Rotator Cuff Problem

Discussion in 'Health & Fitness' started by janm, Aug 30, 2012.

  1. janm

    janm Rookie

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    Hi guys,

    About a month ago I noticed some soreness around my shoulder, it was'nt very bad so I still played but only lightly and last week I felt no pain or soreness anymore and thought I was over it.

    I would play but conservatively because I needed to practice for in club tournement...

    A few days ago I felt a sudden pain (looking at anatomy diagrams the pain seems to be the teres minor and major tendon region) whilst reaching for a high ball. It felt like muscles tendons rubbing over each other with a lot of force. straight afterwards the pain was so bad I could not move my arm. It felt like my arm was broke at the shoulder when I tried to raise it. I massaged it straight away and the pain went away enough for me to drive home. I felt a light pain/soreness around the area for a few days since.

    I have not noticed a notable loss of strength but doing certain things on youtube to test teres major/minor regions give me a bit of pain.

    I have made a doctors appointment but that is not for a few days.

    I am concerned it may be a tear. Just wondering if anyone knows a test or way to differentiate between rotator cuff tendonitis or a tear.

    thanks,
     
    #1
  2. LeeD

    LeeD Bionic Poster

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    Could be almost anything, without a sport's doc looksee.....
    Wear and tear thru the years could onset that quickly.
    A strain or tear could bring it on quickly.
    For years, I couldn't brush my teeth with either hand alone, or shave, from wear and tear usage thru the 50 years of sports and injuries. Had to sleep with my arms pinned over my head.
    But that's me, old age overuse.
    Don't know much about you.
     
    #2
  3. janm

    janm Rookie

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    I am 34 years old and have been playing for about 3 years. Before that I used to do weights but not very heavy.

    Build is 178 pounds and height is 182cm.

    I have a GP's appointment tomorrow afternoon but don't think I'll get an answer straight away unless its something obvious. I'm hoping he'll send me for an MRI but that could be months away.
     
    #3
  4. LeeD

    LeeD Bionic Poster

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    You advanced age could be a sign of wear and tear.
    Everyone wears out differently.
    Did you do lots of lifting throughout your years?
    And without a sports doc's diagnosis, we can only speculate.
     
    #4
  5. janm

    janm Rookie

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    A reasonable amount of lifting just to maintain good shape nothing serious.

    I will see what the doctor says tomorrow and report back. Reading the internet I guess there is no easy way to diffarentiate a tear from tendonitis.

    Thanks for the information, appreciate it.
     
    #5
  6. LeeD

    LeeD Bionic Poster

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    Problem here is that if it was so easy, why would we need doctors who charge and see you?
    We don't know your threshold of pain, don't know if you wince when you lift your arms, don't know your exersise history, don't know your work and play schedules, or what you look like and what your physical fitness has been and is currently.
    A doctor will find the answer to all those questions before answering any of your questions.
     
    #6
  7. janm

    janm Rookie

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    Yeah I see what you mean, I thought maybe I was missing the obvious and someone who'd had a similar problem would be able to point out something which could confirm one or the other.

    Again thanks for your time in replying, I will post what the doctor says tomorrow.
     
    #7
  8. floridatennisdude

    floridatennisdude Hall of Fame

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    Unfortunately, the shoulder is a very complex joint. I had a labrum tear go undiagnosed for 3 months of dr visits (crap insurance) before I finally got an MRI that showed the tear.

    My experience was that they practice conservative and rule out tendinitis first through medication. Then they can get the go ahead to scope it. Unless you are a college or pro athlete, you kind of are forced into a waiting game.
     
    #8
  9. Chas Tennis

    Chas Tennis Hall of Fame

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    I have read that some injuries, including some shoulder injuries, because of the lack of nerves in the injured tissue, may progress for some time without much or any pain.

    QUOTE from an earlier reply (http://tt.tennis-warehouse.com/showthread.php?t=437621&highlight=todd+ellenbecker+shoulder+video)

    " This Todd Ellenbecker video is the best detailed description of shoulder issues that I have found. At minute 8 he describes the orientation to hold your shoulder in serving to minimize the risk of impingement (similar to the Jim McLennan video advice in Reply #3).

    http://www.tennisresources.com/index.cfm?area=video_detail&vidid=3712&ATT=&reso=hi

    There are many recent shoulder injury discussions in the Health & Fitness Forum. Use to inform yourself but it is a very risky approach to diagnose or treat yourself based on the internet.

