Shoulder Pain in Tennis: Prevention and Recovery Strategies
Common shoulder injuries in Tennis
As we discussed in my previous blog, the shoulder endures significant stress during tennis, especially during the serve, which is one of the most demanding movements in the sport. Players often experience shoulder pain during the late cocking and acceleration phases of the tennis serve. However, this pain typically follows a long history of non-specific discomfort and various treatments, both surgical and non-surgical. Below are three of the most common shoulder injuries associated with tennis, their causes, and their impact:
1. Rotator Cuff Tendinitis and Overuse
What It Is: Inflammation or microtears in the rotator cuff tendons caused by repetitive strain, particularly during overhead motions like serves and smashes.
Cause: High rotational velocities (up to 3,000 degrees/second) and distraction forces (~750 N) during deceleration stress the rotator cuff as it works eccentrically to stabilise the joint.
Symptoms: Pain during the late cocking and acceleration phases of the serve, deep shoulder soreness, and reduced strength, particularly in overhead actions.
Risk Factors: Fatigue, improper technique, and muscle imbalances (e.g., dominance of the pectoralis major over the rotator cuff).
2. Impingement Syndrome
What It Is: Compression of the rotator cuff tendons and subacromial bursa under the acromion during arm elevation, leading to irritation and pain.
Cause: Poor scapular mechanics (scapular dyskinesis) reduce clearance for the humeral head, particularly during the follow-through of serves or backhands. Tightness in the anterior capsule and imbalance in scapular stabilisers exacerbate the issue.
Symptoms: Pain during overhead motions, stiffness, and reduced range of motion, especially in abduction and external rotation.
Risk Factors: Muscle imbalances, poor scapular control, and repetitive overhead activity without proper recovery, age.
For a more detailed overview of shoulder impingement, visit my blog.
3. Labral Tears (SLAP Lesions)
What It Is: Tears in the superior labrum where the biceps tendon attaches, commonly caused by repetitive overhead motions.
Cause: High shear forces (~3,573 N during forehand strokes) and capsular stretching during extreme external rotation in the late cocking phase of a serve can damage the labrum, leading to instability and pain.
Symptoms: Pain deep in the shoulder, feelings of instability, clicking or popping sensations, and weakness during rotational movements.
Risk Factors: Repeated microtrauma to the posterior capsule, anterior capsule instability, and poor kinetic chain function.
The Role of Mechanics in Injury
Injury risk is amplified by several factors:
Kinetic Chain Breakdowns: Weak legs, hips, or core increase reliance on the shoulder, leading to overuse.
Scapular Dysfunction: Improper scapular motion reduces efficiency and increases stress on the rotator cuff and capsule.
Repetitive Stress: The sheer volume of strokes (up to 1,000 serves per tournament) and high forces involved take a cumulative toll on the shoulder.
For a more in depth understanding of the biomechanics of the shoulder in tennis, check out this blog - The Biomechanics of the Shoulder in Tennis: A Deep Dive
The Role of Microtrauma in Shoulder Injury
As mentioned earlier, the repetitive nature of the tennis serve is a significant contributor to shoulder injuries, particularly through microtrauma to the anterior capsule. The repeated stress and strain on the shoulder can lead to elongation of the ligaments, resulting in subtle instability. This anterior displacement of the humeral head shifts the centre of rotation to a more anterior position, which brings the greater tuberosity (tuberculum majus) and the rotator cuff tendon closer to the posterior glenoid. This causes internal impingement, which, while it can occur in healthy shoulders, becomes pathological in the tennis player.
Prevention and Recovery
Preventing these injuries involves addressing the underlying causes:
Strengthening the Kinetic Chain: Ensuring efficient energy transfer from the legs and core.
Improving Scapular Mechanics: Strengthening the serratus anterior and trapezius to maintain proper alignment and movement.
Balancing Muscles: Developing rotator cuff endurance alongside larger muscle groups.
Monitoring Workload: Allowing sufficient recovery time between high-intensity sessions.
By understanding these common injuries and their mechanisms, tennis players can take proactive steps to safeguard their shoulders, enhance performance, and extend their playing careers. If you'd like to learn more about how you can prevent these conditions from becoming an issue, get in touch.