotators, since weak hip control lets the knee fall inward on every lunge.
• Manage load: fewer consecutive match days, more surface variety, and drills that reduce deep repeated lunging while it is irritable.
• For patellar tendon pain, heavy slow resistance or eccentric loading twice a week over at least three months.
• Adjust technique so the split step and recovery use the hips rather than a deep collapsing knee bend.
• Imaging only if there was a clear traumatic event or if progress stalls despite consistent rehabilitation.

Shoulder Injuries (including Tendinitis and Rotator Cuff Pain)

The rotator cuff tendons, mainly supraspinatus and infraspinatus, and the long head of the biceps take repeated high load in the cocking and follow through phases of the serve, when the arm is in extreme external rotation. Over time the tendon tissue degenerates, and the capsule at the back of the shoulder tightens, which shifts the mechanics further. In tennis this is an overuse pattern from thousands of serves and overheads, not usually a single tearing event.

Symptoms

• Pain deep in the shoulder or on the outer upper arm, worse when serving.
• Difficulty reaching overhead or behind the back.
• Pain when lying on that shoulder at night.
• The serve loses pace and the arm feels tired much earlier than before.
• A catching or pinching sensation at a certain point in the arc of motion.

How serious it is: Irritation of the tendon without a tear responds to loading over weeks to months. A partial tear takes longer and needs a structured program. A full thickness tear, especially after a fall, causes clear weakness in lifting or rotating the arm and needs orthopedic assessment.

Typical time out: Six to twelve weeks for tendon irritation with a rehabilitation program, three to six months for a partial tear, and six months or more after a surgical repair. The wide range reflects how much tendon tissue is involved and how much serving volume you want to return to.

See a doctor if: Get it checked if you cannot hold your arm out to the side against gravity or if the weakness came suddenly after a fall.

What helps

• Progressive rotator cuff and scapular strength work, taken into higher load and higher speed rather than stopping at light bands.
• Restore rotation range at the back of the shoulder, since a tight posterior capsule changes how the humeral head sits during the serve.
• Train the legs and trunk contribution to the serve, because an arm dominant motion puts the whole load on the shoulder.
• Control serve volume: cap serves per session and avoid stacking heavy serving days back to back.
• Corticosteroid injection can reduce pain in the short term but does not improve the tendon and may work against it, so it is reserved for cases where pain blocks rehabilitation.

Wrist Injury

Most tennis wrist pain sits on the little finger side, where the extensor carpi ulnaris tendon runs in its sheath and where the triangular fibrocartilage complex cushions the joint. The western and semi western forehand grips and the two handed backhand load these structures with every heavy topspin swing and every off center hit that twists the racquet in the hand. Pain on the thumb side is usually the tendon sheath of the thumb extensors instead.

Symptoms

• Pain on the little finger side of the wrist when hitting topspin or turning a door key.
• Clicking or a snapping sensation when rotating the forearm.
• Weak grip and pain when opening a jar.
• Swelling over the back of the wrist after playing.
• Pain when loading the wrist in a push up position.

How serious it is: Simple tendon irritation calms down in weeks with load reduction and grip changes. A subluxating tendon that snaps out of its groove or a torn cartilage complex is a different level and often needs immobilization or surgical assessment.

Typical time out: Three to six weeks for tendon irritation, six to twelve weeks when a splint is needed, and three months or more after a cartilage repair or surgery. Timelines vary because the wrist is loaded on nearly every shot and cannot be spared the way a leg can.

See a doctor if: See a clinician if the wrist is visibly deformed after a fall, if the hand goes numb, or if a tendon audibly snaps across the bone.

What helps

• Reduce the aggravating grip and swing for a while: a flatter, less extreme grip lowers the load on the ulnar side.
• Wrist and forearm strength work in rotation as well as flexion and extension, since pronation and supination carry the load in tennis.
• A short period in a wrist support or splint for genuine tendon sheath problems, followed by loading rather than continued immobilization.
• Check string tension and racquet weight, because a stiff setup transmits more shock into the wrist.
• Persistent ulnar sided pain beyond a few weeks deserves imaging, since cartilage and tendon subluxation are not visible on examination alone.

