Tennis Doctor & Tennis Expert Guide
If you play tennis regularly, pain around the shoulder, elbow, hip, or knee can sometimes be caused by more than a strained muscle or “tennis elbow.” One possibility is bursitis—irritation and inflammation of a small fluid-filled sac called a bursa.
Bursae act like cushions between bones and nearby muscles, tendons, and skin, helping tissues glide smoothly during movement. When a bursa becomes irritated, repetitive tennis movements can make the pain worse.
For tennis players, the important question isn't simply, “How do I get rid of the pain?”
It's:
“What caused the irritation, and how can I return to tennis without repeatedly aggravating it?”
Quick Overview
Bursitis occurs when a bursa becomes irritated and swollen. It can develop in many areas of the body, but the shoulder, elbow, hip and knee are common locations.
For tennis players, repetitive racket movements can contribute to irritation, particularly around the shoulder and elbow. Repetitive motion is a recognized cause of bursitis, although trauma, prolonged pressure and infection can also cause it.
Tennis-specific takeaway
Pain around your elbow does not automatically mean tennis elbow.
Tennis elbow involves a tendon, while olecranon bursitis involves the bursa at the back of the elbow. The two conditions can look similar but require different clinical assessment.
Bursitis Symptoms
The symptoms depend on which bursa is irritated, but common signs include:
1. Pain and Tenderness
You may notice:
- Dull, aching pain
- Local tenderness
- Pain when moving the affected joint
- Pain when pressing directly over the area
- Discomfort that increases after repetitive activity
Bursitis pain may develop gradually or sometimes appear more suddenly after trauma.
2. Swelling
Some bursae, particularly the one behind the elbow, can become visibly swollen.
A noticeable lump around the back of the elbow after repeated pressure or trauma is a classic example of olecranon bursitis.
3. Stiffness and Reduced Movement
An inflamed area may become uncomfortable to move, making it difficult to:
- Reach overhead
- Serve
- Hit a backhand
- Bend the elbow
- Squat
- Climb stairs
- Perform normal daily activities
4. Warmth or Redness
Warmth, redness and increasing swelling can occur with inflammation.
However, when these symptoms occur together with fever, chills or significant worsening pain, infection needs to be considered. Septic bursitis requires medical evaluation.
Why Tennis Players Develop Bursitis
1. Repetitive Tennis Movements
Tennis involves thousands of repeated movements:
- Serving
- Forehands
- Backhands
- Volleys
- Overheads
- Repeated shoulder rotation
- Repeated elbow movement
Repetitive racket-sport movements can contribute to irritation of bursae, particularly around the shoulder.
2. Sudden Increase in Training
One of the mistakes I frequently emphasize to recreational players is doing too much too quickly.
For example:
Playing twice a week for several months and suddenly jumping to five hard sessions per week can dramatically increase the workload on your tissues.
Your cardiovascular system may feel ready for the extra tennis, while your muscles, tendons and bursae may not be.
3. Direct Pressure or Trauma
Repeated pressure or a direct blow can irritate a bursa.
This is particularly relevant for elbow bursitis, where repeatedly leaning on the elbow or hitting the elbow against a hard surface can contribute to irritation.
4. Technique and Workload
Technique isn't the only factor, but inefficient movement can increase the physical demand placed on particular tissues.
For tennis players, examine:
- Serve mechanics
- Shoulder rotation
- Footwork
- Training volume
- Recovery time
- Racket specifications
- Recent changes in playing frequency
The goal isn't simply to blame your technique. We want to identify what changed before the pain appeared.
Bursitis vs. Tennis Elbow
This distinction is important.
Bursitis
Structure involved: Bursa
Typical example:
Olecranon bursitis → swelling and irritation of the bursa at the back of the elbow.
Tennis Elbow
Structure involved: Tendon
Tennis elbow, also called lateral epicondylitis, involves the tendons around the outside of the elbow and is commonly associated with repetitive gripping, twisting and swinging movements.
Why this matters
If you assume every tennis-related elbow problem is “tennis elbow,” you may overlook another condition.
Location, swelling pattern, tenderness and movement symptoms matter.
How Is Bursitis Diagnosed?
A healthcare professional will usually begin with a physical examination.
They may evaluate:
- Where the pain is located
- Whether swelling is present
- Tenderness
- Range of motion
- Recent activity or trauma
- Signs of infection
- Other possible causes of pain
Imaging isn't always necessary, but X-rays, ultrasound or MRI may be used when another condition needs to be ruled out or the diagnosis isn't clear.
Bursa Fluid Aspiration
If infection or another condition such as gout is suspected, a clinician may remove a small amount of fluid from the bursa for testing.
This can help determine whether bacteria, blood or crystals are involved.
Treatment: What Should a Tennis Player Do?
Treatment depends on the location, severity and cause of the bursitis.
Step 1: Reduce the Irritating Activity
You don't necessarily need complete bed rest.
Instead, temporarily reduce the movements that provoke symptoms.
For a tennis player, that might mean temporarily avoiding:
- Hard serving
- Overhead shots
- High-volume drilling
- Repetitive volleys
- Long matches
- Any movement that clearly increases pain
The objective is to give the irritated tissue an opportunity to settle down.
Step 2: Ice
An ice pack wrapped in a towel can be applied for short periods to help with pain and swelling.
