Upper Arm / Elbow Pain when Serving (videos)

[kjjay]

Hi all,

I would really appreciate some opinions on my serve + this pain I've been battling for a number of years! I've attached links to my serves from behind and the side at 240fps to critique the technique/possible causes.

I get a pain that almost feels like shin splints but in the upper arm, above the medial epicondyle of the elbow (i.e inner upper arm). It feels like it's beneath the biceps, right on the bone and I can reproduce the pain by pressing deep into that area. It's only painful from serves.

I know there are lots of threads on Golfer's elbow from serves but I don't think it's this (I'm a doctor).

When I say it's been a problem for a number of years I don't mean all the time, I just mean whenever I go back to practising serves (likely too intensely) after resting for many months, it comes back.
I suspect it's something to do with my technique. I have had a number of coaches look at my technique and refine it and my serve technique seems to have gotten to a good place (though still v inconsistent). Mishits or hitting bad tosses (e.g behind head) really trigger the pain. If I hit cleanly in front of me at a low speed, no pain.

My theories:

1) I'm really going for it with my serves, in terms of pace and power and my muscles are likely just not ready for that intensity. I used to be a gymnast so have very good shoulder flexibility which allows me to get a lot of speed and power but I suspect the tendons aren't ready or primed for this, causing a tendinitis type pain.

2) Possible hyperextension related? The pain occurs only when contacting the ball, with my arm straight. It's possibly to do with the strike with the ball hyperextending my elbow, or to do with the sudden deceleration

3) Possible referred pain from Golfer's elbow, but I doubt it's GE.

All in all I suspect it's technique related so any tips on the videos would be appreciated.

Videos:

 

[socallefty]

You have the #1 problem of those who get pain from serves. You bring your arm straight up over your head on the forward swing which puts a lot of stress on your elbow area. Watch any slow motion pro or coaching video and you will see the correct way to do it which is to bring the racquet head tilted inward (tip pointed to left) towards your head and then swiping it outward (to the right) towards the contact point. You’ll get a better serve with more spin and a higher % that way also.

 

[kjjay]

Thanks the reply. That’s useful that you say that, as I’ve done quite a lot of slow mo side by side comparisons and have noticed that difference too.

It seems to come more from the wrist causing the racquet to be more vertical, right?

I can’t quite work out what to change in order to change that racquet head contact point (wrist or arm positioning etc).

 

[socallefty]

Thanks the reply. That’s useful that you say that, as I’ve done quite a lot of slow mo side by side comparisons and have noticed that difference too.

It seems to come more from the wrist causing the racquet to be more vertical, right?

I can’t quite work out what to change in order to change that racquet head contact point (wrist or arm positioning etc).

More internal shoulder rotation (ISR) - the whole arm has to be tilted inwards and not just the upper arm or wrist.

 

[ey039524]

You might try taping your elbow w KT tape to help prevent hypertension.

 

[SystemicAnomaly]

Distal biceps tendinopathy?

 

[GAS]

Wrong grip. Server's tray. Pain that can be reproduced with shoulder external rotation.

 

[SystemicAnomaly]

^ While not a classic or an extreme WTE, the racket face does open up too early. It should still be pretty much “on edge” at the inverted L (Big L) phase of the upward swing.

Big L:

 

[SystemicAnomaly]

You might try taping your elbow w KT tape to help prevent hypertension.

Kinesio tape can provide an additional feedback path to help minimize hyperextension or other non-optimal arm actions.

Take a look at the following image for arm and racket angles at contact. The arm is angled slightly to the right while the racket is angled to the left. You might also include a Very slight flexion in the elbow to ensure that you are not hyperextending the elbow.

 

[kjjay]

^ While not a classic or an extreme WTE, the racket face does open up too early. It should still be pretty much “on edge” at the inverted L (Big L) phase of the upward swing.

Big L:

Agree, I definitely open up the racquet face a little early and should stay on edge longer. Thought I'd overcome this hurdle already but slow mo video definitely tells a different tale!

 

[kjjay]

Kinesio tape can provide an additional feedback path to help minimize hyperextension or other non-optimal arm actions.

Take a look at the following image for arm and racket angles at contact. The arm is angled slightly to the right while the racket is angled to the left. You might also include a Very slight flexion in the elbow to ensure that you are not hyperextending the elbow.

Thanks for the replies, I somehow missed the notifications.

I filmed some more serves yesterday focussing on trying to get the above stance or "power triangle" between the arm positioned diagonally to the right, and racquet towards the left (11 o clock) and really struggled. I filmed some shadow swings which looked perfect but as soon as a ball is involved I'd revert to hitting the contact point with the racquet extended straight up overhead.

I suspect it's due to a combination of muscle memory forcing my wrist into ulnar deviation (found it really hard to prevent this wrist movement without tensing up my grip to "force" from stopping that outward wrist motion) and also the early racquet opening (waiter's tray error) likely forcing my wrist into that position before the pronation/internal shoulder rotation, so no matter how much I pronate, the racquet head will still be straight up since the wrist has already extended and ulnar deviated (as in the WTE).

All in all, I don't know if this is the cause of the upper arm pain but it's worth correcting and seeing how it goes.
I can definitely see how adding the ulnar deviation to the wrist can cause extra strain on the muscles/tendons and hitting with the arm overhead will certainly stress the shoulder more (though I don't have any shoulder problems/pain when hitting (after a lot of strengthening work over the year).

I'll try strip it back and slow things down to get the technique changed.

 

[SystemicAnomaly]

Agree, I definitely open up the racquet face a little early and should stay on edge longer. Thought I'd overcome this hurdle already but slow mo video definitely tells a different tale!

