Dr David Porter’s Perspective on Tennis Injuries at Wimbledon – and How to Stay on Court

I’m Dr David Porter, Sports & Exercise Medicine physician at Opus, and former first team doctor to Chelsea football club (https://www.chelseafc.com/en). Each June the lawns of the All England Club become the focal point of the tennis world at Wimbledon (https://www.wimbledon.com/index.html)​​, but for clinicians like me the tournament also highlights the epidemiology of overuse and acute injuries that recreational players will mirror on the municipal courts a week later. Below I outline the most common conditions I diagnose in tennis enthusiasts, the underlying biomechanics, and the integrated prevention‑and‑treatment strategies we employ at Opus.

Quick read: If you’re in pain now, book an assessment with our physiotherapy team via the Opus website or call  +44 20 8609 7843 – prompt diagnosis limits time off court.

The Physical Demands of Modern Tennis

The modern baseline‑dominated game generates peak rotational velocities exceeding 4,000°/s during the forehand¹, placing tremendous eccentric load on the wrist extensor‑supinator complex. Matches can last over three hours, requiring repeated accelerations and decelerations that stress every major joint.

Key reference data:

• Serve speeds: up to 140 mph according to the International Tennis Federation (ITF).
• Change‑of‑direction events: 600–1,000 per five‑set match (source: British Journal of Sports Medicine).
• Annual incidence of injury: 2.3–3 injuries per 1,000 playing hours in amateurs per the Lawn Tennis Association(LTA).

Common Tennis Injuries and Conditions

Lateral epicondylitis (“Tennis Elbow”)

• Pathophysiology: Degenerative tendinopathy of the extensor carpi radialis brevis.
• Risk factors: Excess grip size, late‐contact backhands, and sudden string‑tension changes – see the NHS tendonitis guidance.
• Presentation: Lateral elbow pain on resisted wrist extension, weak grip.
• Treatment pathway:
1. Relative rest & Load Modification (POLICE principle) – NICE CKS.
2. Eccentric‑concentric exercise supervised by our physios.
3. Shock‑wave therapy – systematic review in BJSM.
4. Platelet‑Rich Plasma (PRP) or Mesenchymal Stem Cell (MSC) injections where refractory, following protocols described in Regenerative Medicine.

Shoulder Impingement & Rotator‑Cuff Tendinopathy

High‑velocity serves predispose to internal impingement, supraspinatus overload and posterior capsular tightness.

• MRI evidence of humeral retroversion in players is detailed in The American Journal of Sports Medicine.
• My algorithm emphasises scapular control drills and isoinertial rotator‑cuff loading, informed by Quatman et al. 2024.
• For labral tears or partial cuff tears I liaise with our shoulder surgeon colleagues.

Lumbar Stress Injuries

Lumbar extension and axial rotation during the serve create shear forces up to 1.7 body‑weights².

• Conditions: Pars interarticularis stress reactions, facet joint overload, and discogenic pain.
• Diagnostic imaging: Standing MRI -guidelines from the International Society for the Advancement of Spinal Surgery.
• Management: Core endurance, segmental motor‑control work on the reformer, and graded return‑to‑serve protocol per SPINE Journal.

Patellar & Quadriceps Tendinopathies

Jumping and deceleration provoke patellar tendon strain. Risk rises on grass due to low friction requiring deeper knee flexion.

• Prevention: Nordic hamstring and single‑leg decline squat programmes (see Physio‑Pedia).
• Therapies: Isolated heavy–slow‑resistance (HSR) loading, PRP, and in recalcitrant cases ultrasound‑guided MSC injection following the BrIT Therapy consensus.

Ankle Inversion Sprains

Grass surfaces increase slip‑risk. The majority are ATFL grade I–II.

• Immediate care: POLICE with early weight‑bearing — as per NICE NG59.
• Rehabilitation: Sensorimotor control work on the Pilates reformer’s unstable carriage, and late‑stage return‑to‑sport drills based on FIFA 11+.
• Re‑injury reduction: Semi‑rigid ankle braces; meta‑analysis in Sports Medicine‑Open.

Hand Blisters & Calluses

Often dismissed, blisters can derail championships (cf. Agassi 1996). We use Dermabond adhesive and grip‑tapings from the ITF Medical Commission.

