hurt shoulder/rotator cuff (need help)

[Bobo96]

I am a 17 year old high level player. I am seeing a a professional phys therapist on Monday that I was referred to. However, I wanted to run it by you all and see if I could gather any advice/information.

. I have missed practically the whole summer from tendinitis in my elbow. After several months of frustration and different strategies to help my elbow, I finally felt that it was 98% healed about 3-4 weeks ago. I started back playing cautiously. I slowly gained confidence until I started going practically all out for the last 1-2 weeks before the shoulder issue. I was still giving myself more rest than usual, but maybe I still got a little too excited. I have been serving very hard, like 100 plus on first serves. And being very aggressive on groundstrokes. Perhaps I should have built up some of the strength I lost while off, before jumping back into things?

. last Wednesday evening I hit a shot, I think it was a hard forehand but maybe serve, my shoulder certainly felt different after that shot, a little strained, or stuck. I continued to play, and did not think much of it. I could pretty much play the same, it just felt a little weird sometimes. I had a 2 hour lesson with a pretty good player the next day that I was getting paid for, so I wasn't just going to cancel cuz it hurt a little bit. I played and it hurt a little more, but I could still play pretty well, but at that point I knew I had at least tweaked my shoulder. I didn't play the rest of the day.

. the next day I had a one hour lesson I was giving that I had already planned. The kid is a younger player, but he can hit the ball with good pace and consistency, I have to try against him. The pain was more noticeable, it definitely felt inflamed, and sorta a dull pain. I went to the chiropractor, she adjusted and said she thought it would be fine if I took a few days off, but she says that about a lot of things. That night It was a little throbing from the inflammation probably, but not after a little icing.

. aside from a little feeding, and some pull UPS, I rested my shoulder from Friday until this Wednesday. I hit for about 15-20 minute Thursday to see how it felt. It felt fine warming up and hittng soft, the last 5 minutes I was hitting hard I could do it, but I knew it still wasn't healed, there was still some pain. There was a 4.5 Men's point play drill that night that I had to run, and I'm supposed to play in. I was going really easy, just soft slicing and droppers/volleys. I trid to go hard for a few forehands, but it didn't go too well. I decided to just pick up balls the rest of the time.

. the pain is in the front of my shoulder, but sometimes on top. I wasn't overly sore or anything when it happened, it came out of nowhere. I am still able to move my arm, with little pain. There is a a little pain/twinge when the arm goes overhead, or across body like on a forehand. I cannot describe how frustrated I am with these injuries. This is a huge year for me as far as my future/college, there are college coaches waiting to see me play, but I can't seem to get healthy. I would greatly appreciate any advice or information on what it is or how I can get better asap, also any exercises I can do to help.

I am 6,1 175 lbs, pretty strong kid, maybe not as flexible as I could be. Please don't say "see a doctor". I really do not have the money. I am going to see a therapist Monday, but wanted to see if anyone here had any advice.

Thanks for any help!!!!

 

[shindemac]

You need to stop arming the ball. On your serves and groundstrokes. It's the cause of your tennis elbow and shoulder. It's worse when you hit hard like you do, because it doesn't take much to destroy your shoulder. I'm not a dr, but here's my advice.

1. Stop playing. Let it heal completely.
2. When you play again, have a relaxed arm on your serve and groundstroke. Do NOT use your shoulder or arm in your swing! I do NOT recommend this! Use the rotation of your trunk and let your arm be loosey goosey and come along for the ride.
3. Do not try to hit hard AT ALL! Until you get the loose arm correct. If you feel any tension or pain in your arm/shoulder, then you are not relaxed enough.

 

[shindemac]

Just remember that when you hit a ball, there are tremendous forces generated that travel down your racket and down your arm. When you tense up or try to arm the ball, it acts like a brick wall that stops the force. One bb gun fired at a brick wall may not do much damage, but if you do it 1000 times, then you start to wear down the brick wall. Well, this brick wall is your elbow or your shoulder. If your arm is relaxed, then this force will flow harmlessly through your arm. Look at some vids of pro vs 5.0, and you'll see the pro is really relaxed and generating more power than the 5.0 easily.

