Tennis is an excellent way to stay active, challenge your cardiovascular system, maintain coordination, and enjoy competition as you get older.

But tennis also asks a lot from your knees.

Every match can involve hundreds of movements requiring you to:

• Accelerate
• Stop quickly
• Move laterally
• Lunge
• Pivot
• Change direction
• Recover toward the center of the court
• Repeat those movements while becoming increasingly fatigued

Research examining recreational tennis injuries has found that the lower extremity is the most frequently injured region, accounting for 59% of acute injuries in one study. Twisting injuries and falls were among the most common injury mechanisms.¹

For players over 50, knee pain can create a frustrating question:

“Do I need to stop playing tennis?”

Not necessarily.

Knee pain may be a sign that the demands of tennis are currently exceeding your body’s ability to tolerate them.

Rather than immediately giving up the sport, it may be more useful to determine why the knee is becoming overloaded and what can be improved to increase your capacity to play.

Why Does My Knee Hurt When I Play Tennis?

Tennis is different from many forms of exercise because it requires movement in nearly every direction.

Walking and cycling primarily involve predictable forward movement.

Tennis requires:

Forward + backward + lateral + rotational + diagonal movement

And those movements happen rapidly.

You may sprint toward a short ball, plant your foot, lunge, hit a forehand, recover toward the baseline, split-step, and immediately move laterally toward your backhand.

Your knee must repeatedly produce force, absorb force, and control rotation.

Tennis injury research consistently identifies the lower extremity as a major site of injury, reflecting the significant physical demands placed on the legs during play.^1,2,5

The question, therefore, isn’t simply:

“What’s wrong with my knee?”

It may be:

“What part of my movement system isn’t adequately prepared for tennis?”

Why Knee Pain May Become More Common After 50

Turning 50 doesn’t suddenly make your knees fragile.

However, several changes can influence your ability to tolerate tennis as you get older.

These may include:

• Reduced muscle strength
• Reduced muscle power
• Previous knee injuries
• Changes in joint mobility
• Osteoarthritis
• Reduced balance
• Slower recovery between demanding activities
• Changes in training volume
• Reduced exposure to high-speed movement

Research examining active athletes over approximately age 50 emphasizes that older athletes have different physiological and orthopedic considerations from younger athletes but may still have high expectations for returning to their previous sports and performance levels.

The important distinction is that chronological age alone does not determine athletic capacity.

How you train matters.

The Capacity vs. Demand Problem

One of the most useful ways to think about tennis-related knee pain is the relationship between:

Physical Capacity ↔ Tennis Demand

Suppose your body currently has enough capacity to comfortably handle 45 minutes of moderate doubles tennis.

But you play:

90 minutes of competitive singles tennis.

Your knee may tolerate the first 30 minutes.

Then the quadriceps fatigue.

Your movement becomes less efficient.

You stop controlling your lunges as well.

Your recovery steps become slower.

Eventually, your knee begins to hurt.

The problem may not be tennis itself.

The problem may be that the dose of tennis exceeded your current physical capacity.

This is an important distinction because capacity can often be improved.

7 Common Reasons Your Knee May Hurt While Playing Tennis

1. Your Quadriceps May Not Be Strong Enough

Your quadriceps play a major role in controlling the knee.

Every time you:

• Lower into a ready position
• Lunge toward a ball
• Stop after running
• Push yourself back toward the center
• Change direction

your quadriceps help control the movement.

They are especially important during deceleration, when the muscles work to control the knee as your body slows down.

If your quadriceps fatigue or cannot generate enough force, other structures may be exposed to greater stress.

This is one reason strength training becomes increasingly important for recreational tennis players after 50.

2. You May Not Be Strong Enough Through Your Hips

Your hip muscles help control the position of your pelvis and thigh.

That directly influences what happens at the knee.

During lateral movement or a tennis lunge, the gluteal muscles help control:

• Pelvic position
• Femur position
• Knee alignment
• Balance
• Rotation
• Push-off

This is especially relevant for players experiencing pain around the kneecap.

Clinical practice guidelines for patellofemoral pain recommend combined hip- and knee-targeted strengthening to reduce pain and improve physical function.³

That means treating knee pain may require strengthening more than the knee itself.

