Preventing Upper Limb Injuries in Tennis

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Written by Renuka Pinto, former WTA physio / trainer

The nature of tennis as a sport exposes players to the risk of trauma based injury such sprained ligaments and strained muscles, especially around the ankle and knee. Rapidly changing directions, accelerating and decelerating on hard surfaces will always produce a few lower limb injuries. However, many of the upper body injuries related to overuse and instability are most certainly preventable.

In my experience working as a physical therapist with both elite and recreational tennis players in the New York area and around the world, including 3 seasons on the WTA, I’ve seen and treated a host of different upper limb injuries. Below I’ve detailed some of the most common breakdowns at the Shoulder, Elbow and Wrist, along with my approach to fixing them and more importantly, preventing repeat injury.

A key component of my process is using a science based training system called GravityFit. The exercises and equipment is the product of revolutionary space research conducted by GravityFit with NASA, amongst others. It’s a very different approach to injury prevention that really addresses the cause and not the symptom of the breakdown. To my knowledge I’m the only practitioner in the world using the system to specifically treat and prevent tennis related injuries, and it’s for that reason that I would like to give you an insight to how and why I use it.

Essentially I look to train the deep muscle system, which stabilizes the spine and key joints, allowing for more controlled movement and less strain on the joint structures themselves.



 Most of the problems I see around the shoulder are rotator cuff and labral tears.

This is mainly due to poor technique relating to the whipping motion of the racket head when speed is generated by high torque of the glenohumeral joint (ball and socket of shoulder).

This can be avoided by improved scapula (shoulder blade) stability at the start of the stroke and body rotation during ball contact. If the muscles around the scapula can’t provide stability to the shoulder then the slack has to be taken up by the rotator cuff muscles in particular. They are left doing a job that they aren’t designed for and will eventually wear out, resulting in pain and injury.

Equipment – GravityFit TPro

Technique – Developing more stability around the scapula through changing the motor patterning using postural feedback and applying appropriate load.


Receiving feedback on spine and shoulder posture under gentle load from the elastic tubing on the TPro.



The elbow joint is the victim caught between the cross fire of torquing forces generated by the shoulder and wrist joints, largely due to its lack of ability to rotate. Ligament injuries are common due to increased forces on a mistimed ball or from aiming to imparting spin. They are especially common during clay court season due to the slower ball and higher bounce.

Equipment – GravityFit TPro

Technique – Again the preventative solution here is to stabilize the scapula and strengthen the rotator cuff, using the TPro once more!




Different press and hold variations for the key stabilizers of the shoulder with constant postural feedback



These injuries tend to occur in both hands due to manipulation of the racket head when trying to finding angles and lines, disguising shots or imparting spin. On the dominant forehand arm, we see mainly capsular tears or tendinitis due to overload. On the backhand its usually shear forces that injures the tendons and/or cartilage. Key reasons for the manipulation of the wrist and ensuing injuries both is lack of rotation resulting from weakness and loss of resting curve in the thoracic spine (upper back). If we can strengthen the upper back, it can both stabilize and rotate more efficiently.

Equipment – GravityFit TPro

Technique – This time I use the TPro for a slightly different purpose; establishing neutral curve of thoracic spine which improves range and quality of rotation whilst provides the opportunity to strengthen the deep muscles.


Advanced press variations (complexity and load), training dynamic rotation through thoracic spine.


In summary, the common injuries I see in the upper body can be largely prevented through improving posture and strengthening the muscles surrounding the scapula and thoracic spine (shoulder blade and upper back). This has the benefit of removing strain from the shoulder, elbow and wrist through reducing torque and improving technique. GravityFit is by far the most effective method I use to achieve this, largely because this is the exact task they were designed for!


Renuka Pinto is an internationally trained and traveled physical therapist with over a decade of experience in sports medicine and manual therapy, working at the highest levels of tennis and cricket.