 

[Bobo96]

Just remember that when you hit a ball, there are tremendous forces generated that travel down your racket and down your arm. When you tense up or try to arm the ball, it acts like a brick wall that stops the force. One bb gun fired at a brick wall may not do much damage, but if you do it 1000 times, then you start to wear down the brick wall. Well, this brick wall is your elbow or your shoulder. If your arm is relaxed, then this force will flow harmlessly through your arm. Look at some vids of pro vs 5.0, and you'll see the pro is really relaxed and generating more power than the 5.0 easily.

hey, thanks for advice! Here is a video of my forehands from a while back. I have changed/ improved a lot since then. I hit higher over the net with much more spin now, I'm more versatile and steady per say. My footwork is better now too. I just wanted to give you this video so you could explain when in the stroke in specifically arming. I'm not saying I'm not, I just want to make sure I understand. Thanks!
http://tt.tennis-warehouse.com/showthread.php?t=497628

 

[BMC9670]

Your technique looks solid. Good use of the legs and core. I don't see you arming the ball, although overuse can be a real issue even with perfect technique.

What's your racquet and string set up? How often and long are you training? Do you have a shoulder/arm specific strength and flexibility routine? Do you warm up properly? Now that you posted video and your technique is solid, I would look at these other areas.

 

[Bobo96]

Your technique looks solid. Good use of the legs and core. I don't see you arming the ball, although overuse can be a real issue even with perfect technique.

What's your racquet and string set up? How often and long are you training? Do you have a shoulder/arm specific strength and flexibility routine? Do you warm up properly? Now that you posted video and your technique is solid, I would look at these other areas.

before I got tennis elbow I was using a modified Boris Becker London with tourna big hitter silver 16 at 55#. I was playing around 3-7 hours a day, with a lot of repitition training, and some match play. When I hurt my shoulder I was using yonex ezone Ai 98 with yonex poly tour pro 1.20 ay 48lbs. I was playing for about 2 weeks at 2-4.5 hours a day, with a day of rest every few days.

. my warm up routine varies, sometimes it is good, sometimes I end up not having any time. The warm up is usually more lower body oriented, maybe that's a problem?

. before I hurt my elbow I was playing a lot. I'll admit that many of times I was too busy/tired/sore to get a significant amount of weight lifting in. After the recovery/before shoulder issue. I have been doing a lot of exercises to help/prevent my tennis elbow.. My focus was so much on not hurting my elbow again, I was trying not to do too much extra arm exercises, because my arm had been so used to not doing anything, let alone tennis and strengh training. I was planning on starting a fitness plan very soon, but then the shoulder issue came up!!!

 

[WildVolley]

At a minimum you need to stop playing and to start doing the thrower's 10 exercises - that is if you can do those exercises without pain.

Best case scenario is that you have a mild injury that can be healed with rest and exercises. Worst case scenario is that you've got a more serious injury that will need surgery.

I injured myself in my 30s hitting big serves with slightly off form. It took two years of rehab to get to play without pain. If I had taken more time off, I would have healed more quickly. My serve still hasn't fully recovered. I keep my shoulder mostly healthy by doing relaxed dead hangs from a pull-up position, pull ups and deadlifts, and a focus on the external rotation exercises from the thrower's 10.

 

[Bobo96]

At a minimum you need to stop playing and to start doing the thrower's 10 exercises - that is if you can do those exercises without pain.

Best case scenario is that you have a mild injury that can be healed with rest and exercises. Worst case scenario is that you've got a more serious injury that will need surgery.

I injured myself in my 30s hitting big serves with slightly off form. It took two years of rehab to get to play without pain. If I had taken more time off, I would have healed more quickly. My serve still hasn't fully recovered. I keep my shoulder mostly healthy by doing relaxed dead hangs from a pull-up position, pull ups and deadlifts, and a focus on the external rotation exercises from the thrower's 10.

thanks! Do you think I should do all the 10 or just the external rotation exercises?

