Tennis offers exceptional cardiovascular and social benefits for adults over 50, but age-related changes in muscle, tendon, and joint tissue create new injury risks that weren’t present in younger decades. This guide explains the most common tennis injuries in mature players, why they occur, and the evidence-based strategies that prevent them.
What Matters Most
Tennis injuries in players over 50 are predominantly overuse conditions rather than acute trauma. Tennis elbow, rotator cuff problems, knee arthritis flares, Achilles tendinitis, and lower back strain account for the majority of court-related complaints. These injuries arise from cumulative stress on tissues that have lost elasticity, strength, and repair capacity with normal aging. The good news: most are preventable through targeted conditioning, technique adjustments, and intelligent load management.
Common Injuries and Their Roots
Tennis elbow (lateral epicondylitis) is highly prevalent among recreational players, with studies reporting prevalence rates between 14% and 41% (Pluim et al., 2006). The condition develops when repetitive wrist extension overloads the forearm extensor tendon at its attachment to the outer elbow. Poor backhand technique—especially arm-dominant strokes without proper trunk rotation—accelerates tendon breakdown.
Rotator cuff tendinopathy and tears increase sharply after age 50. Ultrasound studies show approximately 36% of older players (age 60-83) have rotator cuff tears in their dominant shoulder, many asymptomatic until tennis aggravates them (Akasaka et al., 2022). Without adequate rotator cuff and scapular strength, players develop impingement, chronic pain, or partial tears that limit play.
Knee injuries—particularly meniscal tears and osteoarthritis flares—stem from the pivoting, lunging, and sudden stops inherent to tennis. The knee is the most frequently injured region in players over 50, with older athletes experiencing higher rates of degenerative joint changes.
Ankle sprains and Achilles problems occur frequently during rapid directional changes. The Achilles tendon undergoes age-related degeneration and can rupture during explosive movements, especially in players who are active only on weekends without maintaining baseline conditioning.
The Science of Prevention: Strength Training
Strength training reduces sports injuries to less than one-third according to meta-analyses published in the British Journal of Sports Medicine (Lauersen et al., 2014). For tennis players over 50, targeted conditioning compensates for muscle loss and protects vulnerable joints and tendons.
Rotator cuff and shoulder strengthening should include lightweight or resistance-band exercises: external and internal rotations, scapular retractions, and eccentric loading drills. Performing shoulder conditioning two to three times per week significantly reduces impingement and cuff injury rates.
Core and trunk stability protects the spine and enables efficient force transfer from legs to upper body. Planks, bridges, bird-dogs, and anti-rotation exercises form the foundation of a protective core program.
Lower extremity strength and balance work stabilizes knees and ankles while maintaining power and agility. Balance training—single-leg stands, wobble boards—cuts ankle sprain rates by nearly 35% by improving proprioception and reaction time (Hupperets et al., 2009).
Warm-Up and Smart Load Management
Dynamic warm-ups prepare tissues for explosive movements and reduce injury rates. A tennis-specific warm-up should include 10 to 15 minutes of light aerobic activity, dynamic stretching, and sport-specific movements like shadow strokes and practice serves.
Overuse injuries arise from “too much, too soon.” Gradual progression—no more than a 10% increase in play time per week—allows tissues to adapt without breakdown. Older players need adequate rest days between intense sessions, as fatigue degrades form and increases injury risk.
Technique and Equipment Matter
Players who rely on arm strength instead of the kinetic chain overload elbows and shoulders. Proper technique engages legs and core to generate power, reducing stress on vulnerable tendons. Players with recurrent tennis elbow often benefit from switching to a two-handed backhand, which distributes force across both arms.
Equipment choices affect injury risk. Quality tennis shoes with lateral support should be replaced every six to nine months. Racket selection matters: slightly heavier frames absorb more vibration, and softer strings at lower tensions reduce impact forces on the elbow.
What to Do Next
- Perform a 10-minute dynamic warm-up before every session: light cardio, dynamic stretches, shadow strokes, and gradual intensity progression.
- Strength train two to three times per week: focus on rotator cuff exercises, core stability, leg strengthening, and balance drills.
- Schedule tennis no more than three to four times weekly with rest or cross-training days in between to allow tissue recovery.
- Evaluate technique with a qualified coach: address arm-dominant strokes, excessive wrist motion, and serve mechanics that strain shoulders or backs.
- Replace tennis shoes every six to nine months and ensure proper racquet grip size, frame weight, and string tension for arm comfort.
- Address pain early: persistent elbow, shoulder, knee, or Achilles discomfort warrants evaluation before minor issues become chronic.
Play Smart, Play Longer
Tennis can be a sport for life, but only when approached with the same strategic thinking applied on the court. Prevention isn’t about playing less—it’s about playing smarter with proper preparation, conditioning, and awareness of how aging tissues respond to stress.
The players who remain competitive and pain-free into their 60s, 70s, and beyond share one trait: they prioritize injury prevention as seriously as they do their serves and backhands. By investing time in conditioning, technique refinement, and load management now, players protect not just their tennis careers but their overall mobility and quality of life.
Ready to create a personalized injury prevention strategy? Contact Naples Concierge Health today at (239) 690-6286 or visit www.naplesconciergehealth.com. The team can assess individual risk factors and develop a targeted plan that keeps you healthy, active, and enjoying the game you love for decades to come.
References
- Pluim, B. M., Staal, J. B., Windler, G. E., & Jayanthi, N. (2006). Tennis injuries: occurrence, aetiology, and prevention. British Journal of Sports Medicine, 40(5), 415–423. https://doi.org/10.1136/bjsm.2005.023184
- Harada, Y., Yokoya, S., Sumimoto, Y., Iwahori, Y., Kajita, Y., Deie, M., & Adachi, N. (2022). Prevalence of rotator cuff tears among older tennis players and its impact on clinical findings and shoulder function. Journal of Sport Rehabilitation, 31(7), 849–855. https://doi.org/10.1123/jsr.2021-0105
- Hupperets, M. D. W., Verhagen, E. A. L. M., & van Mechelen, W. (2009). Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ, 339, b2684. https://doi.org/10.1136/bmj.b2684