The NHS recommends around 10 minutes at a time, repeated as needed.
Don't place ice directly against your skin.
Step 3: Pain Medication When Appropriate
Some people may benefit from medications such as ibuprofen or other anti-inflammatory medicines.
However, these medications aren't appropriate for everyone.
Consider your:
- Kidney health
- Stomach history
- Blood pressure
- Other medications
- Allergies
- Other medical conditions
Ask a healthcare professional or pharmacist before using NSAIDs if you're unsure they're safe for you.
Physical Therapy and Rehabilitation
Once the acute irritation has settled, rehabilitation can help restore normal movement and strength.
Depending on the affected area, a physical therapist may work on:
- Range of motion
- Strength
- Shoulder stability
- Rotator-cuff function
- Forearm strength
- Hip strength
- Lower-body mechanics
- Tennis-specific movement patterns
The goal is not simply to make the pain disappear.
The goal is to make the body capable of handling tennis again.
What About Corticosteroid Injections?
A corticosteroid injection may sometimes be considered for persistent bursitis.
However, it should not automatically be treated as the first solution.
Importantly, steroid injections should not be given into an area when infection is suspected.
Your clinician should determine whether an injection is appropriate based on the diagnosis, location and individual circumstances.
When Is Surgery Necessary?
Fortunately, surgery is uncommon.
Most bursitis cases can be managed without surgery.
In persistent or recurrent severe cases, a specialist may consider procedures such as drainage or, rarely, surgical removal of the chronically inflamed bursa.
When a Tennis Player Should Seek Medical Attention
Don't simply “play through it” if you develop:
- Fever
- Chills
- Significant redness
- Increasing warmth
- Rapidly increasing swelling
- Severe pain
- Inability to move the joint normally
- A wound or cut near the swollen bursa
- Symptoms that are getting worse instead of better
These symptoms can indicate infection or another condition requiring medical assessment.
Septic bursitis can become serious if untreated.
Returning to Tennis After Bursitis
This is where tennis players often make their biggest mistake.
Don't use “I can tolerate the pain” as your return-to-play test.
Instead, look for functional recovery.
Stage 1 — Normal Daily Movement
You should be able to perform normal daily activities without significant pain.
Examples:
- Walking
- Reaching
- Bending the elbow
- Getting dressed
- Going up stairs
depending on which joint is affected.
Stage 2 — Tennis Movement Without Impact
Try controlled movements such as:
- Shadow swings
- Footwork drills
- Mini-tennis
- Gentle movement patterns
Keep the intensity low.
Stage 3 — Easy Hitting
Progress to:
- Short-court hitting
- Easy groundstrokes
- Controlled rallies
- Reduced session duration
Avoid immediately jumping into a two-hour competitive match.
Stage 4 — Increase Intensity
If symptoms remain controlled, gradually increase:
- Rally speed
- Court coverage
- Stroke intensity
- Practice duration
- Serve intensity
Increase one variable at a time rather than increasing everything simultaneously.
Stage 5 — Return to Competition
Only after you can tolerate progressively harder tennis without significant symptom escalation should you consider returning to full competitive play.
If pain repeatedly returns when you increase workload, that's information—not something to ignore.
What About Racket and Equipment?
Equipment can be part of the overall picture, but don't assume equipment is automatically the cause.
Check:
Grip Size
An inappropriate grip can alter how you hold and swing the racket.
String Setup
String type and tension influence racket feel and impact characteristics, but there is no universal string tension that prevents bursitis.
Racket Weight and Balance
A change to a substantially heavier or differently balanced racket can alter the physical demands of your swing.
Most Important: The Entire Load
Think beyond the racket.
Ask:
How many hours am I playing?
How many serves am I hitting?
How many days am I playing consecutively?
Did I recently change my racket, technique, training volume or playing intensity?
The answer may reveal the real trigger.
How to Prevent Bursitis From Coming Back
Warm Up
Start with progressive movement before intense tennis.
Increase Training Gradually
Avoid sudden increases in playing volume.
Take Recovery Days
Your body adapts during recovery—not only during training.
Improve Tennis Mechanics
Work with a qualified tennis coach when technique or movement patterns may be contributing to excessive load.
Strengthen Supporting Muscles
A tennis-specific conditioning program can improve your ability to tolerate repetitive movement.
Protect Vulnerable Areas
If your sport or work puts repeated pressure on an elbow or knee, appropriate padding can reduce direct pressure.
The Tennis Doctor's Bottom Line
Bursitis is usually a load-management problem that needs the right diagnosis, not simply a painkiller-and-play-through-it problem.
If your shoulder, elbow, hip or knee becomes painful and swollen after repetitive tennis, don't automatically assume it's a muscle strain or tennis elbow.
Find the structure causing the pain.
Then:
Reduce the aggravating load → control symptoms → restore movement → rebuild strength → gradually reload the tennis-specific movement → return to competition.
And remember:
The fastest route back to tennis is not always playing through the pain. Sometimes the smartest training session is the one you skip so your body can recover.
Medical Disclaimer
This article is for general education and does not replace an examination by a qualified doctor, sports-medicine professional or physical therapist. Persistent, severe or worsening symptoms—particularly swelling accompanied by fever, redness or warmth—should be medically evaluated.