Most upper extremity tennis injuries are chronic and result from non-contact mechanisms, and most injuries result from the serve. The kinetic chain that generates a serve is largely responsible for being the root cause of upper extremity injuries in tennis. The athletes vary in terms of their serve and groundstroke styles.

The serve has been broken down to:

1.  Wind-up
2. Early cocking
3.  Late cocking
4. Acceleration
5. Follow through

Forehand or backhand groundstrokes have been broken down to:

1. Racket preparation
2. Acceleration
3. Follow through

The kinetic chain, or the route of energy that flows through the body during a serve or groundstroke, allows for effective transfer of energy to the ball. The hip, knee, shoulder, elbow, and wrist joints serve as sequential links in the kinetic chain that absorb, generate, and transmit energy. During these strokes, safe and efficient energy transmission through the kinetic chain depends on endurance and technique. As energy transfer between links becomes inefficient secondary to fatigue or poor technique, joints in the chain can become overloaded and subsequently injured. In an energy flow comparison between injured and non-injured tennis players, injured players demonstrated lower quality of energy flow through the kinetic chain, lower ball velocity, and higher rates of energy absorbed by the shoulder and elbow joint compared with non-injured players.

Our physiotherapists have worked extensively in tennis both with recreational and professional players and tennis elbow is a condition we see a lot. In professional athletes the pain will be on the inside of the elbow due to the way they hit the ball. In recreational players the pain tends to be on the outside of the elbow – this is called lateral epicondylitis. In more experienced players lateral epicondylitis is due to an increase of wrist extension just prior to ball impact , and in more novice players it is likely to be due to striking the ball with their wrist in more flexed position at impact. Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. We will firstly ask you questions about string tension, racket weight and grip size as many of these problems can be greatly eased by asking the advice of a tennis coach or racket stringer about the above. If you have the correct string tension, racket weight and grip size then physiotherapy is the next option. We will assess, not only the elbow, but your whole technique as it is rarely just an elbow problem. It is more likely to be a combination of biomechanical ‘inefficiencies’ which manifest themselves in a painful elbow.

Our approach would be:

•  Manage the pain
•  Improve the range of movement throughout the kinetic chain
•  Improve shoulder stability, wrist strength and elbow control
•  Balance and position sense (proprioception) is also very important
• Progress to increasing the load, skill and speed of upper limb in generally and wrist and elbow movements in particular

It is not only sports people who experience tennis elbow, many keyboard users will have similar problems due to the ergonomics of their workstation, or simply how long they are spending at their desk on the computer.
Whatever the cause, be rest assured that your physiotherapist will thoroughly assess and diagnose the problem and will explain the underlying cause. Treatment may be hands on initially with an increasing emphasis on exercises and education. Your physiotherapist will progress the difficulty of these on an individual basis until we achieve self-management or resolution. Many people with tennis elbow say that it never goes away. This need not be the case. With the appropriate treatment, management, and education we can and have achieved resolution of the condition.

Wrist injuries are also common in tennis players depending on how they hit the ball as the load delivered to the wrist during the forehand stroke varies depending on hand grip position. There are four traditional single-handed hand grip positions

1. the Continental,
2. Eastern,
3. Semi-Western,
4.  and the Western

• The Eastern grip position is found to be associated with radial-sided wrist injuries while the Western and semi-Western grip positions are associated with ulnar-sided wrist injuries
• The impact position of the ball on the racquet and grip tightness can affect force transmission on the wrist. Off-centred impacts substantially increased wrist extension torque when compared with an impact that occurred at the centre of the racquet.
• Increased grip pressure resulted in a decrease in racquet rotation in the hand and a 20% increase in wrist extension torque compared with the normal grip. Ball-racquet location and grip tightness are important parameters when assessing the cause of a wrist or elbow problem in tennis players.
• The triangular fibrocartilage complex (TFCC) is a load-bearing structure between the lunate, triquetrum, and ulnar head. Its function is to act as a stabilizer for the ulnar aspect of the wrist. With the repetitive movements that are a feature of tennis, it is at risk of either acute or chronic degenerative injury.
• Forced compression on the ulnar side of the wrist as well as over stretching the complex may result in injury to the TFCC.

Treatment follows a full assessment and if imaging is required to confirm the diagnosis we will request an MRI, however, on most occasions this will not be necessary. We will look at the whole chain of movement and aim to make this as efficient and effective as it possibly can be in order to ease the strain on the upper limb and on the wrist in particular. Specific exercises will also be advised for the injured area and there will be some hands on treatment to help ease symptoms and provide pain relief.