Advertisement

Rehabilitation of the Shoulder in Tennis Players

  • Todd S. EllenbeckerEmail author
  • Ann Cools
Chapter

Abstract

In epidemiologic studies of elite tennis players, the shoulder is frequently cited as one of the most often injured regions from high-level repetitive tennis play [1]. Ellenbecker et al. [2] reviewed many epidemiologic studies and reported high incidences (4–24%) of shoulder pain among elite players. Additionally, Kovacs et al. [3] surveyed 861 elite junior tennis players regarding their injury history. Shoulder pain was second only to lower back injury among the elite male and female players in their study. On the ATP World Tour, the evaluation and treatment of shoulder injury again are second only to spinal pathology in elite professional male players in injury frequency. Of the diagnoses commonly encountered in male professional players, rotator cuff impingement and tendonitis are most frequently reported. These studies identify the shoulder as a common site of injury and highlight the need for both rehabilitation and treatment programs as well as prevention programs for the shoulder.

References

  1. 1.
    Pluim BM, Staal JB, Windler GE, et al. Tennis injuries: occurrence, aetiology, and prevention. Br J Sports Med. 2006;40:415–23.CrossRefGoogle Scholar
  2. 2.
    Ellenbecker TS, Pluim B, Vivier S, Sniteman C. Common injuries in tennis players: exercises to address muscular imbalances and reduce injury risk. J Strength Condition. 2009;31(4):50–8.CrossRefGoogle Scholar
  3. 3.
    Kovacs M, Ellenbecker TS, Kibler WB, Roetert EP, Lubbers P. Injury trends in American competitive junior tennis players. J Sci Med Tennis. 2014;19:19.Google Scholar
  4. 4.
    Priest JD, Nagel DA. Tennis shoulder. Am J Sports Med. 1976;4(1):28–42.PubMedGoogle Scholar
  5. 5.
    Ellenbecker TS, Windler G, Dines D, Renstrom P. Musculoskeletal profile of tennis players on the ATP World Tour: results of a 9-year screening program. J Med Sci Tennis. 2015;20(3):94–106.Google Scholar
  6. 6.
    Young SW, Dakic J, Stroia K, Nguyen ML, Harris AH, Safran MR. High incidence of infraspinatus muscle atrophy in elite professional female tennis players. Am J Sports Med. 2015;43(8):1989–93.CrossRefGoogle Scholar
  7. 7.
    Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg. 2002;11:550–6.CrossRefGoogle Scholar
  8. 8.
    Ellenbecker TS. Musculoskeletal examination of elite junior tennis players. Aspetar Sports Med J. 2014;3:548–56.Google Scholar
  9. 9.
    Cools AM, Johansson FR, Velde AV, Palmans T, Cambier DC, Witvrouw EE. Descriptive profile of scapulothoracic position-, strength- and flexibility variables in adolescent elite tennis players. Br J Sports Med. 2010;44(9):678–84.CrossRefGoogle Scholar
  10. 10.
    Cools AM, Palmans T, Johansson FR. Age-related sport-specific adaptations of the shoulder girdle in elite adolescent tennis players. J Athl Train. 2014;49(5):647–53.CrossRefGoogle Scholar
  11. 11.
    Johansson FR, Skillgate E, Adolfsson A, Jenner G, Debri E, Swärdh L, Cools AM. Asymptomatic elite adolescent tennis players show tendinosis signs on their dominant shoulder compared to their non-dominant. J Athl Train. 2015;50(7):719–25.CrossRefGoogle Scholar
  12. 12.
    Johansson FR, Skillgate E, Adolfsson A, Jenner G, Debri E, Swârdh L, Cools AM. Asymptomatic elite young tennis players show lateral and ventral growth plate alterations of proximal humerus on MRI. Knee Surg Sports Traumatol Arthrosc. 2016;25:3251.CrossRefGoogle Scholar
  13. 13.
    Johansson F. The shoulder in the elite adolescent tennis player: Exploration of structural and functional sport specific adaptations, Doctoral Thesis Ghent University, Supervisor Ann MJ Cools. 2017Google Scholar
  14. 14.
    Chandler TJ, Kibler WB, Stracener EC, Ziegler AK, Pace B. Shoulder strength, power and endurance in college tennis players. Am J Sports Med. 1992;20(4):455–8.CrossRefGoogle Scholar
  15. 15.
    Ellenbecker TS. A total arm strength isokinetic profile of highly skilled tennis players. Isok Exer Sci. 1991;1:9–21.Google Scholar
  16. 16.
    Ellenbecker TS. Shoulder internal and external rotation strength and range of motion in highly skilled tennis players. Isokinet Exerc Sci. 1992;2:1–8.Google Scholar
  17. 17.
    Ellenbecker TS, Roetert EP. Age specific isokinetic glenohumeral internal and external rotation strength in elite junior tennis players. J Sci Med Sport. 2003;6(1):63–70.CrossRefGoogle Scholar
