Common Table Tennis Injuries & How To Prevent

What are the most common injuries and pains in table tennis? Players often suffer from upper extremities pain such as wrist, elbow, ankle and shoulder joints. Diagnosis, treatment, and prevention of common table tennis injuries are very important for your safety. Physicians and doctors can provide informed advice and treatment recommendations, but you should read this article to prevent unnecessary injuries.

Is table tennis safe?

Table tennis is one of the most popular sports in the world. This sport is suitable for all ages and all levels: From 7 years old to 77 years old. So in general, table tennis is safe! Much safer than football, tennis, badminton, etc.

However, at a high level,  physical demands for the top athlete are known to expose to various musculoskeletal injuries (mostly soft tissue problems). These problems are usually a result of overuse of some specific muscle groups. With the bigger ball (new trends), many top players suffer from the injury problem.

Table tennis is safe, but muscle strain and soft tissue injuries are a huge problem!

At the amateur level, injuries are also common. Personally, I know many beginners (junior and senior) suffers from small injuries. Incidence of injuries varies with age, gender and level of experience(beginners, intermediate, advanced level).

 

There are in general 5 types of injuries in table tennis, which are presented below.

Why do we feel pain after long training?

Many players asked me this question. Something like:

Dear coach ERT. I feel pain in my wrist after training backhand topspin for long, is this normal?

I coach young players (around 12 years old – 18 years old), and veteran players (over 50 years old). So I understand well how often my players get these types of injuries.

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In general, there are 3 main reasons that you feel pain in table tennis:

1. Bad habit – Bad stroke mechanism
2. Hit too hard, overused, and repetitive motion tension
3. Not warm up correctly

Bad habits and bad stroke mechanisms happen to new players. They just stand up too straight and use only one muscle group. They forget to use the whole body in the stroke. For beginners, the most common injury is a shoulder injury. They use only the arm, shoulder during the topspin strokes.

 

While young players often hit too hard. During the training, they want to finish the point too soon. They often get the “overused muscle” problem. Normally, young players got pain in the wrist, the back, and sometimes the elbow.

Veteran players are slow to warm up. They often forget to do the proper warm-up, so not enough “liquid” for the joint. Senior players often suffer from Arthralgia (Arthralgia literally means joint pain). Arthralgia (from Greek “arthro” is joint, and “algos” is a pain) literally means joint pain. Older players often get ankle injuries, knee injuries. They don’t have good footwork and don’t know how to move. To deal with this, veteran players should do the stretching exercises, warm up correctly. At least 10 minutes before the real training.

What to do when you feel pain?

What to do when you feel pain? Should you continue or stop?

When you contract your muscles repeatedly, they begin to feel tired, sore. It’s normal. But if the pain does not go away or the ache is very strong. You should stop.

Do you know that Ma Long has knee injuries for more than 6 months? He needs to stop all of the competition before an impressive comeback this year. Pain is the signal from your body that says “Slow down. I can’t support”.

 

 

Top table tennis players suffer more and more injury. It could be due to the larger ball, heavier ball so it requires more physical demand. Zeio (on TTD) has posted a meme post for this:

 

You could hear the “tennis elbow” term. In table tennis, there is also the tension of the triceps tendons, repetitive motion tension fatigue, ankle, and knee pain, etc. I recommend you to stop, and go to see a doctor. Any pain needs to be treated to avoid a more serious problem in the future.

Short periods of intensive training produce weak patterns of movement faster than anything else. Once an inappropriate movement pattern is established, it is almost impossible to correct it in a normal person, let alone a well-adjusted athlete. Liu Guoliang has to do the shoulder-operation, due to his bad gesture during many years with short pimple attacks. Tiger Woods damaged his body and he has never been the same since. Larry Bird had to retire because of the bad mechanics of the body to run on the basketball court.

So take your time! Learn and correct yourself with the help of a coach, an expert before it is too late!

 

 

Another tip for you that helps you prevent injury when getting older: Choose lighter racket.

