Association Between the Backhand Technique and the Prevalence of Dominant-Arm Elbow Pain and Low Back Pain in Tennis Players: A Cross-Sectional Study.

Background Tennis is a physically demanding sport characterized by explosive movements, repeated trunk rotations, and asymmetric loading of the dominant upper limb. Overuse injuries are common, with dominant-arm elbow pain (DEP) and low back pain (LBP) representing frequent musculoskeletal complaints among tennis players. Biomechanical differences between the one-handed backhand (1HB) and the two-handed backhand (2HB) may influence the distribution of mechanical loads on the upper limb and spine; however, their relationship with clinically relevant symptoms remains unclear. This cross-sectional observational study aimed to investigate the association between the backhand technique and the prevalence of DEP and LBP in a heterogeneous population of tennis players. Methodology An anonymous online questionnaire was distributed through tennis clubs and social media between February and November 2025. A total of 455 responses were collected, of which 445 complete questionnaires were included in the final analysis. Results The mean age of the participants was 35.1 ± 17.9 years, and 73.9% were male. The median weekly training volume was five hours (interquartile range = 3-11). In crude analyses, elbow pain was more frequent among players using the 1HB (56.5% vs. 32.9%, p < 0.001), while LBP was slightly more common in the same group (59.5% vs 49.5%, p = 0.049). However, multivariable Poisson regression models adjusted for age, sex, training volume, competitive level, and years of practice showed no independent association between the backhand technique and DEP (prevalence ratio (PR) = 1.08; 95% confidence interval (CI) = 0.80-1.46; p = 0.625) or LBP (PR = 1.18; 95% CI = 0.95-1.48; p = 0.142). Stratified analyses revealed that the 1HB was significantly more common among male players (p < 0.001), and elbow pain was also more prevalent in males (p = 0.00076), whereas the prevalence of LBP did not differ significantly between sexes (p = 0.798). Among participants reporting elbow symptoms (n = 190), 64.7% localized pain to the lateral epicondylar region and 35.3% to the medial epitrochlear region. Overall, the backhand technique was not independently associated with either elbow or lumbar symptoms. Conclusions These findings support a multifactorial model of injury risk in tennis, suggesting that factors such as age, sex, cumulative load, and player characteristics may play a greater role than the isolated choice of the backhand technique.