Shoulder tendonitis is inflammation due to overuse of the bicep and rotator cuff tendons. The rotator cuff muscles incase the shoulder joint, and when they are injured, they swell. Because these muscles are surrounded by bone, the swelling causes pressure to build within the muscles. The result: the muscles are compressed and there is a loss of blood flow to the small blood vessels. If untreated, tendonitis can worsen, leading to an eventual weakening of the tendon structure. This can lead to a tear of the tendon or the muscle attached to it.
Common causes of tendonitis include poor posture, lack of flexibility due to failure to stretch, weakness and imbalances in shoulder muscles, and repetitive and forceful overhead movements. This injury is commonly seen in tennis and squash players.
Recently, there has been an abundance of shoulder tendonitis due to the latest trend in tennis: top-spin. In the past, the classic way of hitting a tennis ball was hitting it flat on the forehand motion. The latest style of forehand is “Nadal-style,” with lots of top-spin. This motion puts tremendous amounts of force on the anterior aspect of the shoulder. Ironically, when sports and orthopedic doctors examine patients’ shoulders to rule out impingement tendonitis, they put the arm in the replicate position of a forehand thus eliciting pain due to creating impingement.
Kids and teenagers, in particular, are very prone to this type of injury. I see very high numbers of high school and college-age players with the above described shoulder diagnosis. Recently, we saw an epidemic of shoulder tendonitis cases, including Episcopal senior Brandon McLaughlin (Episcopal’s top squash player) and Episcopal freshman Devin McLaughlin (their number two player). Declan Hahn, a sophomore on Friends’ Central tennis team, also presented to us with shoulder tendonitis. His recent growth spurt made him more susceptible to overuse injuries; the rapid and sudden lengthening of his limbs were not being supported sufficiently by underdeveloped musculature. Thanks to this and his booming serve and terrific top-spin on his forehand, Declan developed shoulder impingement tendonitis.
We started their treatment with an evaluation to find the imbalances which were causing the impingement tendonitis. Upon evaluation of Brandon, Devin, and Declan, we found weak rotator cuff muscles, and mechanically we observed footwork faults which were preventing them from being ready as the ball was coming to them. This required increased use of their arm and not enough foot and body weight transfer.
Being on a tennis or squash court every day and going through long practices took its toll on the shoulder and the players presented to us unable to play and worried about playing in upcoming tournaments. To correct faulty mechanics, we used Gua Sha (more on that in my next blog post) and manual therapy methods and modalities to reduce inflammation, reduce adhesions and allow healing to begin. We worked to correct asymmetry, imbalances in muscles of the core (which are essential to increasing power), helped them improve footwork, and instructed them on how to better transfer body weight.
Declan returned to tennis and won Friends League Championships. Devin and Brandon returned to squash and won U.S. squash national high school team championships. They continue to apply the lessons I’m about to share with you and they put them to good use each day. Follow these tips and you can avoid the pain of tendonitis in the first place.
1. Warm up and stretch prior to playing. Do a few laps around the tennis court and a couple of multidirectional sprints (forward, backward and sideways). Then stretch the hamstrings, groin, and calves, as well as the arms and shoulders. Hold each stretch for 5-10 seconds.
2. Add a rotator cuff strengthening program specific to your sport. This program must be prescribed by a physician or a physical therapist after evaluating your shoulder. The exercises for rotator cuff strengthening involve external rotation and lateral raises.
3. Consult with tennis pro (instructor or coach) to analyze your technique and choice of racquet. Consulting with a pro will ensure that your technique for hitting the ball is most effective and least likely to create overuse injuries to elbow and shoulder. The racquet grip and face size will also be recommended by the pro for the most effective stroke.
4. Perform footwork drills. Footwork drills—again, see a professional tennis player or a physical therapist for drills—help you learn proper body mechanics so that when the ball is coming at you, you’re not caught with your feet dead. Just as a boxer dances all around, a tennis player needs to do the same so they hit the ball at the proper distance from the body. This allows you to derive power from your body weight, not just your arm and shoulder.
5. Ice the shoulder immediately following play. Ice for 10 minutes to reduce inflammation.
Joseph Zarett is a physical therapist and president and founder of Zarett Rehab and Fitness. He’ll be blogging for Be Well Philly bi-weekly.