 

You may want to consider using a lighter paddle to reduce stress on your damaged tendon. Light racket Around 150g can help you reduce the shoulder and wrist strain. Be sure to give a few weeks to get used to the new weight. At first, you may hate the feel of the light palette. A few weeks later, you will love the new speed and lack of fatigue. Using a lighter racket can help you recover faster too!

Most used muscles in table tennis

In order to understand which muscles group is overused during the table tennis strokes, you need to understand the biomechanics in table tennis.

Similar to other racket sports (tennis, golf, squash), table tennis includes different types of strokes and services. Each movement includes different biomechanical factors that could affect injuries. In the 10 most popular strokes, the forehand topspin and forehand smash are the movements that consume the most energy and require a lot of muscle to be used.

3 stroke phases

The table tennis strokes are characterized by three phases of different movements:

• Yin pai – Preparation with the whole body, legs, and hips
• Acceleration – Using the wrist, the elbow, and the forearm at the moment of contact
• Follow through – Using mostly the waist to transfer the “forward force”

6 energy link in table tennis

In this process, musculoskeletal joints such as the knee, shoulder, and elbow serve as links in the kinetic chain by generating and transmitting energy to the next link. Here is the list of energy link:

1. Ankle (Weak): The first link to transfer the “power from the ground”
2. Knee (Medium): The intermediate link between the ground and the hips
3. Trunk (Strong): Hip and waist – Very strong core then fewer injury possibilities
4. Shoulder (Strong): Link between the core and the rotation axes
5. Elbow (Medium): Link between the core and the forearm
6. Wrist (Weak): Weak link but suffer the highest velocity

So you can see that link #1, and link #6 are very important but they are weak. Ankle and the Wrist are the first and last links in the procedure. But unfortunately, the ankle and wrist are very weak. While the Trunk (hip and waist) is a very strong link. The ankle will absorb the “power from the ground”, and the wrist will transfer this energy to the ball.

 

The waist is the narrowest part of your torso. While the hip is the widest part of your buttock. Both the waist and hip are very important in table tennis. They generate a lot of power for your strokes.

So weak link will be prone more to injury in table tennis. Old players (veteran, senior) will suffer more ankle and knee injury. And junior players will suffer more to wrist, elbow and shoulder injury (based on my coaching experiences).

During a good stroke, this energy cycle (from the ground to the ball) will make the ball spin. Don’t just impact the ball with only your racket, but think about this “linking concept”. By thinking about this, you can reduce the injury possibility.

Use all of the links to reduce injury

In a single table tennis match, this linking cycle is repeated many times and greatly depends on the strength, stamina, flexibility, and technique of an athlete. If energy transfer in articulation is not coordinated effectively, the following joints can easily become overloaded.

By understanding the “energy linking” concept in table tennis, you can greatly reduce the injury and pain during your intense training. That’s why biomechanical is very important in table tennis. I want to explain this concept to every high-leveled players and new players. High-level players and coaches can use it to improve their performance. While new players can use it to have a proper technique and stroke mechanism. All players should know this for your safety.

 

I’ve observed that there is a huge difference between experienced table tennis players and amateur players. Experienced players prefer using many muscle groups to generate power. Amateur players forget to do adequate knee flexion and hip rotation, so they must use more 25% of shoulder and elbow to generate similar speed and power.

Should and elbow is “overused” 25% in table tennis, if you don’t use the “power from the ground” concept

As I coach, I emphasize on the fluid, the correctness of the stroke for my players. The kinetic connection depends on the level of experience.

 

Advanced table tennis players manipulate the kinetic connection more effectively to reduce the impact forces transmitted to the weak linkings: wrist, ankle.

In turn, beginner or recreational table tennis players often use excessive and uncoordinated force in the absence of an effective technique, which does not result in increased ball speed and spin. You need to learn optimal technique which helps enormously to maximize the prevention of injuries and also increase the quality of your shots.

Most common injuries and pains in table tennis

In table tennis, we can divide the injuries by its position on the body. Therefore, we have injuries on the upper part, and on the lower part. Injuries of the upper part are the most often because of the overused muscle. Due to the complex anatomy of the biomechanical properties of table tennis shots, it’s very hard to understand the interaction between several muscle groups.

