The shoulder, one of the joints that takes the most strain in tennis
Shoulder pain is common in tennis: it often results from repetitive overhead movements, especially during the serve, and can affect amateur players, competitive teenagers, and professionals alike. Serving, smashing, forehands, backhands: the dominant shoulder is constantly under strain, placing significant stress on the joint, the rotator cuff, and the entire muscle chain connecting the legs, torso, and arm.
Shoulder injuries account for between 4% and 17% of all injuries observed in tennis players (Alrabaa et al., 2020). The authors of this review also note that rotator cuff injuries are often related to repetitive and progressive stress rather than a single traumatic event.
Shoulder pain can therefore affect both casual players and competitive athletes. Common injuries and conditions include rotator cuff tendinopathies, certain tendon injuries, shoulder impingement, labral tears, and scapular control disorders.
A broader review specifically cites rotator cuff injuries and internal impingement among the main upper extremity injuries observed in tennis (Dines et al., 2015).
Understanding these mechanisms is helpful for continuing to play under good conditions, limiting the worsening of an existing injury, and identifying sooner situations that call for adjusting your practice. The following section helps you identify common causes, key statistics, injury mechanisms, warning signs, prevention strategies, and guidelines for determining whether it’s best to continue playing, scale back, or temporarily stop playing tennis.
Shoulder Pain in Tennis: Some Statistics You Should Know
The available data show that shoulder injuries are a significant issue among regular players and competitors, with varying degrees of severity depending on age and skill level.
Among competitive adolescents aged 13 to 19, the SMASH prospective study found an incidence of approximately 0.38 new shoulder injuries per 1,000 hours of tennis, or roughly one injury per 2,600 hours of play in the study population (Johansson et al., 2022).
Professional tennis is no exception.
A study of injuries treated at Roland Garros, the Paris tournament, between 2011 and 2022 identified 750 musculoskeletal injuries among 687 players (Montalvan et al., 2024).
The shoulder was the second most common anatomical site affected, with 89 injuries, accounting for 11.9% of all reported injuries.
Of the injuries involving the shoulder and arm region, 57% were tendon-related.
These figures show that, even at the highest level, shoulder pain and injuries are far from rare.
Why do tennis players injure their shoulders?
The shoulder is an extremely mobile joint. This mobility allows players to generate the speed needed for serves and overhead shots, but it also requires significant muscular stabilization, which is essential for proper shoulder function. Repeated overhead movements can place significant stress on the joint (Van der Hoeven et al., 2006).
Proper shoulder function depends not only on the rotator cuff, but also on the positioning of the shoulder blade and the coordination of the entire kinetic chain. This comprehensive approach to repetitive strain is broadly consistent with what are known as musculoskeletal disorders of the shoulder, which are also found in activities very different from sports, such as office work in front of a computer screen.
Practicing serves and smashes
Rotator cuff injuries observed in tennis players are often overuse injuries. They can develop gradually as a result of repetitive movements and high stress. Repetitive movements can cause microtears in the tendons (Alrabaa et al., 2020).
The serve is one of the most demanding movements for the shoulder. It is the stroke that produces some of the highest levels of muscle activity in the shoulder and forearm, with a high intensity of stress (Dines et al., 2015). The tendons of the shoulder’s stabilizing muscles also undergo microtrauma over repeated use.
An imbalance in the rotator cuff muscles
Tennis players naturally develop muscular adaptations between their dominant and non-dominant arms.
The muscles responsible for internal rotation are heavily engaged to accelerate the racket, while the external rotators play a key role in controlling and slowing down the arm.
A significant imbalance between these muscle groups can alter shoulder mechanics. A review focused on the prevention of shoulder injuries in athletes who perform repetitive overhead movements specifically identifies the strength of the external rotators, joint mobility, and scapular control as important parameters to monitor (Cools et al., 2015). In this type of subacromial impingement, muscle imbalance or poor posture can exacerbate the discomfort.