    I have read that with shoulder pain you can be doing damage without much pain so take it very seriously. Some swelling
    may also be present that might make any mechanics painful.

    Best to stop and see a Dr.

    For mechanics you need to study the serve, video your own serve (60p fps video can be useful but high speed video/fast shutter is excellent). A well qualified instructor who can coach the serve is a good idea. In any case, you should especially not be experimenting with your serve if injured. Can one bad motion tear something? "
     
    Last edited: Sep 1, 2012
    #9
  10. Chas Tennis

    Chas Tennis Hall of Fame

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    My non-tennis arm rotator cuff injury first appeared at the gym as a loss of strength and some pain on lifting. There was no indication beforehand and I did not ever sense that an acute injury had happened. The MRI showed 'mild supraspinatus tears', the most common rotator cuff injury. No surgery, rested the shoulder and did targeted PT, which I found very effective and informative. Nearly normal now after 6 years with 90% or more strength, no pain except when certain positions and the pain is not bad. Discomfort, for example, if I am lying on my side in bed and try to lift a bed sheet up using just my shoulder, there is pain. This motion might more use the supraspinatus (?) before the medial deltoid has contributed because the arm's abduction angle is too small for the deltoid. (?) Or I could have some other shoulder issue causing that pain. (?)

    I have read that by age 70 about 30% of people have had rotator cuff tears that would show up on examination or autopsy. Most do not know that they have ever had these injuries.

    I believe that the shoulder joint is the most difficult joint to diagnose due to the complex motions and all the components. For example, inflammation can affect adjacent structures such as bursa sacks, etc. I would not take one person's experience with their injury as applying to yours, but it might.
     
    Last edited: Aug 31, 2012
    #10
  11. janm

    janm Rookie

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    Thanks for the information Chas will look up the serve video when I'm able to get back to playing.

    Went to the doctor today and he made me do some arm motions and felt around the shoulder ligaments. He says I have not got a major tear but is unable to give a confident diagnosis to rule out small tears.

    He recommends I take break from tennis and other activitys that cause pain in the region for 3 weeks and if the pain persists to see him again.
     
    #11
  12. Chas Tennis

    Chas Tennis Hall of Fame

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    From your description of the acute injury I would be concerned without a better diagnosis. Can you get a second opinion from an orthopedic specialist or well qualified sports medicine Dr? Unfortunately, many people with HMO type medical insurance seem to have more difficulty getting MRIs or seeing specialists.

    Most rotator cuff injuries involve the RC muscles & tendons. I have read that tendon injuries take from 2-6 months to heal. Suggest that you research this point on your own.

    I don't know much about the ligaments of the shoulder (don't visualize any ligaments as being part of the rotator cuff). [A ligament connects a bone to a bone.] Did the Dr use the term "ligaments"? Were there any other terms used that you can look up? From the examination, were any injuries identified as possibilities?

    The Ellenbecker video is very useful for the shoulder anatomy and injury issues, the serving advice is only a small part of the video.
     
    #12
  13. FastFreddy

    FastFreddy Semi-Pro

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    Get an mri then go PT route or surgey then PT. Your doc and you will decide which is best for u.
     
    #13
  14. janm

    janm Rookie

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    Hi guys,

    I'm in the UK so just seen a GP (general doctor) no chance to seek a second opinion unless I go to the ER. I have to go back to him if the problem persists after 3 weeks.

    I used the term ligament myself, I guess a better term should have been muscles and tendons. Anyway he just did the basic arm movements and felt around the shoulder. The only thing he ruled out was a full tear. When I asked questions about weather it was maybe a strain/tendonitis or partial tear he did not want to give an opinion and just kept saying come back in 3 weeks if it does not show signs of clearing up.

    Usually for a non urgent case like mine a MRI can take months to a year from the date it was requested. I think GPs cannot request them and only specialists in hospitals can. A GP to specialist referal can take a month or more too.

    I just have to hope its not serious otherwise it will be a long wait and convoluted process to get it treated.
     
