Tennis Serve Biomechanics, Joint Load Mechanics and Overuse Injuries: A Narrative Review

The tennis serve is a fundamental stroke in a player's performance during matches. But it may be also eminently traumatic as it causes very high joint mechanical loading which can lead to injury regardless of the player's experience, sex or age. This narrative review aims to synthesize current scientific knowledge on the key factors contributing to changes in joint mechanical loadings during the tennis serve and its potential association with overuse shoulder, elbow, wrist and lower back injuries.

The databases PubMed, Google Scholar, ScienceDirect and SPORTDiscus were used to search the related literatures. The publications that evaluated joint mechanical loadings through 3D biomechanical serve motion capture or video analysis in tennis players of all ages, sexes and competitive levels, with or without epidemiological monitoring of injuries were included. Most studies have involved small populations of expert able-bodied male players and focused only on the flat first serve. The results show that multiple factors - including skill level, energy flow, waiter's serve technique, temporal kinematics, fatigue and racket specifications - seem to influence upper limb and lower back loadings, thereby influencing injury risks. The impact of serve type (kick, slice or flat), leg drive and backswing style (full or abbreviated) on joint loadings remains unclear.

Teaching proper serving technique, choosing appropriate equipment and training conditions can limit the intensity of forces and moments applied on the joints and therefore decrease the risk of injury. However, further research is needed on this topic, especially in under-represented populations such as female, lower-level, juniors, and wheelchair tennis players.