Low back pain is one of the most common musculoskeletal conditions among tennis players, with a particularly high incidence in high-level athletes.
What is Low Back Pain?
Low back pain (LBP) is a painful condition localized in the lumbar region of the spine, often of multifactorial origin. In tennis—a sport characterized by explosive movements, high-speed trunk rotations, and repetitive technical actions—low back pain represents a significant health issue for athletes. Epidemiological studies report a prevalence ranging from 30% to 50% among professional tennis players over the course of their careers (Campbell et al., 2013).
The pathogenesis of low back pain in tennis players is closely linked to the inherently asymmetrical nature of the sport, as well as to the multifactorial interaction between intrinsic elements—such as muscle imbalances, motor control dysfunctions, and postural alignment alterations—and extrinsic factors, including the biomechanics of stroke execution, the characteristics of the playing surface, and the overall training load.
Causes of Low Back Pain in Tennis Players
The main causes include:
- Repeated microtraumas: the serve, in particular, involves a combination of torsion and lumbar hyperextension, predisposing the spine to disc and facet joint overload (Ng et al., 2005).
- Biomechanical alterations: muscle asymmetries, hip mobility limitations, and core weakness compromise the stability of the lumbar spine.
- Incorrect technique: errors in stroke mechanics, particularly during the serve and open-stance forehand, increase shear and compressive forces on the spine.
- Environmental factors: hard playing surfaces and prolonged use of inappropriate footwear increase axial and torsional stresses.
Diagnosis
The differential diagnosis of low back pain in tennis players requires a thorough clinical and functional assessment:
- Sport-specific history: onset, duration, correlation with athletic movements, intensity, and radiation of the pain.
- Physical examination: assessment of posture, lumbar mobility, core strength, movement patterns, and provocative tests (e.g., Kemp’s test, Straight Leg Raise).
- Imaging diagnostics: MRI for identifying structural pathologies (herniated discs, discopathies, spondylolysis), and CT scans in complex cases or those resistant to conservative treatment.
Therapeutic intervention should be multimodal and personalized based on the clinical picture and the stage of the condition.
The Conservative Approach
The conservative approach includes:
- Physical exercise and postural therapy: core strengthening exercises, motor control training, segmental stabilization, and spinal mobilization.
- Instrumental physical therapies: TENS, high-power laser therapy, and TECAR therapy, with documented effectiveness in acute or subacute cases.
- Pharmacotherapy: targeted use of NSAIDs or muscle relaxants, following a sports medicine evaluation.
- Technical and Load Adjustment: biomechanical review of technical movements through video analysis, with a temporary reduction in training intensity.
In selected cases, an infiltrative approach (e.g., analgesics, ozone, corticosteroids) may be indicated, or, when clear indications are present, a surgical approach (e.g., unstable spondylolisthesis or unresolved extruded disc herniations), in accordance with international guidelines. Current evidence suggests that PRP (platelet-rich plasma) may be a promising therapeutic option for chronic low back pain, particularly of discogenic origin. However, further studies with larger sample sizes and long-term follow-up are needed to confirm these findings and to establish optimal treatment protocols.
Prevention
Prevention plays a central role in managing clinical risk, especially in young individuals who play tennis. It is therefore essential to promote and reinforce protective behaviors and healthy lifestyles aimed at reducing the incidence of low back pain.
Primary prevention of this condition is mainly based on:
- Core stability programs specifically designed for tennis players (Elliott et al., 2007).
- Postural education and work on hip and spinal mobility and flexibility.
- Pre-season biomechanical screening.
- Planned management of load and recovery.
- Technique optimization through specialized coaching and video analysis.
Low back pain in tennis is a highly prevalent condition that can compromise performance and athletic longevity. An integrated approach—including clinical assessment, functional rehabilitation, technical education, and load monitoring—represents the most effective strategy for managing the condition and preventing recurrences.
References
- Campbell RS, et al. Low back pain in elite tennis players. Br J Sports Med. 2013.
- Ng JKF, et al. Spinal loading during the forehand and backhand strokes in tennis players with low back pain. Clin Biomech. 2005.
- Elliott B, Reid M. Biomechanics and tennis. ITF Coaching & Sport Science Review. 2007.
