Tennis is one of the most popular sports in the world. In the U.S. alone, there are almost 18 million players, with another 14 million expressing interest (TIA 2018). Unfortunately, the dynamic, forceful twists and turns of the game pose ever-present injury risks to players (Roetert & Kovacs 2011).

If your fitness clientele includes people interested in playing this sport, you need to understand the causes of tennis-related injuries. This will help you develop strategies for improving movement function, reducing pain and keeping clients on the court.

Causes of Common Tennis Injuries

Tennis players most often suffer joint and muscle strains to the knees, lower back and shoulders (Roetert & Kovacs 2011). The roots of these injuries start with basic tennis biomechanics.

Tennis groundstrokes—forehand and backhand—require the body to generate a lot of power to hit the ball. This force results primarily from taking the racket back and following through quickly while striking the ball. The legs pivot in the hip sockets, allowing the spine and shoulders to rotate and the arms to swing (Kovacs et al. 2016).

To generate even more power, advanced tennis players often jump during the swing and follow-through. These movements also sync with the leg/hip pivot to help generate upper-body rotation.

Thus, ample rotation of the hips is fundamental to many tennis moves that require rotation. Moreover, adequate hip rotation mitigates stress to the joints, tendons, muscles and other tissues most prone to tennis injuries (Kovacs et al. 2016). The knees are a hinge joint designed primarily to flex and extend. The lumbar spine can rotate but not as effectively as the hips. The shoulder blades protract and retract as the torso twists, but they lack the rotational capacity of the hips (Price & Bratcher 2010; McGill 2016; Cook et al. 2010).

Enhancing hip rotation therefore reduces the risks of tennis-induced overuse, potentially preventing pain and/or injury to the knees, lower back and shoulders.

You can improve clients’ hip rotation with a three-step process:

  • Assess their ability to internally and externally rotate the hips, looking for movement restrictions.
  • Identify muscles and other soft-tissue structures affected by the movement restrictions.
  • Select and design appropriate corrective exercise strategies to address muscle and movement dysfunctions (Price 2018).

Let’s explore these steps in greater detail.

Step 1: Assess Internal and External Hip Rotation

The hips must rotate internally and externally to allow a tennis player to make powerful, “pain-free” strokes. These tips will help you assess a client’s hip rotation:


Have your client lie on the floor with legs spread about 18-24 inches apart. Coach him or her to try turning both legs inward so the feet move toward each other. Tell the client not to bend the knees or let the pelvis lift off the ground as the legs rotate inward.

Next, see how far your client can turn the legs toward the midline. Both legs should be able to turn in about 40 degrees. Assess if one leg cannot turn in as far as the other leg or if both sides lack internal rotation.


Instruct your client to try turning both legs outward so the feet move away from each other. See how far the legs can turn away from the midline. Again, remind the client not to bend the knees or let the pelvis lift off the ground as the legs rotate outward. Both legs should be able to turn out about 45 degrees. Assess if one leg cannot turn out as far as the other leg or if both sides lack external rotation.

Step 2: Identify Affected Soft-Tissue Structures

A client who cannot internally or externally rotate the hips may have problematic soft-tissue and muscle imbalances (Kovacs et al. 2016).


A thorough understanding of functional anatomy—including the muscles that affect hip function—is crucial to choosing the most appropriate corrective exercises. For example, inability to internally rotate the hip may result from muscle tightness and/or restriction in the gluteus maximus; in the posterior fibers of the gluteus minimus, tensor fasciae latae and gluteus medius; in the hip rotators, adductors and hip flexors; and in the obliques (indirectly). Conversely, an inability to externally rotate the hip may reflect soft-tissue restriction or dysfunction in the hip adductors and hip rotators; in the anterior fibers of the tensor fasciae latae, gluteus minimus and gluteus medius; in the medial hamstring muscles; and in the obliques (indirectly) (Price 2018; Gray 1995).

In your assessment, ask where the client feels the most tightness or restriction. This information will help you identify the muscles and soft-tissue structures that need the most help from corrective exercises.

For Step 3—with illustrated examples of corrective exercises that can help clients improve hip function, enhance movement performance, and decrease the incidence of pain and/or injury from playing tennis—see “Tennis: Reduce Pain, Improve Performance” in the online IDEA Library or in the September 2018 print edition of Fitness Journal. If you cannot access the full article and would like to, please contact the IDEA Inspired Service Team at 800-999-4332, ext. 7.


Cook, G., et al. 2010. Movement: Functional Movement Systems: Screening, Assessment, Corrective Strategies. Aptos, CA: On Target Publications.

Gray, H. 1995. Gray’s Anatomy. New York: Barnes & Noble Books.

Kovacs, M.S., et al. 2016. Complete Conditioning for Tennis (2nd ed.). Champaign, IL: Human Kinetics.

McGill, S. 2016. Low Back Disorders: Evidence-Based Prevention and Rehabilitation (3rd ed.). Champaign, IL: Human Kinetics.

Price, J., & Bratcher, M. 2010. The BioMechanics Method Corrective Exercise Specialist Certification Program. San Diego: The BioMechanics Press.

Price, J. 2018. The Biomechanics Method for Corrective Exercise. Champaign, IL: Human Kinetics.

Roetert, P., & Kovacs, M.S. 2011. Tennis Anatomy. Champaign, IL: Human Kinetics.

TIA (Tennis Industry Association). 2018. Tennis participation in the U.S. grows to 17.9 million players. Accessed June 5, 2018:

Justin Price, MA

Justin Price is the creator of The BioMechanics Method® Corrective Exercise Specialist (TBMM-CES) program, the fitness industry’s highest-rated specialty certification. There are trained TBMM specialists in over 70 countries helping people alleviate pain and reach their performance goals. He is also the author of several books including the esteemed academic textbook The BioMechanics Method for Corrective Exercise. Justin is a former IDEA Personal Trainer of the Year, founding author of PTA Global, and a subject matter expert for The American Council on Exercise, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men's Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine. Learn more about The BioMechanics Method®

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