Tennis Identity

How to protect your spine from your tennis serve

When most people think about chronic injuries that occur from tennis, they usually think of “tennis elbow.” But if you ask a serious tennis player about the most common tennis-related injuries, low back pain will almost always make that list. There’s good reason for that. We spoke with Dr. Todd Lanman, a spine surgeon in Beverly Hills, California. He says that:

“imaging studies such as MRI show that 62% of serious amateur, elite, and professional tennis players have injuries in the spine in their lower backs. In fact, four out of ten professional tennis players admit to missing at least one tennis tournament because of low back pain.”

So while low back pain and spine injury may not be as famous as an injury in that other joint, it is clearly a big problem for tennis players.

If you’re an avid player, you’ve probably thought a lot about your serve. But you may not have thought a lot about how your body is affected by your serve. Dr. Lanman states,

“One of the most common causes of back pain and injury to tennis players is the serve. You place extreme forces on your spine during a tennis serve.”

Dr. Lanman is a world-renowned spine surgeon at Cedars-Sinai Medical Center in Los Angeles. As a top back and neck surgery specialist practicing in Beverly Hills, he counts many professional athletes, business leaders, and entertainment luminaries among his clients.

Consider what a serve does to your body. You start out by hyperextending your back, stretching out the muscles and elongating the spine. The spinal column is not vertically straight during the serve, either, as it would like to be. The serve itself is a violently rapid contraction of these same muscles coupled with a forcible rotation of almost the entire body.

Imagine how these forces are transmitted along the length of your spine. The vertebrae in your lower back (lumbar vertebral) really don’t handle rotation very well, especially forceful rotation. The vertebral discs between the bones don’t handle it well either. This is largely why 30% of tennis players have disc herniation (i.e. bulging disc) in their lumbar spines (i.e. lower back).

The backswing and contact aren’t even the most spine-damaging parts of the serve. Dr. Lanman adds,

“It really is the deceleration after the ball has been hit that causes the extreme forces that damage the discs and joints throughout the spine.”

The strongest abnormal forces occur toward the end of your follow-through, when the body slows itself down. The muscles in the back and abdomen have to stabilize the body after this explosion of energy. These core muscles are also the way that tennis players can protect the health of their spines.

“Tennis players with weaker core muscles are more likely to experience injuries,” says Dr. Lanman, “So strengthening these core muscles is an important way to protect against injury.”

Treatment and conditioning programs for tennis players desiring to strengthen their core muscles often focus of eccentric and plyometric exercises. During eccentric exercises, the muscles contract as they lengthen. One example of an eccentric exercise is to keep tension on the biceps while straightening the arms after a curl. Plyometric exercises involve stretching the muscle before contracting, and applying high force over short periods. Plyometric exercises are sometimes called “jump training” because plyometric exercises in the legs include explosive jumps. The exercises help build up a reserve that can protect bones and joints for the stresses of repeated tennis serves.

It is also important to remember that the muscles of the back are just as important to core strengthening as abdominal muscles are.

“I tell my patients to work the muscles that extend the back twice as hard as they work the abdominal and oblique muscles in the front. The extensor muscles are often overlooked, but they are the ones that decelerate the motion at the end of the tennis serve,”

states Dr. Lanman. It is more difficult to target the back muscles, but back curls against light resistance are a good start.

Exercises aren’t always enough to prevent or treat spine injuries caused by playing tennis, however. Many tennis players will eventually need spine surgery to relieve pain or other symptoms. For some, spinal fusion surgery is a reasonable option. However, if tennis players wish to return to play, Dr. Lanman tells us, artificial disc replacement is the better option.

“Artificial disc replacement is superior to fusion for maintaining spinal motion and mobility.”

With fusion, the spinal bones are fused together, but with disk replacement, the individual vertebral bones keep their ability to move. This is essential for elite and professional tennis players who want to stay at the top of the sport.

“Artificial disc replacement surgery can be performed without any damage to the muscles of the spine, recovery is faster, and players can return to play more quickly. It really is the better surgical treatment for active, young adults.”

It seems the key to protecting your spine from your serve is to make sure core strengthening is part of your overall workout routine. Dr. Lanman reminds,  your back muscles are part of your core, so work them twice as hard as your work your abs. And if you do end up needing spine surgery (Heaven forbid) and want to get back out on the court, artificial disc replacement is a good option.


Alyas F, Turner M, Connell D. MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players. Br J Sports Med. Nov 2007;41(11):836-841; discussion 841. doi:10.1136/bjsm.2007.037747

Maquirriain J, Ghisi JP, Kokalj AM. Rectus abdominis muscle strains in tennis players. Br J Sports Med. Nov 2007;41(11):842-848. doi:10.1136/bjsm.2007.036129

Marks MR, Haas SS, Wiesel SW. Low back pain in the competitive tennis player. Clin Sports Med. Apr 1988;7(2):277-287.