Tennis Physio

So you have a mean groundstroke; yet no one knows that with each hit, you get a sharp pain down the right side of your back. Now every hit causes a grimace of pain that your opponents start to notice. What does this mean? Why do you have low back pain while playing tennis?

Obviously, tennis is a very complex sport that requires skill, technique, motor control, strength, power, and coordination. If one of the pieces isn’t there, something has to give.

And it usually does. Research shows that recreational tennis players sustain 1.5 injuries/year/player. The majority of these injuries happen in the lower extremity.¹

Today, we are going to focus on the importance of pelvic and hip mobility while playing tennis. Good hip movement and strength will decrease the incidence of low back pain and injury in tennis players.

The Kinetic Chain and Lower Extremities in Tennis

The Kinetic chain concept of motion represents an energy transfer from the ground up to the point of impact between the racket and the ball. Most of the time when players learn how to hit a tennis ball, the focus is on the arm, wrist, and racket position.

However, by using your legs and hips to produce power during a swing, you can protect yourself from injuries up the chain in the low back, shoulder, and elbow.

According to Scott Miller in Applied Biomechanics of Tennis, an effective leg drive during a serve is important to decrease injuries, requiring a players front knee to bent at an angle of at least 14°. In addition, the trunk and legs together deliver 51-55% of the kinetic energy to the hand while the shoulder only delivers 13% of the kinetic energy.²

low back pain during tennis

The hips are especially important in tennis because they are the mode of power transfer between the lower and  upper body. And in order to produce power, mobility is a prerequisite. If the hips aren’t moving like they should, it will affect the rest of your swing.

Specifically, for more power output, you need to separate your hip turn from your shoulder turn during a groundstroke. The hips should start to rotate first (since groundstrokes start from the bottom up), with the shoulder either staying still or rotating the opposite way. After the hips start moving forward, then the shoulders follow. The more you separate the time between the hip rotation and shoulder rotation, the more power you are going to be able to generate during your swing.³

What Does This Have To Do With Low Back Pain During Tennis?

When it comes to the quick stop and starts required on the court, the hip is one of the most important parts of the body to have ready. The importance of hip mobility can not be emphasized enough. There is a strong correlation between decreased mobility of the hips and an increased risk of low back pain during tennis. If the pelvis can’t rotate on the legs properly, the low back or knees are forced to take the brunt of this.³

It is also imperative you have adequate hamstring flexibility. When the hamstrings are not flexible enough, this can lead to decreased pelvic and hip mobility. Tennis players tend to have decreased hamstring flexibility, which may possibly be explained by the “low ready position.”

Since tennis is a game of unpredictability, starting with your body low to the ground makes sense. It allows you to generate explosive movement quickly. However, this same position also has your hamstrings in a shortened position for extended periods of time. Therefore, is it important that hamstring flexibility is maintained in order to prevent risk of low back and/or lower extremity injury.


Because the game of tennis requires a combination of various lower and upper body movements, it may be difficult to determine why you get low back pain during tennis.

If adding a core routine or flexibility exercises doesn’t seem to be helping your tennis game, check out In Motion PT’s tennis rehabilitation page for more info.

Stay tuned for In Motion Physical Therapy’s next blog post for more tips! In the meantime, give us a call to schedule your sports rehabilitation consult to improve your tennis game.


  2. Miller, S.T (2011). Applied Biomechanics of Tennis. In D.J. Magee (Ed.), Athletic and Sport Issues in Musculoskeletal Rehabilitation (pp.307-330). Saint Louis, MO: Elsevier Saunders.