Reduced mobility in internal rotation
Repetitive tennis movements also lead to changes in mobility.
A study of 100 professional tennis players found an association between reduced internal rotation of the dominant shoulder and a history of shoulder pain (Vad et al., 2003).
Another study showed that internal rotation of the dominant shoulder tended to decrease with years of practice (Kibler et al., 1996).
Finally, a meta-analysis examined the link between glenohumeral internal rotation deficit ( GIRD) and the risk of upper-limb injury among athletes who perform repetitive overhead movements (Keller et al., 2018).
Poor control of the shoulder blade
The scapula plays a central role in shoulder function.
When its movement is impaired, the condition is referred to as scapular dyskinesia. It can alter shoulder mechanics and be associated with certain rotator cuff disorders, impingement, or instability.
A systematic review involving 1,401 athletes found scapular dyskinesia in 61% of athletes who participated in sports involving repetitive overhead movements, compared with 33% of other athletes (Burn et al., 2016).
However, this does not mean that 61% of injured tennis players have scapular dyskinesia. The study included several sports, and this abnormality can also be observed in athletes who are pain-free.
Leading studies on scapular dyskinesia and the kinetic chain also highlight the importance of scapular function in shoulder pain and injuries among athletes, with movement coordination occurring throughout the entire kinetic chain (Burkhart et al., 2003).
An overly rapid increase in training load
A sudden increase from a low volume of tennis to several practices and matches per week can expose the shoulder to a load for which it is not sufficiently prepared.
In the SMASH study mentioned earlier, 301 competitive tennis players aged 13 to 19 were followed for one year (Johansson et al., 2022). The researchers observed that each new peak in training or match load was associated with an approximately 26% increase in the rate of shoulder injuries.
The key factor, therefore, is not only the total number of hours played, but also the rate at which the training load increases.
What are the most common shoulder injuries in tennis?
Shoulder pain in tennis players can have various causes.
Among the conditions described in the literature are, in particular:
- rotator cuff tendinopathy;
- partial tears of the rotator cuff tendons;
- internal or subacromial impingement;
- injuries to the long biceps tendon;
- certain labral tears, including a SLAP tear, which involves damage to the stabilizing cartilage of the shoulder;
- stiffness of the posterior capsule;
- scapular dyskinesia;
- certain types of shoulder instability.
In rotator cuff tendinopathies, thesupraspinatus tendon is most commonly affected. Rotator cuff injuries in tennis players often have an initial, progressive course, and complete tears are more common in older players; certain neurological-type pain symptoms also tend to appear more frequently after age 35 (Alrabaa et al., 2020).
The term “shoulder tendinitis” is still widely used in everyday language. However, healthcare professionals often refer to it as tendinopathy, since persistent tendon pain does not necessarily correspond to pure inflammation of the tendon.
When should you be concerned about shoulder pain while playing tennis?
Occasional discomfort after a particularly intense session does not automatically mean that a serious injury is present, even for a tennis player.
However, certain symptoms should raise concern:
- pain when serving or spiking;
- pain on the side or back of the shoulder;
- pain that persists after a workout;
- nighttime shoulder pain, which often suggests active inflammation of the shoulder;
- a gradual decline in mobility;
- a feeling of unusual weakness or fatigue in the arm;
- a loss of power on serve;
- a feeling of instability or blockage;
- severe pain following a sudden jolt or a fall.
Pain should be taken seriously, especially when it lasts for several days, worsens, recurs consistently with the same movement, or is accompanied by a loss of strength or mobility. Taking a break from sports helps prevent further microtrauma.
A doctor, a sports medicine physician, or a physical therapist can identify the source of the pain and determine whether further testing is necessary. Pain management often involves applying ice after exercise to help manage pain and inflammation and, if necessary, taking anti-inflammatory medications. This is precisely the area of expertise of our scientific advisory board, which includes surgeons, sports medicine doctors, and physical therapists.
