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MECHANICS IN TENNIS GROUNDSTROKES: Differences in Elite Adolescent Players With & Without Low Back Pain

An Article Review by Brittany Laxton DPT

Low back pain and injury is a common occurrence among junior tennis players [1]. Recent research has focused on the relationship between serves (flat and kick), lower lumbar kinematics and low back pain [2]. However, with groundstrokes found to be 1.62x more prevalent in match play than serves [3], the repetitive demand placed on the lumbar spine and groundstroke mechanics could be a source of etiology for low back pain and should be taken into consideration.

A recent study looked at the relationship between lumbar kinetics/kinematics, groundstrokes and low back pain in 19 adolescent elite male tennis players. Researchers assessed their active lumbar range of motion, analyzed the upper and lower lumbar ROM performed during specific groundstrokes and compared the data between pain and no pain groups.

These athletes (7 with a past medical history of a low back injury and 12 with no history of low back injury) were required to return fed balls with max effort “down the line” until 3 successful groundstrokes were recorded using a motion analysis system. The following groundstrokes were performed: Open stance forehand, square stance forehand, open

stance backhand, and square stance backhand.

There was no significant difference found in upper lumbar active ROM between the low back pain (LBP) and no pain (NP) groups. However, the NP group demonstrated greater lower lumbar active range of motion in extension, left lateral flexion and right rotation. When groundstrokes were grouped, there were no significant differences found in the kinetic variables or the kinematics between the NP and LBP groups [4].

Lumbar kinetics/kinematics did not exhibit a difference among stance types (open versus square). However, a significant difference was noted between forehand and backhand lumbar kinematics. Specifically, upper lumbar leftward rotation was involved during backhands and lower lumbar right rotation was involved during forehands, with participants consistently going beyond the end range of motion during the backswing of the respective strokes [4].

Although this study presents with limitations including small population and a restricted demographic (elite level male adolescent tennis player) these results can be useful for coaches, rehabilitation specialists and medical providers when designing a training program or return to sport protocol specific to the game of tennis. Professionals should be aware that players with a past medical history of low back pain may present with limited lumbar range of motion in key directions needed for both serves and groundstrokes [2,4]. When designing a program, the professional should focus on normalizing range of motion and strengthening the entire kinetic chain (hips, lumbar spine, thoracic spine and shoulder girdle) in order to distribute movement and load and reduce risk of (re)injury [4].


  1. Hjelm N, Werner S, Renstrom P. Injury profile in junior tennis players: a prospective two year study. Knee Surg Sports Traumatol Arthrosc. 2010;18(6):845-50.

  2. Campbell A, Straker L, O'sullivan P, Elliott B, Reid M. Lumbar loading in the elite adolescent tennis serve: link to low back pain. Med Sci Sports Exerc. 2013;45(8):1562-8.

  3. O' donoghue P, Ingram B. A notational analysis of elite tennis strategy. J Sports Sci. 2001;19(2):107-15.

  4. Campbell A, Straker L, Whiteside D, O'sullivan P, Elliott B, Reid M. Lumbar Mechanics in Tennis Groundstrokes: Differences in Elite Adolescent Players With and Without Low Back Pain. J Appl Biomech. 2016;32(1):32-9.

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