Shoulder Pain In a Tennis Player
In this case, I’ll be presenting Tom—a guy in his 50s, right-handed, who enjoyed playing tennis competitively but was restricted due to shoulder pain. Tom played tennis about three times a week, mostly with a younger population, and competed throughout the year. Outside of tennis, he did some stretches and workouts in the gym about 1-2 times a week. Besides that, Tom worked in an office job and had some limitations sleeping in certain positions because of his shoulder pain, but no limitations outside of playing tennis. He denied any sudden injury to his shoulder or trauma that may have led to the pain.
When he came to see me, Tom had already seen another PT for some foot and ankle pain and was also following up with a physical medicine physician. Tom built himself a team of professionals to help him overcome his limitations.
On his first visit, Tom presented with limited overhead movement, limited rotational movement of his shoulder, and some strength deficits—all primarily a result of pain. Overall, his clinical picture was consistent with rotator cuff-related shoulder pain.
Treatment sessions included manual therapy and therapeutic exercises in an attempt to overcome the described limitations. However, Tom continued to play tennis during rehab but agreed to reduce his frequency to 1-2 times a week instead of more than 2.
After a few sessions, Tom’s shoulder was improving, and he felt ready to play more intensely. At that time, he was generally happy with his conditioning and was eager to increase his intensity.
A few months passed before I saw Tom again. This time, he had received an injection for a tendon in his foot/ankle because it was still a limitation for him. However, he returned to see me for his shoulder. This time, Tom’s frustration was apparent. It’s important to note that at this point, Tom had all the tools to recover from his shoulder pain.
Knowing that Tom was likely doing his home exercises and continuing to play tennis, we needed to take a different direction. Even though he came for his shoulder, our session actually focused on his foot and ankle. Although the injection helped alleviate some of his pain, we found limitations in balance on the painful leg and some strength deficits.
Our treatment sessions included dynamic balance exercises, specific strength training for the leg, and some full-body plyometrics, along with homework to independently work on his shoulder strength.
I saw Tom for a total of about 10-12 sessions over an 8-month period. In the end, he was 90% better, returned to playing tennis at high intensity, and, most importantly, felt hopeful about doing the activity he loved the most.
Learning point -
I like to refer you to this video:
you can watch it all or just skip to the demonstration at the end of the video.
Observe the movement pattern - the requirement to push up with legs and then shift weight to the forward leg. When you abilities to transfer energy from bottom up is limited - you will use primarily the “top”. In Tom’s case - he had limited ability to transfer his energy with movement due to a dysfunction of his foot/ankle, that he overloaded his shoulder repetitively and led him to experience overuse symptoms.
Hope you enjoyed reading the case and learned from it.
Carmel Ofir, PT
