The Keys to Caring for Nashville Tennis Players

Tennis is one of the best sports for staying active as we age. It requires strength, coordination, balance, mobility, speed, and cardiovascular fitness, while also providing a competitive and social outlet. For many Nashville tennis players, however, the challenge isn't finding the motivation to play—it is keeping their body healthy enough to tolerate the amount of tennis they want to play.

We see this frequently with active adults and club tennis players. They may have an elbow that starts hurting after a few matches, a shoulder that becomes painful with serving, or an ankle, knee, or hip that never quite feels the same after an injury. Often, these players have accumulated previous injuries or are aware of mobility limitations that make them question whether they are simply asking too much of their body.

The solution isn't always to stop playing. Instead, it is important to understand why the body is struggling to tolerate the demands of tennis in the first place.

At Integrated Rehab and Performance Center, our approach to tennis injury treatment is built around a simple principle: treatment should go well beyond the site of pain. Tennis is a full-body sport, and many of the injuries we see are not simply isolated problems with one joint. They are often the result of how the entire kinetic chain is sharing and transferring force.

Tennis Elbow: Don't Stop at the Elbow

Tennis elbow is commonly associated with pain on the outside of the elbow, while pain on the inside is often referred to as golfer's elbow. Despite their names, either condition can occur in tennis players. The repetitive demands of the forehand and backhand strokes place significant forces through the elbow, wrist, and forearm. Repeatedly loading these tissues through rapid stretches and high-speed movements can eventually exceed their ability to tolerate the workload.

Our evaluation goes much further than simply identifying where the elbow hurts. We evaluate the movement of the elbow itself, the mobility of the surrounding joints, and the specific structures of the elbow through orthopedic testing to establish a diagnosis. We then compare those findings with the player's tennis history, symptoms, playing volume, and, when appropriate, their actual stroke mechanics. This gives us the opportunity to move beyond treating symptoms and develop a comprehensive understanding of the injury.

One of the findings we commonly see in players with chronic or recurring elbow pain is limited shoulder internal rotation. At first, that may seem unrelated to an elbow injury, but the body does not operate as a collection of independent joints. When the shoulder has limited motion, the player has fewer options for distributing movement throughout the upper extremity. The elbow may then be asked to accommodate positions and movements that place additional stress on the tissues around it.

For that reason, we don't stop at the elbow. Treatment may include localized chiropractic adjustments, soft tissue therapy, targeted loading of the involved muscles and tendons, strength work, and extensive mobility and stability training throughout the surrounding joints. Soft tissue treatment can be particularly useful for tendon-related pain, but it is only one part of a larger process. We need to improve the way the tennis player creates and transfers force throughout the entire kinetic chain. If those underlying movement limitations remain, the elbow may continue to absorb more stress than it should.

Check out this article for more on elbow pain…

Tennis Shoulder Pain: The Shoulder Doesn't Work Alone

The tennis serve places tremendous demands on the shoulder. It requires the shoulder, scapula, rib cage, thoracic spine, pelvis, hips, and lower extremities to work together to create and transfer force. Despite this, shoulder pain is often approached as though the shoulder joint exists in isolation.

Our evaluation looks at the entire shoulder complex. We assess the shoulder joint itself, how the scapula moves over the rib cage, the rib cage, and the thoracic spine. We also consider the rest of the body because restrictions farther down the kinetic chain can influence how the upper body has to move during a serve.

One of the most common findings we see in tennis players with shoulder complaints is restriction in thoracic spine extension, rotation, or side bending. These limitations can have significant consequences for shoulder movement. If the spine cannot extend appropriately, the shoulder may be required to contribute additional motion to accomplish the same overall task. Over hundreds or thousands of serves, these compensations can become increasingly important.

Our Lat Test is one example of how we can evaluate spine and surrounding tissue mobility and determine how those restrictions may influence overhead shoulder movement. The goal isn't simply to determine whether someone passes or fails a mobility test. The important question is what that limitation means for the athlete's actual movement and ability to tolerate tennis.

Check out this article for more details on this test and how it relates to shoulder and low back pain…

-How the Lat Muscle Effects Low Back Pain and Shoulder Pain

We also evaluate the foot, ankle, hips, pelvis, and spine when appropriate. If a tennis player cannot effectively control their lower body or transfer force through the trunk, the shoulder may ultimately become the area that absorbs the consequences. Treating only the painful shoulder may provide temporary relief, but it does not necessarily address the reason the shoulder continues to be overloaded.

We also enjoy communicating with tennis players' coaches and pros when appropriate. Understanding what a player is currently working on can provide valuable context for rehabilitation. An injury can be an opportunity to improve more than pain. It can be an opportunity to improve movement quality, efficiency, strength, and performance.

Returning a tennis player to serving is also a progressive process. We generally think about it in three phases. The first phase focuses on restoring sufficient mobility through the key joints while minimizing pain. Once that foundation is established, we move into a loading phase where higher external loads, strength, and stability are progressively introduced to the involved joint complexes. The final phase incorporates speed and dynamic challenges. The goal is to make sure the player can create the force and racquet speed required for tennis without having to consciously think about avoiding the compensations that contributed to the original problem.

Hip, Knee, and Ankle Injuries: Build a Lower Body That Can Move

Tennis places enormous demands on the lower extremities. Every point can involve acceleration, deceleration, lateral movement, cutting, rotation, single-leg loading, and rapid changes of direction. As a result, we see a wide range of hip, knee, and ankle problems in tennis players.

