How To Stop Tennis Destroying Your Shoulder, Elbow and Wrist!

What Are The Most Common Tennis Injuries?

We naturally think of tennis injuries as elbow, wrist or shoulder issues. Potentially falling into the RSI general bracket. I don’t normally like this term. Specifically the injury bit.  To me it should be more Repetitive Strain That Your Body Isn’t Fully Conditioned To Deal With Right Now But With The Right Knowledge, Treatment And A Dose Of Common Sense Will Most Likely Be Tickety Boo In Next To No Time. Sadly RSTYBIFCTDWRNBWTKTADCSWMLBTBINTNT isn’t as catchy. I’ll stick with RSI for conciseness – but try to think of any condition you in this less threatening way. If it’s less threatening – it’s less painful. We talk about this concept in our previous article What Is Pain?

With this reputation for elbow, wrist shoulder injuries I was surprised to find this piece of research which states that leg injuries are more common in tennis players. However, reading a little deeper into this research it suggests that leg problems are more common acute injuries. That is an injury that happens suddenly – informally we say something goes twang, snap or pop. Whereas the arm injuries were more insidious. As in the injuries come on gradually with no obvious start point.

This makes more sense of the tennis injuries we see at the clinic. I’ve seen an even smattering of shoulder, elbow and wrist RSI type conditions. With the odd knee issue thrown in for good measure. The same piece of research also suggests that groin injuries and muscle imbalances elsewhere can affect the mechanics of the shoulder and in so doing impact the elbow and wrist. Now they’re talking my language! That’s the whole body approach that we think is the most effective way of sorting injuries and getting them to stay away.

It’s Tough At The Top

Tennis injuries can be caused by the slightest imbalance. If you remember Andy Murray’s early career he struggled with his fitness to keep up with the world’s best he simply ran out of steam. He then went through a succession of ankle sprains. Perhaps this was due to the muscles that stabilise the ankles not working as well when he’s tired? Perhaps.

He then finds a solution his ankle problems by wearing ankle supports for every game which stop him going over on his ankles. Does the underlying instability remain? Is it just masked by the external supports? Fast forward 10 years of intense playing at the very top of the game and his hip is all kinds of bother. Could this be due to residual instability in the ankle putting more strain through the hip? We’ll never know. Just a nice high profile example of the factors we need to consider when we need to truly get to the bottom of someone’s tennis injury.

We see a lot of what we call referred pain affecting tennis players. That is you feel the pain in a different place to the area that’s causing it. In fact I’d go as far as to say that most injuries, tennis or otherwise, fall into this category. The site of the pain is the scapegoat not the problem.

You might have experienced this yourself already. If you’ve done lots of physio exercises to sort an injury and it’s made no difference this is probably you. Let’s take another high profile example to explain the concept of referred pain.

Novak Djokovic at the height of his powers started getting problems with his elbow. It affected his performance, he dropped from his number 1 spot and finally he had to admit defeat and have surgery on the elbow. He made steady progress in his recovery getting back towards his best game… and then started complaining of shoulder problems.

Was the original elbow problem in some way referred from his shoulder all along? Was the shoulder not functioning correctly all along which led to increase load going into the elbow? With the tendon all healed and rehabbed is it just the shoulders turn to complain? Does the limitation in his shoulder come from long standing lower back tightness? We’ll never know. But if I was in charge of looking after him these are the things I would be considering, treating and investigating.

I have theories about Mr Nadal and his dodgy knees too. I don’t think it’s a coincidence that until the very end of his career Roger Federer has been the least injury prone. He’s clearly the most graceful mover putting least load through his body.

What Are The Causes Of Tennis Injuries?

Let’s bring ourselves back down to reality and talk about real players injuries! Many of us have similar stories as the players at the top of the game. Life happens. Injuries happens. And those guys get seriously better rehab then we do… unless you come and see us of course! So whilst we might not have the same amount of load and repetition as the big boys and girls at the top of the game we too all have a potted history of previous injuries, tension and stress.

