Epidemiological studies have indicated that the serve, arguably the most important facet of the game of tennis, is also the most likely stroke to cause injury, particularly to the elbow and back. A review of the kinematic and kinetic studies on the service action fails to clearly identify the reason(s) for these injuries. Data from these studies does, however, allow possible causes of injury to be postulated. Electromyographic data from the prime mover muscles involved in the serve have shown that muscle action was greater for beginners, whose muscles were active for longer periods than those of advanced players. Ground reaction forces associated with different serving techniques were small compared to those recorded from activities involving running or jumping. The potential to cause injury seems to be related to high internal forces (combination of muscle and joint reaction forces), particularly where these forces are associated with poor technique and high segment accelerations. These situations occur when the racket moves behind the body and the vertebral column is laterally flexed and hyperextended. The pronation of the forearm and the forces associated with the swing to the ball, the impact and the early follow through are also factors that have the potential to cause injury. The action of serving induces strains and pressures upon the body. A sensible approach to the number of serves, particularly when practising (overuse), appropriate physical preparation and a technique that does not introduce excessive forces to selected body parts (misuse) will greatly reduce the potential for injury from this activity.