 

[WildVolley]

thanks! Do you think I should do all the 10 or just the external rotation exercises?

You could do all ten, but I'd guess that the external rotation ones are what are going to be important. I mostly do the external rotation exercises these days, because I believe that almost all my tennis strokes involve internal rotation. Strengthening the external rotators should make it easier to maintain the proper shoulder position even when hitting hard.

I bring a length of tubing with me to the court (like Nadal uses) in order to lightly warmup my external rotators prior to hitting and then I do external rotation exercises (both with my arm at my side and lifted at a 90 degree angle to the torso) until I feel a burn in the muscles after I play.

You might also try the hanging from a bar. That is said to stretch the acromion arch which is part of the scapula that comes over the top of the shoulder. Stretching it out seems to relieve pain with impingement. There was a thread in this forum on that topic. I do shoulder width pull-up hand position deadhangs for 30 seconds at a time.

 

[GrandSlam45]

As mentioned, make sure you feel no pain when doing the exercises. If you feel any pain at all, then stop immediately.

Also, since you're only 17, don't your parents have health insurance so you can see a doctor? One doctor's visit to diagnose the problem wouldn't be that expensive.

 

[Bobo96]

As mentioned, make sure you feel no pain when doing the exercises. If you feel any pain at all, then stop immediately.

Also, since you're only 17, don't your parents have health insurance so you can see a doctor? One doctor's visit to diagnose the problem wouldn't be that expensive.

No, they do not.

 

[T1000]

thanks! Do you think I should do all the 10 or just the external rotation exercises?

Just do the ones where you grab the cable and rotate out and in (do both shoulders not just the injured one) and the one where you mimic the serve going forwards and backwards. I did these religiously and went from pain in tennis and lifting in my shoulders to zero pain playing tennis and my presses shot up and I can lift heavy with no pain.

Are you really 175? You look a lot smaller in those vids.

 

[Bobo96]

Okay, so I was diagnosed with mild to moderate tendonitis in my shoulder. He said the cause was almost for sure weakness in my rotator cuff, for how hard I'm playing and serving. He said it is generally 2-4 weeks of rehab for mild, and 4-8 for moderate, he seemed to be leaning towards mild though. He gave me a great workout for my rotator cuff that I can start doing now. He seemed to think that it would be fine to do any pulling, curling, or tricep extension movement when I workout, but to stay away from any pushing, especially overhead.

. what do you all think of this, would you agree with most of what he said? Or there any tips you can give me to recover from this faster, other than doing the strengthening program, which I will be doing regularly.

at T100: last I cheled I was about 175 with clothes on. I may have grown an inch or 2 since then, and may e added on a little muscle in my legs.

 

[Chas Tennis]

Here is a video by Todd Ellenbecker on the shoulder, impingement and the shoulder orientation to use for serving.

I believe that serving with ISR is never forced and could cause injury if practiced incorrectly. Here are some known issues. With forceful and rapid ISR the small external shoulder rotator cuff muscles have to be conditioned to keep the ball of the humerus in place and to stop the arm rotation in the follow through. See recommended shoulder conditioning exercises. Easy, light exercises.

There are also the important safety issues related to technique such as the shoulder high orientation for the serve to minimize impingement risk. Just one very bad motion can cause injury.

1) Jim McLennan short video on the rotator cuff, impingement and serving
http://www.youtube.com/watch?v=lTRvxaBMh8s

2) Todd Ellenbecker video on shoulder anatomy, impingement, and serving. At about minute 8 he describes the same issue as McLennan but in more detail.
http://www.tennisresources.com/index.cfm?area=video_detail&vidid=3712&ATT=&reso=lo

If you are concerned because you are having pain, how can you determine that the technique that you use is OK? You have to study and know the proper technique and verify that you are doing it with high speed video or find a well qualified instructor. Keep in mind that the more rapid motions during the serve cannot be seen by eye or even 60 fps video so an instructor who uses HSV is a plus.

