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Tennis Injuries of the Lower Extremity

by MASS4D® Prescription Orthotics April 30, 2017

Tennis Injuries of the Lower Extremity

The physiological demands of tennis place an intense amount of load on the joints of tennis players, making them susceptible to a wide range of injuries of both the upper and lower extremity.

For preventative strategies to be successful, it is necessary to target specific areas most prone to common tennis injuries; the lower extremity has been reported as the most frequently injured region in tennis players particularly the lower leg, ankle and thigh.

Muscular imbalances throughout the kinetic chain further increase the predisposition of tennis players to both acute and chronic injuries because of the integrated nature of the kinetic chain.

Dines et al. divide the phases of the tennis service motion into the following – wind-up (knee flexion, trunk rotation), early cocking, late cocking (maximal abduction, external rotation), acceleration and follow-through.

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The authors describe muscular segments and forces as beginning at the feet and knees,  with the interlinked kinetic chain passing these forces on from the lower extremity through the core to the shoulder and elbow, where the forces end at the wrist, hand, and ultimately the racquet. 

In order to prevent injury, players must practice effective knee flexion and extension during the service motion, as this has been found to decrease loads in the upper extremity, specifically elbow valgus loading and anterior shoulder stress.

The epidemiology of musculoskeletal injuries in tennis players was outlined in detail by Abrams et al. who reported that 11 percent of players with knee injuries incurred on court were diagnosed with anterior cruciate ligament (ACL) injury in follow-up; the other knee injuries found to be common in tennis players include patellar tendonities and patellofemoral pain.

High incidences of low back pain in players are attributed to the large loads in axial rotation during tennis; the combined repetitive motions of extension, lateral flexion and rotation fatigue supporting structures of the lumbar functional unit and overwhelm viscoelastic protective mechanisms of the intervertebral disks and ligaments.

The sharp movements undertaken during the game such as abrupt stopping, starting, cutting or twisting manoeuvres increase the chances of hip injuries such as femoroacetabular impingement and labral tears; this necessitates improving range of motion and stabilisation of the hip joint in order to decrease the risk of hip injury.

Among the player-specific risk factors listed out by Abrams et al. in their study, the volume of play, skill level, racquet grip position, racquet properties and court surface are important considerations in the formulation of preventative strategies for tennis players.

Strength and conditioning programmes are recommended for improving muscular strength, stability and to achieve full range of motion in the lower limbs which can reduce the incidences of injuries to the lower extremity in tennis players.

In addition to this, individual biomechanical discrepancies must also be addressed with the use of customised foot orthotics such as MASS4D® to reduce excess stress on the lower extremity that is subjected to intense forces during the game; with the lower limbs functioning at their optimal best, the risk of injuries is prevented and the player’s performance is enhanced.

Copyright 2017 MASS4D® All rights reserved.

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Related Links

The Foot-Knee Arthrokinetic Relationship 
Femoroacetabular Impingement Syndrome
Custom vs Non Custom Orthotics


  1. Dines, J. S., Bedi, A., Williams, P. N., Dodson, C. C., Ellenbecker, T. S., Altcheck, D. W., Windler, G., Dines, D. M. (2015) Tennis Injuries: Epidemiology, Pathophysiology, and Treatment. The Journal of the American Academy of Orthopaedic Surgeons: March 2015, Vol. 23, No. 3, pp. 181-189.
  2. Abrams, G. D., Renstrom, P. A., Safran, M. R. (2012) Epidemiology of Musculoskeletal Injury in the Tennis Player. British Journal of Sports Medicine: May 2012. doi: 10.1136/bjsports-2012-091164
  3. Ellenbecker, T. S., Pluim, B., Vivier, S., Sniteman, C. (2009) Common Injuries in Tennis Players: Exercises to Address Muscular Imbalances and Reduce Injury Risk. Strength and Conditioning Journal: August 2009, Vol. 31, No. 4, pp. 50-58. DOI: 10.1519/SSC.0b013e3181af71cb 

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