Sports Medicine: Musculoskeletal Injuries

(The information in this article was taken or adapted from the High Performance Coaching Program Study Guide.)

As a high-performance coach, you need to know some of the basic terminology regarding injuries to the musculoskeletal system.  These are the most common injuries in tennis, and they generally fall under the broader heading of overuse injuries.  Overuse injuries are injuries that, instead of occurring from one particular event or incident, happen when repeated stresses are applied to body tissues, resulting in overload and breakdown.  Some of the most common overuse injuries in tennis are shoulder or rotator cuff tendon problems, tennis elbow, and shin splints.  Some acute injuries do occur from a single event, such as an ankle sprain, and may not be considered to be overuse injuries.  Often, however, such injuries occur due to underlying weakness and deficiencies caused by the volume of training and tennis play required by higher-level players.

Here is more detail on some common injuries, including sprains, strains, tendonitis, and stress fractures.


Injury to the ligaments, which are the structures that hold a bone to another bone, are termed sprains.  These injuries are graded I, II, or III based on the amount of tearing or disruption of the ligament.  Sprains to the ankle, knee, and elbow are most common in tennis, but other areas such as the wrist can also be injured with tennis play.  As the ligaments hold the bones of the body together, ligament sprains can be very serious, and once ligaments are injured, they often cause instability at the joint where the injury  occurred.  For example, once a player has sprained an ankle, the primary ligaments that hold the ankle together remain stretched, as a ligament does not shorten or tighten while healing.  Therefore, regardless of the quality of rehabilitation and the player’s healing responses, the injured ankle will almost always remain looser than an uninjured ankle, making it more likely that the player will reinjure the ankle.  It takes from six weeks to several months for a ligament to heal properly due to the limited blood supply in these structures.


Injury to the muscle or muscle fibers is termed a strain. Strains are also graded as I, II, or III, with grade III being the most severe and representing a complete tear of the muscle. (Complete tearing is not common in tennis players, but can occur in episodes of trauma.) Strains to muscles that cross two joints, such as the hamstrings, quadriceps, or groin muscles, are most common in running-type sports such as tennis.  Once injured, a muscle has the ability to return to full strength and flexibility. Muscles have a very good blood supply and thus heal much more quickly than ligaments or tendons.


Tendons attach muscles to bones. Injury to tendons is termed tendonitis or tendonosis. The most common tendons injured in tennis are the rotator cuff tendons in the shoulder, the tendons on both the inside and outside of the elbow, and the Achilles tendon at the ankle.  Injuries to the tendon occur with overuse and can become chronic, such as in tennis elbow.  Severe injury to the tendon can require surgery; however, most injuries to the tendon are amenable to rehabilitation and rest. Tendon injuries, like ligament injuries, are difficult for the body to heal, as tendons have a very limited blood supply. Strengthening the muscles around the injured tendon and restoring flexibility to the muscle-tendon unit are the primary goals in rehabilitation.

Stress Fractures

While complete fractures of bones are not common in tennis players, stress fractures can occur due to the repetitive loads players incur during tennis play.  A stress fracture is a partial or incomplete fracture of bone that occurs when repeated rhythmic submaximal loads applied to the bone produce a failure or crack in the bone. The most common bones to have a stress fracture are the bones of the lower body, particularly the foot and lower leg.  Unfortunately, stress fractures do not show up initially on standard x-rays.  Often a special test called a bone scan is required to identify and confirm the diagnosis of a stress fracture.  A typical treatment is placing the foot or ankle in a walking boot for four to six weeks to protect the bone from stresses while it heals. Ways to prevent stress fractures in the lower body include wearing proper footwear (with orthotic inserts for players with certain types of feet) and using responsible training load and rest periods. Some athletes can be more prone to stress fractures due to their diet and their general structure and makeup.

Preventing Musculoskeletal Injuries

Here are some tips on how you can help prevent musculoskeletal injuries:

  • Use a periodized training program that allows players active rest and periods of recovery from high-level training and competition.
  • Evaluate your players for proper biomechanics and stroke production to minimize the chance that improper mechanics may cause injuries.
  • If a player becomes injured, follow the PRICE method when the area is initially injured. Seek proper medical advice from a doctor, therapist, or trainer who can initiate the proper rehabilitation steps.