1 - Rotator Cuff Injuries in Tennis Players
Tennis is a physically demanding sport, and shoulder injuries are common, particularly among athletes who perform repetitive overhead movements. Most shoulder injuries in tennis players develop gradually, starting with simple muscle fatigue (Renström, 2002). A classic example of this involves the rotator cuff. When the rotator cuff muscles weaken, the stronger deltoid muscle can overpower them, causing the humeral head to migrate upwards on the glenoid during overhead arm movements. Left untreated, this imbalance can worsen, leading to the rotator cuff tendon rubbing against the coracoacromial arch, escalating the injury (Renström, 2002).
Causes of Rotator Cuff Injuries
Rotator cuff injuries in tennis players often occur due to tensile failure—where the muscles contract to resist forces during deceleration, distraction, horizontal adduction, and internal rotation of the shoulder. These movements are common in tennis and put significant strain on the rotator cuff tendons (Van Der Hoeven and Kibler, 2006). Repeated stress can lead to fraying or tears, particularly in the supraspinatus and infraspinatus tendons, which often cause pain during the late cocking phase of a tennis serve (Van Der Hoeven and Kibler, 2006).
Shoulder Rotational Changes in Tennis Players
Tennis players frequently exhibit changes in the rotational arc of their dominant shoulder, showing increased external rotation with decreased internal rotation (Van Der Hoeven and Kibler, 2006). This imbalance is associated with posterior capsular tightness at the rear of the shoulder joint (Perkins and Davis, 2006). These rotational changes can compromise shoulder stability, potentially leading to impingement and reduced range of motion as the body limits painful movements (Di Giacomo, De Gasperis and Costantini, 2016).
Burkhart, Morgan, and Ben Kibler (2003) also noted that overhead tennis motions, particularly during follow-through, exert significant forces on the posterior capsule of the shoulder. The eccentric activity of the infraspinatus muscle compensates for these forces, but it triggers adaptive changes that lead to decreased active tension and increased passive muscle tension. This disrupts proprioception, known as the thixotropic mechanism, and results in a stiffened posterior capsule (Van Der Hoeven and Kibler, 2006). Regular stretching of the shortened structures is crucial to prevent further tightening, reducing the risk of impingement and preserving shoulder function.
2 - SLAP Lesions: A Common Labral Injury
Superior labral anterior-to-posterior (SLAP) lesions are common among athletes and occur when the superior labrum frays or tears at the point where the biceps tendon attaches. This disrupts the normal interaction between the labrum and the glenoid (Van Der Hoeven and Kibler, 2006). Studies show that during the late cocking phase of an overhead serve, the shoulder joint is subjected to significant stresses, making the superior labrum particularly vulnerable.
Tennis players with SLAP lesions often experience deep shoulder pain, weakness, or dysfunction during the external rotation phase of the serve (Van Der Hoeven and Kibler, 2006). Some may even feel a popping sensation in the shoulder, indicating underlying labral pathology. This can limit shoulder range of motion and reduce strength, impairing performance and causing discomfort during play.
Factors Contributing to Shoulder Injuries
Many shoulder injuries in tennis players stem from scapular dyskinesis—an imbalance in the muscles that stabilise the scapula (Paine and Voight, 1993). Scapular dyskinesis disrupts shoulder mechanics and increases the risk of injury (Van Der Hoeven and Kibler, 2006).
The scapula is vital for shoulder mobility, anchored by muscles like the serratus anterior and trapezius, which stabilise it against the chest wall. Weakness or tightness in these muscles can lead to abnormal scapular movement, increasing injury risk. Scapular dyskinesis manifests in three main types (Van Der Hoeven and Kibler, 2006):
Type I: Tightness in the front of the shoulder and weakness in the lower trapezius and serratus anterior, causing the scapula to tilt backward, narrowing the subacromial space.
Type II: Fatigue in the trapezius and rhomboid muscles causes the inner edge of the scapula to protrude outward at rest.