3. Your Ankles May Not Be Mobile Enough

Now consider what happens below the knee.

Your ankle must move well when you:

• Lunge
• Squat
• Decelerate
• Reach toward a low ball
• Change direction

If ankle mobility is restricted, your body must find another way to complete the movement.

That compensation may occur through the foot, knee, hip, or trunk.

This is why simply treating the painful knee without assessing the rest of the lower extremity may miss an important part of the problem.

4. You May Be Able to Accelerate—but Not Decelerate

This is one of the most overlooked aspects of recreational sports training.

Many people train themselves to move.

Very few specifically train themselves to stop.

Consider a wide tennis forehand.

You push off.

Accelerate laterally.

Reach the ball.

Plant your outside leg.

Slow your body.

Hit the ball.

Then push back toward the center.

Your muscles must absorb significant force during that sequence.

If you don’t have adequate strength and neuromuscular control to decelerate effectively, the knee may absorb more of the stress.

Research in recreational tennis has found twisting mechanisms to be a major cause of acute injury, highlighting the demands associated with planting and directional movement.¹

For tennis players, braking ability is just as important as acceleration.

5. Your Knee May Be Irritated by Repeated Lunging

Tennis requires repeated lunging.

Sometimes forward.

Sometimes diagonally.

Sometimes laterally.

A deep lunge places the knee in a flexed position while the leg supports and controls body weight.

For people experiencing patellofemoral pain—pain around or behind the kneecap—activities involving loading of the knee in a flexed position can provoke symptoms.

Clinical guidelines identify squatting, stairs, running, jumping, and other activities that load the patellofemoral joint while the knee is bent as common symptom-provoking activities.³

That doesn’t mean lunges should necessarily be avoided forever.

It may mean that your knee needs to gradually develop greater tolerance to lunging.

6. Your Weekly Exercise May Not Match the Demands of Tennis

This is particularly common among recreational players.

Imagine your week looks like this:

Monday: Walk 30 minutes

Tuesday: Rest

Wednesday: Stationary bike

Thursday: Walk

Friday: Rest

Saturday: 90-minute tennis match

You may be physically active.

But nothing you did Monday through Friday required you to:

• Sprint
• Lunge
• Move laterally
• Pivot
• Decelerate
• React quickly
• Change direction

Then you expect your body to perform all of those movements on Saturday.

Your cardiovascular system may be ready.

Your musculoskeletal system may not be tennis-ready.

General fitness is important.

But sport-specific preparation matters too.

7. You May Have Increased Your Tennis Too Quickly

Sometimes knee pain isn’t caused by one particular movement.

It is simply a workload problem.

Maybe you normally play twice per week.

Then friends visit and you play four days in a row.

Maybe you normally play doubles but start playing singles.

Maybe you return to tennis after spending several months away from the sport.

Maybe you increase from 60-minute matches to two-hour matches.

Research examining injury risk in tennis supports paying attention to training and competition workload rather than making abrupt increases in activity.⁴

The body adapts to stress when it is given an appropriate amount of stress and adequate time to recover.

Sometimes the answer isn’t:

“Stop playing tennis.”

It is:

“Progress your tennis more gradually.”

Could My Knee Pain Be Arthritis?

Yes.

Knee osteoarthritis becomes increasingly common with age and may contribute to:

• Pain
• Stiffness
• Reduced mobility
• Swelling
• Difficulty with stairs
• Aching after activity

Historically, some people with knee arthritis were advised to simply reduce their activity.

Today, exercise is considered an important component of evidence-based management for knee osteoarthritis.⁶

For an active adult, an arthritis diagnosis should therefore be interpreted alongside:

• Symptoms
• Strength
• Mobility
• Balance
• Previous injuries
• Functional ability
• Activity goals

An X-ray can tell us something about the structure of the knee.

It cannot tell us everything about what you are physically capable of doing.

What If the Pain Is Around My Kneecap?

Pain around or behind the kneecap is often referred to as patellofemoral pain.

