Tennis Injury

Well, I have a real pain in my shoulder and am trying to figure out what to do about it. It started about two months back and now has grown to be “a problem.”

The pain is on the front, below where the front piece of the deltoid muscle attaches to the shoulder; and hurts when I hit a drive/topspin forehand. Serving seems to be OK and backhands are mostly OK; but the forehand hurts.

It is to the point now where I am taking four ibuprofen before playing, and it doesn’t quite do the job anymore. It feels like tendonitis (what do I know?); so, I will be on a business trip next week and will take at least six days off; but am wondering:

  • Should I ice it each day?
  • Massage the place where it hurts?
  • Do any stretching of it, or not?
  • Change from the hard-feel of the Luxilon strings, which I have been using for almost a year and really like?
  • When should I lift weights to bring back the strength, while there is pain or only after it is gone?
  • Take ibuprfen during the layoff?  What dose?

I really want to get this cleared up to get back on the court and in playing shape for the Newk Camp (Larry Starr, are you out there?). Any good advice is welcome.

18 thoughts on “Tennis Injury

  1. Hi George – It doesn’t have the classic symptoms of rotator cuff problem but you can’t rule it out yet. I have had many problems in the past but usually they involve pain in raising the arm directly in front of you also. I was treated by Bob Gajda, who rehabbed Yannick Noah and Tracy Austin years ago also, as well as Jim McMahon of the Bears after his shoulder surgery. I also give lectures at our hospital health club on rotator cuff injury prevention and treatment, so some of this might apply. There is a set of exercises done with elastic bands, and you can actually put a simulated tennis handle on one end of the band when these are done (I’ll email you a photo of the device). The set of exercises is called the Big Four, but I actually do eight different ones and I do them religiously, since I play as much as you do. Knock on wood, I have had no shoulder problems in many years, and I still lift weights three times a week and stretch a lot. I would definitely do the ice treatment, not heat (just increases inflammation), and if you’re taking 4 Ibuprofen, that’s 800 mg, Most studies have shown that you get the maximum therapeutic dose with 600 mg, so three is plenty – you need to be very careful with ibuprofen, no more than 1800 mg/day or you risk kidney failure and other side effects. Look this over and if you think this might help, I could send some photos of the specific exercises. As far as weights and stretching, I would use the rule: if it hurts don’t do it, if it doesn’t hurt do it.
    talk to you soon
    Len

  2. Have you thought about seeing a sports medicine Orthopedist?? I had rotator cuff surgery in 2000 and was out of tennis for about 3 months. Then I started to work back and now everything is just fine!! Before that I went thru the same symptoms that you are now experiencing. Hope you get better quick!

  3. per my comments when you started using Luxilon strings—its not for older players. You are not able to create enough racquet head speed to really benefit from those type strings and the stiffness has finally caught-up with you. String w/ a softer string and I bet the pain will go AWAY….

  4. Paul – i think you may be right; and will go have the hard strings cut out tomorrow — and may even try gut (for the first time in my life!) tks

  5. Lenny – tks for the thoughtful reply. So are you suggesting that i start these exercises AFTER the pain goes away? and what would you do during my time off: ice and ibuprofen only?

  6. No, I started doing these specific exercises when I was having the problem, just using the “if it hurts, stop” concept. Some of the exercises will be fine, some might hurt, some might be uncomfortable but you can adjust the intensity simply by using a lighter elastic or slackening the tension. It’s really the motion that does the treatment, not the intensity or heavy resistance. And I would continue the ice but only use the ibuprofen sparingly to help reduce the inflammation.

  7. George,
    I’ve been told by a trainer that rotator cuff issues typically can be identified by pain on raising your outstretched arm ahead of you or directly to the side – ABOVE SHOULDER LEVEL.

    As Len says, beware of taking excess Advil (ibuprofen) above the recommended dosage or duration. I was acquainted with a woman who took too much Advil for months (or even a year or two or three) because it relieved her headaches. Unfortunately she experienced kidney failure followed by dialysis, then death.

