Introduction:
The 3 most common injuries in tennis are shoulder, elbow/wrist and back.
I was able to experience all three, to my great dismay… But it is one of the reasons that pushed me to become a sports coach and to strengthen my body in order to practice the sport that I love.
After implementing the rehabilitation program below, and training around my injuries, I was able to return to tennis after 8 years off and win my first trophy!
Very good atmosphere and sportsmanship - CIL 2022
Part I: Shoulder Injury
The shoulder injury is the most common in the world of tennis.
According to a study published in 2020, the main cause is prolonged exposure.
Indeed, depending on the level of the player and the longer the game continues, the load on the shoulder increases.
Increased fatigue can lead to subacromial impingement.
To put it simply, if you raise your arm above your head and it hurts, you can talk about a subacromial impingement.
You can imagine your shoulder as a tennis ball in a baseball glove.
To keep the ball in the glove, you have small muscles called tendons that help stabilize the ball and spin it around. Now the problem is that when those little muscles aren't trained OR the movement you're doing is incorrect (i.e. forcing a serve in tennis with just the arm instead of using the whole body), this will cause the ball to come out of the glove, which will stretch then pinch the tendons and gradually create inflammation.
Proper technique and muscle building help keep the ball snug in the baseball glove.
The previous illustration helps to understand the effect of subacromial impingement. The tendon is pinched between the acromion and the humeral head.
This remains a simplification, connective tissues other than tendons can be damaged.
Another area to consider is genetics. Depending on your acromion type, you may be more prone to developing a subacromial impingement.
Looking at the image above, you will notice that a flat type 1 acromion allows more freedom of movement in the shoulder compared to the aggressive type 3.
That being said, it is still possible to develop a subacromial impingement even with type 1.
A simple test you can try at home is to lean against a wall and raise your arms above your head, trying to touch the wall with your thumbs without your back coming away from the wall.
Can you do it? Do you feel pain? If so, you might have a type 2 or 3.
The last thing you can do is get an x-ray, asking your doctor to order one for you.
Where Type 1 may have a bit more leeway in terms of shoulder mobility and therefore avoid subacromial impingement, Types 2 and 3 will have to rely on perfect shoulder biomechanics (movements), where the shoulder blades come into play!
This brings me to the next point: "scapular dyskinesia". If the muscles responsible for the movement of the scapula (upward rotation here) are fatigued or simply untrained, there will be a greater chance of developing scapular dyskinesia or shoulder pathology.
In the previous image, there is a difference between the left and right shoulder blades in a neutral position, usually one protrudes more than the other.
For good shoulder mobility, you need about 60° rotation of the shoulder blade and the rest (120°) of the arm.
A good rule to remember: Where the arm goes the scapula goes.
In the case of dyskinesia, the scapula already starts lagging (literally and figuratively), causing the upper arm bone (the humerus) to touch the acromion before it reaches its full range of motion.
When you serve in tennis the ball is above your head, you need to be able to get an arms overhead position without pinching between the acromion and humerus.
The muscles to remember that help with the rotation and translation of the scapula are:
Serratus
Trapezius
An exercise for the serratus :
Be sure not to overextend the back, the area you should feel working is under the armpit, pushing the elbows towards the wall while rolling the roller upwards.
For the trapezius muscle, it is best to train it in relation to the sport you practice, here tennis.
Exercise "Y" is excellent:
The area to feel is the middle of the back (lower trapezius muscle).
According to the types of acromions, the shoulder blades can differ from one individual to another:
In these images, you will notice that each individual may not only have a different type of acromion but also the shape of the scapula.
Being aware of this allows us to train properly for the sport we want to practice.
https://www.paulgrilley.com/bones
Here are some exercises that I have put in place to rehabilitate my shoulder (non-exhaustive list):
Lying external rotation
Band Y
Mini band 90/90
Yoga push-ups
Turkish get-up
Part II: Elbow and wrist injury
The second most common injury among tennis players is the elbow and wrist.
Following up on the previous study, lateral epicondylitis, or “tennis elbow”, was indicated as one of the most common injuries in tennis, especially among beginners.
Lateral epicondylitis could be associated with poor tennis technique.
Indeed, professional tennis players are able to place less load on the joints thus decreasing the risk of developing shoulder, elbow or wrist injuries.
This is where skill plays an important role in injury prevention.
The mistake that we often see among beginners is to play only with the arm and the elbow or to flick the wrist just before impact with the ball, which puts a lot of pressure on these joints.
Where the more advanced player will use their whole body (kinematic chain) to generate power.
Make sure:
Turn your shoulders well (not just your arm)
Stay low on your legs and shift your weight into the ball
Finish your swing far ahead and around your head/body
Exhale while typing (stay relaxed)
You should feel your whole body hitting the ball, which is more efficient and less traumatic for your joints.
Here are some exercises I followed for my elbow and wrist (non-exhaustive list):
Wrist extension:
Hang from a bar and set goals (30secs, 45secs etc…)
You can also consider training with kettlebells, such as swings:
Part III: Back injury
Finally, the tennis back injury.
Not as common as previous injuries, this type of tennis injury is related to overhead strokes.
Indeed, during the serve for example, if you throw your ball too far behind and you arch your back in hyperextension, this can trigger long-term pain.
When overhead strokes, the back should remain in a neutral position and the movement should come from the hips and bending of the knees.
We find some individuals who arch their back to compensate for a lack of mobility in the shoulder.
More info part I.
Above, the image on the left shows a person with poor shoulder mobility trying to put their arms above their head.
Due to the lack of mobility, the back compensates by arching and putting pressure on the vertebrae. By hitting the ball in this way, there is a high chance of injuring your back.
The image on the right is the position you want to get before practising the overhead strokes.
Roger Federer is arguably the most efficient server on the professional circuit.
The mechanisms presented for back injuries are related to tennis, however, the same principles are found in everyday life.
Performing movements with the back instead of the hips and legs can at any time create lower back or nerve pain (for example, sciatic nerve).
Improve low back resiliency:
Emphasize a solid abdominal belt (plank, side plank)
Work the back muscle safely with the "bird dog".
Always think about your position when you have to lift a weight.
Conclusion:
Sports performance pushes us to adapt our movements to the skills required by the activity.
Throwing athletes where the arm movement is dominant and recreational tennis players tend to have an excessive load on the shoulder, especially as play continues and fatigue increases.
Nobody likes to be injured, with the right training you can spend more time on the court and enjoy sports without pain.
If you found this article interesting, do not hesitate to leave a comment and share it with your tennis friends.
If you want to go to the next level (physically or tennistically), do not hesitate to contact me for a free consultation.
Reference:
https://www.paulgrilley.com/bones