How can you prevent shoulder injuries in tennis?
There is no method that can completely eliminate the risk of injury. However, several measures can help better prepare the shoulder for the stresses of tennis. A specific dynamic warm-up before playing is one useful guideline, and 10 to 15 minutes are generally recommended to reduce the risk of shoulder injury. A properly fitted racquet can also help limit the strain on the shoulder. Outside of practice sessions, providing good support for the shoulder while at rest—for example, with an —contributes to comfort and a more appropriate resting position between training sessions.
1. Gradually increase your tennis workload
Avoid sudden changes in volume.
If you’re returning to play after several weeks off, it’s best to gradually build up the number and intensity of your workouts and your time on the court, rather than immediately resuming your previous routine. In fact, a link has been shown between successive peaks in tennis-related load and an increase in the rate of shoulder injuries among young competitive players (Johansson et al., 2022).
2. Maintain mobility in the dominant shoulder
Tennis often leads to a decrease in internal rotation of the dominant arm.
For some players, individualized mobility training may be beneficial in order to maintain an appropriate range of motion. In particular, an association has been found between limited internal rotation and a history of shoulder pain (Vad et al., 2003).
However, this does not mean that a difference in range of motion between the two shoulders is necessarily pathological.
3. Strengthen the rotator cuff and the stabilizers of the shoulder blade
Prevention efforts aren't just about "building up strength."
In particular, it may involve the external rotators, the rotator cuff muscles, and the muscles responsible for scapular control. The same review specifically identifies internal shoulder rotation, rotator cuff strength, and scapular control as important parameters (Cools et al., 2015).
4. Work on the entire movement chain
Good service isn't just about physical strength.
Targeted strengthening exercises should also be performed in a controlled manner, without causing pain, to maintain good stability of the shoulder and shoulder blade within the entire body.
The legs generate some of the energy, the torso transfers it, the shoulder channels that energy, and the wrist ensures the final transfer of force to the racket.
When one of the components of this chain functions less efficiently, the shoulder may be subjected to greater stress. Leading studies on the biomechanics of the shoulder in tennis highlight the importance of this coordination in the transfer of forces to the upper limb (Kibler, 1995).
Training the legs, core, and stabilizing muscles is therefore also part of a player’s preparation to maintain the quality of their movements and athletic performance.
5. Work on your serve technique
An ineffective motion repeated hundreds or thousands of times can unnecessarily increase stress on the shoulder, especially if the arm and body are positioned incorrectly during the serve.
Since this serve places a particularly high strain on this joint, it is essential to have a coach check your form:
- ball throwing;
- coordination between the legs, torso, and arms;
- the position of the arm relative to the shoulder;
- the pace of service;
- relaxation during the movement.
A technical flaw in the serve can also contribute to discomfort in the shoulder or even the elbow. The same journal highlights the importance of the kinetic chain and coordination in tennis movements (Dines et al., 2015).
6. Schedule real recovery periods
Fatigue and a heavy schedule can temporarily affect shoulder function.
One study found that after a game, isometric strength during external rotation of the dominant shoulder decreased by approximately 4.8% (Moreno-Pérez et al., 2019).
Another study, conducted during a three-hour game, also found changes in internal rotation and total range of motion of the shoulder over the course of the game (Martin et al., 2016).
Recovery is therefore an integral part of training, especially when the number of games or serves increases.
Can you keep playing tennis if you have shoulder pain?
This question should be directed primarily to your primary care physician or a sports medicine specialist, who can provide an answer based on the established diagnosis. It alldepends on the cause, intensity, and progression of the pain.
Mild, occasional discomfort is not the same as pain that gets worse with each game or that persists at rest and during the night.
Continuing to play despite significant pain can also cause the player to unintentionally alter their form to compensate. This can make the situation worse or even lead to other conditions elsewhere in the body.
If pain persists, it is best to determine its cause before increasing your training load again.