Plantar Fasciitis

The plantar fascia is a thick sheet of connective tissue running from the heel bone to the base of the toes, and it tightens like a bowstring every time you push off. Repeated sprinting, stopping and pushing off on hard courts loads its attachment at the heel until the tissue degenerates. It is a load problem of the tissue, not an infection or a true inflammation of the joint.

Symptoms

• Sharp pain under the heel with the first steps in the morning or after sitting.
• Pain eases after a few minutes of walking and returns later in the day.
• Tender spot on the inner front edge of the heel bone when you press it.
• Pain when pushing off or standing on tiptoe.
• Worse after a long match or after a day standing on hard floors.

How serious it is: The mild form is limited to the first steps of the day and responds to calf and foot loading within weeks. The persistent form hurts throughout the day, has lasted many months and typically needs a longer structured program.

Typical time out: You can often keep playing at a reduced level while it settles over six to twelve weeks. Cases that have already lasted several months commonly take six to twelve months to resolve fully.

See a doctor if: Get it assessed if the heel pain started suddenly with a snap, if it hurts at rest at night, or if you cannot bear weight at all, which can indicate a stress fracture of the heel.

What helps

• High load calf raises with the toes propped on a rolled towel, done slowly and progressively, loads the fascia itself and is the best supported exercise.
• Calf and plantar fascia stretching to reduce the morning pain, done before the first steps out of bed.
• Cushioned court shoes with adequate arch support, replaced before the midsole is dead, and avoiding barefoot walking on hard floors while it is irritable.
• Reduce, but do not eliminate, the hard court volume: fewer consecutive playing days rather than a total stop.
• Physiotherapy is worth involving if there is no clear progress after six to eight weeks, and imaging only if a stress fracture or nerve problem is suspected.

Stress Fracture

A stress fracture is a fine crack in bone that develops when repeated loading outruns the bone’s ability to rebuild, most often in the metatarsals, the shin bone, the navicular of the foot or the lower back. In tennis the load comes from thousands of hard landings and lateral pushes on unforgiving surfaces, and a sharp increase in playing volume is the usual trigger. In young players the lower back version, a stress reaction of the pars interarticularis, is driven by the arch and twist of the serve.

Symptoms

• Pain that builds during activity and eases with rest, then starts earlier each session.
• A pinpoint tender spot on the bone you can find with one finger.
• Later on, pain when walking or even at rest.
• Local swelling over the bone.
• Hopping on that leg is clearly painful.

How serious it is: Low risk sites such as the shaft of the lesser metatarsals or the shin heal reliably with reduced loading. High risk sites, the navicular, the fifth metatarsal base, the front of the shin and the femoral neck, heal poorly and can progress to a full fracture, so they need imaging and often immobilization or surgery.

Typical time out: Six to eight weeks for a low risk stress fracture with graded loading, three to six months for a high risk site or a delayed diagnosis. The spread is large because bone healing depends on the site and on how long you kept playing on it.

See a doctor if: Stop and get imaging if bone pain persists at rest or at night, or if you cannot walk without limping.

What helps

• Offload the bone: relative rest from impact while keeping fitness with cycling, swimming or pool running.
• Get imaging early, because plain X rays often miss a stress fracture in the first weeks and MRI does not.
• Address the cause: sudden jumps in training volume, low energy availability, low vitamin D or iron, and menstrual irregularity in female players all raise the risk.
• Rebuild impact gradually with a step by step return, adding load only if the bone stays pain free the next morning.
• Custom or off the shelf insoles and better court shoes can help where foot mechanics concentrate the load on one bone.

Back Injury

The lumbar spine in tennis is loaded by the combination of extension, side bend and rotation in the serve, a movement that compresses the small facet joints and the pars interarticularis at the back of the vertebra. Most back pain in players is muscular or facet related, but repeated serve loading in adolescents can produce a stress injury of the bone, and a disc can be irritated by heavy rotational load. Symptoms are usually local rather than radiating.

Symptoms

• Aching or stiffness low in the back, often on one side, after serving.
• Pain when arching backward or reaching overhead.
• Difficulty getting out of a chair or turning in bed in the first days.
• Muscles that feel locked and guard against movement.
• Occasional pain spreading into the buttock.

How serious it is: A muscular or joint related episode without nerve symptoms usually settles in days to a few weeks. Pain running below the knee with numbness or weakness suggests nerve involvement, and one sided extension pain in a teenage player suggests a bone stress injury, both of which need assessment.

