Tennis Injuries in Recreational Players: What Goes Wrong, Why It Happens, and How Physical Therapy Can Help
Tennis is one of the most popular recreational sports in Central Florida, and Winter Park in particular has a thriving tennis community. From the courts at Winter Park Racquet Club to the members at Interlachen Country Club and recreational leagues throughout the Orlando area, adult tennis players are among the most active and dedicated recreational athletes we see at Cross the Line Physical Therapy and Performance.
They are also among the most likely to push through pain longer than they should.
Tennis places unique physical demands on the body. The combination of explosive lateral movement, repetitive overhead and rotational loading, hard court impact, and the simple fact that most recreational players are competing multiple times per week creates a physical stress profile that is easy to underestimate. This post covers the most common tennis injuries we see in recreational adult players, why they happen, and what Physical Therapy can do to help.
Tennis Elbow: The Most Common and Most Mismanaged Tennis Injury
Despite the name, tennis elbow affects far more people who have never picked up a racquet than actual tennis players. But for those who do play tennis, lateral epicondylitis or tennis elbow is by far the most common complaint we see and one of the most frequently mismanaged.
Tennis elbow involves irritation and breakdown of the tendons attaching to the outside of the elbow, driven by the repetitive gripping and wrist extension forces involved in groundstrokes, volleys, and serves. It typically presents as pain on the outside of the elbow that worsens with gripping, lifting, or any wrist extension movement, and in more irritable cases even simple daily tasks like lifting a coffee cup become uncomfortable.
The most common mistake tennis players make with tennis elbow is treating it as an inflammatory condition requiring rest and anti-inflammatory treatment. While rest and NSAIDs may reduce symptoms temporarily, they do not address the underlying tendon pathology. Tennis elbow is a tendinopathy, meaning a structural breakdown in the tendon tissue itself, and it requires progressive tendon loading to heal properly.
Treatment focuses on a progressive loading program targeting the forearm extensors, addressing any contributing factors in grip mechanics, racquet setup, and stroke technique, and managing overall training load intelligently during recovery. For presentations that are too irritable for traditional loading, Blood Flow Restriction Training allows meaningful tendon stimulus at lower intensities during the earlier stages of rehabilitation. Our Elbow Conditions page covers tennis elbow and related elbow conditions in more detail.
Shoulder and Rotator Cuff Pain
The serve and overhead shots in tennis place significant and repetitive demand on the shoulder, particularly the rotator cuff. The explosive external rotation and internal rotation forces involved in a serve, combined with the volume of overhead movements in a typical tennis session, create a loading environment that can accumulate into rotator cuff irritation, impingement, and tendinopathy over time.
Recreational adult tennis players are particularly susceptible to shoulder overuse because many are playing significant volumes of tennis without the physical preparation, specifically rotator cuff strength and endurance, to support that demand. The rotator cuff muscles fatigue over the course of a match or practice session, and as they fatigue their ability to maintain proper shoulder mechanics diminishes. This is when impingement and irritation tend to occur.
Treatment for tennis-related shoulder pain focuses on restoring rotator cuff strength and endurance, improving scapular control and thoracic spine mobility, and progressively rebuilding tolerance for the overhead and rotational demands of the sport. Dry Needling can be a useful adjunct for reducing the muscle tension and trigger point activity that often accompanies rotator cuff irritation in overhead athletes. Our Shoulder Conditions page covers the full range of shoulder conditions we treat.
Low Back Pain
The rotational demands of tennis groundstrokes, combined with the repeated extension and lateral flexion of the serve, create a specific loading pattern for the lumbar spine that differs meaningfully from most other activities. Low back pain is one of the most common complaints in recreational tennis players and is frequently driven by a combination of limited hip mobility, inadequate core endurance, and the cumulative rotational load of playing multiple sets multiple times per week.
When hip mobility is restricted, the lumbar spine compensates by contributing more rotation than it is ideally designed to handle. Over time this compensation accumulates into pain and stiffness that is often worse after playing and first thing in the morning.
Treatment focuses on addressing the specific contributing factors identified in the evaluation, which typically includes improving hip mobility, building core endurance for rotational stability, and addressing any movement patterns in the groundstroke or serve that are placing disproportionate demand on the lumbar spine. Our blog post on Low Back Pain covers the broader picture of what drives low back pain and why the approach matters.
Knee Pain
The lateral movement, pivoting, and quick direction changes of tennis place significant demand on the knee, particularly on hard courts where impact forces are higher than on clay or grass. Patellofemoral pain syndrome, IT band syndrome, and patellar tendinopathy are among the most common knee complaints in recreational tennis players, and all are driven by a combination of repetitive loading and the strength and movement deficits that allow that loading to concentrate in the wrong places.
