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At Richmond Physiotherapy we see a variety of tennis related injuries but the more ‘chronic’ complaints are far more frequently reported in the upper limb. Of these, tendon related issues are the most common source of pain – the dreaded tennis elbow being the more renowned example. However, shoulder issues appear almost as troublesome and are growing in infamy.
This is due largely to the complex design of the shoulder and its competing roles of providing a flexible joint that remains stable throughout movement. Tipping the scales too far in either direction can cause irritation in the multitude of structures in and around the shoulder girdle. The rotator cuff, a muscle-tendon unit which helps to support the ball and socket joint, appear particularly susceptible.
The reason for the injury prone nature of the rotator cuff remains a source of debate; the ‘Victor Meldrew’ of soft tissues tendons are slow to adapt to change and can be highly irritable when introduced to new activities. This appears especially pertinent in tennis which requires repetitive actions and complex, highly demanding movements such as the overhead serve. It is easy to see how breakdown in any of the following key aspects required for tennis could result in additional strain on these structures:
- Flexibility is a fundamental requirement in tennis. Full shoulder elevation requires adequate spinal extension and rotation, shoulder blade mobility and finally local shoulder soft tissue compliance.
- The strength, length and co-ordination of the muscles around the shoulder blade are of particular interest due to their vital role in provision of a stable base for arm placement in the air.
- Contribution from the entire kinetic chain is required to distribute force effectively; 50% of the power generated in a typical tennis serve should come from the legs and trunk.
- Adequate muscle balance both globally and locally at the shoulder is required during all strokes and overhead serve. Imbalances often can occur as result of lifestyle and work place postures. Commonly we see gym programs which bias chest and abdominal muscles at the expense of the back, bottom and shoulder elevation/ rotation strength.
- Neuro-muscular control is the final requirement in tennis. These complex skills demand adequate body awareness, rehearsal and understanding of the movements required to prevent compensations or technical errors.
With this in mind, consider the potential fair weather tennis enthusiast; long winter months spent hunched over a computer, confined to the gym / cycling / jogging to sustain them. During this time the most demanding elevated shoulder activity performed involves lifting a Grande Starbucks or holding up an umbrella. With the arrival of spring and Wimbledon looming they dust off their racket and head to the court. These shoulders are often ill prepared for the demands of a tennis game, lacking the flexibility, strength and endurance required, especially in elevated positions. This scenario describes one common pathway to the development of overuse injuries. At Richmond Physiotherapy and through our clinic at the Hurlingham Club we work closely with tennis coaches to assist players returning from injury or prevention strategies to stave off problems before they have begun. Many of the overuse injuries described are preventable or more easily managed with simple advice. The following tips should help ease into the start of the season and ensure you last until the end!
Injury prevention advice
1 Pre-season, consider commencing a form of exercise or completion of a prescribed program that introduces overhead shoulder actions and global strength and flexibility.
2 Early in the season introduce training sessions which focus on technique and begin at a lower intensity.
3 Spread out your games, sessions and other exercise appropriately with rest or lower intensity days in between.
4 Perform warm ups that elevate your heart rate and ‘prepare’ your body for the task at hand; this should consist of a dynamic warm up replicating some of the movements you are likely to encounter alongside a flexibility program which includes your spine, shoulders arms and legs.
5 Perform a post exercise cool down with consideration of post exercise stiffness the following day which may need to be managed with additional stretching / foam rolling / gentle exercise.
6 Consider how court conditions and weather may vary so appropriate attire might be necessary. Similarly soggy balls, early starts or training after a long day at work may also influence your game or injury risk.
For further advice or assessment contact us at Richmond Physiotherapy.