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
1 arm
Structural asymmetry — the dominant side accumulates nearly all rotational and overhead load.2
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.
Block 1 of 5
General warm-up
Baseline-to-baseline movement, side shuffles, split-step practice, hip openers.
- Land the split-step
- Stay low
- Progressive intensity
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.
Stage 1 of 5
1. Pain-free daily function
Full range, no night pain, normal walking and overhead reach.
Questions coaches and parents ask
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.
Every claim, sourced
12 peer-reviewed sources. Each links to its PubMed record 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 25944058 - 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 21685316 - 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 16476915 - 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 25872521 - 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 24100287 - 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 26758673 - 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 24427397 - 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 15722287 - 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 37752011 - 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 24463911 - 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 33733235 - 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 24370992
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