Symptoms may become more noticeable with:

• Squatting
• Stairs
• Running
• Jumping
• Prolonged sitting

Repeated activities with the knee bent³

Tennis includes many of these demands.

You’re repeatedly lowering into an athletic stance, lunging, stopping, and pushing off.

For patellofemoral pain, evidence-based clinical guidelines recommend exercise therapy combining hip- and knee-targeted strengthening.³

This reinforces an important concept:

Where you feel the pain isn’t necessarily the only place that needs attention.

What About Meniscus Problems?

The meniscus is a cartilage structure within the knee that helps distribute load.

Meniscus-related symptoms may include:

• Joint-line pain
• Swelling
• Pain with twisting
• Difficulty with deep bending
• Catching sensations

Tennis involves repeated planting and twisting movements, and meniscal injuries have been reported among recreational tennis injuries requiring surgical treatment.¹

However, structural meniscus changes also become increasingly common as we age.

An imaging finding should therefore be interpreted alongside your symptoms and physical examination rather than automatically being assumed to explain all knee pain.

Why Does My Knee Hurt After Tennis but Not During the Match?

This is common.

Your knee may feel relatively good while you’re playing.

Then you sit in the car afterward.

When you get out:

It feels stiff.

Later that evening:

It aches.

The next morning:

Going downstairs hurts.

This delayed response can provide important information about your current activity tolerance.

When evaluating how your knee handles tennis, pay attention to:

During the match → Immediately afterward → Later that day → The next morning

If symptoms consistently remain substantially elevated the following day, your current tennis volume or intensity may be exceeding your present capacity.

That doesn’t necessarily mean tennis needs to disappear.

It may mean the dose needs to change temporarily.

Should I Stop Playing Tennis If My Knee Hurts?

Not automatically.

There are certainly situations where temporarily stopping and obtaining an evaluation is appropriate.

But many recreational players can modify their tennis while rebuilding physical capacity.

That might include:

• Playing doubles instead of singles
• Shortening matches
• Taking longer breaks
• Avoiding consecutive playing days
• Reducing competitive intensity temporarily
• Limiting aggressive wide-ball chasing
• Gradually rebuilding court time

The objective is to find the appropriate amount of activity your knee can tolerate and then progressively increase capacity.

Singles vs. Doubles: Does It Matter for Your Knees?

It can.

Singles generally requires greater court coverage.

That can mean:

• More running
• More lateral movement
• More deceleration
• More wide-ball retrieval
• Greater cardiovascular demand

Doubles typically reduces the amount of court each player needs to cover.

For someone returning from knee pain, temporarily playing doubles may provide a useful bridge back to more demanding tennis.

The long-term goal, however, should depend on what you actually want to return to doing.

If your goal is competitive singles, your rehabilitation eventually needs to prepare you for singles.

Five Ways to Prepare Your Knees for Tennis After 50

1. Build Leg Strength

A tennis strength program should generally address the entire lower extremity.

Important muscle groups include:

• Quadriceps
• Hamstrings
• Gluteals
• Calves
• Trunk muscles

Exercises may include:

• Squats
• Sit-to-stands
• Step-ups
• Split squats
• Calf raises
• Hip strengthening
• Progressive resistance exercises

The appropriate exercise depends on your symptoms and starting ability.

2. Train Single-Leg Strength

Tennis repeatedly requires you to control your body over one leg.

That means your exercise program should eventually include single-leg challenges.

Examples may include:

Step-up → Split squat → Single-leg balance → Single-leg squat variation → Sport-specific single-leg control

Progression matters.

3. Practice Lateral Movement

Walking forward doesn’t adequately prepare you to move sideways.

Your training should eventually incorporate:

• Side stepping
• Lateral reaches
• Lateral lunges
• Controlled shuffling
• Faster lateral movement
• Tennis-specific court movement

The closer you get to returning to full tennis, the more your training should resemble the demands of tennis.

4. Train Deceleration

If you want to stop quickly during tennis, practice stopping before you need to do it during a match.

A progression might include:

↓ Slow step and stop

↓ Faster step and stop

↓ Forward deceleration

↓ Lateral deceleration

↓ Multi-directional movement

↓ Reactive tennis movement

You wouldn’t prepare for a marathon without running.

