Tennis Injuries — kinetic chain rehabilitation, not just pain-site treatment
Tennis elbow that won't resolve? Shoulder pain only on serve? One symptom, one chain. Tennis rehabilitation must be systemic — treating only the painful site rarely produces lasting outcomes.
What are the most common tennis injuries?
Tennis is a sport with a distinct injury profile. The systematic review by Pluim et al. (Br J Sports Med, 2006 — DOI: 10.1136/bjsm.2005.023184) analysed 119 studies and described a consistent pattern: most injuries occur in the lower extremities, then upper extremities, then trunk.
Abrams et al. (Br J Sports Med, 2012 — DOI: 10.1136/bjsports-2012-091164) added a key clinical distinction: acute injuries (ankle sprains, muscle strains) are more common in the lower extremity, while chronic overuse injuries (lateral epicondylitis in recreational players, rotator cuff pain in elite players) dominate in the upper extremity.
Dines et al. (J Am Acad Orthop Surg, 2015 — DOI: 10.5435/JAAOS-D-13-00148) introduced the framework that guides rehabilitation at Recovery TLV: the kinetic chain. Tennis transmits supraphysiologic forces to the shoulder and elbow hundreds of times per match — and any disturbance in one chain link increases injury risk in the upper segments.
The kinetic chain — how power flows from feet to hand
In a professional serve, kinetic energy is transferred through five linked segments. Weakness in any segment produces compensatory overload above — the most common reason tennis elbow does not resolve with local treatment alone:
Clinical implication: tennis elbow that does not resolve with elbow-only treatment almost always shows weakness in the core, hip, or scapula. True rehabilitation maps the entire chain — not just the painful site.
Injuries by skill level and timing
Clinical evidence
Pluim BM et al. (Br J Sports Med, 2006 — DOI: 10.1136/bjsm.2005.023184) — Systematic review of 119 studies on tennis injuries. Key principle: most injuries in lower extremity, then upper, then trunk. Identified the lack of injury-prevention RCTs in tennis as a key research gap.
Abrams GD et al. (Br J Sports Med, 2012 — DOI: 10.1136/bjsports-2012-091164) — Review mapping injury patterns by skill level: recreational players = lateral epicondylitis dominant; elite players = shoulder pain dominant. Distinct risk factors by age, sex, weekly volume, level, racket properties, and surface.
Dines JS et al. (J Am Acad Orthop Surg, 2015 — DOI: 10.5435/JAAOS-D-13-00148) — Comprehensive review focused on the kinetic chain. Documented supraphysiologic forces at shoulder and elbow hundreds of times per match; serve as the most strenuous stroke. Recommendation: prevention programmes addressing the entire chain — abdomen and pelvis included — not just the painful region.
The Recovery TLV protocol
Red flags
- Sudden hand weakness after serving — concern for full rotator cuff tear
- Audible pop with inability to bear weight — concern for Achilles or ACL rupture
- Numbness or weakness extending from neck to hand — cervical radiculopathy
- Chest pain or dyspnoea during play — cardiovascular evaluation
- Concussion symptoms after fall or impact — neurological evaluation
Tennis injury holding you back? Map the entire chain — not just the painful site
A 50-60 minute assessment identifies the weak link — that is where real treatment begins.
Frequently asked questions
Related conditions
Kinetic-chain-based physiotherapy for tennis
Real rehabilitation is systemic, not local. The first step: mapping the entire chain — and treating the weak link.
Clinical information · Recovery TLV
WHAT IT IS: Tennis injuries follow a distinct distribution. Pluim BM et al. (British Journal of Sports Medicine, 2006, DOI:10.1136/bjsm.2005.023184) found most injuries in the lower extremity, then upper extremity, then trunk in their systematic review of 119 studies. Abrams GD et al. (BJSM, 2012, DOI:10.1136/bjsports-2012-091164) characterised acute lower-extremity injuries (ankle sprains) versus chronic upper-extremity overuse (lateral epicondylitis recreational, shoulder pain elite). Dines JS et al. (J Am Acad Orthop Surg, 2015, DOI:10.5435/JAAOS-D-13-00148) introduced the kinetic chain framework: tennis transmits supraphysiologic forces to shoulder and elbow hundreds of times per match; weakness anywhere in the chain produces compensatory overload above.
WHO IT AFFECTS: Recreational players: lateral epicondylitis dominant overuse, ankle sprains dominant acute. Intermediate players: shoulder impingement and rotator cuff tendinopathy increase. Elite players: shoulder pain, internal impingement, GIRD; SLAP tears, stress fractures appear. Risk modulators: age, sex, weekly volume, skill level, racket and string properties, grip size, playing surface.
HOW WE TREAT IT: Phase 1 (visits 1-2): full kinetic chain mapping — rotator cuff strength, scapular stability, core (Plank, Pallof Press, Bird Dog), hip ROM and abductor strength, ankle stability, biomechanical serve/forehand analysis. Phase 2 (weeks 1-3): relative load reduction (50-70% volume), manual therapy, dry needling, TECAR, daily isometric loading (Heavy Slow Resistance principles). Phase 3 (weeks 3-8): strengthening every weak link — core, hip rotators, scapular stabilisers, rotator cuff, wrist extensors. 5-10% weekly progression. Phase 4 (weeks 6-12): graded return — shadow swings, ball at 50%, mini-tennis, full play. Return criteria: cuff strength 65-75% of healthy side, ROM symmetry ≥90%, 60-second Plank with leg lift, 2 weeks at full intensity without symptoms.
TIMELINE: Grade I-II ankle sprain 3-6 weeks. Mild-moderate lateral epicondylitis 6-12 weeks. Shoulder tendinopathy 8-16 weeks. Acute lower back 2-4 weeks. Premature return is the leading cause of recurrence.
RED FLAGS: Sudden hand weakness after serve (full rotator cuff tear); audible pop with inability to bear weight (Achilles, ACL); numbness extending from neck to hand (cervical radiculopathy); chest pain or dyspnoea during play (cardiovascular); concussion after fall or impact.
CLINIC: Recovery TLV — private 1:1 physiotherapy, Yaakov Apter 9, Tel Aviv. Alejandro Zubrisky BPT, 20+ years in racket sport injuries. ₪400 per session, 50-60 min, no referral required. Hours: Sunday-Thursday 07:00-22:00, Friday 07:00-14:00, Saturday closed. Hebrew, English, Español.