William B. Stetson, MD

Stetson Powell
Orthopaedics &
Sports Medicine
191 South Buena Vista Street
Suite 470
Burbank, CA 91505

Call (818) 848-3030
to make an appointment.

Tennis Pro Dave Hagler discusses Tennis Elbow and Tennis Shoulder

Tennis injuries fall into 2 broad classifications – overuse and deceleration.  According to a 2004 USTA study, about 2/3 of all tennis injuries are overuse injuries.  These suggestions are for the upper body – tennis shoulder and tennis elbow. 


Tennis players frequently have a muscle imbalance because their internal rotators (used for serves and forehands) are stronger than external rotators.  This is true for players who hit backhands either one or two handed.    In most instances, tennis elbow (lateral epicondylitis) is the result of poor technique which may be exacerbated by hitting backhands with a forehand grip.  If you slightly hyperextend your arm (usually a result of miss hitting a volley or by hitting lots of topspin serves) you can also make tennis elbow worse.  Less frequently a player may get medial epicondylitis (also called forehand tennis or golfer’s elbow), and this is almost always an overuse injury.


1.  Use proper technique.  If you are not sure that your technique is correct, go to a reputable teaching professional.  Ask this pro questions, and see if the answers make sense – and do this prior to taking the lesson.

2.  Warm up gradually.  Start at the service line and hit there for several minutes.  Hit softly but move quickly and try to follow through completely on every shot.

3.  Don’t hold your racquet too tightly.  Dr. Howard Brody (professor emeritus from the University of Pennsylvania) contends that no human is strong enough to prevent a racquet from twisting laterally on off-center hits.  If a tennis ball is shot into a racquet that is held in a vise or free standing on a table it will leave the racquet with the same velocity.

4.  Use the right type of string.  There are two basic types of strings – poly based strings and softer strings.  Many players now combine these two types by using one (typically the poly) for the mains (long strings), and the other (a softer real or synthetic gut [nylon]) for the crosses.  If you use a poly based string you should reduce the string tension for these strings by about 10%.   Stiffer strings move less - when a tennis ball strikes the ground, the ground does not move but the ball flattens out and then bounces up.  Stiff strings do not move much and the ball flattens out on the strings in much the same way it does when it hits the ground.  Soft strings “pocket” the ball and then the ball “shoots” out of the racquet when the string bed flattens out.  Poly is tougher on joints because the dwell time (time the ball is on the strings) is shorter.  Use softer strings!

5.  String at the right tension.   A study done by Rod Cross, (Associate Professor in Physics, University of Sydney Australia) found that 11 out of 18 professional satellite players could not distinguish a difference of 11 lbs. provided they did not have auditory cues which would help determine string tension.  Cross, Brody and other physicists contend that a 10 lb. difference in string tension results in a less than 1% change in ball velocity.  What does change is the trajectory of the ball.  If you have elbow or shoulder problems decrease your string tension by at least 5 lbs.  Initially you may lose control, but after a few days you should be able to keep your shots in the court.   

6.  Use a standard length racquet.  Long, very light, stiff and powerful racquets contribute to injuries.  Many racquets that are very light if you place them on a scale are very head heavy.  It may be easier to swing a racquet that is slightly heavier and more evenly balanced.  If you have shoulder or elbow problems you would be better off using a racquet that is 105 sq. inches or less and of moderate weight.  Factors to consider are weight, length and balance point.  If you want a formula for the swing weight of a racquet, it is available on the net.

7.  Adjust your grip size.  There are two opposing schools of thought on this, and each makes sense.  One is to use a larger grip because a player will tend to have more tension (in the forearm) if they use a smaller grip which they tend to squeeze.  The other is to use a smaller grip because this will increase the maneuverability of the racquet.  If you have backhand tennis elbow I would suggest putting an extra overgrip or two on your racquet.

8.  Use surgical tubing to strengthen your external rotators.  Stand next to a pole and attach (wrap) the tubing around the pole at elbow height.  Let your arm hang at your side, then lift your hand so you end up with your forearm parallel to the ground and your hand facing 90 degrees forward.  Keep your elbow close to your side and pull the tubing so your arm forearm ends 80 – 90 degrees out (your palm is facing forwards) from where you started.  You should be able to do 3 sets of 10 repetitions without strain.  

9.  Wear some sort of band or neoprene sleeve for tennis elbow.  There are many good products on the market that will help reduce the strain on your tendons.  You may find that wearing one in the short or long term is of great benefit.

If you have a rotator cuff problem there are other simple exercises that can help.  Go to www.familydoctor.org and search for “rotator cuff” or simply click on the following link:

Dave Hagler is USPTA Master Professional and PTR Pro based in Los Angeles, California.  Dave is a 2001 graduate of the USTA High Performance Coaching Program.  He has received service awards from the Southern California and Intercollegiate Tennis Associations.  Dave has spoken at coaching conventions on topics including anticipation, games based teaching, and maximizing potential at all levels. He has been published in Addvantage, TennisPro, Tennis, SmashTennis and on www.TennisPlayer.net.  Dave’s articles have been translated into Dutch, Italian, German, Spanish and Japanese. He is a member of the Head/Penn Advisory Staff. 

If you have questions you may email him at dave.hagler@sbcglobal.net

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Stetson Powell Orthopaedics and Sports Medicine
191 South Buena Vista Street, Suite 470
Burbank, CA 91505

(818) 848-3030 to schedule an appointment.

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