The classic reason for tennis injuries, especially around Wimbledon time, is too much too soon. We need to give our bodies time to adapt to what we want them to do. Every year in July we’ll see new clients come to us as a direct consequence of being inspired by Wimbledon. They dust off their racket, get out there, and smashing tennis balls for the first time since last year’s Wimbledon. Their body simply isn’t ready for it.

Another factor is the one sided nature of tennis. Whether you play single handed or double handed. Muscles can develop to a such a degree what they actually cause a curve in the spine, scoliosis. Technically speaking we term this a functional scoliosis. In that it is not due to the shape of the spine itself but more pull on the muscles that attach to it.

Now if we slowly adapt up to playing lots of tennis then all will be fine. I’m pretty sure Mr Federer will have some kind of functional scoliosis and he seems to have done ‘OK.’ But this can be a factor in injuries we, and maybe Roger, sustains.

Limited movement at the shoulder is another factor. I’m going to steal a quote from this research: “Optimal shoulder function requires good kinetic chain function.” Kinetic chain function simply meaning other muscle and joints throughout the body working properly. Most commonly this will be seen as a lack of internal rotation at the shoulder. Internal rotation being the movement as you reach your hand up behind your back. This is commonly more limited in our dominant side. This is especially true of tennis players. Frequently a causative factor in rotator cuff issues. The real fun is trying to work out why the limitation in internal rotation exists!

If I had to say one injury that we see the most in tennis players it would be rotator cuff. Rotator cuff are 4 small intrinsic muscles around shoulder which optimise the position of the ball and socket (glenohumeral) joint. These are most commonly overused due to the large load that obviously goes through the shoulder when playing tennis. If you’re interested the 4 rotator cuff muscles are called supraspinatus, infraspinatus, teres minor and subscapularis. Supraspinatus seems to be most commonly at fault in tennis players. But issues with all rotator cuff muscles can, and often do, co-exist. If you want more information specifically check out our previous article on rotator cuff injuries.

How Do I Avoid Tennis Injury?

Before we get into the rehab exercise section of this post some quick common sense advice that may mean you don’t have to do any of the rehab exercises. I know from bitter experience that everyone would rather be fixed without having to do the exercises! Not that I’m complaining – speeding up people’s recovery with our hands on treatment is the cornerstone of our business. So we have 2 common sense rules you can apply straight away and then into the rehab exercises.

1. Don’t Do Too Much Tennis Too Soon!

Make sure you increase the amount of tennis you are playing gradually and you will massively reduce your risk of injury. Of course play more around Wimbledon time just hold yourself back just a little bit.

2. Get Some Tennis Lessons

No offence meant! I’ve not even seen you play. As we’ve discussed most tennis injuries come from too much load going through the bit that hurts. The single biggest cause in amateur players is dodgy technique. Lessons will make you more efficient and reduce the load on the bit that hurts. Local tennis pros – you’re welcome. I hope this piece of advice swells your coffers to help you get through the lean winter months!

The following exercise videos come from Brighton Physiotherapy and Sports Therapy’s YouTube channel. If you’d like to subscribe to our channel so you don’t miss out when we add new content you can subscribe to our channel by clicking here.

3. Hip Flexor Stretch

This one will keep the body nice and open. It directly impacts the nerve that affects tension into the front of the thigh and also the nerve that sense pain in the knee. It can also be a factor in limiting the range of motion into the shoulder – so just as important for shoulder, elbow and wrist issues. For this and any further stretches we recommend holding for a minimum of 30 seconds preferably longer. Stretch to comfort, never to pain and use your breathing to work into the stretches. As we breathe out muscles relax so focus on a nice long out breath and relax your stomach as you do so.

4. Pec Stretch

One of my favourite opening out stretches. Also good after a long day sat at your desk. Great to help those with rounded shoulders and great for tennis as you can focus on your racket side. This will in most cases be tighter on your racket side and a possible cause of future or current injury.