    #14
  15. DInosaurTT

    DInosaurTT New User

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    UK GPs

    I am also based in hte UK and have had shoulder problems in the past. Without private health cover it could all take a long time as you say and considering the cost of MRI scans, the GP will avoid and dealy sending you for one as long as possible. Unless it is impacting your normal daily life outside of sport they are unlikely to be interested in spending that budget. Hopefully you have an understanding GP who agrees that tennis is important in keeping you healthy.

    In terms of the understanding of shoulder injuries I would not expect much int he way of certainty from your GP. I say this with great respect as I am the son of one and as my wife is also a doctor, we have many GP friends. The shoulder is very difficult to diagnose and even the specialists don't find the answers easy.

    My story last year involved a visit to the GP to whom I explained my shoulder injury. He asked me to raise it to the side and front, asked where it hurt, how I did it etc. As it only impacted my tennis or ball throwing abilities there was almost no interest. Fortunately they were willing to write me a letter for referral as I have private healthcare. I was then seen by a sports specialist doctor who is now a professor in a shoulder clinic at a private hospital. After unltrasound, examination and MRI, the best guess was SLAP tear, slight impingement and bursitis as a result. There was no certainty despite the MRI and the only way to tell was to let the surgeon scope it with a view to repairing what they were expecting to find or not if their best guess was wrong. In the end they were right and it was repaired and it has all healed over time.

    I am lucky as I have private cover, but if you don't and don't fancy running up large bills paying directly, then you will need to make sure you impress on your GP the impact it is having overall. Hopefully they will be helpful, but the NHS is not well set up for sport injuries in many places although there are some specialist clinics I know of in London hospitals. Make sure you research what is nearby if you want to push for a referral.

    Best of luck with the injury
     
    #15
  16. BeHappy

    BeHappy Hall of Fame

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    Perhaps the OP should exaggerate how much it's hurting him? Pretend he can't drive etc? That sounds like it would get him the treatment he needs? Or would the doctors not fall for that?
     
    #16
  17. DInosaurTT

    DInosaurTT New User

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    It is important no to be too British about it and understate the issue. I would make sure to emphasis the fact it has stopped all sport and if it is making practical things hard then definitely highlight. If you want to stretch things a bit, it might be worth saying it is keeping you awake at night as that is probably the easiest stretch and if getting to sleep had not been my main strength in life would certainly have been true with my shoulder injury.

    I have always kept my private healthcare in the UK as I played a lot of rugby for many years before returning to more tennis and golf and have always been concerned about tearing cruciates etc. It is an important expense for me, but becomes less affordable each year as costs rise.

    Assuming money is not unlimited as for most of us, then try and be as patient as possible and not rush back. I wish I had not pushed some injuries in the past as they certainly took longer to heal as a result.
     
    #17
  18. janm

    janm Rookie

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    Hi guys,

    thankyou very much for your information.

    Its been about a week now and i'm starting to notice more pain.
    I have not gotten much sleep last night. I went to bed approx 2am and woke at 4am in agony. Its been a few days like this now with the most severe pain occuring when i'm sleeping.

    It feels like a broken bone in my shoulder. The exact same type of pain when I broke my arm a few years back and the broken bones would rub against eachother.

    Also I'm starting to feel pain when driving. I have a gear shift car and changing gears is causing a pain. Sometimes so much that I cannot get it into the gear i'm intending to when changing. Also getting pain when changing clothes and especially trying to put my socks on.

    I cannot see any swelling or brusing. The pain is worst when i'm doing a similar motion to a windsheild wiper follow through.

    I'm going to try and get another appointment with the GP in the morning.

    I'm hoping i'm not causing more damage to the injury just doing everyday tasks like driving etc...
     
    #18
  19. Chas Tennis

    Chas Tennis Hall of Fame

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    When you talk to the Dr again emphasize this part of what happened to you. This sounds as if some acute injury took place. What possible injuries might it have been? Since you are having more issues indicate that you need a more definitive diagnosis. If you can influence the choice of Dr, do you have any friend who can recommend one based on their first hand experience? Don't consider how far you must travel just your chance of getting a well qualified Dr. Hospital with good reputation? Good luck in finding the Dr.
     
