Why you don't need to be a tennis player to suffer from a painful shoulder
With the Wimbledon tennis tournament having started this week, it got me thinking about the incredible amount of training and the slogging of tennis balls that players must endure in preparation and on the court. Hitting a tennis ball with great power as they do puts such an incredible strain on the joints and soft tissues of the arm. This is particularly so at the elbow and the shoulder.
Today I will explore the common injuries at the shoulder joint in tennis players. However, as sport physios we see these injuries very commonly in a large proportion of the population. Let's take a look at the injuries and how to they are best managed through physiotherapy and exercise.
Why is the shoulder so susceptible?
The shoulder joint has great mobility and inherent instability. It is a shallow ball and socket joint and therefore has a heavy reliance on the soft tissue support, including the ligaments and muscles. Stability of this region also comes from a coordinated control of muscular activations, or good muscular 'balance'.
Because of this heavy dependence on muscular support for the shoulder, injuries are common in these muscles. Muscles and tendon strains can occur frequently with overstretching or overloading. This is especially so with ballistic or high power arm movement such as with throwing, tennis shots and serves. Improper warm up, poor strength and condition, or fatigue of the muscles can result in strain. Not only do the shoulder muscles need to generate power for the tennis shots, but also decelerate or slow the swinging arm. This is a huge amount of work load on little muscles about the region.
Poor neck and upper back postures in us non- tennis players can cause the same gradual wear and tear of these muscles and soft tissues. The common postures such as the 'slumped spine' or 'poke chinned' posture can set up a multitude of poor shoulder postures and therefore risk of injury and pain in the arm.
What is the rotator cuff?
You have possibly heard about the rotator cuff through time spent at the gym, or at our Fix classes. But what is it and why is it so important for a healthy and happy shoulder?
The rotator cuff is actually a 'cuff' or fan of 4 muscles. These 4 muscles run across the shoulder blade surface and attach to the shoulder joint up near the tip of the shoulder. They are essential for controlling the movement precision required at the shoulder when elevating or reaching upwards with the arm. They are considered the stabilising muscles of the shoulder and also keep the arm bone (or humerus) set into the joint, effectively stopping it from slipping down your arm. The most commonly heard rotator cuff muscle is the supraspinatus.
Pain associated with this cuff is usually felt down the arm a little from the tip of the shoulder. Wear and tear of these tendons, or small tears can occur due to their location in the top of the shoulder, or repetitive overhead motions of the arm such as with tennis serves or with a painter painting your ceilings all day long. It can be thought of as a pinching type erosion of the structures in the top of the arm, or impingement.
What is shoulder joint impingement?
Impingement is a very common injury of the shoulder. It is most frequent in occupations of sports involving over head activity. It can also be caused by old age, shoulder muscle weakness, poor shoulder joint stability or movement, and bony deformities. Many structures at the top of the shoulder can become inflamed, swollen and 'pinched', including the rotator cuff tendons, the biceps tendon, the fluid filled cushions, called bursa and ligaments.
Pain is felt on elevation of the arm and can again refer into the upper arm.
What about any other shoulder conditions?
There are a full host of shoulder problems and disorders that have not been mentioned here, from frozen shoulders to dislocations to those shoulder pains that may actually be referred from the close by neck and upper back nerves.
Am I always going to be stuck with a painful shoulder?
The short answer is 'no'. The shoulder may be a complex joint, but as a result and in most cases, strengthening programs offer the best long term solution. Classes like ours at The Fix Program where there is a strong focus on good spinal, neck and shoulder blade alignment offer a fix to the cause, not just a bandaid for the pain. Sure, massage and physio, ice and taping can help also with the pain initially, but getting to the root cause of the movement problem and muscle weakness will prevent pain, swelling and injury in the future.
Exercises aimed at good shoulder blade posture such as
- the diamond press
- the dart
- the cobra,
and visual and movement cues such as
- slide your blades into their pockets
- melt your shoulders from your ears
- pivot your arm from the shoulder point
- gently lengthen through the base of the skull
- hold your mango under your chin,
will all assist in returning the upper back and shoulder region into a good movement control. Thoracic stretches and chest stretches will also aid good alignment. Even those over the favourite bolsters!
For some, the damage may be too great on the tendons and soft tissue about the shoulder joint. In this instance, surgery may be required (as a last resort- the rehab after shoulder operations is very very intensive), or an injection of cortisone into the injured structure to try to calm inflammation and encourage healing.
Regardless, you will get to know and love your physiotherapist very well, as they take you through a structured and slow course of treatment and exercise therapy to restore the shoulder and upper back to a well-oiled machine!
If you are at all worried about shoulder pain, get onto it early. As with most niggles, early intervention prevents a greater problem. Your physio will assess and work out what structure is involved - whether it be in the shoulder or neck- and start your road to recovery. Be prepared to work hard on it and you will get good long lasting results.