Typical time out: A few days to three weeks for a muscular episode, six to twelve weeks for disc related pain, and three to six months for a bone stress injury of the spine. The range is wide because the serve cannot simply be avoided when you return.

See a doctor if: Seek help immediately for numbness in the groin area, loss of bladder or bowel control, or progressive weakness in a leg.

What helps

• Keep moving. Bed rest makes back pain worse, and gentle activity within pain limits speeds recovery.
• Build trunk and hip strength and endurance, since the back takes over when the hips and shoulders do not rotate enough.
• Improve hip and thoracic rotation range so the serve does not force the lumbar spine into extreme extension and twist.
• Manage serving volume, especially in growing players, and avoid stacking heavy serving sessions.
• Imaging is not needed for most episodes, but persistent one sided extension pain in an adolescent should be imaged early.

Groin Strains

A groin strain is a tear in the adductor muscles on the inside of the thigh, usually the adductor longus close to its attachment on the pubic bone. In tennis it happens on the wide lunge, the slide on clay and the sudden change of direction, when the muscle has to brake the leg moving away from the body. Long standing groin pain in players is often adductor related tendon pain rather than a fresh tear.

Symptoms

• Pain on the inside of the thigh or right at the pubic bone.
• Pain when squeezing the knees together or pushing off sideways.
• Stiffness on the first steps after sitting.
• Sometimes a sharp catch at the moment of a wide lunge.
• Bruising on the inner thigh in the days after a clear tear.

How serious it is: Grade 1 to grade 3 as with other muscle strains, from a stretch with mild pain to a complete tear with marked weakness. Pain located exactly at the bony attachment tends to take considerably longer than pain in the muscle belly.

Typical time out: One to three weeks for a grade 1, four to eight weeks for a grade 2, and three months or more for a complete tear or a long standing tendon problem at the pubic bone.

See a doctor if: Get it examined if the pain sits in the groin but is felt deep in the hip joint, or if it wakes you at night, since hip joint and bone problems can present the same way.

What helps

• The Copenhagen adduction exercise, built up gradually, is the best supported way to strengthen the adductors and reduce recurrence.
• Start isometric squeezes early at a comfortable intensity rather than waiting for the pain to go away completely.
• Progress from straight line running to lateral movement, then to lunging and sliding, before returning to matches.
• Train hip abduction and rotation strength as well, since the groin overworks when the hip is weak in the other directions.
• Persistent groin pain beyond six weeks belongs in the hands of a clinician, because several structures overlap in that area.

Hip Flexor Strains

The hip flexors, mainly the iliopsoas and the rectus femoris, lift the thigh and stabilize the front of the hip. They strain when the leg is forcefully braked in extension or accelerated forward, which in tennis means the sprint start toward a drop shot, the lunge recovery and the leg drive in the serve. The rectus femoris is especially exposed because it crosses both the hip and the knee.

Symptoms

• Pain at the front of the hip or high in the thigh when lifting the knee.
• Sharp pain when sprinting from a standstill.
• Tightness and pain when stretching the hip backward.
• Discomfort getting out of a car or climbing stairs.
• Sometimes a clicking or snapping at the front of the hip.

How serious it is: Grade 1 to grade 3 as with other muscle strains. A strain at the tendon attachment on the pelvis, especially in an adolescent where the growth plate can be pulled off, is more serious than a strain in the muscle belly and needs assessment.

Typical time out: Two to four weeks for a mild strain, four to eight weeks for a partial tear, and three months or more for an avulsion at the bone. The range depends heavily on whether the tendon attachment is involved.

See a doctor if: See a clinician if a young player felt a pop at the front of the pelvis and cannot lift the leg, which suggests a growth plate avulsion.

What helps

• Early gentle loading in the shortened and then the lengthened position, staying within acceptable pain.
• Strengthen the hip flexors directly, since stretching alone leaves the muscle unable to handle the sprint load.
• Include eccentric quadriceps work, because the rectus femoris takes the load on deceleration.
• Return to sprinting and serving in steps, and treat the serve leg drive as a separate progression.
• If the pain sits deep in the front of the hip and clicks or locks, get the joint itself checked rather than treating it as a muscle problem.

