# Risk Factors and Prevention of Musculoskeletal Injuries in Adolescent and Adult High-Performance Tennis Players: A Systematic Review

## TL;DR

This review identifies risk factors and prevention strategies for musculoskeletal injuries in elite tennis players across adolescence and adulthood.

## Contribution

The study synthesizes evidence on injury risk factors and effective prevention strategies specific to high-performance tennis players.

## Key findings

- Abrupt increases in workload ratio are the strongest extrinsic predictor of injury in tennis players.
- Kinetic-chain conditioning and core stability training reduce overuse injuries by 26%.
- Personalized grip size and serve timing modifications significantly lower injury risk.

## Abstract

Background: High-performance tennis exposes players to repetitive high-load strokes and abrupt directional changes, which substantially increase musculoskeletal injury risk. This systematic review synthesized evidence on epidemiology, risk factors, and physiotherapy-led preventive strategies in elite adolescent and adult players. Methods: Following a PROSPERO-registered protocol, MEDLINE, Web of Science, and Scopus were searched (2011–2024) for observational studies reporting epidemiological outcomes in high-performance tennis. Methodological quality was appraised with NIH tools, and certainty of evidence was graded with GRADE. Results: Thirty-seven studies met inclusion criteria: 16 in adolescents, 18 in adults, and 3 mixed. Incidence ranged from 2.1 to 3.5 injuries/1000 h in juniors and 1.25 to 56.6/1000 h in adults. Seasonal prevalence was 46–54% in juniors and 30–54% in professionals. Lower-limb trauma (48–56%) predominated, followed by lumbar (12–39%) and shoulder overuse syndromes. Across age groups, abrupt increases in the acute-to-chronic workload ratio (≥1.3 in juniors; ≥1.5 in adults) were the strongest extrinsic predictor of injury. Intrinsic contributors included reduced glenohumeral internal rotation, scapular dyskinesis, and poor core stability. Three prevention clusters emerged: (1) External load control, four-week “ramp-up” strategies reduced injury incidence by up to 21%; (2) Kinetic-chain conditioning, core stability plus eccentric rotator-cuff training decreased overuse by 26% and preserved shoulder mobility; and (3) Technique/equipment adjustments, grip-size personalization halved lateral epicondylalgia, while serve-timing modifications reduced shoulder torque. Conclusions: Injury risk in high-performance tennis is quantifiable and preventable. Progressive load management targeted kinetic-chain conditioning, and tailored technique/equipment modifications represent the most effective evidence-based safeguards for adolescent and adult elite players.