For most people who sustain a sports injury for the first time, it comes as a big surprise to realize that they are susceptible to such occurrences.
In the seven years as the physical therapist for the Champions Tour, with such legends as Conners, McEnroe, Borg, Villas, Gomez, and 16 years of working as the physical therapist for the Atlanta ATP tour, I rarely saw tennis elbow problems. The most common upper limb problems were because of rotator cuff weakness and overuse injuries to the shoulder.
Shoulder impingement and tendonitis are common injuries among recreational athletes. The overhead motion of the tennis serve, for instance, is a provocative activity that places increased stress on the shoulder and predisposes it to injury. The shoulder is the most mobile joint in the body, and therefore the least stable. The shoulder joint is a complex arrangement of three bones held together by 17 muscles, assisted by tendons and ligaments. Four of these muscles-tendon units form the rotator cuff. The function of the rotator cuff is providing dynamic stability to the shoulder during such movements as overhead serve and forehand and backhand movements. The rotator cuff muscles are more explosive muscles that generate excessive force and quick movements during tennis activities of serve and volley. If these muscles are weak because of overuse they are vulnerable to tendon damage or inflammation (tendonitis). This is especially true in people over 40 where a combination of wear and tear and overuse while performing overhead motions can be the beginning of a shoulder problem that might manifest initially as elbow pain.
Determining the source of the problem in the shoulder or elbow is essential to recommend the right method of treatment. Therefore, a thorough evaluation includes a history of the symptoms and a physical examination of the shoulder. The physical examination will detect any muscle weakness, joint instability, and asymmetry of joint posture, neuromuscular deficits, and severe internal joint problems such as tendon and labral tears. In cases where severe pathology is suspected, the orthopaedic surgeon might order Magnetic Resonance Imaging (MRI), to further diagnose the problem.
Depending on the diagnosis and the soft tissue dysfunction the treatment of shoulder problems could range from surgery to rest and a simple exercise program at home. Remember, 17 muscles hold the shoulder together; therefore exercise is an important part of keeping it moving and pain free. However, the exercises themselves can be detrimental if performed incorrectly and produce excessive forces to the shoulder joint. Many people lift weights and cause injury to the shoulder. Several myths about weight lifting include,
•Weight lifting can make me less flexible. Not true… In fact if you strengthen the appropriate muscle groups it will actually increase flexibility.
•Weight lifting will cause me to lose my accuracy of hitting the ball to specific parts of the court. Not true… Strengthening the specific muscles of the shoulder responsible for overhead activities will prevent fatigue during long matches and improve the ability to hit the ball to any part of the court with more accuracy.
•Weight lifting will not improve my game. Not true… Several studies have demonstrated that by strengthening the shoulder rotators the velocity of the serve was increased up to 11 miles per hour.
Injuries caused by fatigue, such as rotator cuff strain, tendonitis, or shoulder instability are in many cases avoidable. The following tips will help you to overcome and prevent further injury to the shoulder and upper limb.
• Avoid overuse and fatigue by limiting your tennis activities to your individual physical limitations. • Do not ignore or “work through” persistent pain. • Strengthen, balance, and stabilize the shoulder muscles with weight training exercises using the appropriate weight, reps, and sets. • Engage in sports specific training to prepare for advanced levels of play. • Train early before your season begins. • Cross train with such sports as skiing, running, and biking. • Warm up for 5-10 minutes prior to a game.