5. Lat Stretch

My personal favourite stretch as it just helps so much of the body. Be sure to check your non racket hand on this one just in case. Another one for opening the body up and taking the slump out of your posture.

6. Wrist Flexor and Extensor Stretch

Particularly good for elbow and wrist pain. But make sure it affects the right muscle and doesn’t give you pain as you do it. As an experiment on yourself you could try these stretches, do the Pec and Lat stretches, then try them again. They may well be easier after Pec and Lat stretching. It will most likely be tighter on your serving arm.

7. Thoracic Rotation

Quite an unusual one this one but one I’ve been enjoying for many years. As a swimmer I use it lots to help me better rotate to my weaker side when swimming front crawl. The same applies to tennis. Your body can get ‘locked’ in a rotated position. Which whilst a useful adaptation to tennis it can be a factor in injury throughout the body.

8. Levator Scapulae

Great for symptomatic relief from tension and pain in the muscles into the neck and shoulders. Specifically any supraspinatus issues as levator scapulae is continuous into supraspinatus. This may also be useful for conditions down the arm (e.g. wrist, elbow) could also help with any impingement symptoms – that is pain when you take your arm up high on an overhead smash or serve.

9. Half Moon

Interestingly this is one that I got from the Nintendo Wii some years ago. Stolen straight from yoga. It affects lots of muscles in many different ways. The oblique muscles most specifically. These muscles are involved in trunk rotation and important for generating power on your ground strokes.

More optimal length muscles enables you to generate more force with them. So even if you’re not injured this is well worth doing as it may give you power on your ground strokes. It may well also help quadricep (front of thigh) length and in so doing also help your knees. The reasons behind this we want go into here. Just trust me on this one!

10. Quad Stretch

This video talks you through the best way to stretch the muscles in the front of your thigh. (quadriceps). They’re usually the ones you feel the most after a long tough game. These are the ones that look massive on Rafael Nadal! And possibly a factor in his ongoing knee issues.

11. Leg Pit Stretch

Leg pit is a term that always raises eyebrows. But it is a thing. At least conceptually. The principle is that the anatomy of the leg and arm are very similar. This ‘leg pit’ is very important as it houses the nerve that gives sensation in and around the knee as shown in the following diagram:

To target specifically this region to best affect the sensation in the knee do the stretch in this video.

12. Glute Stretching

These are the muscles that generate our speed across the court. You want them to be working as optimally as possible. Tension in these muscles can also cause low back pain, tight hamstrings and limitation into your shoulders

13. Rowing For Tennis Shoulders

This exercise strengthens the muscles that oppose the shoulders rounding. These are also the muscles that stabilise your shoulder blade (scapula) which will also help you generate more power on your strokes and reduce load on those potentially troublesome rotator cuff muscles.

This kind of exercise is excellent as a preventative exercise as back up by this nice piece of research.

What Not To Do With Tennis Injuries

Be wary of exercise programs on the internet! He says having just given an exercise program on the internet. I’ve given a lot of information here, as much as I can without doing you an assessment. This is all up to date and to the best of my knowledge. There’s a whole load of articles like this one on the web that dish out a very old school rehab exercise which I see make so many people’s conditions worse. Here’s one final video to explain why:

One final piece of common sense advice. Don’t carry on playing through something that hurts! It’s much easier for us as therapists to help you at the early stage of a problem rather than when it’s been around for year and years. Don’t worry it’s not terminal and you can still be fixed. It’s just a lot easier and quicker. And cheaper for you in the long run.

Generally speaking if pain is getting worse, affecting your day to day activities or limiting your ability to play the shots you want you need to see someone now. We’d love that to be us of course. Whoever you choose taking action is the best thing to do.

Time On Tennis Injuries

That’s it. I hope you found this article on tennis injuries useful. If you did please share with all of you tennis playing friends using the sharing buttons. If you would like more information specifically on our approach and how it may help your tennis injury please check out our homepage here: Brighton Physiotherapy and Sports Therapy.