Tennis and Achilles tendonitis – When and how to get back out on court

Tennis is hard on your Achilles tendons. As a sports physio who used to play competitive tennis at a national level, I know that it’s tricky to get back to playing when you’ve had Achilles tendonitis – and more so if you’ve completely torn your Achilles tendon. In this article, I discuss the best way to decide when and how (and whether) to return to playing tennis after an Achilles injury. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. Your Achilles tendons and tennis

2. Getting back to tennis after Achilles tendonitis

3. Taking up tennis again after a complete Achilles rupture

4. How we can help

We’ve also made a video about this:

Your Achilles tendons and tennis

First, let's think about what you’re asking your Achilles tendons to do when you're playing tennis. A tennis player’s tendons have to deal with much greater forces and a greater variety of movements than that of, say, a runner.

Yes, you do need to run and jump, but you also need to land, and research has shown that landing on one foot can send forces of more than seven times your bodyweight through your Achilles tendon. For example, if you play right-handed, your left Achilles tendon has to deal with a strong, sudden force when landing every time you serve.

Your Achilles tendon also works hard when you push off in different directions, accelerate, and decelerate. And then, instead of propelling you in a certain direction or acting like a shock absorber when you land, it may have to go into an excessive stretch unexpectedly.

Getting back to tennis after Achilles tendonitis

Before thinking about getting back to playing tennis, you first need to do the general Achilles rehab that is necessary to get back to running.

We won’t focus on the rehab to get you running in this article. My colleague Maryke wrote an article that provides an excellent overview of the correct general rehab approach for Achilles tendonitis to get back to running. Once you’ve worked through such a programme and can run in a straight line without flaring up your injured tendon, it’s time to start thinking about getting back onto the tennis court.

To get back to tennis you have to be able to hop and jump into all directions.

To see whether you’re ready to start playing tennis again, you can do some hop tests to check whether your Achilles tendon can cope with these. Unlike muscles, tendons may only complain some time after you’ve asked too much of them, so monitor your tendon for 24 hours after each of these tests and the subsequent exercises.

Please remember that we only do these tests once we are sure our patients have built enough strength in their Achilles tendons to handle them. You can injure your tendon if you’re not ready for them, so please check with your physio before trying them:

• Don’t just hop up and down; also go forwards, backwards, and side-to-side.

• If your tendon can handle that, do the “hop-for-distance” test: Stand on one foot, hop as far as you can, landing on the same foot, and see whether you can hold the landing. You should be able to get the same distance with either foot on three attempts each without losing your balance. (See video for demo.)

If these are all good, then you can usually get onto a tennis court or similar type of space and just run in different directions without the pressure of playing. By not playing yet, you can keep things predictable for now and avoid any sudden lunges or other movements that may catch your Achilles tendon unaware. Run forwards, backwards, and diagonally, and add in some quick changes in direction. Both your ankles should have full range of motion and your Achilles shouldn’t be painful when it’s stretched.

Your Achilles tendon will need time to build the strength for full intensity match play, so slowly ease into training

Now you can actually start playing, but don’t start with match play right away. Build up towards it gradually by putting in some training sessions first – this way it’s much easier to control how long you’re playing and at what intensity.

Your tendon won’t immediately have the full capacity to handle your normal training sessions. So, it’s best to start with something simple, like half an hour of easy hitting, and then just check whether it's fine afterwards as well as the day after.

If your tendon complains, then it might well be that it's not quite ready, in which case you just need to stay at the same level until it has adapted. If it feels fine, you can gradually increase the load and eventually consider returning to something like match play.

Taking up tennis again after a complete Achilles rupture

The management of an Achilles tendon that has completely torn is very different from that of one that is suffering from a tendinitis/tendinopathy, which is typically an overuse injury.

Unfortunately, there is a higher risk of re-rupture of the Achilles tendon with any racket sport because of the acceleration, deceleration, and sudden stretching involved. So, whether you really want to get back to playing tennis is something you should think about carefully.

If you've had a complete rupture and you're considering taking up tennis again, then your Achilles tendon must have come a long way already with its rehab and be doing very well. It's not completely impossible, but you should definitely get someone professional to have a look at your tendon and guide you through the later stages of rehab and back to tennis.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Steph Davies is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can follow Steph on LinkedIn.

Reference:

Baxter JR, Corrigan P, Hullfish TJ, O'Rourke P, Silbernagel KG. Exercise Progression to Incrementally Load the Achilles Tendon. Med Sci Sports Exerc. 2021 Jan;53(1):124-130. doi: 10.1249/MSS.0000000000002459. PMID: 32658037.