Tennis. Padel. Pickleball. The holy trinity of summer sport is back.
Whether you’re a seasoned player dusting off the racket after a winter off, or you’ve just discovered padel through its popularity on Instagram, or playing at Newcastle’s real tennis club, there’s never been a better time to be picking up a racket in Newcastle. The courts at Town Moor are booking out, the padel scene is growing fast, and pickleball; once the preserve of retirement communities in Florida, is genuinely one of the most popular new sports in the UK right now.
All four are brilliant forms of exercise. Social, competitive, great for cardio, and easy to pick up. There’s just one problem.
Going from doing very little to sprinting around a court several times a week is a fast track to injury. And as physios, we see it every summer without fail.
So here’s what you need to know.
The Most Common Racket Sport Injuries & Why They Happen
Most injuries in racket sports; whether that’s tennis, padel, pickleball or real tennis, aren’t from freak accidents. They’re from doing too much, too soon, with a body that isn’t conditioned for the demands of the sport.
Racket sports involve explosive lateral movement, rapid acceleration and deceleration, repeated overhead or swinging motions, and often a hard surface underfoot. That combination loads the elbow, shoulder, ankle and knee in ways that everyday life simply doesn’t prepare you for.
Tennis Elbow & Why Pickleball Might Be Worse For It
Despite the name, most of the people we see with tennis elbow have never played tennis. It’s a very common overuse injury of the lateral forearm tendons, the ones that control wrist extension and grip, and it can come from any repetitive gripping or swinging activity.
Tennis elbow (lateral epicondylalgia, to give it its proper name) typically develops when you load the forearm tendon faster than it can adapt. This is exactly what happens when someone picks up a racket sport for the first time, or returns to one after a long break, and plays several sessions in quick succession.
Pickleball in particular is worth flagging here. The pickleball paddle is heavier than it looks, the grip mechanics are different to a tennis racket, and the dinking game; lots of short, controlled shots in the kitchen (close to the net for the unseasoned readers), requires sustained forearm engagement in a way that tennis often doesn’t.
The result: a lot of people find their elbow starts complaining within the first few weeks of playing regularly.
What to do about it: Tendon injuries respond really well to load management and progressive strengthening. The worst thing you can do is rest completely and then go back to full play as the tendon will just get irritated again. A physio can give you a specific programme that builds forearm capacity while you continue playing at a modified level.
Shoulder Pain with Rackets
Serving and overhead smashing put significant load through the rotator cuff; the group of four muscles that stabilise and control shoulder movement. For recreational players who don’t do much upper body strength work, the rotator cuff can quickly become the weakest link.
The serve in tennis is one of the most demanding movements the shoulder can produce. It involves rapid internal rotation at high speed, followed by a deceleration phase that the posterior cuff and scapular muscles have to manage. Repeated across a match or a week of playing, this can accumulate into rotator cuff tendon irritation or impingement.
Padel involves a similar overhead demand, particularly the smash. Pickleball’s serving is lower impact, but the overhead drive can still load the shoulder under fatigue.
Real tennis brings its own unique physical demands too. Lower ceilings, awkward ball rebounds, asymmetrical loading patterns, and longer rallies can place significant stress through the shoulder.
What to do about it: If your shoulder starts aching during or after play, don’t ignore it and hope it goes away. Early intervention, loading the right muscles, addressing any technique issues, and managing volume can turn a niggly shoulder around in a few weeks. Left longer, it tends to become a persistent problem.
Ankle Sprains: The Most Underestimated Injury in Racket Sports
Lateral ankle sprains are extremely common across all four sports, and they’re almost entirely preventable.
The mechanism is usually the same: a sudden change of direction, a split-step landing, or reaching for a wide ball. The foot plants, the body continues to move over it, and the ankle rolls outward. Hard court surfaces and the contained court in padel both create scenarios where this can happen quickly and without warning.
The issue for most recreational players is lateral ankle stability. The ability to control the foot and ankle during rapid direction changes is not something most people train. If you spend most of your week sitting at a desk, your ankle proprioception is probably not what it needs to be for sprinting around a court.
What to do about it: Single-leg balance work, calf raises, and lateral hop progressions are all simple things you can build into a warm-up or gym session. If you’ve already rolled your ankle, get it assessed, a grade 2 sprain that isn’t rehabilitated properly is a future grade 2 sprain or worse waiting to happen.
Knee Pain: What All That Lunging Does
The tennis lunge. That wide, low reach for a ball that puts the knee under significant load at a deep angle. Repeated across a match, particularly on hard surfaces, this can irritate the patellar tendon (the tendon just below the kneecap) or provoke knee pain in people who aren’t conditioned for it.
Patellofemoral pain; pain around or behind the kneecap, is also common, particularly in players who are loading the knee in flexion without much posterior chain (glute and hamstring) support. When the glutes aren’t doing their job, the knee picks up more of the load than it should.
What to do about it: Strengthening the posterior chain and working on single-leg control goes a long way here. Knee pain in racket sports is rarely a ‘the knee is broken’ problem and usually a ‘the muscles around the knee aren’t doing enough’ problem.
From Nothing to the Court: How to Not Hurt Yourself
The most common pattern we see is this: someone hasn’t played since last summer, books four sessions in a fortnight because they’re loving it, and by week three their elbow, ankle or shoulder is complaining.
The body adapts but it needs time to do it. Tendons, in particular, adapt more slowly than cardiovascular fitness. You might feel fine during a session but the tendon is accumulating load that it hasn’t had time to manage.
A sensible build-up looks something like this:
- Weeks 1–2: one or two sessions per week, no more than 45–60 minutes. Let the body tell you how it’s responding before adding more
- Week 3 onwards: add sessions or duration gradually. Not both at the same time!
- In between: some basic gym work (calf raises, glute strengthening, wrist/forearm loading) goes a long way toward building capacity for the demands of the court
The Warm-Up Nobody Does (But Everybody Should)
Here’s a stat: most recreational racket sport players do zero warm-up. A couple of gentle rallies is not a warm-up.
Five minutes before you play makes a meaningful difference – particularly for tendons, which need progressive loading. Try:
- Wrist circles and gentle forearm mobility before picking up the racket
- Walking lunges with rotation to prepare the hips, trunk, and lower limb for rotational court movement
- Lateral shuffle steps and split-step jumps to prepare the ankle and knee for rapid direction changes
- Light rallying from close range before progressing to full-court play
It takes five minutes. Your body will thank you.
The Bottom Line
Tennis, padel and pickleball are genuinely great for you: physically, mentally, and socially. We’re not here to put you off. We’re here to help you keep playing.
The injuries that end people’s summer are almost always preventable. Build up gradually, warm up properly, do some basic gym work alongside your court time, and if something starts niggling – get it looked at early rather than pushing through and turning a two-week problem into a two-month one.
Because the goal isn’t just to pick up a racket this summer. It’s to still be playing when summer’s over!
Got a Niggle That’s Stopping You Playing?
Whether it’s a sore elbow after your first pickleball session, a shoulder that’s been complaining since the tennis started, hip pain after an awkward retrieval in real tennis or an ankle that rolled a few weeks ago and isn’t quite right, we can help.
Book in with Pro Health Physio NE for an assessment and we’ll get you back on the court as quickly as possible.
✉️ therapist@prohealthphysione.com
🔗 Book online: pro-health-physio-ne.uk1.cliniko.com