The human shoulder is a complex set of three joints (the “Gleno-Humeral“ (main ball & socket); the “Scapulo-Thoracic“ (shoulder blade over chest wall); and the Acromio-Clavicular (the small joint between the collar bone and shoulder blade).
It has a far greater range of motion, in 4 separate planes, than any other joint in the body and requires the coordinated action of many muscles to enable us to place the hand in the space around us.
Tennis requires high speed and power and places a huge demand on the shoulder involving very high forces, acceleration and deceleration.
Injuries often occur from forcing excessive power in players with insufficiently toned / poorly coordinated shoulder muscles.
This can occur not only in competitive players when the demands exceed the level of preparation, but perhaps even more commonly in the occasional player, returning to the sport after periods of inactivity.
Higher stresses occur especially during high speed / high elevation strokes such as a serve, smash, or high forehand.
Damage can occur as a single incident or more commonly following repetitive overuse.
There are common patterns of injury, often affecting the rotator cuff or biceps tendons, or the result of instability of the shoulder.
This can give rise to progressive pain, typically at the side / front of the shoulder, aggravated by elevating the arm above shoulder height or behind the back; often initially of low intensity but later severe and debilitating. More severe damage can also cause weakness of arm elevation. Biceps tendon injuries can cause a click or snapping sensation associated with shooting pain.
Specifically, injuries are often caused by poor control during the follow through phase of the serve when the shoulder “overreaches” with associated high intensity but irregular contractions of the rotator cuff and shoulder blade muscles (referred to by physiotherapists as “eccentric overload”). This can lead to repetitive strain, tendon inflammation and progressive damage or tear.
One of the main functions of the rotator cuff muscles is to provide dynamic stability (alignment) for the ball and socket joint and they work especially hard during fast and powerful action at high arm elevation such as in tennis; when inflamed, they will not be as efficient and this can lead to instability of the joint (during acceleration / deceleration): this compounds the problem including causing more damage to the same rotator cuff tendons.
Additionally tennis players frequently have a muscle imbalance because their internal rotators (used for serves and forehands) are stronger than their external rotators (used more for backhand)
These effects set up a “vicious circle” causing progressive damage to the cuff rubbing under the edge of the (Acromion) bone, referred to as “impingement syndrome”. The initial inflammation of these tendons can weaken them and eventually lead to a structural tear.
Problems also result from poor posture and / or an incorrect pattern of movement of the shoulder blade on the chest wall, especially during high elevation of the arm.
A poorly controlled follow through can also place additional stresses on the biceps tendon and its attachment within the shoulder joint (causing painful tendonitis, fraying, or a SLAP tear).
If you have shoulder symptoms you could take a look at www.londonortho.co.uk for further explanation and go through a simple self diagnosis.
• Start some preventative shoulder conditioning. This will not only help avoid injury from overuse or the above effects but it will enhance performance and help to avoid fatigue.
• Stretching: It is important for the competitive tennis athlete to maintain good shoulder flexibility (range of motion) this improves stroke potential but also reduces the risk of internal shoulder joint injury. The stretching program should concentrate on “internal rotation” (stretching the usually tight posterior and inferior joint capsule).
• Strengthening: Use “therabands” or free weights to strengthen your shoulder external rotators (see physiotherapy section in www.londoortho.co.uk)
• Maintain good core strength and spinal posture.
• Execute proper and full follow through under control for all your volleys especially overhead shots
• Racquet strings should be at the right tension: decrease the string tension if you have a shoulder problem
• Use the correct racquet grip size and don’t hold your racquet too tightly.
• Use a racquet of correct weight and balance. A racquet which is too light or too “head heavy” will increase the risk of injury.
• Try and hit the ball in the centre or “sweet spot” of the racquet, reducing additional vibration and rotation forces
• If the exercise or game causes discomfort or pain, discontinue and consult a physiotherapist or shoulder specialist doctor.
Mr Mathew Sala is an orthopaedic Surgeon specialising in Shoulder Problems.