    There are exercises which may help prevent rotator cuff tear ( I started with a 2lb or 3lb dumbbell, the graduated to a 5lb dumbbell).

    Ice should reduce swelling and inflammation (as does ibuprofen).

    Good luck!

    Dag Williamson

  8. Dag – If rotator cuff hurts to raise above your shoulder, i am feeling that is NOT the problem… i can raise it, and can actually serve without pain. it is the forehand motion that hurts.

    Len – what is your definition of “sparingly”? tks

  9. As I mentioned in the first reply, rotator cuff problems can manifest in many ways, even though the most common is pain in raising the outstretched arm. The problem with a lot of orthopedic surgeons is that they’re way to quick to diagnose a tear and recommend surgery, when in fact almost all such early injuries, excepting a traumatic one, are treatable with conservative measures. With regard to a definition of “sparingly”, if you are taking time off for a few days or a week, I would think that one advil four times a day would be plenty.

  10. Sorry about your shoulder!! I think I could agree with some from column A and some from column B especially the suggestion about seeing an Orthopedist.I had no surgery! My “man” from Manhattan(M.D.) sent me to physical therapy where they built up muscle in the front and back of my shoulder problem. I had a “frozen shoulder”. It’s been a few years now with no problem(knock,knock). Try putting your arm down and then behind your back(if you can). If that hurts–uh oh. Rx–ice(peas-in-the-bag),rest it,etc.and all of the good things from above. I will look for my exercise sheets!!! Hope it feels better soon. gf

  11. George, I am no doctor. But it seems to me that fears about doctors who are too quick to cut, etc. are just irrational. Nobody makes you undergo surgery; you have to consent, and you are always entitled to a second opinion. It also seems to me that trying to self-diagnose with advice from friends on an internet site is equally irrational. I am sure that everybody is well-intentioned, but nobody, not even a doctor, can competently tell you what your problem is and what is the best way to fix it without seeing you and examining you personally. Finally, as others have pointed out, it is irrational — in fact, downright dangerous — to overdue the ibuprofen, or any other NSAID (or drug) for that matter; aside from the possible kidney failure issues that have been pointed out, these drugs (all NSAIDS, including aspirin) have been known to cause stomach and, I believe, intestinal bleeding and can be associated with GIRD, ulcers and other assorted esophagal and gastro-intestinal problems that you don’t want to mess with.

    When our old friend Mike Lawhon was alive, he would have told you to get yourself to a competent orthopedic doctor and get examined ASAP. I believe that there are now MRIs that can diagnose what may be going on in your shoulder without any invasive surgery. (In fact, I just read that Maria Sharapova pulled out of the Olympics with a shoulder injury, diagnosed as a few rotator cuff tears, and I think it was an MRI or a similar technique that led to that diagnosis). Mike Lawhon would also have counseled NOT to begin surgery right away, but instead to try more conservative therapies first. Mike, whom I knew quite well and watched give advice to countless guys with various sports injuries over the years at Tennis Fantasies camp, always took the position that surgery is a last resort — to be tried only when more conservative therapies have proved to fail and/or when the injury is so obvious and severe that surgery is the only practical answer. Remember that Milke was also one of the top surgeons in his field, so I think that anybody like him would have similar philosophies.

    The bottom line is you really need to see a specialist to ascertain and diagnose your problem. It could be something really simple, like bursitis, that will self adjust on its own. Or it could be a rotator cuff tear that may or may not respond to conservative therapy. (I don’t want to scare you, but it could be something altogether different as well, that would definitely need medical intervention ASAP.) If you try to embark on an exercise or self-therapy program without truly knowing what it is that you have, you may wind up hurting yourself even more.

    – Marty

    Marty – thanks for the thoughtful reply. I am going on a biz trip next week and will take the “whole week” off from tennis. IF the pain is still there when i get back, it may be time to see a professional.

