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Tennis and Other Racquet Sports

Tennis and other racquet sports have a large following among recreational athletes. More than 30 million Americans participate in racquet sports. Racquet sports bring into play almost all of the muscle groups of the body. A half hour of tennis singles against a similarly skilled opponent three times a week can improve your health and endurance. Racquetball and squash are even better for conditioning; few sports burn calories at such a high rate.

Accidents do happen on the court, and the recreational nature of these sports can make players particularly susceptible to injury.


Eye injuries happen in all racquet sports, though less frequently in tennis than in racquetball. Anyone playing a racquet sport should wear some type of eye protection. Even tennis players should wear goggles or eye guards. Injuries can occur from the ball or the racquet striking the eye. They can cause severe, permanent damage.

If you are hit in the eye, apply ice intermittently for several days to reduce swelling. If your vision is very blurry, or if it remains blurry after one day, see an eye specialist immediately.

Wearing eye guards can prevent virtually all eye injuries. Most eye guards or goggles completely cover the eyes with a pane of clear, shatter-resistant glass or plastic. They cost from $10 to $40 in sporting goods stores.


Looking up to hit an overhead or a serve can pull a neck muscle. This injury, called wry neck, is the same pain that you may feel upon waking and that allows you to turn your head in only one direction.

To treat wry neck, ice the stiff side and then gently stretch the neck away from the stiff side. That is, if your right side is stiff, try to place your left ear on your left shoulder.


One of the most common sites of pain among tennis players is the shoulder. The shoulder's rotator cuff muscles may be strained from the serving or other overhead motion, but not from ground strokes.

You will feel the pain in the front of your shoulder or the outside of your upper arm. The pain is usually due to a slight dislocation of the shoulder and an impingement of the biceps tendon. Less frequently, you will feel pain in the back of the shoulder from an impingement of the supraspinatus tendon.

You can strengthen the rotator cuff muscles with the weight program in Chapter 6, or you may need to undergo physical therapy with isokinetic machines. If exercise fails, you may need surgery to repair the muscles.


Many racquet sport injuries happen because the muscles and tendons in the forearm are not strong enough to withstand the impact of the ball against the racquet.

Tennis elbow is usually the main topic of conversation in tennis clubs. About half of all tennis players suffer from tennis elbow at some time. Those in the 35-to-50-year-old age group are the most likely to complain of elbow pain.

The tendons that extend the wrist and turn the palm up become inflamed, usually from hitting a backhand improperly or trying to slice the serve. The tendon that attaches these muscles to the outside of the elbow also becomes inflamed.

These structures become irritated because the forearm is not strong enough to meet the demands placed upon it. Tennis elbow often results when a player tries to step up in class and then finds that the ball is coming at him harder. The elbow ends up absorbing most of the shock. Also, the player may be a little late hitting the ball because of its speed.

Once you develop tennis elbow, the activities of everyday life are enough to keep the elbow irritated. So just putting your racquet away and resting is usually not enough to solve the problem.

The proper treatment of tennis elbow is an exercise program with light weights to strengthen elbow muscles and tendons. These exercises should include the Arm Curl and Reverse Arm Curl from Chapter 6 and, from Chapter 8, the Wrist Curl, Reverse Wrist Curl, Unbalanced Wrist Rotation, and Ball Squeezing, which also helps develop the forearm flexor muscles.

Extending the fingers against a strong rubber band is also a helpful exercise, as illustrated in Chapter 9. Other excellent exercises for tennis elbow are the Elbow Stretches in Chapter 8.

Only in resistant cases do I ever inject cortisone into a tennis elbow. Physical therapy may also be necessary for very resistant cases. To help prevent this injury, you may want to take a backhand lesson to review proper swing technique.

Wearing an elastic elbow band, either a single band or a double band with a bar, is definitely beneficial for tennis elbow. These bands compress the muscles and reduce the shock transmitted to the tendon.

I suggest that a tennis player ice the elbow 15 to 20 minutes after play. I usually tell my patients to apply ice as soon as they get home. Fill a plastic bag with a mixture of ice and water, and keep the elbow cool for up to 30 or 40 minutes.

A second type of tennis elbow causes pain on the inner side of the elbow, similar to the pain experienced by baseball pitchers. This is an inflammation of the muscles and tendons that flex the wrist forward and turn the palm down. The pain is usually the result of turning the hand over the top of the racquet while hitting topspin shots on the forehand side.

This condition can be treated with the same exercise and flexibility program just described. You may also want to take a lesson to correct any technical flaws in your topspin stroke.


A sore wrist is a common tennis injury. The wrist may be sprained or sore from overuse. A sprain causes sudden pain and is due to one specific move. An overuse pain comes on gradually and gets progressively worse as you continue to play.