Upper Part injuries: Wrist, Elbow, and Shoulder.

Lower Part injuries: Ankle, Knee.

 

Here we will discuss the common injuries diagnostic and treatment methods. In term of injuries frequency, here is the top 5 most common injuries and pains in table tennis:

1. Wrist Injuries
2. Ankle Injuries
3. Knee Injuries
4. Elbow Injuries
5. Shoulder Injuries

1. Wrist Injuries

In table tennis, wrist injuries are very popular because the wrist is a very weak “energy connection”. Wrist injury is associated with ulnar pathology associated with the extensor tendon of the body and occur during backhand strokes. For the forehand stroke, we don’t use often the wrist. Bending and wrist extension are important components of the speed of the ball for the backhand flick technique.

 

The speed of the ball in the backhand flick depends on the wrist angular velocity. Therefore, you can reduce the wrist injuries by reducing the wrist flexion and extension. It will help to reduce the dynamic repetition of this stroke.

One way to protect your wrist is by using a wristband (for example from Adidas).

 

A wristband is also useful to absorb the sweat. There is a very nice design colorful wristband for sport both male and female players. Another good option is Neo-G wrist band: Support For Joint Pain, Arthritis, Sprains, Strains, Instability in racquet sport: table tennis, golf, tennis, or basketball.

• Adidas wristband
• Stylelist wristband
• Pain Relieving Wrist Support for Sport

 

 

 

2. Ankle Injuries

Ankle injuries are very common for veteran players. It could be due to the bad choice of footwear, bad footwork techniques, and lacking a warm-up routine.

Your shoes should have excellent grip and should keep you low to the ground. You don’t want a shoe with a too high heel. In table tennis, you have to move quickly and do a lot of lateral movements.

 

That’s why you should buy a shoe specifically designed for table tennis because these shoes are built for “quick movement” and “protection of ankle”.

 

You need also to learn the right warm-up routine. This warm-up can improve the strength and flexibility of your ankle joint.

 

Finally, improve your footwork! Learning the right footwork will help ensure you have the coordination to properly move around the court in a safe and effective manner.

 

Work with a coach and don’t neglect your footwork drills.

 

A good warm-up is necessary before starting to play. The warm-up involves 5-15 minutes of light physical activity to raise your heart rate and make your muscles warmer. Then do some gentle stretching to complete the warm-up.

 

 

In general table tennis players just want to keep playing even having an injury and strain. To do that, you should consider using a wrist strap and ankle supports. It can help you prevent the worst injury due to your ankle weakness.

Some of my players just use the ankle and wrist supports and then they never looked back. It’s good news for table tennis players.

 

3. Knee Injuries

The knee is a much stronger “energy connection” than the ankle. Therefore, knee injury is less common in table tennis. However, knee requires a lot of “liquid”, so you need to warm up your knee carefully.

 

Knee injuries are common in other sports. The rider’s knee is a disease that can affect anyone who bends a lot, such as running, walking, jumping or cycling. Knee ligament tears may result in sudden knee pain.  It is felt as pain around the patella and may be the result of excessive use, injury, abnormal leg or foot bones, and weak muscles.

 

To minimize the knee injuries, you should warm-up your knee before the competition. You can also buy a knee strap, this help to fix kneecap and minimize pain or soreness under or behind the kneecap.

 

 

Wang Hao and Zhang Jike are using the Mueller Jumper ‘s Knee Strap. There are 2 colors: red and blue that you can choose.

If you forget to stretch your knee, you can sometimes get clicking laterally too.

Here is some quick advice if you get the knee pain in table tennis:

• Stretch before playing.
• Wear a knee strap.
• Ice the knees after playing.
• Take fish oil. Cod liver oil can be beneficial for muscles, blood vessels, and joints.
• Do exercise to strengthen the knees.

 

4. Elbow Injuries

Yes, elbow injuries in table tennis are very similar to “golfers elbow”, or “tennis elbow”. Less experienced table tennis players or recreational players generally experience elbow injuries due to improper technique, while professional players tennis players can be injured in the elbow as a result of forced strokes (too hard striking).

