Returning to Tennis After Injury

On the first visit, patients always ask, “When can I go back to playing tennis?” The love for the sport is deep and I find people don’t like to be away from it for too long (myself included). However, if you jump back in too soon, it can delay your play for even longer. The potential for reinjury or create a new injury due to compensation is high. 

Criteria to return to playing tennis

Unfortunately, returning to tennis post an injury hasn’t been studied as rigorously as sports such as baseball, soccer and running. There are some specific injuries such as rotator cuff surgery or ACL surgery that can give us some insights into how best to return to sport. And based on other return to sports protocols, we can glean what might be best to return to sport. As always, I really speak to my patient about their specific goals and tailor a solution to fit their needs. These are three things based on the research and my clinical experience that I help my patients return to playing tennis.

Strength Symmetry

During your time at physical therapy, the goal will always be to improve your strength. This will help you better tolerate the load of tennis. The load of tennis can mean how well you absorb the impact of the ball on your racket, the power you create on the ball, or simply absorbing the load of your movement on the court (starting/stopping). As you probably know, tennis is a complex sport, requiring a lot of your body. Before returning to playing tennis, research has found that to decrease risk of injury, it is important for the injured side to have 90-95% strength of the uninjured side.

Pain

If you are still experiencing high levels of pain, it is not time to return to tennis. The goal of physical therapy many times is to get pain to a place where you can manage it. However, returning to the court with 6/10 pain will definitely lead to more problems in the future. It may not be realistic to have 0/10 pain when you return to playing, but my rule of thumb with patients is no higher than 3/10 when stepping back onto the tennis court.

Confidence

One aspect that is being more researched recently is psychological readiness to return to sport. If you are not confident in returning to the sport, this can increase likelihood of reinjury. I try as a physical therapist to help you be your most confident by incorporating exercises that mimic tennis court play so that when you step onto the court you feel prepared.

How to return to tennis

You have now checked the boxes of strength symmetry, pain and confidence. It is time to get back on the court. Depending on how often you like to play and the severity of your injury, it can take anywhere from 4-12 weeks to return to playing matches once you complete physical therapy. If you don’t play matches and just enjoy hitting, then you will be closer to that 4 weeks of being able to play for an hour. If you are someone that is highly competitive, and have a severe injury, you are going to want to ease back into the sport (and I know this can be frustrating!!). I have based my protocol here off of a return to run program from University of Delaware (they also have a tennis agility protocol).

Short Court

When first returning to tennis, I recommend only hitting for 15 minutes from the service line (half court). I get a lot of grumbles about this initially because there is concern for finding someone to hit for only that long. But, we are trying to manage the load when returning. If the next day, you have no soreness (meaning about your injury - you may have body soreness from not playing tennis for awhile), you can play again the following day and repeat playing short court for 15 minutes. I recommend doing this for the first week. The second week, you can play short court for 20-30 minutes. Again, if you have no soreness, continuing hitting every other day (or 3 days/week)

Mid Court

The second week of returning, I recommend moving to mid court which is between the baseline and service line. Again, hitting the third week for 15 minutes and then the fourth week for 30 minutes.

Baseline

The fourth week, I would hit for 20 minutes maximum at the baseline and then the fifth week moving to 45minutes of hitting from the baseline. I would still recommend warming up shortcourt for 10-15minutes prior to moving back.

In your sixth week of returning to tennis, after an hour of hitting, you can go for taking serves at 50% of your normal pace. In your seventh week of returning to sport, you can hit serves at 75% and try for points. I always recommend going for a tie breaker first. The goal is to be getting about 3-4 days of tennis in per week AND hopefully continuing all your strengthening off the court. 

This can seem like a really slow and long way to return to tennis. However, if you have been off the tennis court for months, you will need time to build your stamina. If you haven’t been off the court as long or you aren’t recovering from surgery, these steps might be more truncated. It is incredibly important to consult your own physical therapist to determine what is best for you.