Tennis: Protect your Shoulders and Prevent Injuries

In collaboration with Tennis Québec. 

Tennis is a very popular sport, especially in summer when it can be played outdoors. Despite being accessible, it remains physically demanding - particularly on the shoulders. The mobility required for an excellent serve is often underestimated. In addition, holding the racket with one hand creates asymmetrical movement, and the repeated light impacts on the strings place consistent, low-level stress on the tendons.

Key physical characteristics to watch for

Certain physical traits may increase the risk of shoulder tendon injuries, such as tendinitis or tendinosis, when playing tennis.

1. Lack of shoulder joint mobility

Mobility refers to the ability to move a joint through its full range of motion. Restrictions in shoulder mobility can lead to compensations elsewhere in the body to complete the large movements required in tennis.

Simple self-assessment:

• Try to touch your back between your shoulder blades with one hand, and with the other, try to touch that hand by reaching behind your head.
• Repeat the test with your hands reversed.
• Ideally, your hands should touch or be no more than 10 cm apart.

Note : A slight difference between your dominant and non-dominant sides is normal. If the gap exceeds 10 cm, consult a physiotherapist.

2. Weakness in shoulder muscles

Muscle strength, particularly in the rotator cuff (a group of deep stabilizing shoulder muscles) is essential in tennis. Weakness or poor activation of these muscles can alter movement patterns and lead to overuse injuries.

Good to know :

• These muscles need to be strengthened in a specific way.
• Exercises should mimic actual tennis movements to be truly effective.

3. Stiffness in the upper back

Mobility in the upper back (thoracic spine) is critical to allow the shoulder to elevate efficiently overhead. During a serve, slight spinal extension is needed.

Lack of mobility can cause:

• Poor shoulder positioning
• Tendon overload
• Less efficient strokes

What are the most common tennis shoulder injuries?

The two most common injuries in tennis are:

Rotator cuff tendinopathy

This refers to irritation, inflammation, or tearing of a tendon. When muscle tension exceeds the tendon’s capacity to adapt, pain may occur during tennis movements.

Note: Medical imaging (e.g., ultrasound) is generally not needed unless symptoms persist.

Shoulder impingement syndrome

Though this term is evolving, it refers to situations where certain shoulder areas are overused depending on arm position. Symptoms resemble tendinopathy but are position-dependent.

Main causes include:

• Joint stiffness
• Muscle weakness
• Poor motor control in the shoulder, upper back, or neck

What to do in case of injury

• Targeted rest: Avoid painful movements but stay active with pain-free motions
• Medication: Use pain relievers as advised by your pharmacist
• Avoid ice: Unless directed by your healthcare provider

If the pain lasts more than a few days, consult a physiotherapist for a precise evaluation.

How physiotherapy can help

In physiotherapy, we:

• Identify the root cause (weakness, stiffness, poor control)
• Relieve pain through mobilization, muscle release, and isometric exercises
• Create a progressive strengthening plan to help the tendon adapt to effort again

How to prevent shoulder tennis injuries

Before playing: 

• Perform a complete warm-up:
• Light cardio activation (jumping in place, lateral movements, short sprints
• Light serves and rallies

During your return to play:

• Progress gradually, especially after time off
• Limit match play in your first session
• Gradually increase session length and intensity

Article written by Simon Tremblay, physiotherpy technologist and osteopath.

Article published on June 2nd, 2021. Updated on May 28, 2025.