Bursitis can turn an ordinary tennis movement into a painful experience. A swollen elbow after repeatedly hitting the court, shoulder pain during serving, or tenderness around the hip after hours of lateral movement may sometimes involve a bursa rather than the tendon itself.
From a tennis-focused sports-medicine perspective, the key is to identify what structure is actually causing the pain, reduce the mechanical irritation, and then progressively rebuild the player's ability to tolerate tennis.
Quick Overview
What Is Bursitis?
A bursa is a small, fluid-filled sac located between tissues such as bones, tendons, muscles and skin.
Think of it as a natural cushion and gliding surface that helps reduce friction during movement.
When a bursa becomes irritated, it can become painful and swollen. This condition is called bursitis.
Bursitis vs. Tendinopathy
These conditions are different.
Tendinopathy affects the tendon itself.
Bursitis affects the bursa, the small cushioning sac.
However, they can occur together. For example, repetitive shoulder loading can irritate both the rotator cuff region and nearby bursae.
Where Does Bursitis Occur in Tennis Players?
Olecranon Bursitis — Elbow
The olecranon bursa sits over the bony point of the elbow.
Tennis players can irritate it through:
- Repeated pressure on the elbow
- Falling onto the court
- Repetitive elbow contact
- Prolonged leaning on the elbow
A noticeable soft or swollen bump over the back of the elbow is characteristic.
Subacromial/Subdeltoid Bursal Irritation — Shoulder
The shoulder contains bursae that help structures glide during overhead movement.
Repeated serving, overhead smashing, high-volume hitting, or poorly controlled shoulder movement can contribute to irritation in this region.
Shoulder bursitis can also occur alongside rotator-cuff-related shoulder pain, so the exact diagnosis matters.
Greater Trochanteric Pain — Hip
Pain around the outside of the hip can occur in tennis players who repeatedly perform:
- Side-to-side movement
- Explosive changes of direction
- Pivoting
- Lunging
Importantly, lateral hip pain isn't always caused by bursitis alone. Tendon problems involving the gluteal muscles can produce very similar symptoms.
Symptoms of Bursitis
Typical symptoms may include:
- Localized tenderness
- Pain when the area is pressed
- Swelling
- A visible lump or puffiness
- Pain during certain movements
- Stiffness caused by pain
- Warmth around a superficial bursa
For superficial bursae, such as the elbow bursa, swelling can sometimes be dramatic.
Watch for Infection
Redness, significant warmth, rapidly increasing swelling, severe pain, fever, chills, or drainage from the area can indicate infection.
That is not something a tennis player should simply play through.
Seek medical evaluation promptly if these symptoms occur.
Why Do Tennis Players Develop Bursitis?
1. Repetitive Mechanical Stress
Tennis involves thousands of repetitive movements.
High-volume serving, groundstrokes, lunging, sliding and diving can repeatedly stress tissues around the joints.
2. Direct Trauma
A player who falls directly onto the elbow or hip can irritate a bursa.
This is particularly relevant for players who frequently dive or slide on hard courts.
3. Poor Load Management
One of the biggest mistakes in recreational tennis is the sudden jump in workload.
For example, a player who normally plays two sessions per week may suddenly play five consecutive days, compete in a tournament, and add additional serving practice.
The muscles, tendons and surrounding tissues may not have enough time to adapt.
4. Biomechanical Factors
Shoulder mechanics, muscle weakness, restricted mobility and poor movement patterns can change how forces are distributed.
However, don't assume that poor technique is automatically the cause of bursitis. A proper assessment is necessary.
How Is Bursitis Diagnosed?
Diagnosis usually starts with a clinical examination.
A sports-medicine physician or physiotherapist may evaluate:
- Exact location of pain
- Swelling
- Range of motion
- Muscle strength
- Joint mechanics
- Recent training load
- Previous injuries
Ultrasound
Ultrasound can be particularly useful for superficial bursae because it can demonstrate:
- Fluid accumulation
- Bursal enlargement
- Surrounding tissue abnormalities
X-Ray
An X-ray doesn't directly diagnose most bursitis, but it can help identify:
- Bone abnormalities
- Fractures
- Bone spurs
- Calcification
Aspiration
If a bursa is significantly swollen, particularly if infection or crystal-related disease such as gout is suspected, a clinician may remove some fluid for laboratory testing.
This should be performed by an appropriately trained medical professional and should never be attempted at home.
Treatment for Tennis-Related Bursitis
Treatment depends heavily on why the bursa is irritated.
Step 1 — Remove the Irritating Load
Temporarily reduce the activity that keeps provoking the area.
For example, if serving causes severe shoulder pain, temporarily reduce or stop serving while maintaining activities that don't aggravate the condition.
This is relative rest, not necessarily complete inactivity.
