PLEASE NOTE: The medical opinions in USTA.com's Ask the High Performance Lab are responses intended for the average player. Please consult with your primary physician before beginning any new exercise program.This week's Ask the High Performance Lab expert Dr. W. Ben Kibler is a world-renowned orthopedist and a member of the USTA Sport Science Committee. He is a leading expert in shoulder surgery and the biomechanics of shoulder and upper arm injuries. Dr. Kibler is also an avid tennis player and has focused much of his research on topics aimed at better understanding injuries in tennis.Q: What exercises do you recommend to ensure a player does not get tendonitis in the upper arm area?
-- Robert Shawhan
Dr. Kibler: Prevention of tendonitis in the upper arm/ shoulder can be best prevented through a combination of stretching and strengthening. With regards to stretching, tennis players are typically tight in internal rotation of the shoulder. Internal rotation can be improved by performing the two stretches illustrated below. As with all types of static stretching, it is best to do these exercises after play.
Some general guidelines when performing these stretches are:
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You should feel a stretching sensation in the back of your shoulder – if during either of these stretches you feel a pinching sensation or pain in the front of your shoulder discontinue the stretching program until further evaluation is performed.
Hold each stretch for 15 to 20 seconds while breathing normally. Repeat 3 to 5 times. Do not bounce or stretch to the point of pain.
Sleeper Stretch: Lie on your side with your shoulder flexed out in front of you about 90 degrees (right angle). Bend your elbow 90 degrees as pictured.
Using your other hand, rotate your forearm and hand toward the ground until you feel a stretch in the back of your shoulder. Hold that position.
Posterior Shoulder Stretch: Stand with your arm in front of you at shoulder level. Using your other arm, bring your arm across your body as pictured. Don’t rotate your trunk and try to keep your upper back from rotating as you bring your arm across your chest. You can increase the intensity of this stretch by leaning against a wall with the edge of the wall against the outside border of your shoulder blade.
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This will block your shoulder blade from moving when you do this stretch and make the stretch feel more like when your therapist or trainer is doing the stretch for you. Hold the end position and repeat.
Also perform a dynamic warm up before practice or competition that uses the shoulders and trunk (arm swings, windmills, trunk rotations) just before play. Also cool down by performing arm swings after play.
Strengthening exercises to prevent tendonitis should actually emphasize strengthening the rotator cuff (primarily external rotation), the core of the body (push ups, sit ups, trunk extensions), the front of the shoulder (rubber tubing punches in front of the body), and the upper back (rowing exercises).
Q: I am a left-handed player & recently injured my RIGHT elbow. The pain is on the outside area. It hurts when I'm hitting my 2 handed back hand. Now my backhand is so messed up & unreliable because I think about the injury all the time. They say it's the beginning of carpal tunnel - any advise? I don't think I could handle a one handed back hand. I'm pushing the ball long now!!
-- Sarah Russell
Dr. Kibler: This is not carpal tunnel syndrome - that is down at the wrist and is on the palmar side of the forearm/ wrist. This problem you describe is likely due to overuse- either too much play, poor mechanics so that the arm is late coming through the hitting zone, even with a 2 handed grip, weak right shoulder muscles or weak elbow muscles.
Treatment for this type of pain typically consists of modification of play to a point that you do not feel any pain and possibly modifying your stroke mechanics.
Review your technique with a pro and start a strength and conditioning program to improve shoulder and elbow strength. If those measures don't work, consultation with a sports medicine doctor may be necessary.
Q: What treatment to you recommend for tennis elbow? And what exercises to you recommend to speed up the healing process? And lastly what can be done to prevent future tennis elbow? Thank you!
-- Marie Andrews
Dr. Kibler: The same type of exercises as were discussed in the previous questions are just as appropriate for helping to prevent tennis elbow. There are no treatments or exercises with a scientifically proven advantage in promoting healing. Prevention is based on good technique, from the ground to the wrist, good flexibility in the shoulder, and strength of the shoulder and elbow.
Q: I am a physician/surgeon/competitive tennis player. I have been plagued with TFCC JT pain, not responding to nsaids rest and only temporized by steroid injections for nearly two years. One wrist specialist said I may have too long an luna bone which impinges on the triangular cartilage. Please High Performance experts, I have a lot at stake here!
-- Jim Libby
Dr. Kibler: One of the causes of TFCC (triangular fibrocartilage complex- a cartilage like shock absorber between the forearm and wrist) injury is that the ulna, or bone on the pinkie side of the wrist, may be too long. This puts pressure on the cartilage as the wrist rotates, and may cause a tear. X-rays are good at determining the length of the bone. Other problems on that side of the wrist need to be evaluated as well. These include tendon injury and cysts.
Poor technique, with extra cocking of the wrist before ball impact, or too much "wristiness" in the swing, make all the symptoms worse. Treatments for each of these conditions will usually allow return to play. Consultation with a sports medicine doctor who is familiar with tennis and wrist injuries should be done.
Q: My 9 year old son just separated his shoulder. It has been 12 days since the injury and they told us that he couldn't play any sports for 4 weeks. When is a good time to start a slow fitness routine so he can keep his fitness level up? What about rehab? He really loves to play tennis & wants to get back on the court as soon as possible. Thanks for your help!
-- Melissa Nissen
Dr. Kibler: Not enough information is provided to accurately answer this question. It is unclear what was separated - 2 bones or the growing point on one bone. A precise diagnosis is needed in this situation because this may be as simple as resting for several weeks, or may require more x-rays and further treatment or restriction of activity before the injury has healed.
Also, it is important to know how the injury occurred. Was it direct trauma or overuse? That also plays a major role in determining the treatment plan.
Consultation with a sports medicine shoulder specialist is often the best course. Proper treatment now can allow him to return to the court as soon as possible but also with the best chance of not re- injuring himself.
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