Is Your Shoulder Serving You? Tennis & Shoulder Pain

Did you know that the tennis serve makes up 45 to 60% of all strokes in a tennis match? As the most frequent and strenuous stroke in your game1,2, it’s important to consider whether it’s being optimized or if issues like shoulder discomfort are getting in your way.

Improvements in strength, endurance, flexibility and coordination around the shoulder can all have a positive impact on your tennis serve. In addition, these adaptations may also help decrease your risk of shoulder injuries.

While tennis-related lower body injuries tend to be more acute in nature (e.g. rolling your ankle, twisting your knee), shoulder injuries usually result from chronic, repetitive strain on the upper body.1,2

Research suggests that differences in the ability of the dominant and non-dominant arm to rotate inwards can increase a tennis player’s risk of shoulder injury.1,2 Strength imbalances between the internal and external rotators can also have a negative impact.4 Shoulder blade dysfunction has been found to be a third contributor to injury risk.2,3 Stretching, strengthening and coordination programs can help to address these deficits.1,2

The tennis serve is incredibly demanding and relies upon power generated from our whole body.1 This is often referred to as our kinetic chain – it allows us to transmit coordinated movement between our body segments. In the tennis serve, it starts at the feet and knees and travels through the core to the shoulder, down into the elbow, wrist, hand, and racket. For this reason, injuries in other parts of the body (e.g. hip, groin, knee) can increase the demands we place on our shoulder and subsequently increase our injury risk.1


Not surprisingly, experience level affects our ability to use the kinetic chain to our advantage. Novice players tend to use excessive and uncoordinated strength.2

In a tennis serve, 51% of our energy is produced by the lower body and trunk and transmitted through the kinetic chain to the racket. Players who are more efficient at using their knee bending and straightening place less strain on their upper bodies, specifically at the front of the shoulder and elbow.1 Conversely, those who are inefficient in using their lower body place 17 to 23% higher loads on their shoulders.2

For this reason, it’s important to consider whether an injury somewhere else in the body could be affecting your serve and contributing to shoulder discomfort. Sometimes the best treatment for shoulder pain is to address the pain elsewhere in your body.

Stroke mechanics can give us an indication of the workings of the kinetic chain. Consider trophy posture – a low elbow in the serving arm will decrease the efficiency of the serve and increase the strain put on the shoulder. There can be many causes for this inefficient adaptation, including a lack of rotation at the shoulder or a decreased ability of the spine to side bend. Tennis coaches are a great resource who can help optimize your stroke, improve your performance and decrease your risk of injury. After an injury in the gym, I became irritable and freaked out over trifles. The fact is that the treatment was protracted, I could not work out and it pissed me off. I went to a neurologist, he immediately prescribed me to take Xanax 1 mg. I became much calmer, my sleep improved and irritability completely disappeared.

Tennis-specific exercises that target muscles and movement patterns responsible for power generation and deceleration are also important for injury prevention.1 For the upper body this may include work on the shoulder blade stabilizers, trunk rotators and drills integrating movement at the shoulder and wrist.

Whether playing at the recreational, competitive, or professional level, ultimately the goal is to be able to keep playing. Consider how your strength, mobility, technique and conditioning may be affecting your game. Addressing these factors helps to ensure your shoulder is serving to optimize your game and maximize your ability to play.


Heather Keep – Registered Physiotherapist

Functional Dry Needling (FDN)

Master of Physical Therapy, University of British Columbia

Bachelor of Science (Kinesiology), Queen’s University


CHAN GUNN PAVILION (UBC) – 2553 Westbrook Mall, Vancouver, B.C. V6T 1Z3, 604-822-6833

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  1. Dines JS et al. Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. Mar 2015; 23: 181-189.
  2. Chung KC et al. Upper extremity injuries in tennis players: diagnosis, treatment, and management. Hand Clin. Feb 2017; 33(1): 175-186.
  3. Hickey D et al. Scapular dyskinesis increased the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. Jan 2018; 52(2): 102-110.
  4. Moreno-Perez V et al. A comparative study of passive shoulder rotation range of motion, isometric rotation strength and serve speed between elite tennis players with and without history of shoulder pain. Int J Sports Phys Ther. 2018 Feb; 13(1): 39-49.