Summer sports like golf and tennis often lead to shoulder injuries, including joint instability, internal impingement of the joint, tears in the cartilage surrounding the shoulder socket, and even trauma to the rotator cuff, unless players take appropriate precautions to minimize risks.
June 30, 2021
For golfers and tennis players, it’s “summertime and the livin’ is easy.” Easy, that is, until a player’s shoulder becomes what a popular song calls “achy breaky” from overindulgence in these activities, notes orthopedic surgeon Alejandro Badia MD.
He says common summer sports like golf and tennis often lead to shoulder injuries, including joint instability, internal impingement of the joint, tears in the cartilage surrounding the shoulder socket, and even trauma to the rotator cuff, unless players take appropriate precautions to minimize risks.
“The shoulder joint is most vulnerable when the arm is raised up from the side, the elbow bent approximately 90 degrees, and the hand facing forward. That is exactly the position an athlete assumes when serving in tennis or lifting a club to drive a golf ball from the tee,” says Dr Badia, who is also a sports medicine specialist and founder and chief medical officer of the Miami-based Badia Hand to Shoulder Center and OrthoNOW®, and author of the chapter on hand/wrist injuries in the renowned book, “Tennis Medicine”. “When this action is repeated over and over and over and performed with high velocity and muscular strength, it places extraordinary demands on the shoulder joint.”
Scientists agree. The mechanism of action required in overhead sports like golf and tennis requires “an unnatural and highly dynamic” motion that “often exceeds the physiological limits of the [shoulder] joint,” writes authors of an article published in the British Journal of Sports Medicine. They suggest that proper shoulder joint movement in overhead sports depends on “good kinetic chain function, optimal stability, and coordination of the scapula.”
Located in the upper portion of the back, the scapula, or shoulder blade, functions with surrounding muscles to move the arm. The ball of the humerus – upper arm bone – and the scapula connect to form the glenohumeral joint. Supporting the glenohumeral joint is the rotator cuff, which is composed of four muscles that allow for shoulder rotation but can get overloaded and overworked with repetitive overhead motions as required in golf and tennis, Dr. Badia explains.
In fact, in an article published in a December 2020 issue of Current Reviews in Musculoskeletal Medicine, researchers contend that the “most energy-demanding motion” in tennis – the serve – accounts for 60 percent of all strokes during a match, putting a particular burden on the shoulder joint of older players.
“The interplay between bones, ligaments, tendons and soft tissue in a joint is complex,” says Dr. Badia, who specializes in treating disorders of the upper limbs, including orthopedic injuries in both amateur and professional golfers and tennis players. “Even though golf and tennis are relatively low-impact sports, the explosiveness of the swing while gripping a golf club or slamming down on a tennis ball during the serve puts tremendous stress on joint infrastructure and causes a surprisingly high percentage of painful injuries, particularly in older players whose joints are already compromised by aging.”
Statistics bear him out. Author of an article on the Absolute Health and Performance web site points out that shoulder trauma comprises 17 percent of all tennis injuries, and that as many as 50 percent of players “report significant pain in their dominant arm” by the time they reach middle-age. In golf, shoulder problems make up nearly 20 percent of all reported injuries.
Dr. Badia calls the shoulder “the most mobile joint in the body, with the capacity to assume as many as 1,000 different positions in all directions.” But this very capacity is what experts writing in the British Journal of Sports Medicine say creates a “fragile equilibrium between [joint] stability and mobility, particularly in the tennis player,” making the shoulder particularly susceptible to trauma.
Symptoms of shoulder injury include sudden or persistent – sometimes deep – joint pain, especially when moving the arm up or down or during sleep; joint stiffness; a clicking sound or sense of grinding in the shoulder; decreased range of motion; shoulder instability; and loss of strength.
“These are all signs that an athlete should contact an orthopedic specialist as quickly as possible to avoid an acute injury from intensifying or becoming chronic,” advises Dr. Badia. He notes that common shoulder injuries in golf and tennis are SLAP tears, namely tears in the cartilage (labrum) surrounding the shoulder socket; shoulder instability and dislocation, which occur when muscles and tendons can no longer keep the humerus connected to, and fully functioning within, the glenohumeral socket; and partial or full-thickness rotator cuff tears.
Of course, the best road to a healthy shoulder is injury prevention, “but that does not suggest one has to give up tennis or golf. Both sports are great venues for maintaining fitness,” Dr. Badia says. “Prevention just means playing smarter.”
He offers these tips:
- Learn – and practice – proper technique for your sport. “Correct methods for golf swings and tennis strokes are not simply intended to improve the chances of winning. They help reduce risk of injury,” Dr. Badia says.
- Use sports equipment right for one’s physical characteristics. “Too heavy a tennis racquet or one with a grip too large for the hand, for example, can cause incorrect kinetic energy and put additional load on the shoulder joint during a serve,” states Dr. Badia.
- Warm up shoulder and arm muscles, as well as legs and body core, adequately before a game.
- Maintain trunk flexibility and core strength since otherwise the shoulder joint will bear the brunt of force when driving a golf ball or hitting a backhand
- Talk to physicians, exercise physiologists, and other experts about exercises to perform to strengthen shoulders.
“And, if you experience shoulder pain during or after a match, take a break. The adage, ‘No pain, no gain,’ does not apply,” Dr. Badia emphasizes. “Pain indicates the joint and muscles supporting it need rest. Without taking the necessary brief pause in your sport, you may end up away from the game much longer than you expected as you try to recover from a debilitating joint injury.”
Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member of the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons and an honorary member of many international professional hand societies. Dr. Badia specializes in treating all problems related to the hand and upper extremities, including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. Go to OrthoNOWcare.com and drbadia.com.