Sports Performance
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Tennis is a sport that requires repetitive hitting of the ball, often causing overuse injuries to the elbow and shoulder (rotator cuff). In addition, tennis requires a lot of side-to-side motion and quick changes in direction that may cause calf strains. Learn the best ways to treat and prevent overuse injuries of the elbow and shoulder, and strains to the calf and Achilles tendon, including tendonitis.

Calf Strain

Tennis – Calf Strain

A calf strain occurs when the junction between the calf muscle and the Achilles tendon (the insertion by the heel) becomes strained or torn. Tennis is a sport that requires a lot of side-to-side motion and quick changes in direction that excessively loads the Achilles and makes it easier to overstrain during the push off phase of running. This injury tends to be more common in tennis players 30 years or older since the calf may sustain several minor traumas throughout the younger years of life and the blood supply to this area of the body gradually starts to decrease after you turn 30 years old. This makes the Achilles more brittle and easier to strain. People who experience a calf strain typically state that it feels like someone has “kicked them in the calf from behind.” 

Preventing Calf Strains

Take the following precautions to prevent calf strains:

  • Choose the correct footwear: For tennis, or any sport, the foot should be properly supported. If shoes are too soft, it allows the heel and ankle to roll more than it should, placing more stress on the Achilles tendon and possibly causing injury. So please consult your local tennis center who can assist you with the proper shoe wear to purchase the appropriate tennis shoes for your foot type.
  • Heel Lifts: Putting heel lifts in both shoes helps to reduce the strain on the tendon when you walk and allows faster healing to occur.  
  • Stretching: Before you play, actively stretching the calf is advised by either aggressive heel/toe walking or sitting and actively contracting the front ankle muscles to pull the toes up, holding 20 to 30 seconds, 2 to 3 times. After playing, the traditional passive standing calf stretch is advised, with the knee straight and bent with the heel down, holding 20 to 30 seconds, 3 to 5 times.
  • Maintain a regular conditioning program: Tennis players, especially single players and more seasoned players, need to develop a basic conditioning program to build strength and prevent leg injuries. This program should include drills on the court consisting of side-to-side running, back pedaling and forward running. Foot work drills should be performed using a ladder system that progresses from low impact plyometric training consisting of drills on a flat soft surface to box steps to jumping drills. If you belong to a fitness club, resisted calf raises with knees straight and bent are advised in your fitness/conditioning program.   

Treating Calf Strains

The following treatments may be used when you experience a calf strain:

  • Ice the area 2 to 3 times per day.
  • Take anti-inflammatories as directed, if necessary.
  • Use heel lifts in your shoes to reduce strain on the tendon.
  • Wear a neoprene calf sleeve to help reduce the swelling and pain and allow walking to promote an increase in blood supply to help the calf to heal faster. 
  • Gradually stretch and strengthen the calf muscles pain-free by doing calf stretches as mentioned above, as well as mid-range eccentric heel raises 2 to 3 times per day in 3 sets of 10 to 20 reps.
  • If you are a regular tennis player and must keep playing, wearing a calf sleeve will help to support the calf and protect it from further injury.

If the calf strain is severe, you may need to see your physician to obtain a walking boot to help support the calf and reduce the strain on the injury when walking. In certain cases, if the strain is bad enough, you may be a candidate for surgical repair.

Tennis Elbow

Tennis – Tennis Elbow

Tennis elbow occurs when the lateral (outside) tendon that extends from the elbow to the wrist is strained. Typically, it occurs in players who are between 40-50 years old. This common tennis injury is caused by:

  • Overuse: The tendon becomes strained due to repeated backhands or overhead serves without adequate stretching or rest. Therefore, the strength of the tendon gradually reduces and becomes vulnerable to strains. 
  • Technique: When playing tennis, your body must be set in the proper position to hit the ball when it is directly in front of you. If you hit the ball too late and it is at body level or slightly behind you, it puts too much stress on the outside of the elbow, causing strain. 
  • String tension and grip of racket: When the string tension of your tennis racket is too high, it causes an increased vibrating force to be transmitted to the elbow, causing strain. In addition, if the grip of your racket is too big or too small, you may over squeeze the grip, causing increased stress to the outside of the elbow.

