Tennis Elbow and Other Common Injuries: A Recovery Guide for Adult Players

Most adult tennis players in Australia get injured eventually. The injury that takes you off the court is almost always one of four: tennis elbow, shoulder pain, knee trouble, or a strained calf. This is a plain English guide to each one, what causes it, how to recover, and the strength work that genuinely keeps it from coming back.

Disclaimer up front: this is general guidance written by recreational players who have lived through these injuries, not medical advice. If you have ongoing pain, see a sports physio. Your first session with a good physio is usually $90 to $150 in Australia and will pay for itself ten times over.

1. Tennis elbow (lateral epicondylitis)

What it is

Pain on the outside of your elbow that flares when you grip, lift, or shake hands. Usually a tendon overuse injury at the point where your forearm extensor muscles attach to the elbow.

What causes it in tennis

• Backhands hit late, with the wrist taking the load instead of the body. The most common single cause in adult learners.
• A grip size that is too small for your hand.
• A racket that is too stiff (high RA stiffness rating) or too heavy.
• Strings strung too tight.
• A sudden jump in playing frequency (going from once a week to three times a week).

Recovery

• Stop hitting for two to four weeks. The single hardest part. There is no shortcut.
• Ice the elbow for 15 minutes, three times a day, for the first week.
• Once acute pain settles, start eccentric forearm work: hold a 1kg dumbbell, slowly lower it from a straight wrist position over five seconds, then use your other hand to return it to start. Three sets of 15, daily. This is the single most evidence-backed exercise for tennis elbow.
• Soft tissue work on the forearm (foam roller, massage ball, or physio).
• Return to tennis gradually. First week back: 30 minutes of mini-tennis only. Second week: 45 minutes of rallies. Third week: full session.

Prevention

• Switch to a flexible-frame racket (Wilson Clash, Yonex Ezone) if you can.
• String at lower tension (50 to 54 lbs for most adults).
• Bigger grip size if you have small hands. Pad your existing grip with an overgrip if needed.
• Strengthen your forearm extensors year-round. The eccentric exercise above, twice a week, prevents 80% of recurrences.
• Fix the late backhand with one coaching lesson focused on contact point.

2. Shoulder pain (rotator cuff issues)

What it is

Aching or sharp pain in the front or side of the shoulder, usually worse when serving overhead or reaching for high backhands. The rotator cuff is a group of four small muscles that stabilise your shoulder; most tennis shoulder pain is irritation or partial tearing of these.

What causes it in tennis

• Serving with poor mechanics (especially "elbow first" or arming the ball).
• Too many overheads in one session.
• Weak shoulder stabilisers from the gym side (most adults have very weak rear-shoulder muscles).
• Skipping warm-up before serving practice.

Recovery

• Stop serving and overheads for two to three weeks. You can keep rallying.
• Apply ice after any tennis for the first week.
• Anti-inflammatories if your GP approves them.
• Begin rotator cuff strengthening: external rotations with a resistance band, three sets of 15 each side, daily.
• See a physio if pain is sharp or persists past three weeks. Shoulder injuries can become long-term if ignored.

Prevention

• Warm up shoulders specifically before serving. Five minutes of band rotations + arm circles. Most adult players skip this.
• Limit serves to 30 to 50 per session if you have a history of shoulder pain.
• Strengthen the rear deltoid and rhomboids in the gym (face pulls, reverse flyes, rows). These are the muscles that hold your shoulder in safe alignment.
• Improve serve technique. One coaching session focused on serve mechanics is the single best money you can spend if you have recurring shoulder pain.

3. Knee pain (patellar tendinopathy and meniscus issues)

What it is

Two common knee injuries in adult tennis. Patellar tendinopathy is pain just below the kneecap from overload on the tendon connecting the kneecap to the shin. Meniscus issues are deeper, sharper pain often triggered by pivoting on a planted foot.

What causes it in tennis

• Hard court surfaces (especially synthetic over concrete, which is most Australian public courts).
• Old or worn-out court shoes.
• Pivoting hard on serves and overheads.
• Weak quads and glutes.
• Body weight (one of the few cases where being lighter genuinely helps).

Recovery

• Reduce volume by 50% for two weeks. Do not stop entirely unless pain is sharp.
• Switch to clay if you can find a clay court near you (much easier on knees).
• Replace your court shoes if they are over a year old or the soles are flat.
• Begin isometric quad holds: wall sit at 45 degrees for 45 seconds, five times, daily. Best evidence for patellar tendon recovery.
• For meniscus suspicion (sharp catching, locking, swelling), see a GP for imaging. Do not push through.

Prevention

• Buy proper court shoes and replace them every 12 to 18 months. Running shoes are not court shoes.
• Strength train your legs year-round. Squats, lunges, step-ups, glute bridges. The strongest predictor of knee health in adult tennis players is leg strength.
• Warm up your legs before serving. Two minutes of jogging plus 20 leg swings each side.
• Cross-train with low-impact cardio (swimming, cycling) to give knees a break between sessions.

4. Calf strain

What it is

A sudden sharp pain in the back of the calf during a sprint or push-off, often described as "feeling like someone kicked me". A muscle fibre tear, ranging from mild (1-2 days off) to severe (8+ weeks off).

What causes it in tennis

• Cold muscles. Calf strains are the single most warm-up-preventable injury in tennis.
• Sudden change of direction at full pace.
• Dehydration, which makes muscle tissue more brittle.
• Age. Calf strains spike sharply after 35 and again after 45.

Recovery

• Stop immediately when it happens. Trying to "play through" turns a 2-day injury into a 4-week injury.
• Ice for 15 minutes, three times a day, for the first 72 hours.
• Compression sleeve or wrap during waking hours for the first week.
• Walk normally as soon as you can without pain. Total rest delays recovery.
• Slow calf raises starting day 3 to 5. Three sets of 15, both legs, then progress to single-leg.
• Return to tennis only when you can sprint at full pace without pain in a controlled drill. Usually 1 to 4 weeks depending on severity.

Prevention

• Warm up for at least 8 to 10 minutes before any sprinting. Jog two laps, do leg swings, jog backwards.
• Stay hydrated. Aim for half a litre of water in the hour before play and sip throughout.
• Two sets of calf raises three times a week as part of any strength routine.
• Yoga or stretching once a week. Even ten minutes helps.
• If you are over 40, do a dynamic warm-up every single time, no exceptions.

The pattern across all four

You will notice the same themes:

• Warm up properly. 10 minutes minimum. Most adults skip this.
• Strength train. 30 minutes twice a week of basic resistance work prevents most chronic tennis injuries.
• Replace your gear. Old shoes, old strings, old grips all increase injury risk.
• Take rest seriously. Tennis is hard on the body. A day off between sessions matters more than most adults admit.
• See a physio sooner, not later. Cheaper, faster, and more reliable than internet diagnosis.

One more thing

Track your sessions. If you log every match you play (rough length, intensity, any niggles afterwards), you will spot patterns long before they become chronic injuries. The two-week mark before tennis elbow appears is almost always preceded by a sharp jump in weekly volume. Notice it and back off and you avoid the injury entirely.

Tracking is one of the reasons we built RallyHub. See our post on how to track your tennis matches and why you should bother. Your future self will thank you.