Tennis Toe

Tennis toe is bleeding under the toenail, a subungual hematoma, caused by the toe repeatedly slamming into the front of the shoe during hard stops and direction changes. It is not the same as turf toe, which is a sprain of the ligaments under the big toe joint when the toe is forced upward, although both occur in players. Both come from the abrupt braking forces on hard courts and from shoes that leave too little or too much room at the front.

Symptoms

• A dark red, purple or black discoloration under the nail.
• Throbbing pressure pain in the toe that is worse in a tight shoe.
• The nail loosens and eventually falls off in the weeks after.
• With turf toe instead, pain and swelling at the base of the big toe when pushing off.
• Difficulty bending the big toe upward.

How serious it is: A small bleed under the nail is a nuisance and heals as the nail grows out. A large bleed under pressure is painful and may need draining. Turf toe is graded 1 to 3, from a stretch of the joint capsule to a complete tear with instability, and the higher grades take far longer.

Typical time out: A day to two weeks for a nail bleed once the pressure is relieved. Turf toe is two to four weeks for a grade 1 and up to three months for a grade 3.

See a doctor if: See a clinician if the toe is deformed, if the nail bed itself is cut, or if the toe becomes red, hot and swollen with fever, which suggests infection.

What helps

• Get a large painful hematoma drained by a clinician instead of waiting it out.
• Fit the shoes properly: about a thumb width of space in front of the longest toe and a lacing pattern that stops the foot sliding forward.
• Keep toenails cut short and straight across.
• For turf toe, a stiff soled shoe or a carbon insole limits how far the toe bends and reduces pain during return to play.
• Progress push off and sprint work gradually once the toe tolerates full weight bearing without pain.

Hamstring Strains

The hamstrings, biceps femoris, semitendinosus and semimembranosus, run down the back of the thigh and brake the swinging lower leg during sprinting. They tear when the muscle is lengthening under high force, which in tennis is the first two steps of a sprint to a wide ball and the sudden stop that follows. Tears at the upper tendon near the sitting bone behave differently and heal more slowly than tears in the muscle belly.

Symptoms

• Sudden sharp pain at the back of the thigh, usually mid sprint.
• You have to stop running immediately.
• Bruising appearing over the following days, often lower than the painful spot.
• Pain when straightening the knee with the hip flexed.
• Tenderness in a defined band along the back of the thigh.

How serious it is: Grade 1 to grade 3, from a minor fiber tear with near normal strength to a complete rupture with an obvious defect. The closer the tear to the sitting bone, the longer the recovery, regardless of grade.

Typical time out: One to three weeks for a grade 1 in the muscle belly, four to eight weeks for a grade 2, and three months or more for a proximal tendon tear or a complete rupture. Recurrence is common when players return before full strength in the lengthened position.

See a doctor if: Get it checked if you felt a pop near the sitting bone and cannot walk normally, or if the back of the leg goes numb.

What helps

• Nordic hamstring curls and other eccentric loading, built up over weeks, are the best evidence based way to prevent recurrence.
• Include exercises that load the hamstring at long muscle length, such as the single leg deadlift, not only knee curls.
• Begin walking and light loading in the first days rather than resting completely.
• Return to sprinting in stages with objective criteria: pain free maximal effort and symmetrical strength before match play.
• A proximal tendon tear or a strain that keeps recurring deserves imaging and a supervised program.

Elbow Bursitis

The olecranon bursa is a thin fluid filled sac over the bony point at the back of the elbow that lets the skin glide over the bone. It swells after a direct blow, such as landing on the elbow after a dive for a ball, or after repeated pressure and friction. The swelling sits on the surface, which is why it looks dramatic while the joint itself usually moves normally.

Symptoms

• A soft, sometimes egg sized swelling right on the tip of the elbow.
• The elbow bends and straightens more or less normally despite the swelling.
• Pain when leaning on the elbow or when the swelling is pressed.
• Sometimes redness and warmth over the swelling.
• The area feels squashy rather than hard.

How serious it is: Simple, non infected bursitis is uncomfortable but harmless and settles over weeks. Infected bursitis, with warmth, spreading redness, marked tenderness and fever, is a medical problem that needs antibiotics and sometimes drainage.

Typical time out: One to three weeks for a simple bursitis, four to six weeks or more if it is infected or keeps refilling. Cases that recur despite protection sometimes need the bursa removed, which adds several weeks.

