Hip and groin pain in Tennis players

Hip pain was a symptom that affected mostly older tennis players in the past, but the changes in the game has led to more and younger player being affected.

Advances in racket technology, longer seasons on slower courts have led to players adjusting their techniques, game strategies and training methods to enable them to be more competitive as baseliners and aggressive hitters. Modern rackets allow for more aggressive hitting, but also having to move wider and playing more shots off the back foot (so called open stance shots) for longer points and matches. The demands of the modern game also forces players to train harder to be able to succeed. These are some of the reasons why some of the top professionals of this era like Gustavo Kuerten, Andy Murray and Milos Raonic have been plagued by hip pain.

Top players like Novak Djokovic possess great agility and suppleness, which have started a bigger focus on stretching programs to improve agility and suppleness. Excessive rotation of the hip, overuse of muscle surrounding the hip and insufficient recovery can lead to overuse of pelvis and hip joints.

Basic Anatomy of the hip

It is a ball and socket joint with excellent bony stability. The ligament teres runs from the femoral head (ball) to the middle of the acetabulum (socket), providing stability and some vascular (blood) supply to the femoral head. The acetabulum has a ring of fibrous tissue ( labrum) that deepens it to help with stability and a seal that plays a role in homeostasis of the cartilage of the hip. Anatomic variants of hips vary from flat acetabulums (hip dysplasia) to deep acetabulum (pincer lesions), round heads (normal) to flat heads (cam lesions). A flat acetubulum has a thicker labrum as a general rule.

Cause for hip pain in competitive skeletally mature young high performance tennis players are:

labral tears of hip
femoral acetabular impingement (FAI)
osteitis pubis and stress fractures of pelvis and sacrum
sports hernia (Gilmour groin)
adductor tendinosis

Causes for hip pain in skeletally immature players are rare, unless there is underlying pathology and needs to be investigated

The rigours of competitive tennis lead to high loads on hips and therefore there is a high incidence of osteoarthritis in veteran tennis players that starts to affect players in the 5th and 6th decades.


When an athlete presents with hip pain which do not settle with normal conservative treatment, it needs to be investigated with Xrays and MRI scans. Advances in the medical field of radiology (X-rays and MRI scanning) have allowed for the causes of hip or groin pain to be diagnosed accurately.dvances in treatment options based on better diagnosis and improved outcomes measurements, have led to better treatment methods and results.

Treatment of hip or groin pain

The key to the treatment plan is an accurate diagnosis.

Prevention of hip and groin injuries

Prevention is always better than cure and most cause for hip pain tennis players can be prevented by a combination of shot technique adjustment, adequate recovery and periodization.

Sports physicians in USA and Spain have become aware of the higher incidence of hip injuries and are working on programs to look at changing shot and movement techniques to prevent these debilitating injuries.

Basic principles of shot preparation, balance, weight- transfer and ball contact in front of the body will decrease the load on the hip.

A scientific stretching and conditioning program is essential to protect the lower back facet joints, discs, sacro- iliac joints and symphysis pubis, as well as the hips.

Care must be taken with a gym program that it improves tennis performance and not cause injuries.

Players and trainers must remember that speed on tennis court is a combination of factors (speed, agility and anticipation), very different from sprinting on athletics track or soccer field. Sufficient recovery should be part of all players training programs.

Treatment for acute hip or groin injury

Initial treatment of an acute injury is adequate rest, ice, non-steriodal anti-inflammatory medication and physiotherapy.

Specific injuries

Labrum tears

This diagnosis is made with a MRI scan and arthrogram (dye injected into the joint)

A confirmed labrum tear in athletes need to be repaired arthroscopically. The results of arthroscopic labrum repairs are excellent.

Femoral acetabular impingement

Advances in hip arthroscopy have allowed for treatment of FAI with excellent results.

Osteitis pubis

This is still fortunately a rare, but very difficult condition to treat in a tennis player and recovery might take up to 2 years. This condition needs to be prevented with stretching program, core stability, recovery and periodization.

Sports hernia (Gilmour groins)

This condition can be treated with surgery, in resistant cases, but should be prevented with core stability program.

Lesser common overuse injuries in tennis players

Pelvis or sacral stress fractures and hamstring and adductor tendinosis are overuse injuries that should be prevented, because the recovery from these injuries is a very frustratingly lengthy process.

Hip Osteoarthritis

This common condition in senior tennis players can only be treated with a total hip replacement. Ceramic on ceramic or ceramic on high density poly ethylene cementless prosthesis will allow players to play competitive tennis again, unlikely on the professional tour. Large metal on metal articulations (resurfacing) prosthesis can be indicated in the right cases.