Sport
Tennis & Racquet Sport InjuriesElbow, Shoulder & Wrist
Tennis elbow, shoulder impingement, wrist tendinopathy, and upper back pain for tennis, squash, padel, and badminton players. The site of pain is often not the primary cause.
Book Your First VisitRacquet sports load the upper limb asymmetrically and repeatedly. A theme across all racquet sport injuries: the site of pain is not always the primary driver, so assessment typically covers the spine and full upper limb chain, not just the painful structure. Shoulder impingement can be driven by restricted thoracic extension. Tennis elbow can have a cervical component. Equipment adjustments during recovery reduce ongoing load.
Why racquet sport injuries need a broad assessment
Racquet sports load the upper limb asymmetrically and repeatedly, combining high rotational forces through the shoulder and trunk with rapid wrist and elbow loading. The injury patterns are predictable from these demands. The same sport is played across a range of skill levels and training volumes in Singapore. The presentations I see in recreational players and competitive club players are often similar, just at different severity levels.
The site of pain is often not the primary cause. Shoulder impingement in overhead sports can be driven by restricted thoracic extension limiting the shoulder from moving efficiently. Tennis elbow can in some cases involve cervical nerve root irritation that refers into the forearm and elbow. Treating the contributing regions, not just the painful structure, is the approach I take. This broader assessment tends to identify what local-only treatment might miss. Chiropractic assessment covers the spine, joints, and soft tissues of the full upper limb chain, which fits naturally with these multi-region presentations.
Common presentations
- Lateral epicondylitis (tennis elbow): outer elbow pain that worsens with grip and wrist extension, caused by overload at the forearm extensor tendon origin. Equipment factors (grip size, string tension, racquet weight) often contribute alongside technique and load volume. Progressive tendon loading is the primary treatment approach.
- Shoulder impingement and rotator cuff tendinopathy: pain on serving, overhead smashes, or high volleys, from repetitive loading of the rotator cuff (the muscles that stabilise and rotate the shoulder). Restricted mid-back mobility can be an upstream driver, shifting more load onto the shoulder. Addressing both thoracic mobility and rotator cuff strength is the standard approach.
- Wrist tendinopathy: de Quervain's tenosynovitis (a tendon inflammation on the thumb side of the wrist) and extensor tendinopathies from grip and swing mechanics. More common in players with heavy topspin or wrist snap on contact.
- Upper back and thoracic stiffness: the rotational demands of racquet sports stress the thoracic spine asymmetrically, and restricted thoracic rotation can be what drives shoulder or elbow load rather than a local joint problem. A common finding in frequent players that is often undertreated.
What helps
The goal is to find what level of play doesn't aggravate the injury, then gradually rebuild from there. Equipment adjustments during that period (string tension, grip size, racquet weight) can help reduce load on the irritated structure.
Manual therapy targets both the local structure and the contributing regions. For tennis elbow: progressive loading of the extensor tendon, wrist joint mobilization, and assessment of the cervical spine for C6 nerve root contribution. For shoulder impingement: thoracic joint mobilization, rotator cuff loading, and shoulder external rotation strengthening. For wrist tendinopathy: specific loading and load management alongside grip technique assessment.
Why stretching and rest often aren't enough
Many cases of tennis elbow, including long-standing ones, do respond to a structured loading programme, though timelines are usually longer than people expect. The key is eccentric and isometric wrist extension exercises rather than stretching and rest alone. A structured loading programme is the most commonly missing element in clinical practice in cases that haven't resolved. Equipment changes during the loading phase (lower string tension, slightly thicker grip) reduce irritation while the tendon adapts.
If you play squash, padel, or badminton
Squash adds significant lower-body loading from explosive lunges in a confined court, and players often develop hip, groin, or low back complaints alongside the upper limb injuries common to all racquet sports.
Padel introduces glass-wall shots requiring rapid rotation in reverse, placing different demands on the thoracic spine and shoulder. Knee complaints from abrupt direction changes on a smaller court are also common.
Badminton is primarily an overhead and wrist sport, with high rates of shoulder impingement and rotator cuff tendinopathy in regular players. Lateral ankle injuries are also more common in badminton than in most other racquet sports.