Step 2 — Control Pain and Swelling
For an acute superficial bursitis, cold therapy may help reduce discomfort.
A practical approach is to use a cold pack for approximately 15 to 20 minutes while protecting the skin.
Compression may also help selected superficial bursae, particularly around the elbow or knee, provided it isn't excessively tight.
What About Anti-Inflammatory Medication?
NSAIDs such as ibuprofen or naproxen can reduce pain and inflammation in some people.
However, they aren't appropriate for everyone.
People with certain kidney problems, stomach ulcers, cardiovascular conditions, medication interactions or other medical conditions may need to avoid them.
Ask a physician or pharmacist before using NSAIDs regularly.
What About Corticosteroid Injections?
In selected cases of non-infectious bursitis, a physician may consider corticosteroid injection.
However, never inject a bursa when infection is suspected.
The decision should be based on the diagnosis, location, duration of symptoms and response to conservative treatment.
Repeated steroid injections also aren't a substitute for correcting the underlying mechanical problem.
Physical Therapy
Once acute pain settles, rehabilitation can become important.
Depending on the location, treatment may include:
- Mobility exercises
- Rotator-cuff strengthening
- Scapular stabilization
- Forearm strengthening
- Hip strengthening
- Core stability
- Movement retraining
- Progressive tennis-specific loading
The objective isn't simply to make the pain disappear.
The objective is to make the athlete capable of tolerating tennis again.
Return-to-Tennis Program
Don't go from painful bursitis directly into a competitive three-set match.
Phase 1 — Calm the Irritation
Before returning to tennis, aim for:
- Reduced swelling
- No significant resting pain
- Improved movement
- Ability to perform daily activities comfortably
If the bursa is still visibly swollen and very tender, you're probably not ready for full tennis.
Phase 2 — Light Tennis
Start with:
Shadow swings, followed by mini-tennis and gentle hitting.
Keep the session short.
Focus on:
- Relaxed technique
- Controlled movement
- Clean contact
- Low intensity
Phase 3 — Baseline Tennis
Progress toward:
- Longer rallies
- Moderate groundstrokes
- Normal court movement
Initially limit:
- Maximum-effort serves
- Repeated overheads
- Diving
- Aggressive sliding
- Explosive changes of direction
Phase 4 — Full Tennis
Gradually reintroduce:
Serves, overheads, points and eventually match play.
Don't increase everything simultaneously.
For example, don't increase duration, intensity, serving volume and competitive match play all in the same session.
Increase one major variable at a time.
The Morning-After Rule
One of the most useful principles for tennis players is to evaluate how the body responds after training.
If your pain or stiffness is substantially worse the following morning, reduce the workload and allow more recovery.
A small amount of manageable discomfort during rehabilitation can sometimes be acceptable, depending on the condition and rehabilitation plan. However, sharp, escalating or persistent pain is a reason to stop and reassess.
Prevention for Tennis Players
Warm Up Before Playing
Gradually progress from walking or jogging to dynamic movement, shoulder and hip preparation, mini-tennis and finally full strokes.
Don't begin with maximum-effort serving.
Strengthen the Entire Kinetic Chain
For tennis, don't focus exclusively on the painful joint.
Train:
- Legs
- Hips
- Core
- Shoulders
- Scapular muscles
- Forearms
- Grip
Manage Weekly Tennis Volume
Avoid dramatic increases in:
- Match frequency
- Serving volume
- Training duration
- High-intensity drills
Protect Vulnerable Areas
If elbow or knee contact repeatedly irritates a bursa, appropriate padding or technique modification may help.
Bursitis Red Flags
See a healthcare professional promptly if you develop:
- Rapidly increasing swelling
- Significant redness or warmth
- Fever or chills
- Pus or drainage
- Severe pain
- Inability to move the joint normally
- Sudden major weakness
- Significant swelling following trauma
These symptoms can indicate infection or another injury that requires medical evaluation.
Final Advice From a Tennis-Medicine Perspective
Bursitis doesn't necessarily mean you have to stop playing tennis permanently.
It means you need to understand why the tissue became irritated and temporarily adjust the workload while allowing the area to settle.
For most tennis players, successful recovery involves three things:
- Reduce the irritation.
- Rebuild strength and movement capacity.
- Progressively return to tennis.
The biggest mistake is returning to full-intensity tennis simply because the pain temporarily disappears.
A quiet bursa today doesn't automatically mean the joint is ready for 100 serves tomorrow.
Build back gradually and make your return to tennis a progression, not a test.
Play smart. Load progressively. Give the body time to adapt.
Medical disclaimer: This article is for educational purposes and isn't a substitute for an examination by a sports-medicine physician, orthopedic specialist, physiotherapist, or other qualified healthcare professional. Persistent, severe, or worsening symptoms—particularly swelling with redness, warmth or fever—should be medically evaluated.