    #19
  20. DInosaurTT

    DInosaurTT New User

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    Janm

    It sounds like you should be able to push for a referral given the problems described. If it is impacing sleeping and normal daily activities please highlight it to the doctor. As Chas Tennis says above, if you can go prepared with where you would like to go in terms of referral that would be a good idea. GPs are sometimes a good source of knowledge on specialists and in many cases a bit useless. Unfortunately I only know London and the people I dealt with only seem to be in private practice and it really depends on where you are in the country. I know there are a few decent NHS hospital sports clinics in different London hospitals, but ask around and search online depending on where you are based.
     
    #20
  21. janm

    janm Rookie

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    I'm still trying to get an appointment with the GP and will try and get some research done as to referal preference before I go.

    I'm in sheffield Btw
     
    #21
  22. Pacific lefty

    Pacific lefty Rookie

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    Hi Janm, you may have seen my few shoulder injury threads. I live in the south of Ireland, and found it really hard to finally get a solution to my problem. For basic general info, I did find the shoulderdoc.co.uk helpful as very few people here (doctors, physios, people) have much experience with tennis injuries. I had a gradual development of pain serving which one day after a long match, caused me to wake up and find it really hard to reach up or back. Long story short, I had no tear, just supraspinatus inflammation and impingement, had the SAD surgery, lots of rehab, and am back playing tennis (conservatively for the moment). I really had to push to get the MRI and had 4 cortisone injections (would not do that again). 18 months after the original injury the ortho specialist and I finally agreed the SAD was the best way out. In Ireland anyway, I really had to push to get the problem resolved, could be similar where you are, not sure. Having private insurance made a huge difference for me.

    Best of luck getting the problem resolved.
     
    #22
  23. janm

    janm Rookie

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    Well finally got to see the doctor today and more of the same, just advises rest. I guess I just have to see how this plays out. Its looking like a long process unfortunatly.

    Thanks for everyones input really appreciate it. I will have a look through the shoulderdoc.co.uk resource later this evening.
     
    #23
  24. charliefedererer

    charliefedererer Legend

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    Did you see a general practitioner?

    General practitioners are great to control blood pressure, treat diabetes and take care of medical problems.

    Very few general practitioners know how to diagnose a shoulder problem.

    But it is also true that statistically, most shoulder problems represent an inflammatory condition (tendonitis, bursitis) that will respond to rest.



    If this is indeed tendonitis, doing some rehab exercises like the thrower's ten (once all the pain has gone away) is less likely to result in an early recurrence once you return to tennis. http://www.muhlenberg.edu/pdf/main/athletics/athletic_training/throwers10.pdf

    And later restarting your tennis with short hitting sessions without serving is a better way of easing back into the game.
     
    Last edited: Sep 10, 2012
    #24
  25. janm

    janm Rookie

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    Yeah saw the GP and he's not going to budge on the referal just yet.

    Thanks for the pdf on shoulder exercises i'm going to print them off for future reference.

    If this does improve with rest I will only start very lightly. Just hope this starts showing signs its going to improve as its not at the moment :(
     
    #25
  26. janm

    janm Rookie

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    Hi guys,

    Just to say a lot of the pain has gone but some still remains. It gets to the stage I have no pain and one day I wake up and it starts again.

    I have been refered to the physiotherapist so just waiting for the letter to come which will confirm appointment.
     
    #26
  27. LeeD

    LeeD Bionic Poster

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    Does you arm like being above your head when you lay down, or go to sleep.
    That is one indicator of rotator cuff problems.
     
    #27
  28. janm

    janm Rookie

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    I usually sleep supine, occasionally on the side but not the side i'm hurt on. I don't sleep with my arm above my head.

    Empty can test hurts only when someone is applying force now. Before it would hurt without force being applied.

    Most of the time I just have a mild pain when its hurting now.

    I have developed a little bursitis around the area since the injury.

    Overall I think I might have gotten away with it.
     
    #28
  29. Chas Tennis

    Chas Tennis Hall of Fame

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    Empty can test? Do you have a link? Did you get it from the Dr?

    I believe that raising the arm with the shoulder inwardly rotated leaves less clearance space under the acromion. That's because there is a bone protrusion with attached tendons there. I would not be making it hurt to see how it was unless a Dr was doing it.
     
    #29
  30. janm

    janm Rookie

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    #30
  31. Chas Tennis

    Chas Tennis Hall of Fame

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    OK, I see, this is a 'Empty Can' Test.

