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

What Injuries Most Commonly Affect Tennis Players?

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 I want you to think of it in the terms I just described. It’s so much less threatening that way. If it’s less threatening – it’s less painful.

With this reputation for elbow, wrist shoulder injuries I was surprised to find this piece of research whilst reading up for this Blog. (Yes, I do actually do some research for these pieces!) It states that leg injuries are more common in tennis players. This was quite a shock to me. However, reading a little more deeply it suggested that leg problems are more common acute injuries (acute in the physio world just means something goes twang all of a sudden). Whereas the arm injuries were more insidious (this one means the problems come on gradually).

This makes more sense of the tennis injuries I’ve seen in the last 14 years. I’d say typically 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 muscles imbalances elsewhere can affect the mechanics of the shoulder and in so doing impact the elbow and wrist. Now they’re talking my language!

It’s Tough At The Top

Tennis injuries can be caused by the slightest imbalance anywhere in the body. Let’s consider the guys at the top of the game. Andy Murray. Cast your memory back 10 years to Andy’s early professional career. He initially struggled with his fitness to keep up with the worlds best and suffered with a lot of cramp. He also used to simply run out of steam.

He then struggles with a succession of ankle sprains. Maybe this was due to the muscles that stabilise the ankles not working as well when he’s tired? Plausible, but we’ll never know for sure. 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 to the recent past. Andy Murray is world number 1 and been playing lots and lots of tennis. Then all of a sudden his hip starts hurting. Could this be due to instability in the ankle putting more strain through the hip than is optimal over an intense 10 year period? We’ll never know. Just a nice high profile example of the factors we need consider when we need to truly get to the bottom of someones injury.

Referred pain (as in you feel the pain in a different place to the bit that’s causing it) is another common tennis issue we see at the clinic. 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 a couple of years ago 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 more recently he is complaining of a shoulder problem.

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 through 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 considering, treating and investigating the impact.

I have theories about Mr Nadal and his dodgy knees too. I don’t think it’s a coincidence that Mr Federer out of the big 4 has been the least injury prone. He’s clearly the most graceful mover.

What Are The Causes Of Tennis Injuries?

Let’s bring ourselves back down to reality. Let’s bring it back to the real players. Us! Now all of us can have similar stories to the big 4. 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 do have our history and it can have even more of an impact.

The classic reason for tennis injuries, especially around Wimbledon time, is too much too soon. You need to give you body time to adapt to what you are asking it to do. Every year in July we’ll see one or two new clients come to us as a direct consequence of being inspired by Wimbledon. They dust of f their racket, get out there, and smash it up. Their body simply isn’t ready for it.

Another factor tennis injury is the one sided nature of it. Especially those who are single handed on both flanks. That said double handed still has a strong element of one side dominance too. 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 translate as a lack of internal rotation at the shoulder. Internal rotation being the movement as you reach up behind your back. This is commonly more limited in everyone on their 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!

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. Wouldn’t that be nice. 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. Then into the rehab or prehab (if you’re not currently injured) exercises. Enjoy.

1. Don’t Do Too Much Too Soon!

Make sure you increase the amount of tennis you are playing gradually and you will massively reduce your risk of injury.

2. Get Some Lessons

No offence meant! I’ve not even seen you play. Most tennis injuries come from too much load going through the bit that hurts. The single biggest cause of that is dodgy technique. Lessons will make you more efficient and use your muscles in the way you should be using them to 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!

Now onto the exercise part. Here’s lots of videos from Brighton 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 one that gives 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, not pain.

4. Pec Stretch

The original opening out stretch. Also good after a long day at the office. 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 tight on that side.

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, go back and do the Pec and Lat stretches, then try them again. They should be easier after Pec and Lat stretching.

7. Indian 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 an adaptation to tennis 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. Also worth investigating if it does good things to pain down the arm and into the wrist. Should help with any impingement type conditions – if you have impingement you’ll know what it is. If you don’t you won’t – and this stretch will help you stay that way.

9. Half Moon

Interestingly this is one that I got from the Nintendo Wii some years ago. Stolen straight from yoga. It hits lots of things in lots of different ways. It hits the obliques which are the muscles involved in rotating your torso. Hence they find themselves being stretched as part of this tennis post. Beyond this it will also have a beneficial impact on your quadriceps 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 / Leg Pit Stretch

Leg pit as a term always raises eyebrows. But it is a thing. At least conceptually. This video talks you through the best way to stretch the muscles and the front of your thigh. The quadriceps. There’s also a variation I made up to specifically target the mystical ‘leg pit’ which is particularly good for knee pain. Even if I do say so myself.

11. Rowing

And finally one we don’t yet have a video for yet (all the more reason to subscribe to our YouTube channel by clicking here – as then you’ll know when it’s live). It’s basically any kind of rowing. Whether that be on an ergo or doing resistance work in the gym. Exercise you can do for these muscles are Single Arm Row, Cable Row and Bent Over Row – I’ll put details of these here in due course when we’ve shot the videos!

Whilst I didn’t want to especially admit in public we’ve got some videos still to do I was still really keen to include these rehab / prehab exercises in here as there are so important. A point which confirmed by this nice piece of research here.

What Not To Do!

Be wary of exercise programs on the internet! He says just giving an exercise program on the internet. I’ve given a lot of information here, as much as I can without doing you all an assessment. This is all up to date and the best to 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 fix 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 during 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. If it’s there sometimes not others, or comes on after a game and then recovers you might get away with it. But it’s always best to get it checked out in the first instance. But then I would say that!

Time

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