Treatment then depends on the diagnosis. For many types of pain related to the rotator cuff or overuse, treatment may involve, in particular, temporarily adjusting one’s activities and following a progressive rehabilitation program that includes mobility exercises, strengthening, and kinetic chain exercises, along with physical therapy, if needed, to help stabilize the shoulder.
Surgery is not routinely performed: it remains rare and is considered only as a last resort for treating shoulder pain in tennis players. It is used for certain specific injuries, may be indicated in cases of tendon rupture, or in situations where appropriate conservative treatment is insufficient; arthroscopy is a commonly used technique, and postoperative rehabilitation is essential afterward.
Shoulder pain at night after playing tennis: Why?
Some players feel their pain particularly strongly when they lie down, especially when they sleep directly on the affected shoulder.
Nighttime pain may be present in various shoulder conditions, including certain rotator cuff disorders, but it is not sufficient on its own to establish a diagnosis.
When your shoulder is painful, the main goal is to find a position that minimizes strain and remains comfortable. The French National Health Insurance system recommends, in particular, that if you have a painful shoulder, you should avoid sleeping on the affected side and instead rest your arm on a pillow placed under your forearm.
This position can be particularly helpful when the shoulder remains sore after a practice session or a match. This phenomenon, which extends far beyond tennis, is discussed in detail in our article on . Beyond the shoulder itself, the effects of poor sleep on daily health are discussed in our article on .
Key takeaways
Shoulder pain is common in tennis because the sport combines speed, repetition, power, and large overhead movements.
To summarize the key figures: 4 to 17% of tennis-related injuries involve the shoulder (Alrabaa et al., 2020). At Roland Garros, shoulder injuries accounted for 11.9% of musculoskeletal injuries recorded between 2011 and 2022 (Montalvan et al., 2024). Among young competitive players, peaks in training load are associated with an increase in the rate of shoulder injuries (Johansson et al., 2022). Finally, shoulder mobility, rotator cuff strength, and scapular control remain the three key parameters to monitor (Cools et al., 2015).
Prevention therefore relies primarily on a combination of progressive training, proper technique, strength training, appropriate mobility exercises, and effectiverecovery and warm-up routines.
And when pain persists, worsens, or limits movement, it’s best to have it evaluated by a healthcare professional rather than continuing to play through it.
Find all of our articles on shoulder health in everyday life in our .
Frequently Asked Questions About Shoulder Pain in Tennis
Why does my shoulder hurt after playing tennis?
Repeated serves, smashes, and other shots can gradually strain the rotator cuff and other shoulder structures. A recent increase in the volume or intensity of play can also contribute to the onset of pain.
What is the most common shoulder injury in tennis?
Rotator cuff injuries, particularly tendinopathies of the supraspinatus tendon and certain partial tears, are among the conditions frequently reported in tennis players (Alrabaa et al., 2020).
Other possible causes include: impingement, labral tear, posterior stiffness, scapular control disorder, or instability.
Can serving cause shoulder pain?
Yes. The serve is one of the most demanding tennis movements for the shoulder; it generates some of the highest levels of muscle activity in the shoulder and forearm (Dines et al., 2015).
How can you prevent shoulder tendinopathy in tennis?
Prevention can include, in particular, a gradual increase in playing load, appropriate mobility training, strengthening the rotator cuff and the muscles that control the shoulder blade, as well as technical work on the serve. The SMASH study specifically highlights the importance of limiting sudden spikes in load among young competitive players (Johansson et al., 2022).
When should you seek medical attention for shoulder pain caused by tennis?
A medical consultation is recommended if the pain persists, worsens despite reduced activity, occurs regularly at night, is accompanied by a loss of strength or mobility, or prevents the patient from serving and playing normally; a patient who continues to experience pain despite rest may then be referred to a specialist. In the case of a complex or persistent injury, a surgeon’s opinion may be helpful, especially since a fall on the court can sometimes result in an ankle injury that warrants a comprehensive evaluation.
Sources
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