  18. 18.
    Byrum IR, Bushnell BD, Dugger K, Charron K, Harrell FE, Noonan TJ. Preseason shoulder strength measurements in professional baseball pitchers: identifying players at risk for injury. Am J Sports Med. 2010;38(7):1375–82.CrossRefGoogle Scholar
  19. 19.
    Ellenbecker TS, Davies GJ. The application of isokinetics in testing and rehabilitation of the shoulder complex. J Athl Train. 2000;35(3):338–50.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Ellenbecker TS, Wilk KE. Sport therapy for the shoulder: evaluation, rehabilitation and return to sport. Champaign, IL: Human Kinetics; 2017.Google Scholar
  21. 21.
    Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence based review. Br J Sports Med. 2010;44(5):319–27.CrossRefGoogle Scholar
  22. 22.
    Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48(8):692–7. (IF 4.17, ranking 6/81).CrossRefGoogle Scholar
  23. 23.
    Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD II, Harker P, Paparesta N, Andrews JR. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39:329–35.CrossRefGoogle Scholar
  24. 24.
    Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39:1997–2006.CrossRefGoogle Scholar
  25. 25.
    Forthomme B, Wieczorek V, Frisch A, Crielaard JM, Croisier JL. Shoulder pain among high-level volleyball players and preseason features. Med Sci Sports Exerc. 2013;45(10):1852–60.  https://doi.org/10.1249/MSS.0b013e318296128d.CrossRefPubMedGoogle Scholar
  26. 26.
    Clarsen B, Bahr R, Andersson SH, Munk R, Myklebust G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med. 2014;48(17):1327–33.  https://doi.org/10.1136/bjsports-2014-093702.CrossRefPubMedGoogle Scholar
  27. 27.
    Johansson FR, Skillgate E, Lapauw ML, Clijmans D, Deneulin VP, Palmans T, Cools AM. Measuring eccentric strength of the shoulder external rotators using a hand-held dynamometer: reliability and validity. J Athl Train. 2015;50(7):719–25.CrossRefGoogle Scholar
  28. 28.
    Castelein B, Parlevliet T, Cools CB. A The influence of induced shoulder muscle pain on rotator cuff and scapulothoracic muscle activity during elevation of the arm. J Shoulder Elbow Surg. 2017;26:497.  https://doi.org/10.1016/j.jse.2016.09.005. pii: S1058-2746(16)30406-2.CrossRefPubMedGoogle Scholar
  29. 29.
    Werner CM, Blumenthal S, Curt A, Gerber C. Subacromial pressures in vivo and effects of selective experimental suprascapular nerve block. J Shoulder Elbow Surg. 2006;15(3):319–23.CrossRefGoogle Scholar
  30. 30.
    Mura N, O’Driscoll SW, Zobitz ME, Heers G, Jenkyn TR, Chou SM, Halder AM, An KN. The effect of infraspinatus disruption on glenohumeral torque and superior migration of the humeral head: a biomechanical study. J Shoulder Elbow Surg. 2003;12(2):179–84.CrossRefGoogle Scholar
  31. 31.
    Townsend H, Jobe FW, Pink M, Perry J. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. Am J Sports Med. 1991;19:264–72.CrossRefGoogle Scholar
  32. 32.
    Boettcher CE, Ginn KA, Cathers I. The ‘empty can’ and ‘full can’ tests do not selectively activate supraspinatus. J Sci Med Sport. 2009;12(4):435–9.CrossRefGoogle Scholar
  33. 33.
    Cools AM, Borms D, Cottens S, Himpe M, Meersdom S, Cagnie B. Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps. Am J Sports Med. 2014;42(6):1315–22.CrossRefGoogle Scholar
  34. 34.
    Castelein B, Cagnie B, Parlevliet T, Cools AM. Superficial and deep scapulothoracic muscle EMG activity during different types of elevation exercises in the scapular plane. J Orthop Sports Phys Ther. 2016;11:1–26.Google Scholar
  35. 35.
    Reinold MM, Escamilla RF, Wilk KE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther. 2009;39(2):105–17.  https://doi.org/10.2519/jospt.2009.2835.CrossRefPubMedGoogle Scholar
  36. 36.
    Cools A, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, Cagnie B, Witvrouw E. Rehabilitation of trapezius intramuscular balance: which exercises to prescribe? Am J Sports Med. 2007;35:1744–51.CrossRefGoogle Scholar
  37. 37.
    Ellenbecker TS, Sueyoshi T, Bailie DS. Muscular activation during plyometric exercises in 90 degrees of glenohumeral joint abduction. Sports Health. 2015;7(1):71–9.CrossRefGoogle Scholar
  38. 38.
    Maenhout A, Benzoor M, Werin M, Cools A. Scapular muscle activity in a variety of plyometric exercises. J Electromyogr Kinesiol. 2016;27:39–45.CrossRefGoogle Scholar
  39. 39.
