Friday, July 31, 2015

How to avoid tennis elbow and other setbacks on the court

When it comes to tennis, the dreaded elbow injuries are only part of the story. Here's how to keep healthy throughout the season.

How to avoid tennis elbow and other setbacks on the court


With the outdoor tennis season comes sprains and strains, aching knees and shoulders. Today, we will focus on common tennis injuries, how to prevent them, and how to treat them when they occur:

Tennis elbow

This seems to be the bane of tennis players as it can be very difficult to treat. Not all tennis players get tennis elbow as some get golfer’s elbow and vice versa. Tennis elbow starts with pain in the lateral elbow where the wrist extensor muscles attach. Golfer’s elbow presents with medial elbow pain where the wrist flexors attach.

There can be many causes of elbow pain including acute soreness from getting back on the court, overuse from playing too much, incorrect grip size, and inappropriate string tension to name a few. One thing that is often a major contributor and is usually overlooked is the shoulder. A loss of internal rotation known as glenohumeral internal rotation deficit (GIRD) and scapular dyskinesia are often times the underlying causes of elbow pain in tennis.

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Once symptoms have occurred, rest and ice can help with acute pain. If symptoms persist, it is best to see a sports medicine physician, athletic trainer, or physical therapist that specializes in overhead athletes for an evaluation and treatment recommendations.


Shoulder pain accounts for the majority of tennis injuries. In younger players (under 40) the common culprit is a labral tear. In older players (over 40) we start suspecting rotator cuff involvement. There are numerous causes of shoulder injuries such as overuse, incorrect racket and string tension, and poor form/hitting mechanics. But just as with elbow pain, GIRD and scapular dyskinesia are often times the root of the problem.

Abdominal/oblique injuries

This is a problem that we really only see in our high level youth and professional players. In a closed or neutral hitting stance, the majority of power is created from the legs. An open stance limits the legs ability to develop power and instead it is produced through the abdominals via trunk rotation.

With the open hitting stance becoming the norm, we are treating more and more of these injuries. In the past we would usually saw a few rectus abdominus injuries from serves per season. Now, we are seeing a dramatic increase in oblique injuries due to the rotational force with the open stance. Two ways to prevent this injury are to change your stance back to a neutral/closed position and the other is to develop a strong core. If you do experience an abdominal injury, make sure to see a sports medicine specialist as these injuries need to be evaluated and treated appropriately.

Knee pain

There are 3 main injuries to the knee in tennis. The first is an ACL injury, which rarely occurs in tennis due to the mainly linear movement patterns as compared to cutting and pivoting sports such as soccer and football. When an ACL injury does occur, one should see an orthopedic surgeon who specializes in ACL reconstruction to discuss surgical and non-surgical options.

The second and more common knee injury is a meniscal tear. These can be acute in nature in our younger players (under 40) or chronic and degenerative in our older players (over 40). As with ACL injuries, one should see a sports medicine physician to discuss treatment options.

The third and most common knee injury in everyday tennis players is an aggravation to underlying arthritis. This occurs from either overuse or an acute irritation to a pre-existing arthritic condition. The best treatment for these injuries is the old RICE method (rest, ice, elevation, and compression).

Injury prevention

Please click on the link to view these exercises.

As with any exercise program, please consult a medical professional if you have any questions or concerns.

There are a few simple exercises that will help keep you in the game. They should be performed 2-4 times a week at the recommended number of sets and repetitions. When in doubt, see an athletic trainer or physical therapist for an individualized program specific to you.


Sleeper stretch: this stretch helps to improve shoulder internal range of motion. Stretches should be pain free. Perform 3-5 repetitions holding for 30 seconds.

No moneys: Will help to improve scapular strength and control. Key is to squeeze your shoulders down and back. Only rotate arms out in a pain free range of motion. Do 2 sets to fatigue.


Timothy Tyler, PT, ATC from the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City has developed an eccentric exercise program for tennis elbow using a rubber bar. His program has been validated by research and has been able to reduce symptoms fairly quickly.


Plank exercises are probably the best and simplest exercises for core strengthening. Key is to contact not only your rectus abdominus (your 6 pack abs) but also your rotators and deep stabilizers (obliques, quadratus lumborum, and multifidus). To do this, suck in your belly button like you are trying to get into a tight pair of pants. Don’t hold your breath. You should feel your abs tight above and below your belly button and more importantly around your sides in your love handle region. Make sure to have good form with the planks (straight as an arrow through your ankles, knees, hips, shoulder and head) and only hold the position as long as you can maintain good form and tightened abs.


Flexibility is important in your thoracic and lumbar spine with extension and rotation being the key factors. Prone press ups or the cobra yoga pose is an excellent way to improve extension. Supine trunk rotation stretches will help maintain and improve rotational range of motion. These should be performed for 3-5 repetitions with 30 second hold. Do not work through pain with stretching.

Knees/lower extremities

Flexibility is also key in the lower extremities. Quad, hamstring, and calf stretches should be performed for 3-5 repetitions holding 30 seconds on each side. Once again, stretching should be pain free.

Justin Shaginaw, MPT, ATC is lead therapist and coordinator of sports medicine at Aria 3B Orthopaedic institute.

Read more Sports Doc for Sports Medicine and Fitness.

Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
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