Hip and glute weakness is one of the most common underlying contributors to knee pain in tennis players. When the hip cannot adequately control the leg during lateral movement and direction changes, the knee takes on more load than it is designed to handle repetitively. Addressing hip strength is frequently as important as treating the knee itself for lasting resolution of tennis-related knee pain. Our blog post on Why Your Knee Pain Keeps Coming Back goes into more depth on this pattern and why treating the knee in isolation so often fails.
Achilles and Calf Issues
The explosive stop-start movement patterns of tennis, combined with the hard court surface that many recreational players in Central Florida play on year round, place significant repetitive demand on the Achilles tendon and calf musculature. Achilles tendinopathy and calf strains are common in recreational adult tennis players, particularly those who are playing more frequently during the cooler months when court availability improves and motivation peaks.
As with tennis elbow, Achilles tendinopathy responds best to progressive loading rather than rest and requires a rehabilitation approach that is carefully calibrated to the specific location of the tendinopathy. Mid-substance and insertional presentations require different treatment approaches, and getting this distinction right is one of the most important factors in avoiding the common experience of doing all the right things and still not improving. Our blog post on Achilles Tendon Pain covers this distinction and the full rehabilitation approach in detail.
Hip Flexor and Groin Strains
The explosive lunging, lateral movement, and rotational demands of tennis place significant load on the hip flexors and adductors. Hip flexor strains typically present as pain at the front of the hip or groin that worsens with lifting the knee or explosive push-off movements, while adductor or groin strains present as inner thigh pain aggravated by side-to-side movement and kicking-style motions.
These injuries most commonly occur when training volume spikes suddenly, when a player returns to tennis after time off without adequate preparation, or when fatigue late in a match leads to breakdown in movement mechanics. They respond well to a progressive loading program that rebuilds the strength and capacity of the affected tissue while managing overall activity load during the recovery process. Our Hip Conditions page covers hip flexor and adductor strains along with other hip conditions in more detail.
Neck Pain and Tension
The sustained head positioning required to track a ball during tennis, combined with the repetitive rotational forces of groundstrokes and the extension of the serve, can accumulate into cervical muscle tension and neck pain over time. This is particularly common in recreational players who also spend significant time at a desk during the workday, as the neck arrives at the tennis court already carrying accumulated tension from sustained posture and then absorbs additional rotational and extension demand during play.
Neck pain in tennis players is most commonly a muscle tension and movement restriction problem rather than a structural one, and it responds well to a combination of manual therapy, Dry Needling for trigger point release in the cervical and upper back musculature, and targeted strengthening and mobility work. Our Head and Neck Conditions page covers the full range of neck conditions we treat.
Why Recreational Tennis Players Are Particularly Vulnerable
There are a few patterns that make recreational adult tennis players particularly prone to the injuries listed above, and understanding them is the first step toward preventing them.
Playing volume often exceeds physical preparation. Many recreational players play two, three, or more times per week, often for multiple sets per session, without a structured physical preparation program outside of tennis itself. Tennis is the training. But the physical demands of tennis require a foundation of strength, mobility, and tissue capacity that tennis alone does not build.
Hard court surfaces amplify impact forces. The vast majority of recreational tennis in Central Florida is played on hard courts year round. Hard courts generate significantly higher impact forces than clay or grass, which accelerates the accumulation of load on tendons, joints, and the lumbar spine over the course of a season.
Age-related changes in tissue recovery. For recreational players in their 40s, 50s, and 60s, the connective tissue changes that come with age mean that recovery from the demands of tennis takes longer than it did earlier in life. Playing frequency and volume that felt manageable at 35 may require more intentional recovery and physical maintenance at 50 to remain sustainable.
Returning after time off without adequate preparation. One of the most common injury scenarios in recreational tennis is the player who takes several weeks or months off and then returns to full play volume too quickly. The body, and particularly the tendons, deconditions faster than most people realize and requires a gradual return to full activity after any significant break.
How We Approach Tennis Injuries at Cross the Line Physical Therapy and Performance
Our approach to tennis injuries starts with a thorough evaluation that identifies the specific movement, strength, and load management factors contributing to your symptoms. We look at the whole picture, not just the area where you are feeling pain, because tennis injuries are rarely caused by a single isolated problem.
Treatment is built around what the evaluation actually reveals and is always designed with your return to the court as the goal. Our default is never to tell you to stop playing tennis. In most cases, continuing to play at some level throughout rehabilitation is both possible and beneficial, and we will work with you to find the level of activity your body can currently tolerate while simultaneously addressing the underlying cause.
Whether you are dealing with tennis elbow that has been nagging you for months, a shoulder that flares up after serving, or a knee that aches through every match, a thorough evaluation at Cross the Line Physical Therapy and Performance will give you a clear picture of what is going on and a targeted plan to address it.
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