Being an explosive sport which requires repetitive jumping, sprinting and rapid changes of direction, there are large forces acting on the knee joints in tennis. The majority of power is generated from the legs as players drive from the ground up transferring energy up the kinetic chain into the upper arms where it is eventually unleashed at impact. Occasionally the knee joint can become overloaded either acutely or overtime due to repetitive stresses being placed on it as the legs drive to generate and transmit force up the chain. The most common knee pain injury in tennis is Patella Femoral Pain Syndrome which results in the under surface of the patella (knee cap) becoming irritated and inflamed. The number one reason why this injury develops is due to poor lower limb biomechanics and strength in the muscles that control both hip and knee movement. Other factors which can contribute to this form of knee pain include poor flexibility in the quads and/or hamstrings, and poor foot mechanics.

Symptoms of PFPS include pain with running and jumping activities. Pushing off from a wide position or changing direction on the court may be sore, similarly driving with the legs on groundstrokes and serve may also be sore. Off court everyday activities such as going up and down stairs and sitting with the knee in a bent position for extended periods can be painful.

Treatment of PFPS usually involves a period of rest or modified play whilst addressing any factors that may have caused or predisposed the player to developing the condition. Hands on manual therapy and/or dry needling may be used to address any muscle tightness which is contributing to the injury. All PFPS patients are placed on a progressive strengthening program to address any weakness in the core, hip and lower limbs helping to prevent future reoccurrence. In cases where poor foot mechanics is contributing to greater stress on the knees orthotics are sometimes prescribed by a chartered physiotherapist.