 

Often linked to a bad forehand technique,  table tennis elbow is the obsession of amateur players. To reduce the risk, you need to apply “power from the ground” concept.

 

A table tennis elbow is an inflammation of the tendons that connect the hand to the elbow and serve to flex the wrist (epicondylar tendons). Result: a pain in the elbow, awakened by the setting in tension or the rotation of the wrist.

5. Shoulder Injuries

The shoulder joint is the most mobile articulation of the body in table tennis. The waist joint generates a lot of power, and the shoulder is the connection between the trunk and the rotation axis (arm – forearm).

 

Table tennis players tend to use a lot of power to create a powerful forehand attack. The amplitude and the rotation movement helps also stabilize the large strokes (like forehand smash).

Shoulder injuries due to excessive use are common among table tennis players of all skill levels. It accounts for around 10% of table tennis injuries.

However, repetition of the abduction-extension movement may alter the arc of rotation of the shoulder, producing an increased degree of external rotation to the detriment of tightening of the posterior capsule. This is the case of Liu Guoliang. He has been operated to fix his shoulder due to “moving up his shoulder” during the forehand smash (with short pips) in his career.

Shoulder and arm injuries are very common in table tennis due to the repetitive motions players use (for example during the forehand topspin training). During many years of training, without a correct relax phase, your shoulder muscle will suffer.

Due to the intense training or the ambition to play in the tournament, some players train non-stop. When injured, they use the wrist, knee, and shoulder supports. If you have arthritis or other complications then you should use support. However if not injured nor prone to injury, you should not use support. It’s not necessary.

 

Table Tennis Injury Treatment

Lesions and tendons injury result from repetitive joint overload is often difficult for physicians because of the complex interplay between soft tissue anatomy. For the treatment, you need to ask for advice of physicians and doctors. I would say get surgery is the last option because our body has its own mechanisms to heal itself. Take time so your body can recover!

 

However, when it takes a too long time (more than 6 months), you need help from conservative treatment. Operational management is considered after trying a conservative treatment but should be approached with caution as favorable results may not be realistic and may not return to the previous level of play. Here is some possible solution that may help you:

Stop playing

If you have a wrist injury, it is imperative to rest your wrist. If the pain is really important, a removable thermoformed wrist splint can be helpful which is prescribed by a doctor.

Resume gradually!

To resume training, you must wait no longer to feel pain for at least a week. If you have elbow injury, you can play mainly by rotating your body, using mainly the waist rotation. Don’t use too much elbow in your stroke, but generate the power from your body (called rotation axis).

Practice the feeling, play close to the table avoid hitting hard. You can also use a lighter racket which will help.

It is during this recovery that it may be wise to buy an elbow bracelet in pharmacies. Worn about a centimeter below the elbow, it can protect the elbow and reduces the shock.

 

Knee Strap

Knee Strap is a good way to prevent knee injury in table tennis. Top players like Wang Hao, Zhang Jike often wear a knee strap.

Far Infra Heat

When you have the tendon and shoulder pain problem which can last very long to heal. You can help the body to heal faster by increasing the blood flow. This will bring in the building blocks to restore the damage.

Heat does this, and direct heat pressed against the injury site to a reasonable temp for 30-minute intervals is something to consider. So using Far Infrared Heat can heal your pain faster. This method is effective for shoulder FIH heating and back FIH heating.

 

 

Far Infrared Heat is effective at getting the heat to penetrate deep into the tissue to stimulate increased blood flow. Magnets also do this. There are many FDA approved back braces that have a series of magnets in the brace to perform the same function as Far Infrared Heat.

 

Ice the elbow

You are hurt in the elbow after the training session? As soon as possible, freeze your elbow for a minimum of 20 minutes. The challenge: do not let the pain settle down.

Ice cubes in a plastic bag do the trick first.

Then, to renew the operation several times a day, you can use a bag of frozen peas or buy in the pharmacy “pack-cool”.

Ease the pain

Different drugs can be less painful: paracetamol if the pain is important, or local anti-inflammatory, to be applied by massage. The gel diclofenac, the topical gel is often advised.

 

 

Hydration and Nutrition

Important: do not forget to hydrate yourself.

