By Dr. Dipan Patel
Every August, Flushing Meadows lights up, and New Jersey does the same thing it always does. We watch Sinner and Sabalenka for a week, remember we used to play, and decide Saturday morning is a good time to dust off a racquet that has been in the garage since 2019.
I love that instinct. I do not love what shows up in my office the following Tuesday.
You do not need to be on Arthur Ashe Stadium to blow out a shoulder, an elbow, or a lumbar disc. A public court in Clifton, a club in Holmdel, or a rec league in Hazlet will do it just fine if the first match of the year is also the longest.
The Injury Nobody Talks About: It Is Not the Big Serve
Most people assume tennis injuries look like a highlight-reel dive or a freak ankle roll. In reality, the majority of what I treat after US Open week is quieter and more preventable.
The most destructive moment in recreational tennis is a serve on a cold shoulder, followed by a wide forehand that asks your lumbar spine to rotate while your feet stay planted.
Your brain remembers how to hit the ball. Your rotator cuff, extensor tendons, and lumbar facets do not remember how to absorb that load. Something takes the force that was not trained for it.
That is how a “friendly set” in Morristown becomes a week of night pain and a cortisone conversation you did not plan on having.
The Three Places Tennis Punishes Weekend Players
1. The Shoulder: The Serve You Have Not Hit Since Last Summer
The overhead serve is one of the most violent motions the shoulder can produce. It asks the rotator cuff to stabilize a joint at end range, over and over, on a structure that has been sitting at a desk all week.
The risk: rotator cuff tendinitis, impingement, and, in older players, a tear that started as “just tightness.”
The fix: do not open with a full serve. Hit 10 to 15 minutes of groundstrokes first. Then start the serve at 50 percent and build. If you feel a pinch on the way up, stop. That is not toughness. That is the cuff asking for a timeout.
2. The Elbow: Tennis Elbow Is Still Tennis Elbow
Lateral epicondylitis is not a branding problem. It is an overuse problem. A stiff racquet, a grip that is too small, and late contact (hitting the ball behind you) overload the forearm extensors on every backhand.
The risk: pain on the outside of the elbow that shows up the next morning when you pour coffee or lift a bag.
The fix: check grip size. Hit the ball in front of your body. If you have not played in months, cap the first session at 45 minutes, even if you feel fine.
3. The Spine: Rotation Without the Feet
Tennis is a rotation sport. When the hips and feet turn with the trunk, the load is shared. When the feet stay planted and the torso rips through the shot, the lumbar discs and facet joints take all of it.
The risk: an acute disc flare, facet pain, or sciatica that starts after the match, not during it.
The fix: pivot. Toes and hips go with the shot. If you hear your sneakers squeak and your back twist at the same time, you are doing it backwards.
What Actually Protects You
Warm up like you mean it. Five minutes of arm circles, thoracic rotations, and easy side shuffles before the first ball. Cold connective tissue does not care that you used to play varsity.
Wear court shoes. Running shoes are built for forward motion. Tennis is lateral. A rolled ankle on a public court is one of the most avoidable September visits I get.
Respect the first match. The first time back should feel a little boring physically. Tendons adapt slower than ego. Give them the runway.
The Signs That It Is More Than Soreness
Muscle fatigue after two sets is expected. These are not:
- Night pain in the shoulder that wakes you up
- Elbow pain that is worse the next morning, not better
- Sharp pain down the leg after a serve or a wide shot
- Back pain that climbs over two to three days instead of fading
- A knee or ankle that swells and is not clearly improving within 24 hours
We Are Local, and the US Open Is in Our Backyard
The drive from Morris County, Clifton, Edison, or Hazlet to Flushing is short enough that a lot of my patients will be in the stands this year. That is great. Just do not treat the local court the next morning like it is a fifth-set tiebreak.
My offices in Clifton, Jersey City, West Orange, Edison, Morris County, and Hazlet see tennis players every September. Most of them do not need surgery. They need an accurate diagnosis, a short period of unloading, and, when it is indicated, a targeted injection or regenerative option so they can get back on court without making it worse.
If something is not right, come in before the next match. That is a better plan than playing through it and sitting out the rest of the season.
Dipan Patel, MD
Double Board-Certified Spine & Joint Specialist