    FYI

    There is also an 'Empty Can' Exercise. (The exercise may also be called 'Pouring Water'.) This blog explains the issue and the anatomical reasons why the movement might be an issue as an exercise -

    http://coachhook.blogspot.com/2010/08/shoulder-exercise-rant.html

    I read in a book by Horrigan, The 7-Minute Rotator Cuff Solution, an older book, that the exercise 'upright rows' also puts the shoulder in a bad position, internally rotated, while raising the arm too high.

    I don't know what to make of these but I would study the issue before doing these or similar exercises (raising the arm when the shoulder is internally rotated).
     
    Last edited: Sep 25, 2012
    #31
  32. janm

    janm Rookie

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    Thanks for the link it was really good, when I do start rehab i'll be sure to avoid the empty can exercise.
     
    #32
  33. Pacific lefty

    Pacific lefty Rookie

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    The article on empty/full can is really interesting, and made me realise that after the surgery I wasn't given either of those exercises to do at any point. I am doing some of the thrower's ten ones myself now, but instinct was telling me to avoid the empty and full can ones...
     
    #33
  34. Frank Silbermann

    Frank Silbermann Professional

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    I guess the only option for people in America without insurance or for people in Europe without private insurance is to read everything on the web that one can find to diagnose one's own condition, and to devise one's own physical therapy program.

    Unfortunately, this is not something everyone is capable of doing. At least there's a lot more information on line that would not have been available a few decades ago.
     
    #34
  35. Pacific lefty

    Pacific lefty Rookie

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    Yes Frank, unfortunately you are completely right. Even in cases like mine, where I do have private health insurance, I live in a place (Ireland) where tennis medicine and generally accessible sports medicine and knowledge are very very scant! Although my actual surgeon was excellent, he had no idea really when I would be able to realistically go back to tennis (6-8 weeks for most activities was what he said). So my PT, who isn't experienced in tennis herself, and I played touch and go for a number of weeks and luckily got the combination right of what to do. I did find it helpful to supplement some of her exercises and to check the Rehab protocols by well known sports medicine institutions in the U.S.
     
    #35
  36. DInosaurTT

    DInosaurTT New User

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    I agree Frank, but with things like the shoulder you can easily end up with the wrong diagnosis. Through my reading and the reading of my wife who is a doctor, but not specialising in this area, we did narrow down my problems to what were broadly the right answers. It is pretty easy to get wrong though and make things worse. As long as I can afford it or work pays and I am playing sport I will keep my private health cover.

    JanM. Glad to hear things are improving and you are waiting for physio. Hopeffuly you are more patient than me as my keeness to get back from previous rugby injuries always made the recovery process longer.

    Pacific Lefty. How is your progress now?
     
    #36
  37. Pacific lefty

    Pacific lefty Rookie

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    Hey DinosaurTT, things are going great now. It is really only in the last two weeks that I feel I have been playing really well, with my arm loose and relaxed and the pain and stiffness have dissipated. I started back hitting in mid-July (about 10-12 weeks post-surgery) and it was a little sore and uncomfortable. I needed a good two or three days in between sessions to recover. Now that it is nearly 5 months, I find I can play more frequently and not have that niggling feeling that I could be stressing my arm.

    I got some great serving tips from a local coach (the first one I met here who understands proper arm/body mechanics for serving) and that helped a great deal.

    Still stretching every day and doing resistance band exercises nearly every other day.
     
    #37
  38. janm

    janm Rookie

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    Hi Pacific Lefty,

    Thanks for adding your thoughts. I must admit the past month i've been looking at pretty much any information I can get on shoulder injuries and now feel much more informed about what to do and what not to do when I get into rehab and thereafter.

    I urge anyone reading this topic who plays regulary to look up rotator cuff exercises and start doing them. They don't take long to to ( 2 mins on daily rotation) and could save you a serious injury down the line. Also when doing your regular exercise routine take time out and look at the proper technique for that exercise. For example I have recently found out whilst doing bench press type exercises the normal way could break down rotator cuff tendons through impingement... the video below shows a better way...

    http://www.youtube.com/watch?v=wfgicn-Z574

    Just wondering if anyone has gone through this type of injury and back into the game has any tips about how to hit serves and other shots so there is as little stress as possible around the shoulder area.

    thanks,
     
    #38
  39. charliefedererer

    charliefedererer Legend

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    #39
  40. Chas Tennis

    Chas Tennis Hall of Fame

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    The best thing that I have found by far is the Todd Ellenbecker video with the link in reply #9.

