Rotator cuff tendonitis in the sport of tennis

For today’s blog I will be talking about rotator cuff tendonitis in tennis players. What is rotator cuff tendonitis? Rotator cuff tendonitis is a tendon injury from repetitive loading with a subsequent inflammatory response. Overuse is mainly with overhead movements such as a serve. The rotator cuff is a group of four muscles and tendons which surround the shoulder joint. This keeps your arm inside it’s shoulder socket. The four muscles are subscapularis, supraspinatus, infraspinatus, and teres minor. They originate on the scapula, cross the glenohumeral joint and they insert onto the tuberosities of the proximal humerus. The main role of the rotator cuff is to provide stability throughout range of movement. It also helps to raise the arm upwards and rotate it inwards and outwards.

Tennis

When it comes to tennis we will be mainly focusing on the serve. Tennis is a very repetitive sport. The same movements over and over again, mainly with one arm. Every point in the game begins with a serve which is done overhead. This is done the same way every time. The better the player the more exact it will be. This can eventually lead to the overuse of the rotator cuff.

A serve is done by throwing the ball up in the air, swinging the arm with the racket back behind their back with the elbow bent. When the ball beings to descent, begin a swinging motion towards the ball. Contact with the ball should occur when the arm is fully extended. Once contact occurs the player follows through with the racket. During a serve great force is applied to the rotator cuff, this continuously challenges the rotator cuff to have to keep the humerus head centred which can eventually cause inflammation.

Rotator cuff tendonitis can also occur during forehand shots and back hand shots but are not as common. It can occur at the late follow-through phase of the forehand shot and with the backhand shot it occurs in the preparation phase.

Symptoms

There are many symptoms depending on the damage level. These include:

o Reduction of strength.

o There may be swelling in the shoulder or tenderness.

o Pain when reaching, lowering the arm, pulling or pushing something.

o Stiffness or a reduction in the mobility of the shoulder.

Rehab

When the injury occurs it is necessary to get it checked from a physio as soon as possible to see the extent of the injury. They might be able to work on it otherwise refer you on to get an MRI which may lead to surgery. * Side note while with an injury it is necessary to keep training endurance and the strength in the opposite arm. We want to avoid losing our fitness and strength as much as possible so that when you return to play everything is not lost. Remember this will be done very slowly but taken the right steps it will reduce the chances of it reoccurring*. Once the physio has worked on it and given the all clear it is time to start working on getting back to playing.

With no pain the rehab steps to follow are:

1. Range of motion and flexibility:

- Using a stick or a towel for ROM.

- Working on stretching.

2. Activation exercises:

- Pendulum exercise.

- In a table top position with elbows slightly bent, weight going through the centre of the hand; lean forward and back, left to right and then on one arm reaching under and across the body.

- Using banded exercises such as; front raises, side raises and between front and side raises.

3. Introducing strength:

- Wall push ups.

- Using banded exercises such as; standing row, external rotation with arm abduction, internal rotation and external rotation.

4. Weighted exercises:

- Floor push ups.

-Using light weights exercises such as; front raises, side raises, shoulder press and upright row.

-Core exercise. This will help generate force in the core which can efficiently be transferred to the arm when serving the ball.

5. Returning to play:

-Very slowly start back at tennis. Focus on proper technique with little power in the shots and overtime build up the power.

Side note

If the injury is not correctly rehabbed it can lead to stiffness and or weakness which is what we want to avoid. By following those five steps your shoulder we will back to normal if not better than before in no time.

Nutrition

This may be a good or bad thing for different people but when out injured calorie intake should remain the same. Yes, I know your first though is but if I’m not training I will gain weight. No, this is not the case short term because the types of foods you are in taking in will change. It is recommended to have a balanced diet. When your body is injured it needs nutrients, so avoiding food because you don’t want to gain weight is actually going to slow down your recovery.

However, lower your carbohydrate intake as you will not need as much energy but not too much as energy is still needed for your injury to heal. It is also recommended to increase protein intake as helps in growth and repair. If you suddenly decrease your protein intake it will lead to a negative nitrogen balance which will result in reduce the healing process and increase muscle loss.

Increase anti-inflammatory foods such as fatty fish, nuts and fruit as they will aid in reducing inflammation. You should also increase micronutrients; zinc, vitamin C and A are essential for healing.