Serve technique for golfers elbow

Curious

Legend
I have figured out serve is the main aggravating factor for my chronic recurrent golfers elbow. I know there are lots of other factors like bad technique, hitting late, too firm a grip, racket, strings etc but I would like some advice specifically on the serve. What should I do or change in my serve?
 

Digital Atheist

Professional
I am sure @Chas Tennis will be able to offer some expert advice on this. In the meantime:

https://www.hss.edu/playbook/golfers-elbow-in-tennis-players/

"Usually the symptoms will subside with avoidance of the inciting activity. If they persist, you should see an orthopedic surgeon to make sure something else isn’t causing the pain. Typically, they will prescribe anti-inflammatory medications, ice, and stretching/strengthening exercises. Most cases will respond to the above treatments within about 4 to 6 weeks. It is extremely important, however, to avoid returning to tennis before the symptoms have resolved, as this can be a set up for further injury."

Long story short, stop playing immediately and see a good doctor.

In order to offer technical advice on your service motion, a video would prove useful (if you have existing footage that would be great, because taking a new video if you are still suffering would be ill-advised).

I know this probably isn't what you want to hear, but taking the appropriate time off to heal is a simple necessity (especially when you mention recurring).

Down the track, maybe you could also look at moving away from poly to something softer (if that's the string type you currently use).
 

Enga

Hall of Fame
I have the same thing, serve aggravates my elbow. I speak from personal experience only and someone may be able to go into better detail, but what seems to cause GE for me is during the serve motion, I was not bringing my elbow all the way back and level with my shoulder. Stretching the pec of your serving arm and keeping it more level with the shoulder line essentially.

Before, I served with my elbow starting kind of in front of my body, which I think caused further stress to the tendon, as it would promote more elbow extension than shoulder rotation.

I havent played much in the last 6 months, so it seems mostly healed for me.
 

Chas Tennis

G.O.A.T.
If you have a new tendon injury stop stressing it immediately and see a well qualified Dr. You have a very, very short golden window of time to allow for best healing. If you try to deal with it for weeks - as is usually done in tennis - it is too late for best healing and you may likely then have Tendinosis, completed, defective tendon healing.

See thread "Tendon Injury Nuthouse" for how a new tendon injury can become a defectively healed tendon in a very short time. One publication talks about 2 or 3 weeks. Be aware of these critical facts before you are injured. Understand Tendinitis, with inflammation and Tendinosis with defective healing.
http://tt.tennis-warehouse.com/index.php?threads/tendon-injury-nuthouse.442912/

TV announcers should stop saying that 'he/she has a little tendinitis' because it trivializes tendon injuries and their risk for defective healing.

I hope things are not so bad but I believe that they are.

There are many long threads on Golfer's Elbow and Tennis Elbow in the Health & Fitness Forum.

Will post some information on GE & serve later but don't have good answers.
 
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Chas Tennis

G.O.A.T.
This is a serve from TomT from a 2013 thread. Toly selected these frames and labeled the two frames below to show internal shoulder rotation (ISR). Between frames 2,3 and 4, I can't distinguish the ISR from the elbow extension.


Shows ISR labeled that I used very forcefully for a poor volley technique.

http://tt.tennis-warehouse.com/inde...nate-or-no-pronate.456513/page-2#post-7607067

TomT made no compliant of GE and had good pace on his serve.

This serve bears a similarity to the serves of Raul_RJ and Bigservesofthands. I'm also now noticing this technique in other servers.
-----------------------------------------------------------------------------------
My experience-

A few years before I learned about ISR and the serve I was experimenting to increase the pace of my volley. I did not know what ISR was. Look at the above serve pictures and imagine the ball much lower and that I'm lower and forward but using a similar motion to develop racket head speed on my volley. After just 3 or 4 very forceful volleys I gave myself a sudden Golfer's Elbow injury.

I had a match a few days later and made the GE worse in the warm up. We played the match and won. I realized that I was injured, stopped playing tennis and started to research the injury. About 3 weeks after the injury I found a specific description of tennis elbow and how such tendon injuries can become defectively healed in just a 'few weeks', 3 weeks was it ?, I had tried to use my elbow for nearly that time. I stopped for some time, maybe 3 months, and when I returned there was still a little pain so maybe it was not long enough. I think I narrowly missed tendinosis. There is probably some tendinosis but not very extensive. I have had occasional slight pain but that has decreased over the years. I have had a few other GE injuries and stopped stressing it with good results. Feels normal 99% of the time.

I have read that Golfer's Elbow in tennis is associated with the serve and forehand. Since (my estimates) 50% of rec players use a Waiter's Tray technique, 30% use miscellaneous techniques and maybe only 20% use a technique resembling a high level serve, what can you believe about the cause if the technique is unknown?

I know that I suddenly gave myself a GE injury doing a volley with a technique similar to what you see in the TomT serve pictures. I would also expect similarity in baseball pitching. There is a condition called little league elbow that is related to GE but may also involve adolescent growth plates. Research baseball pitching injuries.

Why would this stress the elbow at the medial epcondyle? The lat and pec muscles cause large forces to rotate the upper arm. But if the mass of the forearm and racket have to be accelerated their inertia resists the acceleration. In a high level technique, the arm is near straight and only the mass of the racket closer to the axis has to be accelerated. Less torque and less stress on the tendon for a high level serving technique.