    Ellenbecker also has some books

    Complete Conditioning for Tennis I have, excellent book with targeted conditioning for tennis.

    Effective Functional Progression in Sports Rehabilitation- I have, excellent book with many insightful discussions and clear descriptions.
    http://www.amazon.com/Effective-Functional-Progressions-Sport-Rehabilitation/dp/0736063811

    Shoulder Rehabiliation Non-Operative Treatment
    - do not diagnosis & treat yourself.
    http://www.amazon.com/Shoulder-Rehabilitation-Non-Operative-Todd-Ellenbecker/dp/1588903702

    You need to take videos of your serve especially from behind to know for certain what you are doing. This is especially important regarding the shoulder orientation & impingement issue described at minute 8 in the Ellenbecker video (Reply #9). I see many players who don't orient their shoulders correctly for a proper serve - they are doing their own thing.......... Smartphones are not good high speed video cameras but they can catch the orientation of your shoulders which is relatively slow.

    I tore my RC, I believe, from exercises in the gym. I think that external shoulder rotations with too much weight on the pulley may have contributed, but I don't know. Later, I read that external shoulder rotations should not be done with heavy weights. Fortunately, it was my non-tennis shoulder and I could play. Give the gym exercises as much attention as tennis.
     
    Last edited: Sep 25, 2012
    #40
  41. Chas Tennis

    Chas Tennis Hall of Fame

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    Report on injury treatment in the UK.

    Report related to injuries and treatments in the UK. Locate your injury and see if anything sounds familiar.

    http://www.hse.gov.uk/research/rrpdf/rr380.pdf

    I don't know what to make of this information.
     
    #41
  42. janm

    janm Rookie

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    Yeah its pretty much how its gone so far....

    first appointment treatment 2 weeks rest and ibuprofin
    Second oppointment -> more 2 rest weeks and NSAIDs

    then referal to physio if things dont improve. I guess this is the way its done on the NHS.

    I've been studying the various vids by doctors on youtube and the tests they do are much more stringent as to try and pinpoint the pain and then diagnosis. I don't feel my GP was taking much notice of my condition if i'm being frank. I think its probably do to lack of specialist understanding of this type of injury.

    I'm awaiting the physiotherapist appointment and just hope he/she will have a better understanding of this type of injury and at least let me know exactly which tendon/muscle is the problem. I still have no idea which it is as its a dull pain around the top of the humerous.
     
    #42
  43. janm

    janm Rookie

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    chas

    I will take vids when I eventually get back onto the courts and post here to see if my serve/tennis technique is the cause of all this or if it the result of improper lifting technique when I started weights. Actually I did used to have a single handed backhand and did have a some impingement issues about a year into tennis. This is about 2 years ago...

    I did take a vid when I was developing my serve and from memory its pretty much what Pat Dougherty and Todd Ellenbecker recommend. However I dont have quite the knee bend or shoulder angle they recommend.

    Again when i'm back on the courts i'll post vids up for critique.
     
    #43
  44. Pacific lefty

    Pacific lefty Rookie

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    A few Observations

    Hey JanM, I'm glad you are starting to get more information. I went through the same thing. Just a few quick observations:

    My GP (I went to two) had absolutely no idea how to diagnose my problem. He advised rest and a cortisone injection straight away. I really had to persist when the problem wouldn't go away, and became worse. Interestingly enough, the first Physiotherapist I saw, who trained in Limerick with rugby players and their injuries, pinpointed exactly what the problem was (which was confirmed later by MRI as supraspinatus inflammation and impingement). I would say, based on experience, stay away from cortisone. Rest and NSAID's sounds like a good start before rehab. And make sure that rehab exercises are pain free.

    Another thing, one of the worst things I did, when I thought I had improvement, was go back to the gym, and follow a program designed by a totally non-expert exercise advisor there. The best programs I have followed for rehab have always been guided by my physio.

    Finally, I noticed last night, during a club night session, the serve advice I got from a new coach was brilliant. I played two sets and served well, tossing the ball way more in front than I used to, and not as high as I used to, and experienced no pain at all. I even hit an overhead and there were no repercussions!!!