  12. George,

    I had rotator cuff surgery 3 months ago and prior to surgery I had a sore shoulder after I hit. I thought it was old age. When I finally torn my rotator cuff, I could not lift my arm over my shoulder. The surgeon told me that the real culprit was a bone spur that eventually worn down the cuff. Your symtoms don’t sound like a classic cuff problem but I would see a good sports medicine Doctor and maybe have a MRI.

    On another front I’m back hitting off a wall with no pain and have full mobility of my shoulder. Unfortunately, I pulled out of Newk Combat camp just to be on the safe side. Steve Contradi understands as he went through cuff surgery himself. I’ll be there next year.

  13. George
    I suggest the unthinkable rest, ice and anti-inflamatories
    If not see an Orthopedic Surgeon who will put you through some stretches and strength maneuvers to determine a likely cause.
    Generally, I have found all the Orthopedic Surgeons that I have visited treat the problem in a very conservative manner.
    It could be tendonitis, spurs or a tear in the Rotator Cuff.
    The doctor may suggest physical therapy or a shot if he thinks that has a chance of solving the problem.
    Next would probably be x-rays and an MRI which would clearly show what’s going on in the shoulder joint.
    Good luck and I hope this info was of some help?
    Bob

  14. George, I am having pain in my right shoulder and can’t serve or throw a baseball. I’ve gone to an orthopedic doctor and have started PT. The problem is one age and two the shoulder socket is pressing on the rotator cuff muscle that runs under the shoulder blade. Potential solution is stretching and strengthening the muscles to keep the joint loose. Good luck. Peter M.

  15. George
    Check your toss on your serve if it is your right shoulder. If the toss is to far to the left it impinges your shoulder over the course of time.
    J Webb Horton
    Assistant Athletic Director
    Men’s Tennis Coach
    Florida Gulf Coast University

  16. My left shoulder went about a year ago (same initial symptom as yours which I ignored to my bad) and the right one went around March of this year. Both biceptual tendons were inflamed, then frayed and then the left one snapped. There was more to it than that but this is the cheap ‘n cheerful version.

    Doc said it was not the rotator cuff (I could still serve and throw a baseball) and I went back to the gym after several weeks of basic PT with these rules:

    1. No tennis until the pain is gone. I hit singles last week for the first time since March and the pain is gone;
    2. Shoulder program (designed by the therapist) every day alternating between a short and a long program, low weights-high reps. With the pain gone, I do a full shoulder program three times a week;
    3. Ice after each workout;
    4. Stop any specific exercise at the point of pain. Do NOT work thru the pain.

    I also use an elastic wrap as far up my arms as I can get it to help keep the bicepts tendon from sliding sideways. It is also a psychological aid.

    That’s my story for now.

    Casey – Good to hear a story that does not end in the words “rotator cuff tear”. tks, george

  17. hi george;
    it seems you have gotten good advice. exercise and conditioning should follow but only when it is comfortable. this is a very common injury in your (our) age group. autopsies of study cadavers show prevalence of shoulder cuff tears often without ever having a history. it just happens to us cockers, naturally.
    practical suggestions:
    -avoid getting into the pain zone. let the inflammation subside completely. if it bothers you when you sleep- which is often the case, you have to find a position that allows good circulation to the area for the extended healing that can take place during sleep. you might rest your arm on a pillow to open the area instead of crunching down on the tender tissue. achiness during sleep points to decreased circulation.

    avoid surgery if you can. the rehab is long. your game might just end up the same.

    exercise the rest of your body to keep cardio up and muscular conditioning.

    do not cut back on painfree hugs, however. i am sending one.
    l,o,x,
    andrea

    Hi Andrea – that is good advice; especially the one about sleeping position.  I find there is one where i wake up with an ache and have to move my arm.  Let’s see if i can recondition my sleep habits!  (and i would rather the hug was live and in person… hope to see you soon).

    George

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