    Castelein B. The role of the deep scapular muscles in scapular dyskinesis in patients with shoulder or neck pain. Doctoral thesis, 2016.Google Scholar
  40. 40.
    Struyf F, Cagnie B, Cools A, Baert I, Van Brempt J, Struyf P, Meeus M. Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability, accepted for publication. J Electromyogr Kinesiol. 2014;24(2):277–84.  https://doi.org/10.1016/j.jelekin.2013.12.002. Review. (IF 1.72, ranking 32/81).CrossRefPubMedGoogle Scholar
  41. 41.
    De Mey K, Danneels L, Cagnie B, Vandenbosch L, Flier J, Cools AM. Kinetic chain influences on upper and lower trapezius muscle activation during eight variations of a scapular retraction exercise in overhead athletes. J Sci Med Sport. 2013;16(1):65–70. (IF 3.08, ranking 9/81).CrossRefGoogle Scholar
  42. 42.
    Maenhout A, Van Praet K, Pizzi L, Van Herzeele M, Cools A. Electromyographic analysis of knee push up plus variations: what’s the influence of the kinetic chain on scapular muscle activity? Br J Sports Med. 2010;44(14):1010–5. (Impactfactor 4.71; Ranking 6/81).CrossRefGoogle Scholar
  43. 43.
    Bitter NL, Clisby EF, Jones MA, Magarey ME, Jaberzadeh S, Sandow MJ. Relative contributions of infraspinatus and deltoid during external rotation in healthy shoulders. J Shoulder Elbow Surg. 2007;16(5):563–8.CrossRefGoogle Scholar
  44. 44.
    Andersen CH, Zebis MK, Saervoll C, et al. Scapular muscle activity from selected strengthening exercises performed at low and high intensities. J Strength Cond Res. 2012;26(9):2408–16.  https://doi.org/10.1519/JSC.0b013e31823f8d24.CrossRefPubMedGoogle Scholar
  45. 45.
    Wilk KE, Reinold MM, Macrina LC, Porterfield R, Devine KM, Suarez K, Andrews JR. Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health. 2009;1(2):131–6.CrossRefGoogle Scholar
  46. 46.
    Manske R, Wilk KE, Davies G, Ellenbecker T, Reinold M. Glenohumeral motion deficits: friend or foe? Int J Sports Phys Ther. 2013;8(5):537–53.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Ellenbecker TS, Manske RM, Sueyoshi T, Bailie DS. The acute effect of a contract/relax horizontal cross-body adduction stretch on shoulder internal rotation. J Orthop Sports Phys Ther. 2016;46(1):A37.Google Scholar
  48. 48.
    Laudner KG Sipes RC, Wilson JT. The acute effects of sleeper stretch on shoulder range of motion. J NATA. 2008;43(4):359–63.Google Scholar
  49. 49.
    McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures in recreational athletes with posterior shoulder tightness [abstract]. J Orthop Sports Phys Ther. 2005;35(1):A5.Google Scholar
  50. 50.
    Manske RC, Meschke M, Porter A, Smith B, Reiman M. A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health. 2010;2(2):94–100.CrossRefGoogle Scholar
  51. 51.
    Wilk KE, Hooks TR, Macrina LC. The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J Orthop Sports Phys Ther. 2013;43(12):891.CrossRefGoogle Scholar
  52. 52.
    Salamh PA, Kolber MJ, Hanney WJ. Effect of scapular stabilization during horizontal adduction stretching on passive internal rotation and posterior shoulder in young women volleyball athletes: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(2):349–56.  https://doi.org/10.1016/j.apmr.2014.09.038.CrossRefPubMedGoogle Scholar
  53. 53.
    Riemann BL, Davies GJ, Ludwig L, Gardenhour H. Hand-held dynamometer testing of the internal and external rotator musculature based on selected positions to establish normative data and unilateral ratios. J Shoulder Elbow Surg. 2010;19(8):1175–83.CrossRefGoogle Scholar
  54. 54.
    Ellenbecker TS, Reinold M, Nelson CO. Clinical concepts for treatment of the elbow in the adolescent overhead athlete. Clin Sports Med. 2010;29(4):705–24.CrossRefGoogle Scholar
  55. 55.
    Ryu KN, McCormick FW, Jobe FW, Moynes DR, Antonell DJ. An electromyographic analysis of shoulder function in tennis players. Am J Sports Med. 1988;16:481–5.CrossRefGoogle Scholar
  56. 56.
    Kovacs M, Ellenbecker TS. An 8-stage model for evaluating the tennis serve: implications for performance enhancement and injury prevention. Sports Health. 2011;3(6):504–13.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.ATP World Tour and Rehab Plus Sports TherapyScottsdaleUSA
  2. 2.Department of Rehabilitation Sciences & Physiotherapy, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  3. 3.Department of Occupational and Physical Therapy and Institute of Sports Medicine, Bispebjerg HospitalUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations