Tennis injury prevention for girls.
An asymmetric, year-round sport with no offseason and a tournament calendar that never de-loads.
Overuse
The majority of complaints in elite junior tennis are gradual-onset, not acute.
1 arm
Structural asymmetry — the dominant side accumulates nearly all rotational and overhead load.
10 min
On-court warm-up covering shoulder, trunk, and lower limb before hitting.
A season-long prospective study of elite junior tennis players found most complaints were overuse rather than acute, spread across the shoulder, lower back, and lower limbs. Tennis is asymmetric by design — one arm serves and hits thousands of repetitions while the other does relatively little — and the serve loads the shoulder, trunk, and lead hip simultaneously.
It is also a sport with no natural offseason. Junior rankings reward tournament volume, so athletes stack competition weekends across the calendar and their tissue never gets an unloading block. Preventing tennis injuries is mostly a scheduling and strength problem, not a technique problem.
What actually injures tennis players
Shoulder overuse
The classic tennis complaintMechanism: Serve and overhead volume with scapular fatigue and posterior-shoulder tightness.
Female-specific: Cuff and scapular strength deficits are common in junior girls with limited off-court strength programming; range-of-motion asymmetry is measurable and trackable.1,2
Low back pain / lumbar bone stress
Common in servers with a big kick serveMechanism: Repeated hyperextension and rotation during the serve loading the posterior lumbar elements.
Female-specific: Persistent one-sided low back pain in an adolescent server is a bone stress presentation until proven otherwise and needs imaging rather than core exercises alone.1,4
Patellofemoral and hip pain
Common with high hard-court volumeMechanism: Repeated deceleration and lateral loading with limited hip strength.
Female-specific: Hip abductor and extensor strengthening is the highest-value off-court addition for junior girls in this sport.5
Why the risk is different for girls
These factors change what prevention has to address — they are not reasons to train girls less.
Energy availability comes before every other adaptation
When an athlete does not eat enough to cover the energy her training burns, the body downregulates the systems it treats as optional first — menstrual function, bone remodeling, immune response, and tissue repair. The IOC calls this Relative Energy Deficiency in Sport (REDs), and it raises bone stress injury and soft-tissue injury risk independent of how good her mechanics are. Amenorrhea (no period for three or more months) in an athlete is a clinical finding, not a convenience.9,10
Puberty changes the machine mid-season
The adolescent growth spurt lengthens the levers (femur, tibia) faster than the neuromuscular system recalibrates, and in girls the strength gain that accompanies growth is smaller than in boys. The result is a two- to three-year window of reduced dynamic knee control, wider dynamic valgus on landing, and higher relative injury risk. Programming should get more — not less — landing and single-leg work through this window.8
Menstrual-cycle phase is a variable, not a taboo
Hormonal fluctuation across the cycle affects laxity, neuromuscular control, thermoregulation, and perceived exertion, and prospective data in international footballers found injury incidence differed by cycle phase. The practical action is not to restrict training but to track: a simple cycle log next to load data lets athletes and staff see patterns and adjust intensity, hydration, and fueling.11
The protocol, block by block
Run before hitting. Twice a week, add a full off-court strength session — this sport cannot be prevented on court alone.
- 2 min
General warm-up
Baseline-to-baseline movement, side shuffles, split-step practice, hip openers.
- Land the split-step
- Stay low
- Progressive intensity
- 2 min
Scapular and cuff prep
Band external rotation, prone Y-T-W, serratus punch, cross-body and sleeper stretch for the dominant side.
- Blade first
- No shrug
- Slow eccentric
- 2 min
Trunk and anti-rotation
Pallof press, dead bug, side plank with reach — bracing under rotation, which is exactly the serve demand.
- Ribs down
- Breathe through the brace
- No sagging hips
- 2 min
Lower-limb strength and balance
Lateral lunges, single-leg RDLs, hop-and-stick to each corner, calf raises.
- Push through the outside foot
- Stick the landing
- Knee over the toe
- 2 min
Progressive hitting
Mini-tennis to baseline rallies to serves, building intent gradually. Never open with maximal serves.
- Build the range
- Serves last
- Stop if the shoulder pinches
What to check, and when to escalate
Shoulder rotation asymmetry
Passive internal and external rotation at 90° abduction, both sides, at preseason and every eight weeks.