“A lack of hydration can indeed promote tendinitis,” says Dr. Jacqueline Jan.

Also, avoid alcohol and high protein diets for 48 hours. Cod liver oil and fish oil can be beneficial for muscles, blood vessels, and joints. These oils are essential for senior and veteran table tennis players. Using a good Omega fish oil will reduce the risk of ankle, and a knee injury (providing enough “joint liquid” – lubricating synovial fluid).

 

And if that does not happen?

If the pain persists despite stopping table tennis, local care, and hydration beyond 4 weeks. Or the pain is annoying in everyday life or prevents you from sleeping, it is best to consult a doctor who can refer you to a physiotherapist.

 

Injuries in Racket Sports

If you are a coach, you need to understand what factors have to be involved in an injury-prevention strategy for your players. With the new plastic ball, and the modern competitive sport (ITTF’s new policy), the potential risk of injuries in table tennis increase. Injuries mainly involve muscle tissue; they are followed by injuries to the joints and tendons.

This could be due to increasing participation, intensity, demands and longer training periods. Although table tennis is one of the least risky sports in racket sports, there is a common problem of injury between table tennis, tennis and badminton. There is no difference between male and female players. Compared to other racket sports, table tennis players suffer fewer injuries. (Good news for us)

 

You can see that, for both table tennis, badminton and tennis, there are 3 most risky parts: shoulder, spine, and ankle.

The most at-risk parties are the table tennis shoulder (20.05%) and the tennis ankle (20.00%). The second most at-risk body parties are the spine and hips (15.79% each) in table tennis and spine (15.38%), followed by wrist and shoulder (13.85% each) in tennis. Other parts of the body are slightly less prone to injury.

With the introduction of a bigger ball, these strokes have become even more abrupt, KONDRIC M. (2011)

In my coaching experiences, most of these injuries come from the “sudden movements”. In table tennis, no swing phase at the end of the table tennis stroke (read above about the 3 phases in a table tennis stroke) could increase the injury risk.

Through the swing we provide an optimal way to muscles and adequate angle of the involved joints (the shoulder,
elbow and wrist).

That’s very important that you should learn the correct way to swing. It’s yin-pai.

Table tennis has a little higher ankle injury. Due to the fast lateral movements in table tennis, and complete movements in other racket sports, the integrity of the foot is essential because the support of the shoe and the orthoses cannot be used to modify the biomechanics of the foot.

 

Injuries distribution	Table Tennis (%)*	Tennis (%)	Badminton (%)	Squash (%)
lower limb	35	42.2	82.9	68
Upper leg	2	2.3	2.8	5
Knee	21	19.5	11.5	24
Lower leg	10	15.8	14.3	5
Ankle	50	47.2	44.2	26
Foot	6	13.7	10.1	8

Distribution of racket sport injuries

 

A high percentage of injuries to the ankle and foot joints (23.69% overall) indicates that players should pay more attention to choosing appropriate footwear to avoid these injuries.

References:

• Leyla Alizadeh Ebadi “Analysing Of the Types of Injuries Observed In Table Tennis Players According To the Some Variables.” IOSR Journal of Sports and Physical Education (IOSRJSPE) 5.4 (2018): 21-26.
• Kondric, M., Furjan-Mandic, G., Petrinovic-Zekan, L., & Ciliga, D. (2008). 16 Comparison of injuries between Slovenian table tennis and badminton players. Science and Racket Sports IV, 112.
• Brophy, R. H., Barnes, R., Rodeo, S. A., & Warren, R. F. (2007). Prevalence of musculoskeletal disorders at the NFL Combine trends from 1987 to 2000. Medicine and science in sports and exercise, 39(1), 22-27.
• M. Kondric et al.: Injuries in Racket Sports, Coll. Antropol. 35 (2011) 2: 413–417
• Krell ES, Montemurro NJ, Pacific KP, Emele L, Lin SS (2017) Orthobiologics in foot & ankle. In: Valderrabano V, Easley M (Eds.), Foot and Ankle Sports Orthopaedics. Springer, USA, pp. 119-125.

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