Similarly, you shouldn’t expect your body to tolerate repeated tennis deceleration if you never train it.

5. Improve Your Balance and Reaction Time

Tennis is unpredictable.

You don’t know exactly where your opponent will hit the ball.

That means your nervous system must constantly:

See → Process → React → Move → Stabilize

Balance and reaction training can therefore become an important part of sport-specific preparation.

For older athletes, this may be particularly valuable because recreational tennis injuries frequently involve falls and twisting mechanisms.¹

Warm Up Before You Play

Walking from your car directly onto the baseline isn’t ideal preparation.

A tennis warm-up should gradually expose your body to the movements it is about to perform.

Consider:

• Brisk walking or light jogging
• Calf raises
• Shallow squats
• Side stepping
• Controlled lunges
• Lateral lunges
• Gradual direction changes
• Progressive court movement
• Easy groundstrokes
• Gradually increasing intensity

The purpose isn’t simply to “loosen up.”

It is to prepare your muscles, joints, nervous system, and cardiovascular system for tennis.

What About Tennis Shoes and Court Surface?

Footwear matters because tennis involves substantial lateral movement.

Tennis-specific shoes are designed to tolerate multidirectional movement and provide court-appropriate stability.

Court surface may also influence physical demands.

Research has historically suggested differences in injury patterns and loading characteristics among tennis surfaces, with harder, higher-friction surfaces potentially influencing lower-extremity stress.

Footwear and surface are not usually the entire explanation for knee pain, but they should be considered as part of the bigger picture.

When Should Knee Pain Be Evaluated?

Seek appropriate medical evaluation after a significant injury or if you experience:

• Significant swelling
• Inability to bear weight
• True locking of the knee
• Repeated giving way
• Significant loss of motion
• Severe pain following a twist or fall
• Redness or warmth
• Fever or other systemic symptoms
• Persistent or progressively worsening symptoms

An evaluation is also reasonable when knee pain repeatedly interferes with tennis despite attempts to modify your activity.

What Should a Tennis-Specific Knee Evaluation Include?

If your goal is returning to tennis, the evaluation should involve more than asking:

“Where does your knee hurt?”

A comprehensive assessment may examine:

Knee Mobility: Can your knee fully bend and straighten?

Quadriceps Strength: Can your thigh muscles produce and absorb sufficient force?

Hip Strength: Can your hips control your pelvis and thigh during lateral movement?

Hip Mobility: Do you have adequate motion for your groundstrokes, serves, and court movement?

Ankle Mobility: Can the ankle move adequately during lunging and deceleration?

Calf Strength: Can the lower leg produce and absorb force effectively?

Single-Leg Control: Can you control your body when loading one leg?

Balance: Can you maintain stability during progressively challenging movements?

Lunge Mechanics: Can you lunge forward, diagonally, and laterally?

Deceleration: Can you slow yourself safely?

Direction Changes: Can you transition efficiently from one direction to another?

Tennis-Specific Movement: Can you perform the movements required to return to the court?

Patellofemoral pain guidelines similarly recommend functional testing such as squats, step-downs, and single-leg squats, together with assessment of hip and thigh strength and other relevant impairments.³

The Goal Shouldn’t Be Just to Make Your Knee Stop Hurting

Imagine you stop playing tennis for six weeks.

Your knee feels much better.

Success?

Not necessarily.

If your goal is to return to tennis, the real question is:

Can your knee tolerate tennis again?

That’s why rehabilitation should progress beyond symptom reduction.

A return-to-tennis progression might look like:

↓ Reduce irritation

↓ Restore mobility

↓ Build strength

↓ Develop single-leg control

↓ Improve balance

↓ Train lunging

↓ Train deceleration

↓ Add lateral and multidirectional movement

↓ Return to court drills

↓ Return to tennis

The goal is not simply a comfortable knee.

It is a knee—and a body—that can handle the demands of your life.

Frequently Asked Questions About Knee Pain and Tennis After 50

Is tennis bad for your knees after 50?