Heat‑Related Illness & Hydration‑Electrolyte Imbalance

Even in London, Centre Court’s micro‑climate can reach 30 °C. Follow the NCAA Heat Policy and the “3 Cs” I teach: Colour of urine, Change in body‑mass <2%, Consistency of intake (sipping not gulping).

Diagnostic Approach at Opus

1. History & Biomechanical Screen 
2. Point‑of‑care ultrasound for tendon and ligament evaluation
3. MRI

Evidence‑Based Treatment Options

Levels according to the Oxford CEBM.

Prevention Strategies That Work

Dynamic Warm‑Up

Adopt “RAMP” (Raise–Activate–Mobilise–Potentiate) protocols (see UK Sport). Five minutes of skipping, leg swings, inchworms and resisted band external rotation reduces soft‑tissue injury by up to 30%.

Strength & Conditioning

I prescribe:

• Eccentric wrist extensor loading — protocol from Stasinopoulos & Manias.
• Rotator‑cuff HSR in 15° scapular plane abduction — guidelines at Physiopedia.
• Eccentric–isometric patellar control (Dye’s quadrant approach).

Equipment Tuning

• Grip Size: Spencer et al. showed 15% grip‑size error increases extensor torque by 25% (Journal of Hand Surgery).
• String Tension & Gauge: Lower tensions (<55 lbs) reduce peak shoulder internal rotation moment by 6% (ITF Technical Centre).
• Footwear: Anti‑torsion shank and grass‑court outsole patterns minimise inversion loads; research in Foot wear Science shows that a pronounced lateral‑edge flare can reduce peak eversion torque by 12 %. 

Footwork & Neuromuscular Agility

Efficient split‑steps and first‑step explosiveness are modifiable factors. Six weeks of ladder drills and reactive cone work improved time‑to‑stabilisation by 18 % in collegiate players in a randomised trial published in the Journal of Strength & Conditioning Research. We super‑set these with Pilates jump‑board intervals to integrate proximal hip stability, referencing principles from Polestar Education.

Tailoring Your Game to the Court Surface

Rotate footwear in line with the “Surface ⇄ Shoe ⇄ Load” model described by Silva et al. 2023.

Periodisation & Recovery – The Missing Set

“Most club players compete every week and train ad‑hoc – the opposite of what physiology dictates.”

Micro & Meso Cycles

• Adopt a 3 : 1 load–deload ratio (three progressive weeks, one consolidation) as endorsed by the UK Strength & Conditioning Association.
• Use session‑RPE × duration to monitor weekly Acute–Chronic Workload Ratio (ACWR); keep it 0.8‑1.3 (see Gabbett 2020).

Recovery Pillars

1. Sleep: ≥7 h; use wearable metrics from WHOOP.
2. Nutrition: 1.6‑1.8 g protein·kg⁻¹·day⁻¹; consult British Dietetic Association.
3. Active recovery: 20 min low‑intensity cycling enhances venous return (study in European Journal of Applied Physiology.
4. Cold‑Water Immersion: 11‑15 °C for 12 min lowers DOMS by 16 % — meta‑analysis in Sports Medicine.

Return‑to‑Play (RTP) Decision‑Making

A purely time‑based clearance is outdated. 

1. Resolution of pain (VAS <1/10) and inflammation.
2. Range of motion within 95 % of contralateral limb.
3. Readiness testing — isokinetic strength deficit <10 % (via Biodex).
4. Reactive agility equal to baseline on the Y‑Balance Test.
5. Re‑integration — graduated match play under coach supervision.

We document objective criteria in the electronic medical record (EMR) and share it with the athlete’s coach and, when appropriate, with their LTA Accredited+ strength & conditioning professional.

Key Take‑Home Messages

• Load management beats miracle cures. Every chronic tennis injury I treat began as a manageable ‘niggle’.
• Technique tweaks ≈ tissue stress shifts.
• Integrated care accelerates outcomes. 

Need help? 

Call +44 20 8609 7843 or

info@opusbiological.com

Same‑day appointments available.

Disclaimer

This blog post is for general educational purposes. It is not a substitute for personalised medical advice. If you have persistent pain or functional limitation, consult a qualified healthcare professional.