See a doctor if: See a doctor the same day if the swelling is hot and red, if the pain is severe, or if you have a fever, since infection needs treatment.

What helps

• Protect the elbow from further pressure with padding, and stop leaning on it at a desk.
• Short cooling in the first days helps the pain, and a compressive sleeve helps the swelling settle.
• Keep the elbow moving through full range, since the joint itself is not the problem.
• Do not puncture or drain it yourself. If it needs draining, that is a clinical procedure, partly to rule out infection.
• Corticosteroid injection into the bursa is possible for stubborn non infected cases but carries a risk of skin thinning and infection, so it is not a routine first choice.

Neck Strain

Neck strain involves the muscles and small facet joints of the cervical spine, particularly the levator scapulae and upper trapezius, which stabilize the head while the eyes track the ball. In tennis the neck is repeatedly extended and rotated to follow the toss during the serve and the overhead, often for hours. Sustained extension with fatigue is what irritates the joints and the muscles that guard them.

Symptoms

• Stiff, aching neck on one side, worse the morning after playing.
• Difficulty looking up or turning the head fully to one side.
• Pain radiating into the shoulder blade or the back of the head.
• The serve toss becomes uncomfortable to track.
• Muscles feel hard and tender to touch.

How serious it is: A simple muscular strain is stiff and painful but loosens over days to two weeks. Pain travelling down the arm with numbness, tingling or weakness in the hand points to nerve root irritation and is a different and longer problem.

Typical time out: A few days to two weeks for a muscular strain, four to twelve weeks when a nerve root is irritated. Serving is usually the last thing to come back because it demands the most extension.

See a doctor if: Seek help if there is numbness or weakness in an arm or hand, if the neck pain followed a fall or collision, or if you feel dizzy or unsteady.

What helps

• Keep the neck moving gently within pain rather than holding it still in a collar.
• Strengthen the deep neck flexors and the muscles around the shoulder blade, since the neck compensates for a weak scapular base.
• Heat and light massage can reduce the muscle guarding enough to let you move.
• Reduce serving and overhead volume for a week or two and return in steps.
• Look at posture and sleep setup, because many players have a neck that is already loaded before they get on court.

Finger Volar Plate Injury

The volar plate is the thick fibrous pad on the palm side of the middle finger joint that stops the joint bending backward. It tears when the ball or the court forces the fingertip backward, which happens when a ball strikes the outstretched hand at the net or when a player lands on a spread hand after a fall. Small flakes of bone can be pulled off the base of the middle bone along with the plate.

Symptoms

• Immediate pain and swelling around the middle joint of the finger.
• The joint looks fat and sausage shaped within a day.
• You cannot straighten or fully bend the finger.
• Pressing on the palm side of the joint is very tender.
• Bending the joint backward feels unstable or alarming.

How serious it is: A simple sprain without a bone fragment or instability recovers well. A tear with a large bone fragment or with the joint sitting out of place needs orthopedic care, because a badly managed volar plate injury leaves a stiff, permanently thickened joint.

Typical time out: Two to six weeks before you can grip a racquet normally, and three to six months before the swelling and stiffness fully settle. The joint often stays visibly thicker for a year even when it works fine.

See a doctor if: Get it assessed if the finger is crooked, if you cannot straighten it actively, or if the joint felt like it went out of place.

What helps

• Get an X ray after a clear hyperextension injury, since a bone fragment changes the treatment.
• Buddy taping to the neighboring finger allows protected movement and is usually better than full immobilization.
• Start gentle bending and straightening within days, because this joint stiffens very fast when it is held still.
• Expect and accept swelling for months, and keep working range rather than waiting for the swelling to go.
• Hand therapy is worth involving early if range is not returning within two to three weeks.

Thumb Ulnar Collateral Ligament Sprain

The ulnar collateral ligament sits on the inner side of the thumb’s base joint and stops the thumb being forced away from the hand. It sprains or tears when a fall onto an outstretched hand levers the thumb sideways, or when the racquet twists violently in the hand on a mishit near the frame. A complete tear can trap the torn end outside a tendon sheet, in which case it cannot heal by itself.

Symptoms

• Pain at the web of the thumb, right where the thumb meets the hand.
• Swelling and bruising over the inner side of the thumb base.
• Pinching, holding a cup or turning a key is weak and painful.
• The thumb feels loose or floppy when you push it sideways.
• Difficulty holding the racquet firmly on contact.