I really don't have good information on how GE injuries are caused by the serve. If a video of your technique shows that you accelerate the forearm and racket with the elbow bent consider my experience.
 
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Curious

Legend
This is a serve from TomT from a 2013 thread. Toly selected these frames and labeled the two frames below to show internal shoulder rotation (ISR). Between frames 2,3 and 4, I can't distinguish the ISR from the elbow extension.


Shows ISR labeled that I used very forcefully for a poor volley technique.

http://tt.tennis-warehouse.com/inde...nate-or-no-pronate.456513/page-2#post-7607067

TomT made no compliant of GE and had good pace on his serve.

This serve bears a similarity to the serves of Raul_RJ and Bigservesofthands. I'm also now noticing this technique in other servers.
-----------------------------------------------------------------------------------
My experience-

A few years before I learned about ISR and the serve I was experimenting to increase the pace of my volley. I did not know what ISR was. Look at the above serve pictures and imagine the ball much lower and that I'm lower and forward but using a similar motion to develop racket head speed on my volley. After just 3 or 4 very forceful volleys I gave myself a sudden Golfer's Elbow injury.

I had a match a few days later and made the GE worse in the warm up. We played the match and won. I realized that I was injured, stopped playing tennis and started to research the injury. About 3 weeks after the injury I found a specific description of tennis elbow and how such tendon injuries can become defectively healed in just a 'few weeks', 3 weeks was it ?, I had tried to use my elbow for nearly that time. I stopped for some time, maybe 3 months, and when I returned there was still a little pain so maybe it was not long enough. I think I narrowly missed tendinosis. There is probably some tendinosis but not very extensive. I have had occasional slight pain but that has decreased over the years. I have had a few other GE injuries and stopped stressing it with good results. Feels normal 99% of the time.

I have read that Golfer's Elbow in tennis is associated with the serve and forehand. Since (my estimates) 50% of rec players use a Waiter's Tray technique, 30% use miscellaneous techniques and maybe only 20% use a technique resembling a high level serve, what can you believe about the cause if the technique is unknown?

I know that I suddenly gave myself a GE injury doing a volley with a technique similar to what you see in the TomT serve pictures. I would also expect similarity in baseball pitching. There is a condition called little league elbow that is related to GE but may also involve adolescent growth plates. Research baseball pitching injuries.

Why would this stress the elbow at the medial epcondyle? The lat and pec muscles cause large forces to rotate the upper arm. But if the mass of the forearm and racket have to be accelerated their inertia resists the acceleration. In a high level technique, the arm is near straight and only the mass of the racket closer to the axis has to be accelerated. Less torque and less stress on the tendon for a high level serving technique.

I really don't have good information on how GE injuries are caused by the serve. If a video of your technique shows that you accelerate the forearm and racket with the elbow bent consider my experience.
Thanks for the detailed post. This might be too simplistic but when you look at the tendons attaching the medial epicondyl( flexors of fingers and wrist plus pronator teres muscle ) you would think that internal shoulder rotation or elbow extension during serve should have no effect on the golfers elbow so we'd better focus on the exact muscles involved. We know that two shots play the biggest role here, forehand and serve. Too firm grip and wristy forehand and wrist snap( finger and wrist flexors) and the pronation in serve are the factors one should think about. In my case it's probably too firm grip and wristy shots, I hadn't thought about the possible role of pronation in serve until recently.
 
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Chas Tennis

G.O.A.T.
Thanks for the detailed post. This might be too simplistic but when you look at the tendons attaching the medial epicondyl( flexors of fingers and wrist plus pronator teres muscle ) you would think that internal shoulder rotation or elbow extension during serve should have no effect on the golfers elbow so we'd better focus on the exact muscles involved. We know that two shots play the biggest role here, forehand and serve. Too firm grip and wristy forehand and wrist snap( finger and wrist flexors) and the pronation in serve are the factors one should think about. In my case it's probably too firm grip and wristy shots, I hadn't thought about the possible role of pronation in serve until recently.
When I applied a strong torque using ISR with elbow and racket around 90-110? d I got an immediate Golfer's Elbow injury. Wrist joint condition unknown, I'd guess firm. I see some servers using a similar motion in their serving technique. You have an unknown serving technique.

I have read for baseball or tennis that there are vargus or valgus stresses. I did not understand and don't recall the details.

Brainstorming and speculation because I don't understand how injuries occur.

Valgus pictured below is the stress that I believe my volley technique and serve techniques like TomT's cause on the elbow. If ISR is forcefully applied with bent elbow and a tennis racket it causes Valgus stress. The inertia of the forearm and racket resist rotation and cause stress here to the ligament of the elbow. Imagine doing forceful ISR with the forearm against a fixed pole instead of lesser inertia resistance. The information I just found applies to ligament injury at the location of GE tendon injury. The elbow joint is stressed by this motion.

During the serve, how would the tendons become stressed? I believe that the elbow bend during the serve might be a factor and should be examined with high speed video for suspect technique.


http://cses.cumc.columbia.edu/pdf/MCL_handout.pdf



So far I'm finding information on ligament injury but no tendon injury.

Publication on the serve.
http://bjsm.bmj.com/content/48/4/339.full.pdf

Baseball perspective mentions tennis serve. Trying to understand issues.
http://baseballthinktank.com/paul-nyman-to-pronate-or-not-to-pronate-epilogue/

Useful search
Google: valgus stress tennis serve pictures
You can click on the pictures to go to the websites.
 
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