Knee Pain During Tennis? Look Beyond the Knee
Tennis places significant demands on the knees. Every split step, wide-ball recovery, serve landing, and change of direction requires the body to absorb force and quickly produce it again.
Knee pain may develop when the demands of playing exceed the body’s current capacity. Although the pain is felt at the knee, contributing factors may also come from the hips, ankles, movement strategy, training volume, or a combination of these areas.
What May Contribute to Knee Pain?
1. Limited Glute Strength and Control
The gluteal muscles help control the pelvis and thigh during single-leg loading. If they lack sufficient strength or endurance, the thigh and knee may move inward excessively during running, landing, or changing direction.
This does not mean that every inward knee movement is harmful. However, poor control under speed, load, or fatigue may increase stress on the knee for some players. Research supports combining hip- and knee-strengthening exercises when treating common conditions such as patellofemoral pain.[1]
2. Limited Hip Mobility
Tennis requires the hips to rotate, flex, and move laterally. When hip mobility is limited, the athlete may compensate through the knee, lower back, or foot.
For example, insufficient hip rotation may make it more difficult to load efficiently during an open-stance forehand or recover from a wide ball. The knee may then experience additional twisting or side-to-side stress.
3. Limited Ankle Mobility
The ankle must bend forward over the foot to help the body lower its center of mass and absorb force. Limited ankle mobility can contribute to altered mechanics during squatting, landing, and deceleration—including increased inward knee movement in some athletes.[2,3]
For a tennis player, restricted ankle mobility may make it harder to stay low, stop smoothly, or control the body after reaching for a difficult shot.
4. Poor Shock-Absorption Mechanics
Efficient shock absorption requires the ankle, knee, and hip to bend together. Landing or stopping with a stiff, upright posture can reduce the time available to absorb force.
Common movement patterns that may increase knee loading include:
Landing with limited hip and knee bend
Allowing the knee to collapse inward without adequate control
Stopping primarily through one leg
Taking large braking steps with the foot far ahead of the body
Losing trunk control during lateral movement
Maintaining poor mechanics as fatigue develops
Should You Stop Playing Tennis?
Complete rest is not always necessary. Temporarily adjusting court time, intensity, or specific aggravating movements may calm symptoms while allowing rehabilitation to begin.
A complete assessment should examine more than the painful knee. Depending on the individual, treatment may include:
Progressive glute, quadriceps, calf, and hamstring strengthening
Hip and ankle mobility exercises when meaningful restrictions are present
Single-leg balance and control training
Landing, deceleration, and change-of-direction retraining
Gradual exposure to tennis-specific speed and court coverage
Management of weekly playing and training volume
The goal is not simply to eliminate pain temporarily. It is to build the strength, mobility, movement quality, and workload tolerance needed for the demands of tennis.
At Courtlete Sports Rehab & Performance, we assess how your entire body moves during tennis-specific tasks. By identifying the factors contributing to your symptoms, we can develop an individualized plan to help you move more efficiently, reduce pain, and return to the court with confidence. Book a free discovery call to find out more!
This article is intended for general education and does not replace an individualized medical evaluation. Seek prompt medical care after a significant injury or if you experience marked swelling, locking, instability, inability to bear weight, or worsening symptoms.
References
Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(9):CPG1–CPG95. https://doi.org/10.2519/jospt.2019.0302
Lima YL, Ferreira VMLM, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion range of motion and dynamic knee valgus: A systematic review and meta-analysis. Physical Therapy in Sport. 2018;29:61–69. https://doi.org/10.1016/j.ptsp.2017.07.002
Taylor JB, Ford KR, Nguyen AD, Shultz SJ. Ankle dorsiflexion affects hip and knee biomechanics during landing. Sports Health. 2022;14(3):328–335. https://doi.org/10.1177/19417381211019683
