Little wonder that if this is repeated frequently without proper preparation and with poor technique the consequences can be brutal – pain, inflammation, dysfunction and weeks off the court.
The combination of the shoulders unique anatomy, the condition of muscles and tendons around the shoulder and shoulder blade along with the posture of neck and middle back (thoracic spine) ‘serve up’ a perfect storm for injuries to occur.
The shoulder is a ball and socket joint but unlike the hip, the socket only covers a third of the ball which for instance makes it easier to dislocate. In order for us to put a hand behind our back or manipulate our arm overhead the ligaments and capsule that in other joints of the body restrict or stabilize are lax and loose in the shoulder.
We rely on our muscles and tendons therefore to not only provide movement and power but also to provide stability to centralize the ball in the socket. So when we lift our arm up overhead as in a tennis serve the ball spins perfectly in the socket and does not rock and roll errantly causing injury.
In fact with a tennis serve the arm not only moves overhead, out to the side away from the body but also turns out. It is in this position that the upper lip of the socket comes into close proximity to the ball. Several structures that lie in this space including the rotator cuff tendons (in particular the supraspinatus tendon) along with a bursa which is a fluid filled sac that separates the rotator cuff tendons and reduces friction between them, can become squashed/impinged, even torn.
This pinching is enhanced if the posture of the body is more slouched, rolling the shoulder further inwards.
The effect of posture on the shoulder is easily experienced. Try lifting your arm overhead with a slouched body versus a straight body.
Unless you are hypermobile you should feel a restriction in your shoulder movement in the slouched position. Overstretching a muscle or tendon that is restricted leads to the initial micro tearing that begins shoulder injuries. Tightness in the thoracic spine especially between the shoulder blades also inhibits shoulder movement. The shoulder blade (scapula) creates the socket of the shoulder joint. All the rotator cuff muscles attach to the shoulder blade. The shoulder blade in turn is attached to the body by muscles that attach to the thoracic spine. Good length and strength of these muscles, in particular the lower trapezius muscle provided stability and good positioning of the socket for the ball to spin centrally.
When the rotator cuff tendons, bursa or even the shoulder joints two bony surfaces become injured and inflamed the symptoms usually felt include;
- Pain usually over the outer part of the shoulder.
- Pain with lifting arm overhead, usually out to side and felt in a particular painful arc around 60° – 120°. The pain will often decrease with the arm further overhead, i.e. greater than 120°.
- Pain is worse at rest, especially at night and often with lying on the affected side.
- Stiffness in the shoulder in the mornings.
- Weakness in lifting the arm overhead often described as a dead arm feeling.
- The pain can gradually occur and increase over a long period of time.
Initially the treatment is to stop playing, apply lots of ice around the shoulder every 3-4 hours for 10-20 minutes and if not contra-indicated by your G.P, the use of anti-inflammatories can be beneficial. Sometimes taping or using a sling can be used to reduce pain.
An early exercise program initiated by our Physiotherapists is important to return normal range of movement with stretches along with improving stability with some strengthening of the shoulder blade muscles. Our Physiotherapists will also assess your postures influence on the injury and give you exercises for this if appropriate. This begins the process of getting the Shoulder Ball and Socket to be stable and spin centrally.
Watch for Part 2 – Serving Up Shoulder Pain – Tips for rehabilitation and most importantly returning you back to the court and serving up aces rather than pain.