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Player to Player: Rotator Cuff Rehab

May 25, 2008 12:30 PM

Real Tennis Players - Like You! - Asking For, and Offering, Advice on the Sport They Love

Player to Player is USTA.com’s regular feature in which everyday tennis players are given a forum to ask advice on the sport they love – and their fellow players will dish out advice. We’ll post a number of the best responses we receive to our question of the week.

PLAYER TO PLAYER DOESN'T WORK WITHOUT YOUR QUESTIONS, so please send any queries you’d like answered, or responses to other players' questions, to Player@USTA.com.


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Last week’s question from Donald:

(Please note: There's no need to send additional responses to this question)

"I am about to return from rotator cuff surgery, which must rank high on the list of tennis injury comeback problems. Do you have any specific thoughts on rehab on the court for my shoulder?"


From Kenny S., Los Angeles, CA:

When coming back from a shoulder injury, I would really stretch before playing and wear a layer of clothes over it. On your serves, take it easy. Don't go for the huge first serve or heavy spin. After you play, take care of it – no heavy lifting, use a speaker phone or a head set. Ice at home, and don't push it too hard.

From Phil, Briarcliff Manor, NY:

I tore my rotator cuff when I threw a runner out at third base with a soggy softball from deep right as a weekend warrior 30 years ago. I rested it and did a lot of stretching to loosen up the adhesions and scarring.

But the biggest lesson I learned was not to re-injure it again. That happens in the service motion, when the shoulder joint externally rotates to the max (as in stop motion photos of major league pitchers with their arm fully stretched backwards as far as it will go, their gloved hand tucked into their chest and the chest square with the plate).

That is NOT what we old-fart tennis players want our serving arm to look like. The best photos to look at are McEnroe and Federer. The shoulder is NOT externally rotated. However, the shoulder is EXTENDED, with the racquet parallel to the back and the elbow maximally flexed. The torso unwinds, the elbow comes past the ear (like a quarterback's bullet pass) and the forearm extends on the upper arm in one unified motion.

Lastly, the forearm pronates, and the wrist snaps. That way the ligaments of the rotator cuff are not stressed nearly as much. MLB pitchers need that external rotation, but amateur tennis players have the extra reach of the composite racquet and space-age strings to send the ball at 100 mph plus.

Happy rehab-ing.

From Eric R.:

Personally, I have found two areas that have helped my own shoulder pain in the rotator cuff.

One was a series of exercises that are in the same range of motion as the serving stroke. You asked for on-court suggestions, and the same gym exercise can be imitated by taking a racquet-head cover and putting a paperback book inside it near the strings. Then do a few minutes of gentle swinging in the same motion that a good serving stroke would make. The small, extra weight helps warm you up and stretch out the muscles, once you are cleared to start playing again.

Second, I found that hitting flat, over the highest point above my head, puts much more strain on my tender shoulder than putting the ball farther in front and a little more to the side with my wrist, applying a slice to the serve.

Hopefully you have a doc who is a tennis player and understands the specific stresses on the shoulder during play. If not, get one that has a track record of success in the rehab process, specifically with tennis players and their shoulders.

From Sandie S.:

Having gone through this, I can tell you that you have to work on getting the range of motion first. I thought that strength was most important. You do more damage if you try to build strength first.

I used a lot of stretching with light resistant bands and then tried to gradually raise my arm more. The physical therapist I found taught me this. I was able to build the strength, once I started to get the range. It took me about six weeks before I could get my arm up. Luck was that it was my ball-toss arm. I think it would have been longer if it had been my serving shoulder.

From Bob K., Minneapolis, MN:

Learn to hit with the other arm.

From Bob B:

I just went through this myself. Groundstrokes were much easier to re-learn than serves. Just playing made my forehand recover, but the serve was another matter. Throwing a football helped more than any other therapy. First, short throws with my wife; then longer and longer ones with my friends until my strength returned.

From Larry K., Poughkeepsie, NY:

Use a physical therapist who has no regard for your pain. Follow any exercises given by the doctor and therapist to do at home, as often as possible. You want to regain as much mobility as possible.

After the physical therapy, I was playing my normal tennis in two months. Since my rehab, I have no pain and complete use of my right arm/shoulder for tennis, and I play right-handed. It was only a painful process with no tennis limitations.

From George N.:

I had the surgery almost four years ago and have three screws in place there. Takes a good six to nine months to get back to almost normal with the help of therapy, and I am OLD... 70. I am now back to playing two leagues plus two senior softball leagues, also – not recreation, but competitive. Good luck.

From Tom A.:

I have had the surgery on both shoulders. Start with lots of stretching, and then stretch some more. Go easy on overheads for awhile. Stretch two to three times a day to keep the tendons from tightening up after you play. When warming up for a match or practice, do 360-degree rotations, like a ferris wheel! Do both directions. Good luck, and be careful.

From Judy, New York, NY:

I had the surgery five years ago, and I was back on court within five months. I had an excellent physical therapist, and I believe that this was the reason for my successful recovery. I even extended my sessions beyond the 12 weeks covered by insurance and did not return to full activity until the therapist felt I was ready. I attribute my recovery to my strict adherence to her advice.

I have also changed my service motion. Incorporating a technique that I was taught at the Vic Braden School in Utah, I lift my arm straight up in preparation. Sort of like Andy Roddick, although that is where the similarity ends! This seems to produce less wear and tear on the joint.

Good luck!

From Matt, Riverdale, NY:

My best advice is to maximize your physical therapy sessions and make sure that the therapist is a specialist in rotator-cuff injuries.

I had my rotator cuff operated on 15 years ago at the Hospital for Special Surgery in NYC and, though not most convenient, I did all of my rehab at the hospital's physical therapy center because of its expertise.

Also, I purchased extra "therapy bands" and attached them to the door knobs at home and did strengthening exercises (when approved by the therapist) every day for several years to avoid reinjuring the rotator cuff.

Good luck!

From Dave L., Reading, PA:

Sorry to give you bad news, but this surgery is not easy. I've had both my shoulders operated on for rotator cuff at different times. My right shoulder was the worst – a complete tear, and I am right-handed.

After surgery and 40 visits for physical therapy, I continued daily, prescribed exercises for more than a year and did not play tennis during that time. This may sound like a long time, but I have not had a problem with my shoulder since.

From David H., Lexington, KY:

My best advice to rehab a shoulder surgery is to use warm pool therapy. I find the pool therapy will strengthen the tendons by using the water resistance and keep the range of motion in the rotator cuff.

*Please note that any advice given out in this forum should in no way be confused with actual medical advice. Before starting any new exercise regimen or altering your existing one, we strongly urge you to consult with your regular physician.

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