A sprain should be iced until the pain subsides and rested for several days. Then begin the strengthening program of wrist curls and rotations in Chapter 8. An overuse injury requires more prolonged rest (for several weeks), administration of anti-inflammatory agents to ease the pain, and the same strengthening program.

Pain in the fleshy part of the palm behind the thumb is usually due to an oversized grip on the racquet. The obvious remedy is to reduce the size of the grip.

Pain at the base of the hand behind the pinky finger may indicate a severe injury. The butt of the racquet continually hitting the hook of the small hamate bone can break the bone. A sports doctor will need to take an x-ray to see whether the bone is broken. If it is, it will need to be treated as a fracture. If it is just bruised, rest the hand until the pain subsides and then use a racquet with a smaller butt.


Tennis is more of a running game than a hitting game. You are constantly running to hit shot after shot. Therefore, many injuries incurred in tennis are running injuries, such as arch pain, stress fractures of the foot, ankle sprains, runner's knee, thigh and hamstring pulls, and back strain. And you can tear up a knee playing tennis as badly as you can in football from the sudden directional changes.

Many foot problems can be avoided with a good pair of tennis shoes. Look for shoes with lateral stabilizing straps, a strong toe box, a midsole for cushioning, a heel stabilizer, and rubber soles with a pivot ball in front. Cheap, poorly built shoes can compound foot problems.

Ankle sprains are common among tennis players due to sudden side-to-side direction changes. Anything but the mildest sprain should be x-rayed. The ankle may actually be broken, particularly if the inner side is swollen.

Many tennis players complain of pain around the kneecap during and after playing. Some say they feel the pain deep in the knee or behind the knee. The pain usually comes on gradually, and the player may feel fluid in the knee from time to time. These are the signs of runner's knee. The constant bending of the knees in tennis causes the kneecap to pull out of alignment.

The sudden directional changes, twisting and turning, and stops and starts of tennis can lead to cartilage and ligament damage in the knee. These traumatic injuries should be treated immediately with ice and mild compression to avoid swelling. Then see a sports doctor. The knee is a very complex joint, and proper diagnosis and treatment of knee injuries is essential in enabling you to return to full activity. I see more and more tennis players wearing fancy knee braces to support rehabilitated knees.

A quick stop with the knee bent can cause the quadriceps muscle in the front of the thigh to pull or even tear. If your legs are not properly warmed up and stretched, and you lunge for a ball, you may pull a hamstring muscle in the back of the thigh. Anyone who has pulled a hamstring understands the benefits of warming up and stretching before going all out on the court.

If your leg starts to hurt about 20 minutes into the game and keeps getting worse, you probably have iliotibial band syndrome. Once you stop playing, the pain usually disappearsuntil your next match, and then the pain starts up again in the middle of the match. The easy treatment is to stretch the band.

Suddenly twisting the back, hitting a ball offbalance, or skidding to a stop can cause back strain. You may experience severe, shooting pain. You probably have pulled a back muscle, and you need to rest and ice your back for a few days and take anti-inflammatory agents. Begin a back-stretching program like the one in Chapter 7 as soon as possible.

Tennis players often complain of chronic back pain, which may be due to a difference in the lengths of the legs. A small discrepancy in the leg length can cause pain, usually on the side of the longer leg. A heel lift in the shoe of the shorter leg can correct for this discrepancy. Do not permanently attach the lift inside your tennis shoe. Rather, use the lift in all of your shoes to relieve the pressure on your back.


The two major causes of racquet sports injuries are failure to warm up properly and overstressing joints and muscles due to the nature of the sports. Many tennis players hit eight balls over the net and think they are ready to go. A cold, unstretched muscle is just waiting to be torn.

"Tennis leg" is a term used to describe a calf muscle or a tendon that is torn when the player rushes the net, and it is seen almost exclusively among tennis players. It feels as if you were hit in the back of the leg by the ball. This injury can be prevented with an adequate warmup and stretching program.


Racquetball and squash players suffer basically the same injuries as tennis players. They are particularly prone to wrist, hand, and eye injuries.

However, one type of injury seen among racquetball and squash players, and not tennis players, is the result of running into the wall. This usually involves a blow to the shoulder, but the head, hip, or knee may also be injured.

A hard blow can loosen the shoulder joint by partially dislocating it. If your shoulder hurts for more than a few days, see a doctor and begin a shoulder rehabilitation program.

Possible head injuries include a mild or severe concussion. Anything but the mildest head injury should be seen by a doctor.

Hips and knees are usually just bruised and probably will respond to ice and rest.

Racquetball and squash players also suffer more serious eye injuries than tennis players. The ball in these sports is smaller and harder than a tennis ball, so the blow to the eye is much more concentrated. No one should step onto a racquetball or squash court without eye protection. Open-frame goggles are totally useless since the ball, when hit at high speed, can compress and come right through the opening. Clear plastic goggles provide far better eye protection.