Did you ever get your condition diagnosed by a professional?

If you have an old racquet or two, you might consider going out to a grassy park and try some racquet throwing -- simulating a serve motion. The racquet should be released (before a conventional contact point but still) fairly late in the upward swing so the you are launching the racquet upward at a 60° to 75° angle.

Your initial throws should be with the racquet face remaining "on edge" as if you were throwing a tomahawk or axe upward. Do NOT rotate the hand/ racquet face for these throws

After a sufficient number of these throws, start rotating the hand / racquet face just prior to release (incorporating pronation / ISR). Hope this progression can help you feel a delay in opening up the racquet face too early

 

[kjjay]

I've been to a few Physiotherapists who've had various theories. But you very quickly realise what you need is someone who specialises in Tennis injuries/understand tennis techniques alongside their medical qualifications. No one can really tell you why you're getting what is essentially a repetative strain injury without understanding exactly which part of the repetitive strain (serve) you're doing incorrectly. Hence the tips here on technique errors are quite useful!

In terms of the common tennis injuries (Golfer's Elbow, Tennis Elbow, Rotator Cuff Tears) I can rule those out myself.

I think if it flares up as bad as it used in with the coming weeks of practice (I'm only serving once a week currently to ease back into it) I will just get an MRI done privately and see what that shows.

 

[devoker]

Wrong grip. Server's tray. Pain that can be reproduced with shoulder external rotation.

It is not the grip. It is opening the racquet face early. External shoulder rotation part is true though.

 

[Move]

Do not worry / think about aligning arm, wrist e.a. during the explosive phase of the serve. Only think of going upwards with your sternum and elbow. If you try to think and control something you will slow down the swing. The way your shoulders and arm are built should whip the racket against the ball

 

[GAS]

It is not the grip. It is opening the racquet face early. External shoulder rotation part is true though.

It's also about the grip.

 

[kjjay]

It's also about the grip.

Nope. My grip is definitely continental, you should be able to see that throughout the video. I do open up the racquet face too early though.

 

[kjjay]

I did some slice serve today and the pain is there when my arm almost “snaps” into full extension (straight arm). My joints have always been quite flexible/ lax so I suspect it’s actually hyperextension related.

Would make sense with why it doesn’t hurt when I hit the serve slow & and when I hit with a slight bent elbow or early pronation instead.

Hitting with the early open racquet face puts huge stress through the straight or overly-straight (hyperextended) arm vs hitting the ball with internal shoulder rotation (force is less through the elbow joint).

 

[socallefty]

I did some slice serve today and the pain is there when my arm almost “snaps” into full extension (straight arm). My joints have always been quite flexible/ lax so I suspect it’s actually hyperextension related.

Would make sense with why it doesn’t hurt when I hit the serve slow & and when I hit with a slight bent elbow or early pronation instead.

Hitting with the early open racquet face puts huge stress through the straight or overly-straight (hyperextended) arm vs hitting the ball with internal shoulder rotation (force is less through the elbow joint).

Your problem was already diagnosed in post 2. Now you have to solve the problem by changing technique.

 

[GAS]

Nope. My grip is definitely continental, you should be able to see that throughout the video. I do open up the racquet face too early though.

You change your grip just before trophy. Maybe you should read more and post less.

 

[devoker]

You change your grip just before trophy. Maybe you should read more and post less.

I am sorry you were right. Actually, he changed it more than once during first serve. But some of them still end up between continental and eastern, the last one was really close to continental.

 

[kjjay]

I am sorry you were right. Actually, he changed it more than once during first serve. But some of them still end up between continental and eastern, the last one was really close to continental.

What you see is me relaxing the lower fingers before trophy, something a coach got me doing a while back to help loosen the grip. I don’t always do it (check the side view 2nd vid) and it most certainly doesn’t change the racquet position as index finger and thumb are keeping it steady (it’d be a pretty impossible feet to do a one handed grip shuffle mid swing).

The grip is continental. Maybe could turn a little further but definitely not the problem causing arm pain here.

 

[kjjay]

You change your grip just before trophy. Maybe you should read more and post less.

Given the consistent theme in your post history on these threads, I’m going to choose to not engage. Thank you for the input.

 

[kjjay]

Your problem was already diagnosed in post 2. Now you have to solve the problem by changing technique.

Yep your post 2 reply was definitely the most useful and I’ve been working on changing it! Thanks.

I just wanted to post here the realisation that it is most likely related to hyperextension/ locking out that arm before contact (and not GE for example) for the benefit of anyone else who may come across this in future.

I spent hours sifting through all the elbow pains on these threads and found them really helpful so just trying to clarify for others.

 

[GAS]

Given the consistent theme in your post history on these threads, I’m going to choose to not engage. Thank you for the input.

Please don't mention it. I love to give input, particularly to players like you.

 

[GAS]

I am sorry you were right. Actually, he changed it more than once during first serve. But some of them still end up between continental and eastern, the last one was really close to continental.

No, no he didn't. And the grip is totally continental when he hits the ball. You should pay more attention.

 

[devoker]

What you see is me relaxing the lower fingers before trophy, something a coach got me doing a while back to help loosen the grip. I don’t always do it (check the side view 2nd vid) and it most certainly doesn’t change the racquet position as index finger and thumb are keeping it steady (it’d be a pretty impossible feet to do a one handed grip shuffle mid swing).

The grip is continental. Maybe could turn a little further but definitely not the problem causing arm pain here.

First video at 00:14 it looks a bit close to aussie grip but I can't be sure because of the resolution and the motion blur. I have seen people changing the grip mid swing a few times. I still think your problem is due to opening the racquet face early even if your grip changed ever slightly.