Preventing Tennis Elbow

In order to prevent tennis elbow:

  • Have a tennis professional check your racket for proper grip size and string tension.
  • Have a tennis professional watch you hit some backhands and serves to make sure your technique is appropriate to prevent injury.
  • Maintain a strengthening and stretching program for the muscles of the forearm, including the flexors and extensors. This is extremely important in preventing tennis elbow, as strong muscles protect the tendon from becoming strained.

Treating Tennis Elbow

If you wake up in the morning after playing tennis and your elbow is stiff, you may have tennis elbow. There are four stages of any type of tendonitis, including tennis elbow:

  • Stage 1: Hurts in the morning
  • Stage 2: Hurts as you start to play and the morning after.
  • Stage 3: Hurts in the morning, pain goes away while playing tennis, pain returns after playing tennis. At this point, it would be advisable to stop play and seek medical assistance for evaluation.
  • Stage 4: Hurts all the time. A resting splint maybe necessary for complete rest along with non-steroidal anti-inflammatory drug (NSAIDS) and ice.

If you experience pain and stiffness in the elbow after playing tennis:

  • Begin by icing and resting the arm
  • Perform light stretches of the forearm by extending the elbow extended, flexing the wrist and holding 20 seconds, five times, and then extending the wrist and holding for 20 seconds, five times.
  • Do strengthening exercises initiated in the mid-range of wrist flexion/extension and the elbow bent at 90 degrees. As the pain dissipates in a week or two, gradually perform the strengthening with the elbow held in more of an extended position as tolerated. Stretching and strengthening should always be pain-free during and after exercises to be at the proper intensity.
  • If you are a regular tennis player, it is advised to wear an elbow brace while playing to support the tendon and prevent further injury.

If initial treatments of ice, NSAIDS and rest progressing to the basic home exercises mentioned above do not resolve the problem, seek medical attention from a health care professional.

Rotator Cuff Tendonitis

Tennis – Rotator Cuff Tendonitis

Rotator cuff tendonitis occurs when one or more tendons of the rotator cuff muscles that attach to the ball of the shoulder joint become strained or pinched due to poor mechanics of motion or overuse. The main function of the rotator cuff is to stabilize and rotate the ball of the shoulder in the socket so there is normal, pain-free motion of the joint and extremity. Since the shoulder joint is shallow, it provides 20 percent of the stability while the rotator cuff provides 80 percent of dynamic stability to the joint when it contracts during active motion of the arm. Since the overhead position of the upper extremity makes the shoulder joint more unstable, the rotator cuff is overworked to maintain the ball in the socket and can get severely fatigued, causing overuse injuries.

The rotator cuff is only part of the shoulder girdle, which consists of five joints and many muscles that either stabilize the joint, like the rotator cuff, or act as large arm mover. Therefore, rotator cuff impingement and strains can be avoided when a total shoulder girdle conditioning program is developed for proper strengthening, endurance and flexibility to prevent abnormal mechanics of the shoulder girdle that would stress the rotator cuff and strain it. Even with normal mechanics of the shoulder girdle, high volume overhead repetitive hitting in tennis can cause rotator cuff strains, impingements and muscle imbalances, leading to pain at the top of the hitting motion and/or during follow through. Therefore, a good maintenance-conditioning program is needed to prevent injuries to the rotator cuff.  

Preventing Rotator Cuff Tendonitis

The following measures can prevent rotator cuff tendonitis:

  • Have a tennis professional check your racket for proper grip size and string tension. When the string tension of your tennis racket is too high, it can cause strain in the shoulder.
  • Have a tennis professional watch you hit some overhead serves to make sure your technique is appropriate to prevent injury.
  • Maintain a regular strengthening and stretching program of the shoulder girdle muscles. In your strengthening program, make sure there is adequate exercises for scapular and  rotator cuff muscles to maintain the balance of strength front to back in the shoulder girdle.

Treating Rotator Cuff Tendonitis

If you experience shoulder pain while performing activities at shoulder level and above after playing tennis or if you are unable to sleep on your shoulder at night and wake up with pain, you may have rotator cuff tendonitis. The following may help to treat rotator cuff tendonitis:

  • Ice twice per day for 15-20 minutes
  • Take anti-inflammatories as directed
  • Visit your physician or go to a physical therapist to learn basic exercises for rotator cuff stretching and strengthening.

In extreme cases, surgery may be necessary. Consult with a physician to determine appropriate treatments.