How serious it is: A partial tear with a firm end point when the thumb is stressed heals with splinting. A complete tear leaves the joint clearly unstable and often needs surgical repair, because the torn end can flip out of position and never reattach.

Typical time out: Four to six weeks in a splint for a partial tear, three to four months after a surgical repair for a complete tear. The two paths differ enough that getting the diagnosis right early matters more than anything else.

See a doctor if: See a hand specialist if the thumb can be pushed sideways much further than the other side, since that suggests a complete tear.

What helps

• Have the stability tested early, and get imaging if a complete tear is suspected.
• A thumb spica splint that leaves the fingers free for a partial tear, worn consistently rather than intermittently.
• Grip and pinch strengthening after the splint phase, progressed before returning to full racquet contact.
• Protective taping of the thumb for the first weeks back on court.
• Do not test the stability repeatedly yourself, because that keeps pulling the healing tissue apart.

Head Impact and Concussion

A concussion is a disturbance of brain function after a blow to the head, and no structural damage shows on standard imaging. In tennis it is uncommon but real: a partner’s racquet or a hard hit ball to the head in doubles, a collision with the net post or a fall backward while chasing a lob. Sunstroke and heat illness on hot courts can look similar and are far more frequent in this sport.

Symptoms

• Headache and a feeling of pressure in the head after the impact.
• Dizziness, feeling slowed down or foggy.
• Nausea, sensitivity to light or noise.
• Difficulty concentrating or remembering the moments around the impact.
• Blurred or double vision.

How serious it is: Most concussions settle within a couple of weeks with graded return. Loss of consciousness, worsening headache, repeated vomiting or confusion that increases points to a more serious head injury and is an emergency.

Typical time out: Typically one to three weeks before full return to competition using a graded stepwise progression, and longer if symptoms persist or if there have been previous concussions.

See a doctor if: Go to emergency care for loss of consciousness, a seizure, repeated vomiting, unequal pupils, weakness on one side or confusion that gets worse.

What helps

• Stop playing immediately after a suspected concussion and do not return the same day, even if you feel fine within minutes.
• Rest relatively for the first day or two, then reintroduce light activity, since prolonged complete rest delays recovery.
• Follow a stepwise return, adding one level of exertion per day and stepping back if symptoms return.
• Get medical clearance before returning to matches, especially after a previous concussion.
• Avoid alcohol and sleep deprivation in the first days, and do not drive while symptoms are present.

Metatarsalgia

Metatarsalgia is pain under the ball of the foot where the heads of the metatarsal bones bear weight, often with irritation of the joint capsules or the small nerves between the bones. In tennis the forefoot takes the load on every split step, sprint start and push off, and hard court surfaces return that force straight back into the foot. Worn out midsoles and thin insoles concentrate the pressure onto one or two bones.

Symptoms

• Burning or aching pain under the ball of the foot, worse when pushing off.
• The sensation of walking on a pebble or a bunched sock.
• Pain eases when you take the shoe off and sit down.
• Sometimes tingling or numbness in the toes.
• Callus building up under the painful metatarsal head.

How serious it is: The mild form is a pressure problem that resolves with better footwear and load management. Persistent pain that is sharply localized to one bone can be a stress reaction, and pain with numbness between two toes suggests an irritated nerve, both of which need a proper look.

Typical time out: Two to six weeks with footwear changes and reduced impact volume, longer if a stress reaction of the bone is behind it.

See a doctor if: See a clinician if there is a pinpoint tender bone that hurts when you hop, since that points to a stress fracture rather than simple pressure.

What helps

• Replace court shoes on a schedule based on hours played, not on how the upper looks.
• A metatarsal pad placed just behind the painful heads redistributes the pressure and often helps quickly.
• Strengthen the foot’s intrinsic muscles and the calf so the forefoot is not absorbing everything alone.
• Reduce consecutive days on hard courts while it settles, and use softer surfaces where available.
• If numbness between the toes is part of the picture, get it examined rather than treating it as pressure pain.

Hook of Hamate Fracture

The hamate is a small wrist bone with a bony hook that projects into the palm on the little finger side, and the butt of the racquet handle presses directly against it. A mishit that jams the handle into the palm, or repeated pounding from off center contact, can break that hook. It is a classic racquet and club sport injury and is often missed because standard X rays do not show it well.