The treatment principles for upper limb injuries are consistent across all four sports. Sport-specific mechanics are worth discussing at the first assessment.
For all of these presentations, a progressive loading programme and equipment review are typically part of the management approach. Passive rest alone is generally not sufficient for tendinopathy recovery. If you'd like to talk through your situation before booking, get in touch.
When to seek care promptly
See a doctor if you have:
- Acute shoulder pain after a fall or impact with significant weakness (possible rotator cuff tear)
- Acute wrist pain after a fall on an outstretched hand (possible scaphoid fracture)
- Shoulder pain with significant catching, clunking, or instability
- Elbow or wrist symptoms with numbness or tingling in the hand
- An injury that is not improving after 3 months of appropriate conservative management
- Acute elbow pain after a direct impact or fall with visible deformity or inability to fully straighten the arm (possible fracture or dislocation)
Most racquet sport tendinopathies are appropriate for conservative management. Structural injuries and nerve entrapment need assessment before treatment proceeds.
Common questions
Not necessarily. The goal is to manage load during recovery, which usually means modifying how much you play and how you play rather than stopping completely. For tennis elbow, this might mean reducing playing volume and grip intensity temporarily. For shoulder issues, it depends on which part of the game is provocative. Complete rest from a sport you play regularly often leads to deconditioning that makes return harder. I'll give you specific load guidance after the assessment.
Progressive tendon loading is the most evidence-supported conservative approach for lateral epicondylitis, specifically eccentric and isometric wrist extension exercises that progressively load the extensor tendon. Cortisone injections may reduce short-term pain, but studies show significantly higher recurrence rates at 12 months compared with physiotherapy or sham injection. Cortisone has been shown to reduce tendon cell viability and collagen synthesis, and while it may have a role in a severe acute flare, progressive loading is preferred for chronic presentations. Equipment changes (racket weight, string tension, and grip size) also affect lateral elbow load significantly and are worth reviewing. I'll assess the full picture and build a loading programme for your level of play.
Yes, equipment is a real contributor that's frequently overlooked. A grip that doesn't suit your hand size can alter forearm muscle loading during play. String tension affects the shock transferred to the arm at ball contact. Racket weight and balance affect the load on the shoulder and elbow during the swing. These aren't the only factors, but modifying equipment during rehabilitation can help reduce load on the irritated structure. I'll include a review of your setup as part of the management plan.
The serve is the highest-demand movement in tennis for the shoulder. It requires full external rotation in the cocking phase and rapid internal rotation through contact, placing significant load on the rotator cuff and anterior shoulder structures. Pain specifically on the serve suggests impingement, rotator cuff tendinopathy, or anterior shoulder irritation. I'll assess your shoulder mechanics and identify which phase of the serve is provocative, since that points to the specific structure involved.
High frequency isn't inherently a problem if you've built into it gradually and your body is tolerating it. Injury usually comes from a spike in load, a sudden increase in volume, intensity, or technical demand rather than high frequency alone. If you're getting recurrent injuries or symptoms that don't fully settle between sessions, that's a sign your recovery capacity isn't matching your training demand. I'll assess what's accumulating and help you find a sustainable load for your current capacity.
Related reading
References
- Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939. PMID 17012266
- Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461–469. PMID 23385272
- Dean BJF, Lostis E, Oakley T, et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570–576. PMID 24074644
- Berglund KM, Persson BH, Denison E. Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain. Man Ther. 2008;13(4):295–299. PMID 17942362
- Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273–280. PMID 26758673
- Mohandhas BR, Makaram N, Drew TS, et al. Racquet string tension directly affects force experienced at the elbow. Shoulder Elbow. 2016;8(3):184–191. PMID 27583017
Disclaimer
This page is for general information only and does not constitute medical advice. Every person's situation is different. Nothing here should be used as a substitute for assessment and advice from a qualified health professional who can evaluate your specific circumstances.
If you are experiencing severe or rapidly worsening symptoms, loss of bladder or bowel control, progressive weakness, or any symptom that concerns you, seek medical care promptly rather than reading websites.
This page was written with AI assistance and reviewed by Erik Anderson for accuracy. If you find an error, please contact us and we will endeavour to correct it.
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