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How to avoid a shoulder injury while playing tennis

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Winnipeg Health Region
Wave, Summer 2014

Thinking about taking up tennis as a way to stay fit?

If so, you will almost certainly want to do some research on the kind of racket you should get and the type of shoes you should wear before heading to the court. 

But there is one thing that recreational athletes, especially those who are 50 years of age or older, tend to overlook when preparing to make a lifestyle change: how to avoid an injury.

In fact, many people are pretty blasé about the whole thing. They feel that if they are in pretty decent shape and used to play tennis when they were younger, then they are pretty much ready to go.

And that, says Ed Zwingerman, a physiotherapist at D'Arcy Bain Physiotherapy with 30 years' experience, is their first mistake.

As it turns out, injuries to the shoulder from playing tennis are much more common than people realize.

The good news, according to Zwingerman, is that many people could reduce their risk of injury - as long as they are prepared to take the proper steps. Here are three things you can do to help reduce your risk of injury:

Learn about the root causes of injury

To understand how to avoid injuries, it helps to know how they happen.

In tennis, for example, the most common injury involves the shoulder, usually from serving the ball.

"Because it is an overhead activity, it puts different stresses on different tissues," explains Zwingerman. "The most common tissues that get injured are the rotator cuff and bicep tendons."

As shown in the image above, the rotator cuff is a group of four tendons that come together around the ball and socket of the shoulder (humerus) like a "cuff." These tendons work together to stabilize the ball and socket, supporting your shoulder as you "rotate" your arm.

Repetitive overhead movements - like serving - can inflame these tendons, leading to degeneration and injury to the rotator cuff.

But the injury is attributable to more than just the serving motion or the force used in a serve, says Zwingerman.

"The cause of that (injury) is usually an underlying issue, such as the lack of mobility either in the thoracic spine or lack of flexibility in the shoulder girdle."

People who sit all day or have rounded shoulders and a stiff back will have less room to move their shoulder.

"So that predisposes you to these injuries," says Zwingerman.

In fact, many inactive people may suffer some degree of degeneration in the rotator cuff, even before they play their first game.

"In MRIs on normal, pain-free individuals after the age of 40, they still find degenerative changes and tears of the rotator cuff. So sometimes, when you add the strain and the force to an already degenerated tendon, you are set up for injuries."

Get screened

Recreational athletes, especially those who are not feeling any pain or sensing any degeneration in their rotator cuff, can be forgiven for thinking that a simple warm up before playing a game will be enough to avoid injury.

As important as a proper warm up is, injury prevention requires a bit more work.
Zwingerman says it helps to think of the rotator cuff as the "victim" of injury. "It's the victim because of all the predisposing things like posture, muscle tightness, poor movement patterns."

As a result, Zwingerman says recreational athletes who want to play tennis would be very well advised to visit a physiotherapist or a kinesiologist for a screening to determine their physical readiness to engage in what is, after all, a fairly demanding sport.

"It would be good to see if you have proper trunk mobility, proper neck/shoulder range of motion, that sort of thing. It sort of predicts whether you are more likely to get injured.

"Let's say you have a stiff upper back and that is recognized. Well, there are things you can do to keep that loose or more flexible. Because if your upper back is stiff from sitting lots, then your shoulder blade will sit forward and you won't be able to throw it (the ball) overhead and have a lot of space for that shoulder to function."

Once you have been screened, Zwingerman has another bit of important advice: take a lesson or two. "This applies to golf, tennis . . . You can prevent injuries if you have proper technique. It's critical."

Learn how to warm up properly

Most people think they know how to warm up for tennis. It usually involves stretching an arm and holding it in place until the muscles loosen.

Wrong.

The philosophy behind the pre-game or pre-workout warm up has changed dramatically over the last few years, according to Zwingerman.

"The style has changed. It's no longer recommended to do any hard static stretches before an event. So you wouldn't try forcefully stretching your shoulders before a game (although stretching after a game is okay)."

Instead, it is now recommended that players use dynamic stretches to prepare before a game. The difference is relatively straightforward. A static stretch involves holding your arm in a particular position for a period of time, theoretically to stretch the muscle. A dynamic stretch involves slowly and methodically moving your arm.

More important, says Zwingerman, is the need to warm up by raising your core temperature. This helps make the muscles more flexible.

To raise your core temperature, try a slow jog or some jumping jacks. You can also do some sport-specific movements. For example, in tennis, start off with a gentle rally - simply hitting the ball back and forth into each other's service court until you work up a bit of a sweat. If you want to limber up your legs, you can try walking around on your heels or toes.

And remember to warm up gradually. "Just like a pitcher wouldn't start throwing 95 miles per hour, you aren't going to start by hitting your serve as hard as you can," says Zwingerman. "You are going to hit some easy ground strokes and start with movement."

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