    I am doing a Pilates course which my PT teaches, and I feel that working on core strength has really helped in serving and in remembering postural advice important for back and shoulder muscles.

    Best of luck on the road to recovery, remember, patience is really important.
     
    #44
  45. janm

    janm Rookie

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    Thats great news Panic Lefty...

    At the moment i've got my fingers crossed I'll get a physio that has at least some idea whats going on.

    I will be sure to pick his/her brain about lifting techniques etc for the future aswell as the general rehab program for the shoulder.

    I must admit under normal circumstances I would have been back on court within 2 weeks and playing through some pain but researching my injury and resting this time has probably saved me a lot of grief in the long run.
     
    #45
  46. janm

    janm Rookie

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    ]ok managed to dig up an old video and create an image showing various stages of my first serve.

    Anything I should look at to make it easier on my rotator cuff?

    [​IMG]
     
    #46
  47. janm

    janm Rookie

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    Sorry did that wrong

    [​IMG]
     
    #47
  48. Chas Tennis

    Chas Tennis Hall of Fame

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    If you view the Ellenbecker video at minute 8 he describes the shoulder orientation to minimize impingement risk.

    My interpretation

    Consider first the line from one shoulder to the other and, second, the line of the upper arm bone, the humerus. It is OK to have a small angle such as 10° so that the upper arm bone is up 10° to the extended line between the shoulders. As you raise the arm higher the risk of impingement increases. If you are injured and tissue in the shoulder is swollen this advice to minimize the risk of impingement does not apply as it's more complicated.

    http://anatomy.umms.med.umich.edu/anatomy_new/html/modules/upper_limb_module/upper_limb_05.html

    Now look at image #12. My interpretation of Ellenbecker's advice is that your angle is small and OK. But it has to be so on all serves to keep away from impingement. You can also compare to servers on the internet or TV if you have a DVR [Digital Video Recorder].

    (Pacific Lefty, have you taken a video of your new serve from this view?)

    Another issue- I don't understand one point. You appear to never have very much knee bend but I believe that in image #12 you are off the ground (not certain). Your images are too slow to properly evaluate the serve so I guess you must do a quick, minimal, but powerful knee bend somehow between #11 & 12. Or maybe you bent your knees between 10 & 11 and did not show the frame?? Anyway, that knee bend adds stretch to your internal shoulder rotators (mostly lat & pec) and that internal shoulder rotation accelerates the racket head just before impact - ISR is the largest contributor to racket head speed. If you are not using enough knee bend maybe you are using other muscles and that makes your shoulder unstable. ? Somehow I believe that you have gotten off the ground with both feet by image #12??

    If you have any golfer friends with Casio high speed video cameras or others it would show your complete motion. [Manual exposure control is the best to minimize motion blur but some Auto exposure HSV cameras might also select a fast shutter speed in direct sunlight.]

    The time to work on your serve is not when you are injured.
     
    Last edited: Oct 2, 2012
    #48
  49. janm

    janm Rookie

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    Hi,

    Yes I do get off the ground but I don't bend my knee's anymore then is shown in the video stills. There is a little bend but its know where near enough. Its definately one of the things I need to work on. I think the little bend I have and then the rotational energy is enough to bring me off the ground a little.

    If the little knee bend is what could be causing this I will try to work on it when i'm better on 1/2 speed serves. Although my shoulder feels better now I think i'm going to wait a bit even if I get the all clear from the physio. Still waiting for the first appointment

    Whilst i'm recovering i'm trying to find a better camera like the casio you've mentioned. I've tried looking already but they are hard to find now and expensive.
     
    #49
  50. Pacific lefty

    Pacific lefty Rookie

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    Your elbow should lead

    Hi Chas, yes at some point the long awaited video of my revised serve will appear. What the coach I have been working with said, that I found useful, was that in serving when you are ready to hit the ball, your elbow should lead. For me, this makes me focus on the bend of my arm and the use of "hand speed" to go through the ball rather than using the whole arm "arming it through" as I used to. I think this is working.
    Additionally, practising Pilates once a week with my PT, I feel that the awareness of the core, and the supporting muscles, secondary to shoulder, enable me to get more power in serving without just using the arm...
     
    #50

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