From its origins in northern France in the Middle Ages, tennis has grown into one of the most popular sports in the world and is commonly found in high school and college athletic programs. As with all sports played by teens and young adults, participation is not without risk and musculoskeletal complaints are unfortunately common. In fact, it’s estimated that about 28% of male adolescent tennis players and 14% of female teen players experience low back pain which can affect athletic performance, limiting participation in training and competitions. In turn, this can negatively impact their progression to higher levels of competition and a potential professional athletic career.

Tennis requires coordinated, repetitive, and forceful movements throughout the entire body or kinetic chain. At elite levels of play, the physical demands (strength, power, agility, and coordination) are especially high to produce maximal tennis stroke velocity. Tennis is an overhead and rotational sport in which high forces and loads are generated, absorbed and transferred from the lower to the upper body through the trunk. It’s suspected that restrictions in range of motion in the upper and lower extremities can lead to increased strain on the trunk (and lower back) as forces are transferred across the body, elevating the risk for injury.

In a study published in August 2024, researchers examined 176 elite male highschooler tennis players from 14 teams, 59 of whom had low back pain and found that restricted inner rotation in the dominant shoulder and restricted inner rotation in the non-dominant hip are both associated with low back pain in young tennis players. This finding echoes a previous study by the same research team in 2023 that observed for every one degree decrease in hip internal rotation, the risk for low back pain increased by 10%. The authors urge coaches and healthcare providers to develop injury prevention programs in order to address these common physical impairments.

Athletes of all ages and levels of competition are known to utilize chiropractic care, not only when managing an existing musculoskeletal injury, but also in hopes of preventing one in the first place—and this includes tennis players. When a tennis athlete presents for chiropractic treatment, their chiropractor will conduct a thorough examination of the whole patient to identify any issues that may be either the underlying cause or a contributing factor to their chief complaint. As demonstrated in this study, restrictions in shoulder and hip range of motion can play a role in low back pain development, and their care plan would include exercises and manual therapies to restore normal motion to the affected joints. It may also be the case that another issue in the kinetic chain could be affecting the shoulders or hips and those would need to be addressed as well. Past studies have demonstrated that postural abnormalities in the feet, ankles, and knees can affect the hips, for example. Once the patient is able to resume their normal sporting activities, they will also receive instruction on stretches and other exercises they can perform before, during, or after practice to reduce the risk for injury recurrence.