The timeline of these problems is often different. Hip complaints are frequently chronic and may involve long-standing mobility restrictions, impingement, or labral pathology. Knee and ankle problems are more commonly associated with a specific injury, including ligament-related injuries. Regardless of the diagnosis, however, identifying the injured tissue is only part of the process.

For knee and ankle injuries in particular, we always want to understand the entire kinetic chain. We need to establish which tissue or ligament is injured, but we also want to identify the mobility, stability, strength, and movement-pattern restrictions that may have contributed to the tissue becoming overloaded or being unable to tolerate the demands placed upon it.

Treatment may begin with focused loading protocols designed to progressively expose the injured tissue to appropriate levels of stress. From there, we can address the subtle but significant mobility restrictions that may exist throughout the foot, ankle, and hip. As the player progresses, we begin teaching the body how to load the lower extremity more effectively and independently from the upper body.

This is particularly important in tennis because the lower and upper halves of the body constantly have to work independently. A player may need to sprint and cut with the lower body while reaching, rotating, and positioning the upper body to hit the ball. Developing that separation and coordination is an important component of both tennis performance and long-term durability.

Before completing a rehabilitation plan, we want to see more than basic strength or the absence of pain. We work on balance, deceleration, strength, acceleration, and change-of-direction ability. These qualities help us determine whether the player can return to the movement demands of tennis without falling back into the compensations and movement patterns that may have contributed to the original injury.

We generally want a player to demonstrate pain-free movement, the ability to create high levels of force, and the ability to accelerate, decelerate, and change direction without significant movement compensations. They should also be able to practice for 60 minutes or more without developing pain or swelling. The goal is to return the player to the demands of tennis—not simply to the activities of everyday life.

A Comprehensive Evaluation for Tennis Players

Our approach begins with a comprehensive evaluation rather than immediately treating the painful area. We combine movement screening, joint-by-joint mobility assessment, orthopedic and special testing, strength and stability assessment, and sport-specific considerations to develop a complete picture of how the player moves.

We want to understand both the diagnosis and the environment in which that diagnosis developed. That means considering the player's history, training volume, previous injuries, mobility restrictions, strength deficits, movement patterns, and the specific demands of their tennis game.

This is an important distinction. We aren't simply asking, "Where does it hurt?" We are asking, "What is this player asking their body to do, and is their body currently prepared to do it?"

A player may have elbow pain, but the more important finding may be limited shoulder mobility. A player may have shoulder pain, but the contributing restriction could be coming from the thoracic spine. A player may have knee or ankle pain, but the larger issue may involve how they control the foot, ankle, hip, or pelvis.

The painful area is often where the problem becomes obvious. It isn't necessarily where the problem begins.

What Makes Our Approach Different?

A traditional approach to sports pain can often focus heavily on the location of symptoms. Adjust the painful area, perform some soft tissue work, stretch the surrounding muscles, and hope the problem improves. Those tools can absolutely have a place in rehabilitation, but for an athlete who wants to continue playing tennis at a high level, they are rarely enough by themselves.

Our approach is different because we load, strengthen, and address mobility throughout the entire kinetic chain. We don't want to simply make an elbow, shoulder, knee, or ankle feel better. We want to understand why that area was overloaded in the first place and improve the body's ability to distribute force more effectively.

That means restoring mobility where it is missing, developing strength where it is needed, improving stability and coordination, and eventually challenging the player with the speed, force, and movement demands that tennis actually requires.

The goal isn't to create a tennis player who can simply get through their next match. It is to help create a tennis player whose body is better prepared to handle the demands of the next hundreds of matches.

Caring for Nashville's Tennis Players

Nashville has an incredible tennis community, and we have the opportunity to work with a wide range of players—from young athletes developing their game to active adults who simply want to continue playing the sport they love.

Our active adult tennis players often aren't looking to become professional athletes. They want to play league tennis, compete with their friends, participate in doubles, stay active, and enjoy the social and competitive aspects of their club. The problem is that previous injuries and accumulated mobility restrictions can eventually make it harder to tolerate the volume of tennis they want to play.

We commonly work with players who are concerned that they may be overdoing it because they know they have limitations or a history of injuries. In those situations, the goal isn't to tell them to stop playing or give them a rigid limit. Instead, we can evaluate their movement, identify areas that may be limiting their ability to tolerate tennis, and build their physical capacity so that their body is better prepared for the amount of tennis and activity they enjoy!

That is ultimately what tennis longevity is about.

The Key to Tennis Longevity

The best tennis injury treatment isn't necessarily about finding the perfect treatment for the painful joint. It is about understanding shared load.

Every tennis movement requires the body to distribute force across multiple joints and segments. When one area lacks the mobility, stability, strength, or coordination necessary to contribute its share, another area has to compensate. Over time, that can create focal stress and tissue overload.

This is why tennis injuries are often kinetic-chain problems.

It is also why treating only the site of pain can leave the underlying problem untouched.

For Nashville tennis players who want to stay active, competitive, and on the court for years to come, the goal shouldn't simply be to eliminate pain. It should be to build a body that is capable of handling the demands of the sport.

Treat the injury. Understand the movement. Build the capacity. Then get back to playing.

-Dr. Nick DC, MS, TPI, CSCS

If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.

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