Last week we discussed the importance of strengthening and stabilizing the shoulder muscles to prevent injuries in tennis. This week we will focus on stretching the shoulder for injury prevention. As with the exercises for strength, it may be better to do nothing at all than to so improperly. For example, the shoulder must be adequately warmed up and in the proper position and alignment to fully benefit from stretching. New research is demonstrating that proper stretching to promote good posture may help or even prevent shoulder problems.
Part of the rotator cuff, a group of muscles that stabilize the shoulder, passes between the arm bone (humerus) and a bone in the back (scapula). Due to a tennis player’s stoke or the overuse of the rotator cuff with constant hitting, the rotator cuff can be repetitively pinched between the two bones. This produces a painful inflammatory condition known as rotator cuff tendonitis of the shoulder.
If the shoulder blade is tipped downwards, such as the position the shoulder assumes when slouching, it will place the shoulder in a position which pinches part of the rotator cuff. Stretching, strengthening or hitting a ball in this position will ultimately lead to problems. Add excessive training and practicing to the mix and this overuse may cause the muscles and tendons of the rotator cuff to become inflamed and swell. The swelling of the muscles and tendons will make the shoulder more prone to impingement.
A tight neck, chest and muscles in the front of the shoulder may cause a tennis player to assume a hunched over posture. This poor posture decreases the distance between the humerus and scapula making the shoulder more prone to impingement. Good posture with head and shoulders back increases the distance between the humerus and scapula. Therefore, proper stretching and good posture is important for prevention of shoulder pain because it decreases the impingement.
Warm Up:
Never stretch a cold muscle because the muscle can tear instead of stretch. To warm up the muscle one can run or jog for 5 minutes, place a heating pad on the area to be stretched, slowly move the arms in the direction that imitates various tennis strokes at 25-50% speed (dynamic stretching) while never moving far enough to cause discomfort. After practice, one can perform stretches that are more aggressive and held for 5-10 seconds with slight discomfort to improve flexibility. Aggressive stretching before competition may weaken the muscle and effect performance.
The Nicholas Institute of Sports Medicine and Athletic Trauma suggests the following stretches to be performed actively (dynamic) without discomfort to 90% range of motion before competition and passively and hold to 100% end range of motion (static) with slight discomfort after practice.
Triceps stretch:
Begin by raising your arm directly over your head with your palm facing front. Bend your elbow and try to reach the shoulder blade on the same side of you body. Use your opposite arm to push your elbow back.
Doorway stretch to the pectoralis major:
Begin by placing your elbow against the frame of a door. Keep the angle between your trunk and your arm at 90 deg. Rest your forearms against the door frame. Step forward with one foot to feel the stretch.
Infraspinatus stretch:
Extend your arm out directly in front of you and bend your elbow across your body. With your other hand gently pull your elbow across your body.
Levator scapulae stretch:
Begin by placing one arm as in the first part of the triceps stretch. Look towards your opposite hip and use you free hand to gently pull your head towards your hip.
Upper trapezius stretch:
Lean your head to the side trying to bring your ear towards your shoulder without lifting your shoulder
Latissimus dorsi stretch:
Raise both arms overhead and place palms together interlocking fingers. At shoulders lift arms upwards with fingers remaining intertwined.
Axial extension:
Pull your chin down and backwards as if trying to make a double chin.
Middle Back Stretch into Extension:
Pinch shoulder blades together
Lower Back Stretch into Extension:
Lie on belly, prop up on forearms, then extend lower back.
Keep in mind that avoiding bad posture in your day to day activities can help keep your shoulder and back healthy, so remember “Sit up straight!”
Visit your doctor regularly and listen to your body.
Contributor: Gary E. Mattingly, PT, PhD: Professor, University of Scranton, Dept. of Physical Therapy, Shoulder Rehab Specialist, Mackarey & Mackarey Physical Therapy