Type III: The upper edge of the scapula sticks out, often linked to shoulder impingement and rotator cuff issues.
Acupuncture for Shoulder Injuries
Acupuncture has been shown to effectively treat shoulder injuries, including rotator cuff tears and shoulder impingement syndrome. Studies indicate that acupuncture can relieve pain, improve range of motion, and speed up recovery (Guerra de Hoyos et al., 2004; Molsberger et al., 2010; Itoh et al., 2014; Rubio, Mansfield and Lewis, 2017). This makes acupuncture a valuable part of a holistic approach to treating shoulder injuries, complementing osteopathy and exercise therapy.
Conclusion
Tennis players are especially prone to shoulder injuries due to the repetitive overhead movements the sport demands. Understanding the mechanisms behind injuries like rotator cuff tears, SLAP lesions, and scapular dyskinesis is crucial for preventing and treating them effectively.
Incorporating regular stretching, strengthening exercises, and holistic treatments like acupuncture can significantly improve shoulder health. By addressing these issues proactively, players can extend their careers and reduce the risk of chronic shoulder problems, allowing them to serve smarter and play longer.
References
Burkhart, S.S., Morgan, C.D. and Ben Kibler, W., 2003. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(6), pp.641–661. https://doi.org/10.1016/S0749-8063(03)00389-X.
Di Giacomo, G., De Gasperis, N. and Costantini, A., 2016. Tennis: Epidemiology and Injury Mechanism. In: P. Volpi, ed. Arthroscopy and Sport Injuries. [online] Cham: Springer International Publishing. pp.19–23. https://doi.org/10.1007/978-3-319-14815-1_3.
Guerra de Hoyos, J.A., Martín, M.D.C.A., Leon, E.B.Y.B. de, Lopez, M.V., López, T.M., Morilla, F.A.V. and Moreno, M.J.G., 2004. Randomised trial of long term effect of acupuncture for shoulder pain. Pain, 112(3), pp.289–298. https://doi.org/10.1016/j.pain.2004.08.030.
Itoh, K., Saito, S., Sahara, S., Naitoh, Y., Imai, K. and Kitakoji, H., 2014. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study. Journal of Acupuncture and Meridian Studies, 7(2), pp.59–64. https://doi.org/10.1016/j.jams.2013.02.002.
Molsberger, A.F., Schneider, T., Gotthardt, H. and Drabik, A., 2010. German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) - a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Pain, 151(1), pp.146–154. https://doi.org/10.1016/j.pain.2010.06.036.
Paine, R.M. and Voight, M., 1993. The Role of the Scapula. Journal of Orthopaedic & Sports Physical Therapy, 18(1), pp.386–391. https://doi.org/10.2519/jospt.1993.18.1.386.
Perkins, R.H. and Davis, D., 2006. Musculoskeletal Injuries in Tennis. Physical Medicine and Rehabilitation Clinics of North America, 17(3), pp.609–631. https://doi.org/10.1016/j.pmr.2006.05.005.
Renström, P. ed., 2002. Handbook of sports medicine and science. Tennis. Handbook of sports medicine and science. Malden, MA: Blackwell Science.
Rubio, A., Mansfield, M. and Lewis, J., 2017. Effectiveness of acupuncture in the treatment of shoulder pain: a systematic review of published randomised clinical trials. Physiotherapy, 103, pp.e38–e39. https://doi.org/10.1016/j.physio.2017.11.202.
Van Der Hoeven, H. and Kibler, W.B., 2006. Shoulder injuries in tennis players. British Journal of Sports Medicine, 40(5), pp.435–440. https://doi.org/10.1136/bjsm.2005.023218.
Acupuncture and Osteopathy in North West London
Discover the Benefits of Acupuncture and Osteopathy for Tennis Injuries.
Dealing with persistent shoulder pain? Acupuncture and Osteopathy might be your answer. It helps reduce inflammation, improve blood flow, and balance muscle activity.
Living in London? Book your Acupuncture and Osteopathic appointment today!
Comentários