Getting hit by the racquet or by your opponent is also a common source of injury in these sports. Whenever I hear my opponent yell, "Around!" I cringe, half-expecting the ball to hit me in the back of the head. The small, confined area of the court and the side-by-side struggle for the center of the court encourage banging, which causes cuts and bruises. Immediate first aid should take care of cuts, but you may need stitches if they are deep. Treat bruises with ice and rest.


Handball players suffer the same kinds of injuries as racquetball and squash players. In four-wall handball, players often run into a wall and are vulnerable to a concussion, a partial shoulder dislocation, and hip and knee bruises. Eye protection is a must, as the hard ball comes off the wall at high speed.

In both four- and one-wall handball, players crouch low to hit the ball, which puts stress on the knee. This can aggravate an existing runner's knee condition. An ankle sprain is another common handball injury due to the player's rapid changes in direction.

Paddle tennis players suffer injuries similar to those experienced by tennis players, and they are much more likely to suffer from tennis elbow. Unlike the strings of a tennis racquet, the heavy paddle doesn't give, and this, along with the harder ball, increases the stress transmitted to the elbow. Some of my patients develop elbow problems year after year while playing paddle tennis but have no problems from regular tennis.


Backyard badminton may cause ankle sprains from the player's sudden stops or directional changes. Competitive badminton players may suffer rotator cuff muscle injuries and biceps tendinitis as in any other sport where the arm is constantly brought up over the head.

How to Improve Your Game


Using better equipment and improving your stroke technique can reduce the risk of racquet sport injuries.

Tennis elbow sufferers should use a composite or graphite racquet since these transmit the least amount of shock to the elbow. (Wooden racquets are the best at absorbing the shock, but they are no longer available.) The racquet should be strung loosely and should be no larger than midsize. An oversized racquet not only has a bigger "sweet spot" in the center but also has a much larger, elbow-shocking hitting area around the rim. Also, a ball hit out on the rim of an oversized racquet is a shot you probably would have missed with a smaller racquet, which would have spared your elbow.

Manufacturers are now producing lighter, stronger tennis racquets with increased padding to enhance shock absorption. You may want to try one of the racquets with a different style of stringing, such as one strung in a diagonal direction, which are designed to reduce the shock transmitted to the arm.

Racquetball, squash, and handball players should make sure to wear shatterproof eye guards. Also, racquetball and squash players should avoid open-throat racquets, which allow the ball to zoom through when it is hit at a high speed.

Speed Training

Running is an integral part of racquet sports. Wind sprints are particularly good for training. After warming up, run four or five 200- to 300-yard sprints at an easy pace. Work up to a series of 8 to 10 fast sprints once or twice a week. Do not stop abruptly; walk or jog for a minute or two in between sprints. When you finish, warm down and stretch.

Game-Day Warmup

Before playing a racquet sport, go through your typical warmup and stretching program. Then run a series of half- and full-court sprints and shuttle drills, side-stepping from one sideline to the other.

As part of your game-day warmup, do the Lunge Stretch described in Chapter 1 to loosen your leg muscles and to help reduce the risk of a strained groin muscle. Start with one set of 10 lunges in each direction and build up to three sets of 10 to 15.

Before you actually play, go through a series of shadow strokes without the ball. Then hit the ball at half-speed, and do some serves to warm up your shoulder and back muscles. Then stretch the shoulder as described in Chapter 6. Also do a complete lower-body stretch program, as illustrated in Chapter 12, emphasizing calf stretches to reduce the likelihood of a "tennis leg" injury. After playing, take time to warm down and stretch to keep your muscles limber.

Tennis Strength

The best way to improve your tennis game is not simply to play more tennis. You need a total-body strength-training program to help you hit the ball harder, move faster, and beat the players who are now beating you. In tennis, muscle strength has to be accompanied by muscle stamina. That is built by using light weights and doing many repetitions. Top players such as Ivan Lendl and Andre Agassi now travel with strength-training coaches to enhance their games.

To avoid upper-body muscle strains, incorporate calisthenics from Chapter 1 such as push-ups, pull-ups, abdominal crunches, and torso twists into your regular workout routine. For strength training, do trunk rotations and shoulder-strengthening exercises. These should include the Arm Curl and Reverse Arm Curl from Chapter 6 and the Flat Fly, Lateral Raise, and Military from Chapter 1, although you should not do militaries or use a lat pulldown machine if you have any shoulder pain. If possible, do the Bench Press in Chapter 1 as well.

One warning: Don't lift weights and then go out and play tennis. You temporarily lose some fine motor control when you lift weights, and you also tire out muscles. Lift on the days you don't play, or lift after you have played.

Enhancing upper-body strength and agility will improve any racquet-sport player's game. Use the strength-training program in Chapter 1 regularly both during the season and in the off-season to increase and maintain strength. Also do the agility drills in Chapter 17 to improve your ability to change direction quickly.

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