Red flag: Progressive loss of total rotation on the dominant side.
Single-leg control
Single-leg squat and lateral hop-and-stick, both sides.
Red flag: Knee falling in, trunk collapse, or a clearly worse side.
Lumbar extension provocation
Ask about one-sided pain with the serve or with single-leg extension.
Red flag: Reproducible one-sided extension pain in an adolescent — refer for imaging.
Load rules that prevent overuse
- Plan tournament blocks with a deliberate unloading week after each; do not stack more than two or three competition weekends consecutively.
- Cap weekly on-court hours near the athlete's age in hours, and count lessons and hitting sessions.
- Serve volume gets its own count — the serve is the highest-load shot and the one most often ignored in planning.
- Take at least two months a year away from competitive tennis; cross-train instead of adding more court time.
Gear & equipment
- Racquet grip size and string tension matched to the athlete — stiff strings and high tension increase transmitted load to the arm.
- Court shoes matched to surface; hard-court outsoles on clay change the slide mechanics and raise ankle risk.
- Shoe replacement tracked by hours played, not appearance.
Stages, not dates
Progression is criteria-based and clinician-led. A calendar date is not a clearance.
- 1
1. Pain-free daily function
Full range, no night pain, normal walking and overhead reach.
- 2
2. Strength and symmetry restored
Cuff, scapular, and hip strength restored; rotation range comparable side to side.
- 3
3. Groundstrokes only
Rally at controlled pace, no serves, no overheads, symptom-free 24 hours after.
- 4
4. Serve progression
Graded serve counts from flat and low intent upward, with rest days between steps.
- 5
5. Match play
Full practice load tolerated; return to tournaments with a serve-count plan documented.
Questions coaches and parents ask
How many hours a week should a junior girl play tennis?
A widely used guideline is to keep weekly organized hours at or below the athlete's age in years, count lessons and hitting sessions in that total, and keep at least one full day off per week. Beyond that, overuse injury risk rises without a matching performance return.
What causes tennis shoulder pain in teenagers?
Almost always cumulative serve and overhead volume outpacing cuff and scapular capacity, often combined with progressive loss of internal rotation on the dominant side. It responds to a serve count plus structured off-court strength work.
How often does this program need to be run to work?
Meta-analyses of neuromuscular training find the protective effect tracks with dose: roughly two or more sessions per week, sustained across the full season, is the threshold where injury reductions become reliable. Programs run only in preseason lose most of their benefit by mid-season.
Should girls train differently from boys?
The exercises are largely the same; the emphasis and the dose differ. Female athletes get disproportionate benefit from posterior-chain strength, single-leg landing control, and trunk stability work, and they need explicit attention to energy availability, bone health, and menstrual function — areas boys' programs typically ignore entirely.
Is strength training safe for adolescent girls?
Yes. Supervised, technique-first resistance training is safe from pre-adolescence and is one of the most consistently protective interventions in sports medicine. The risk in youth sport is under-training strength, not over-training it.
Every claim, sourced
12 peer-reviewed sources. Each links to a PubMed search so you can read the original.
- 1
Pluim BM, Loeffen FGJ, Clarsen B, Bahr R, Verhagen EALM. A one-season prospective study of injuries and illness in elite junior tennis. Scand J Med Sci Sports. 2016;26(5):564-571.
PubMed - 2
Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39(9):1997-2006.
PubMed - 3
McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103-1111.
PubMed - 4
Kox LS, Kuijer PPFM, Kerkhoffs GMMJ, Maas M, Frings-Dresen MHW. Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes: a systematic review. Br J Sports Med. 2015;49(18):1189-1196.
PubMed - 5
Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877.
PubMed - 6
Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.
PubMed - 7
Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-257.
PubMed - 8
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492-501.
PubMed - 9
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097.
PubMed - 10
De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad. Br J Sports Med. 2014;48(4):289.
PubMed - 11
Martin D, Timmins K, Cowie C, et al. Injury incidence across the menstrual cycle in international footballers. Front Sports Act Living. 2021;3:616999.
PubMed - 12
Sugimoto D, Myer GD, Foss KDB, Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Med. 2014;44(4):551-562.
PubMed