Physical Therapy Corner: Keeping Your Tennis Shoulder Tuned

Overhead activities in the game of tennis place great demands on the shoulders of tennis players. Shoulder injuries are common in tennis players because of repetitive forces about the unstable shoulder joint with various strokes such as the serve, overhead smash, high forehand and backhand volley. Preventive shoulder conditioning is important for tennis players in order to enhance performance, avoid fatigue from eccentric overload, and avoid an overuse problem.

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Etiology

Injuries to the shoulder tendons are almost always caused by eccentric overload. In other words, high-intensity decelerative muscle contractions of the rotator cuff during the follow through phase of the serve can lead to tendinous inflammation. Additionally, because the shoulder is dependent on the rotator cuff muscles for dynamic stability, any fatigue or asynchronous firing of these muscles will lead to instability of the glenohumeral joint. The improper biomechanics of the glenohumeral joint may progress to a secondary impingement which may cause a rotator cuff tear if allowed to continue over time.

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The Program

The following stretching and strengthening program will be helpful for players with asymptomatic shoulders to prevent shoulder injuries and maintain a healthy shoulder. Additionally, the program is genetic for most causes of shoulder pain in order to restore normal function in a PAINLESS fashion. If the program causes moderate discomfort, discontinue and consult a physician or physical therapist.

Stretching

It is important for the competitive tennis athlete to maintain good shoulder flexibility in order to allow for full range of motion which improves stroke potential. The stretching program recommended for the tennis player focuses on stretching the usually tight posterior and inferior joint capsule and increasing shoulder internal rotation. The stretches should be performed 3 times each and held for 45 seconds twice a day. It is also recommended that the stretches be performed before and after playing tennis.

1.	Crossed-arm adduction for posterior capsule
	Starting Position Lift arm out in front of you to shoulder height with elbow bent at 90 degrees.
	Stretch Position Using your other arm, pull the elbow across your body.
2.	Internal rotation and stretch of the external rotators
	Starting Position Place hand in the small of your back with your palm facing out.
	Stretch Position Holding a tennis racquet, pull your arm up your back.
3.	Inferior capsule stretch
	Starting Position Lift your arm overhead with your elbow pointing to the ceiling.
	Stretch Position Holding a tennis raquet, pull your arm towards the ground.

Overhead athletes often have a stretched anterior capsule and therefore it may not be advisable for tennis players to perform aggressive stretches in an abducted and externally rotated position. This stretch may be harmful because it may be exacerbating a subtle anterior instability.

Strengthening

As mentioned above, the shoulder joint is dependent on the rotator cuff muscles for dynamic stability. It is necessary to keep the humeral head in place in the glenoid labrum in order to prevent shoulder impingement. A strengthening program should be followed to prevent injury and may improve power and endurance during play. The following exercises are a few strengthen exercises which will help to prevent injury to the shoulder when the shoulder is in an unstable position such as a serve, volley or overhead smash. The exercises should be done 3-4 times a week in 3 sets of 10 repetitions.

1.	Concentric/eccentric shoulder external rotation at 90 degrees
	Starting Position Facing the attachment of the resistive band, position your shoulder at 90 degrees abduction and 90 degrees flexion and elbow at 90 degree flexion.
	Exercise Pull band backwards and slowly return to starting position
2.	Concentric/eccentric shoulder internal rotation at 90 degrees
	Starting Position Facing away from the attachment of the resistive band, position your shoulder at 90 degrees abduction and 90 degrees flexion and elbow at 90 degree flexion.
	Exercise Pull band forwards towards the floor and slowly return to starting position.
3.	Concentric/eccentric exercises of serratus anterior
	Starting Position Facing away from the attachment of the band, position your shoulder at 90 degrees of forward flexion with your shoulder pulled back.
	Exercise Punch you arm out in fron of you without moving your trunk, then slowly return it to starting position.

This program is not all inclusive and many other shoulder strengthening exercises may be added to maximize muscle strength. Additionally, once full strength is attained, exercises specific to tennis players can be added. Consult a physical therapist or an athletic trainer for proper instruction.