Symptoms

• Deep, aching pain in the palm on the little finger side.
• Pain that is worse when gripping hard and on off center hits.
• Tenderness when you press into the base of the palm.
• Sometimes tingling in the ring and little finger.
• Grip strength drops without any visible swelling.

How serious it is: An acute non displaced fracture can heal in a cast if it is caught within the first weeks. A fracture that has been present for months usually does not join and is treated by removing the fragment, which is a small operation with a good outcome.

Typical time out: Six to eight weeks in a cast for an early non displaced fracture, six to twelve weeks after excision of the hook. Delay is the main reason this injury drags on for a year in some players.

See a doctor if: Get it examined if palm pain on the little finger side persists beyond two to three weeks, especially with tingling in the ring and little finger.

What helps

• Ask specifically for imaging that shows this bone, because a standard wrist X ray commonly misses the hook and a CT does not.
• Stop gripping the racquet while it is being investigated, since continued play is what turns a healable fracture into a non union.
• Cast immobilization for a fresh fracture, followed by graded grip strengthening.
• After surgery, hand therapy for grip and for the ulnar nerve, which runs right past the hook.
• On return, check grip size and the butt cap, and reduce off center contact through technique work.

First Aid for Soft Tissue Injuries: PEACE and LOVE

Sports medicine has moved on from RICE. The current guidance, published in the British Journal of Sports Medicine in 2019, splits care into the first days after the injury and everything that follows.

PEACE, the first two to three days

• Protect: unload the area and limit movement that hurts, but only briefly.
• Elevate: keep the limb above heart level when you can.
• Avoid anti-inflammatories: they may blunt the healing you need.
• Compress: a bandage or taping limits swelling.
• Educate: your body heals this on its own; passive treatments rarely speed it up.

LOVE, from day three onward

• Load: return to movement as pain allows, early loading builds tissue.
• Optimism: expectations shape recovery more than most people assume.
• Vascularization: easy cardio that does not hurt brings blood to the area.
• Exercise: restore strength, mobility and balance before returning to play.

Ice still helps with pain in the first hours. What changed is the evidence that long icing and routine anti-inflammatory drugs slow tissue repair.

How to Lower Your Risk in Tennis

• Increase playing hours and match density gradually. Most overuse injuries in tennis follow a sudden jump in volume, such as the start of a season, a tournament week or a training camp.
• Strength train through the season, not just before it. Nordic hamstring curls, Copenhagen adductor work, heavy calf raises and rotator cuff loading target the exact tissues that fail in tennis.
• Cap serve volume per session and avoid stacking heavy serving days, since the serve is the single most demanding movement for the shoulder and the lower back.
• Match the racquet to the player. Grip size, string tension, string type and racquet weight all change the shock and the grip force at the wrist and elbow, and a stiffer setup is harder on the arm.
• Replace court shoes based on hours played and choose the sole pattern for the surface you actually play on, since a worn midsole is behind much of the heel and forefoot pain in players.
• Train hip and thoracic rotation range so the serve and the groundstrokes do not force the lower back to supply the twist.
• Rehearse the movement patterns you actually use, including side stepping, lunging and deceleration, so the first hard change of direction of the day is not the first one your body has seen in a week.

When to Stop and Get Medical Help

Most of the injuries on this page are treated at home. These signs are not.

• A visible deformity of a joint or limb, or a bone that looks out of line after a fall.
• Inability to bear weight or take more than a few steps on the injured leg.
• Numbness, tingling or loss of strength in an arm or leg.
• A joint that locks and cannot be moved through its normal range.
• Any blow to the head followed by confusion, memory gaps, repeated vomiting or loss of consciousness.
• Rapid swelling within minutes of an injury, or a joint that becomes hot and red with fever.

Sources

• Journal of Athletic Training (NCAA Injury Surveillance Program)
• Sports (Basel), coach survey on injuries and strength training in collegiate tennis
• Cureus, study on backhand technique and elbow pain in tennis players
• American Academy of Orthopaedic Surgeons, OrthoInfo

This article is general information, not medical advice. If you are hurt, a doctor or physiotherapist who can examine you is worth more than any web page. Last reviewed: August 2026.

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