Although there’s no definitive research giving answers to this question, primarily because of the difficulties involved in trying to control the huge number of variables, a study by the ATP published in 2000 did investigate the impact of court surface on number of treatments received during professional matches. Although the number of treatments received is not the same as the number of injuries sustained (it would not take account of any chronic injuries) it is a useful indicator. They found that the clay was far more forgiving than grass or hard court, with 0.2 treatments per match on clay compared with 0.37 and 0.42 on hard court and grass respectively. Clay is a slower, softer surface, encouraging a less explosive style of tennis, with the player having longer to prepare, and ball bounce being higher. These factors could be some of the reasons why the number of treatments received was lower on clay.

On grass the game is generally more aggressive, with the ‘serve’ and ‘return of serve’ being important factors in winning points. Sliding is not a feature of the grass court game and so different physical stresses are placed on the body when moving. Since the ball bounce is faster, more unpredictable, and the bounce height is lower on grass, it means the player has less time to prepare, has to reach more awkwardly for balls, and are more likely to hit the ball off centre, or late, resulting in unfavourable torsion and shock transmission to the arm. Artificial grass, commonly seen at local tennis clubs, has similar qualities to clay. Hard court tennis matches have features of both the grass and clay court styles with points being won on serve, return of serve, and baseline rallies. Long rallies played on hard rough courts might have implications on chronic injury presentation, such as damage to bones and tendons.