Not inherently. Tennis places significant demands on the lower extremities because it requires running, lunging, stopping, pivoting, and changing direction.^1,2 Whether those demands cause symptoms depends partly on your individual joint health, strength, mobility, conditioning, previous injuries, and activity volume.

Can I play tennis if I have knee arthritis?

Many people with knee osteoarthritis remain physically active. An arthritis diagnosis alone does not automatically determine whether you can play tennis. Your symptoms, physical capacity, medical history, and goals should help guide activity decisions.

Why does the front of my knee hurt after tennis?

Pain around or behind the kneecap may be associated with patellofemoral pain. Activities that load the knee while it is bent—including squatting, stairs, running, and similar sporting movements—can aggravate symptoms.³

Why does the inside of my knee hurt after tennis?

Inner-knee pain can arise from several different structures, including the joint, meniscus, ligaments, tendons, and surrounding tissues. Location alone cannot determine the diagnosis. Persistent or worsening symptoms should be evaluated.

Should I wear a knee brace while playing tennis?

A brace may help certain conditions, but it is not automatically necessary for every tennis player with knee pain. The appropriate intervention depends on the cause of the symptoms. A brace also does not replace strength, mobility, balance, and sport-specific conditioning.

Is doubles tennis easier on the knees than singles?

Doubles usually requires less court coverage than singles and may reduce some running and directional-change demands. It can sometimes be a useful temporary modification while rebuilding knee capacity.

What exercises are best for tennis knee pain?

There isn’t one universal exercise. A comprehensive program may need to address quadriceps and hip strength, calf strength, ankle mobility, balance, single-leg control, lunging, lateral movement, and deceleration. For patellofemoral pain, combined hip- and knee-targeted strengthening is strongly supported.³

Want to Keep Playing Tennis After 50? Train for Tennis.

This is the larger message.

If tennis is something you want to continue playing in your 60s, 70s, and beyond, your exercise program should help prepare your body for tennis.

Walking is valuable.

Cycling is valuable.

Strength training is valuable.

But tennis also requires:

• Lunging.
• Stopping.
• Side-to-side movement.
• Single-leg control.
• Acceleration.
• Deceleration.
• Reaction.
• Rotation.
• Recovery.

You don’t necessarily protect your knees by asking less and less of them.

An alternative approach is to progressively build the capacity required for the activities you want to continue doing.

Instead of asking:

“Am I getting too old for tennis?”

Consider asking:

“What does my body need so I can continue playing tennis?”

That question changes the conversation.

At Kriz Mobility and Vitality in Bonita Springs, Florida, we work with active adults who want to continue participating in golf, tennis, pickleball, travel, exercise, and the other activities that make life enjoyable.

Our goal is not simply to identify where you hurt.

We want to understand why your body is having difficulty with the activity you want to perform and help build the mobility, strength, balance, and physical capacity needed to get back to it.

Because the goal isn’t simply less knee pain.

The goal is helping you stay Active for Life.

Move better. Live better. Stay Active for Life.

References

1. Kaiser P, Stock K, Benedikt S, Ellenbecker T, Kastenberger T, Schmidle G, Arora R. Acute tennis injuries in the recreational tennis player. Orthop J Sports Med. 2021;9(1):2325967120973672. doi:10.1177/2325967120973672.

2. Pluim BM, Staal JB, Windler GE, Jayanthi N. Tennis injuries: occurrence, aetiology, and prevention. Br J Sports Med. 2006;40(5):415–423. doi:10.1136/bjsm.2005.023184.

3. Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain: clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2019;49(9):CPG1–CPG95. doi:10.2519/jospt.2019.0302.

4. Amor-Salamanca MS, Rodríguez-González EM, Rosselló D, de Lluc-Bauza M, Hermosilla-Perona F, Martín-Castellanos A, Herrera-Peco I. Risk factors and prevention of musculoskeletal injuries in adolescent and adult high-performance tennis players: a systematic review. Sports (Basel). 2025;13(10):336. doi:10.3390/sports13100336.

5. Dines JS, Bedi A, Williams PN, et al. Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. 2015;23(3):181–189. doi:10.5435/JAAOS-D-13-00148.

6. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149–162. doi:10.1002/acr.24131.