How was your shoulder injury diagnosed and what tendon or tendons have tendinitis? With MRIs there is still uncertainty with diagnoses.

Understand the difference between tendinitis (with inflammation) and tendinosis (with completed defective healing).
http://tt.tennis-warehouse.com/showthread.php?t=442912

See tendon healing time table posted by CharlieFedererer.

 

[Bobo96]

Here is a video by Todd Ellenbecker on the shoulder, impingement and the shoulder orientation to use for serving.


How was your shoulder injury diagnosed and what tendon or tendons have tendinitis? With MRIs there is still uncertainty with diagnoses.

Understand the difference between tendinitis (with inflammation) and tendinosis (with completed defective healing).
http://tt.tennis-warehouse.com/showthread.php?t=442912

See tendon healing time table posted by CharlieFedererer.

by a phys therapist. He moved my arm around, tested strength, finding which movements hurt. I believe it was rotator cuff tendonitis, but maybe I'm getting that mixed up with him saying I have to strengthen rotator cuff. I'm pretty sure he said rotator cuff tendonitis though.

 

[Chas Tennis]

by a phys therapist. He moved my arm around, tested strength, finding which movements hurt. I believe it was rotator cuff tendonitis, but maybe I'm getting that mixed up with him saying I have to strengthen rotator cuff. I'm pretty sure he said rotator cuff tendonitis though.

The rotator cuff has 4 muscles each with tendons. I had some rotator cuff tears of the muscle or tendon, can't recall, of the Supraspinatus, the most common muscle that is injured.

The shoulder is very complex and even after an MRI the exact cause of the pain may not be diagnosed. Ask what muscle is involved in the tendinitis. For myself I would not trust that a diagnosis without any imaging by a physical therapist, not identifying the injured tendon is that reliable. If they see tears in an MRI and that is where the pain is that is a lot more re-assuring. I can get a reference on common tennis injuries and be right most of the time guessing.

Tendinitis is trivialized by the TV announcers - he/she has a little tendinitis.

Read those articles on tendinitis and tendinosis.

Don't have something that you have to do when injured, the big tournamant or a college recruitment demonstration.

If a tendon tear some area of the tendon has torn probably by some tennis motion possibly while your were fatigued. To play on it you are subjecting that area of the tendon to the same forces that tore it in the first place. The article that I linked says that the initial part of healing may be as short as 3 weeks in the case of animal studies. If not allowed to heal properly it heals defectively. Tennis Elbow is the classic example of this injury.

Google: shoulder injury images

Click on the pictures to go to the websites.

Where is your pain?

 

[TennisCJC]

Playing 3 to 7 hours per day is a lot even at 17 yo. Don't play as much.

Drop the tension on your poly strings to high 40s - 50-52 at most.

Yes, as everyone said, do the rotator cuff exercise.

Also, be SURE you place your service toss in front of your body and slightly to your right assuming you are right handed. Even 2nd serves can be hit with contact slightly in front and to the right. You might want to search the shoulder impingement serving video. Get the hitting shoulder up at contact when serving helps a lot too.

I am 58 yo, I have had 3 experiences where my rotator cuff became so inflamed, the shoulder went dead. I literally could not get the shoulder to lift the arm. The arm just dangled. Rest, drugs - pregnazone (spelling?) and anti-inflamatories, and PT rehab helped me. You are heading there if you don't make some changes.

 

[dman72]

Also, apart from what everyone else has said, check your posture. If you slouch your shoulders forward and keep that posture when hitting, you're going to start hurting due to an impingement. I've managed to not have shoulder issues until just recently at 42, but I also never played as many hours as you do. The last year or so I've been having some major pain on forehands in my shoulder.

The last time I played I concentrated on keeping the shoulders rolled back, and I played virtually pain free. After adequate rest, give this a shot.