Racket sports like pickleball and tennis are fantastic ways to stay active, challenge your coordination, and unleash your inner competitor. However, they come with one hidden challenge: shoulder pain. If you’ve ever experienced discomfort after a long game or a series of overhead smashes, you’re not alone. Whether you're a weekend player or a dedicated competitor, understanding how to properly prepare your shoulder, strengthen it, and move efficiently will ensure you stay in the game and avoid injury.
While it’s easy to think of the shoulder as just the joint that allows the arm to swing, it is actually a complex and dynamic system that relies on muscles, tendons, ligaments, and bones working together. When you repeatedly use your shoulder without proper care, especially in the high-stress motions of racket sports, the risk of injury increases. In this blog, we’ll dive deep into the anatomy of the shoulder, common injuries, ways to prevent them, and strategies to ensure that your time on the court is as pain-free and effective as possible.
Why Racket Sports Challenge the Shoulder
The shoulder is one of the most mobile joints in the body, but this incredible mobility comes at a price. The shoulder relies on a finely-tuned balance between the rotator cuff, scapular stabilizers, thoracic spine, and lower body muscles to move efficiently and without pain. In racket sports like tennis and pickleball, the body’s natural coordination and mechanics are put to the test. With each overhead swing, serve, or fast-paced stroke, your shoulder is subject to repeated strain and stress, especially when technique, conditioning, or body mechanics are not optimal.
The Anatomy of the Shoulder
The shoulder joint consists of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). These bones form a ball-and-socket joint, allowing the arm to rotate in almost every direction. The rotator cuff is a group of four muscles that stabilize the shoulder joint: the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles help with movement and provide the stability required to prevent the humeral head from sliding out of the socket during dynamic movements.
In addition to the rotator cuff, the scapular stabilizers (serratus anterior, rhomboids, traps) are key to proper shoulder mechanics. They work to keep the shoulder blade in place during shoulder movements, allowing the rotator cuff muscles to work without excessive strain.
However, despite the complexity and adaptability of the shoulder, the repetitive and dynamic motions in racket sports, particularly overhead swings and fast rotations, can lead to various injuries, especially if not properly managed.
The Challenges in Racket Sports
Racket sports, especially pickleball, tennis, and badminton, require dynamic and often explosive movements that heavily engage the shoulder. These movements include overhead swings, serving, backhand strokes, and fast rotations, all of which require the shoulder joint to operate at full range of motion. When you repeatedly make these types of motions without sufficient warm-up, strengthening, or recovery, you risk overloading the rotator cuff and scapular stabilizers, resulting in pain and injury.
For example, during a forehand or backhand stroke, you rotate your torso and shoulder to generate power and speed. This requires not only shoulder mobility but also a stable thoracic spine, healthy rotator cuff function, and strong scapular stabilizers. Similarly, serving or smashing the ball involves repetitive overhead motions that put added pressure on the rotator cuff muscles and other surrounding structures.
Common Shoulder Injuries in Racket Sports
Shoulder pain in racket sports is often related to one or more underlying conditions that develop over time due to repetitive motion and overuse. These conditions typically involve inflammation, tendon damage, and sometimes structural changes to the joint. Understanding each of these issues can help you prevent and address pain before it becomes a chronic problem.
1. Supraspinatus Tendinopathy
The supraspinatus is one of the four muscles that make up the rotator cuff. It helps stabilize the shoulder and assists with the abduction (lifting) of the arm. In racket sports, particularly when serving or performing overhead strokes, the supraspinatus undergoes repeated stress and strain. Over time, this can lead to supraspinatus tendinopathy, which is characterized by inflammation, micro-tears, or degeneration of the tendon.
Common symptoms of supraspinatus tendinopathy include pain at the front or top of the shoulder, especially during overhead motions. This condition can cause discomfort when reaching up or behind your back, and can sometimes lead to weakness in the arm when lifting objects or playing.
2. Infraspinatus Tendinopathy
The infraspinatus, another rotator cuff muscle, plays a crucial role in external rotation of the shoulder. In racket sports, the infraspinatus is heavily engaged during the follow-through of a swing, particularly during backhand strokes and serves. Repetitive motions and poor mechanics can overload this muscle, leading to infraspinatus tendinopathy, which manifests as pain and discomfort around the shoulder joint and in the upper arm.
Pain from infraspinatus tendinopathy is often felt in the back of the shoulder and may worsen with activities that require external rotation of the shoulder. The condition may also limit the range of motion, especially when reaching behind the back or performing overhead motions.
3. Biceps Tendinopathy
The biceps tendon attaches the biceps muscle to the shoulder, passing through the bicipital groove on the humerus and inserting into the shoulder joint. Biceps tendinopathy occurs when the tendon becomes irritated or inflamed, often due to repetitive overhead movements or excessive stress placed on the shoulder during a high-impact stroke.
Racket sports, particularly tennis and pickleball, require dynamic movements that can cause stress on the biceps tendon. Biceps tendinopathy often causes pain in the front of the shoulder and may be aggravated by lifting, pushing, or performing overhead strokes. Pain is typically felt deep within the shoulder or along the front of the upper arm, and it may worsen with activities like serving or swinging the racket.
4. Subacromial Impingement
Subacromial impingement occurs when the tendons of the rotator cuff, particularly the supraspinatus tendon, become compressed under the acromion (the bony prominence of the shoulder blade). This compression can lead to inflammation, pain, and a decreased range of motion in the shoulder.
In racket sports, impingement often occurs during repetitive overhead motions, such as serving, smashing, or performing high forehand and backhand swings.
Symptoms of subacromial impingement include pain and weakness in the shoulder, particularly when the arm is raised overhead. You may also experience a feeling of tightness or restricted movement when lifting or rotating the arm.
5. Labral Tear
The glenoid labrum is a piece of cartilage that forms a cup around the ball of the shoulder joint, providing stability. Overhead sports like tennis and pickleball are particularly tough on the labrum, as aggressive swings and poor mechanics can lead to tears. A labral tear can cause pain, instability, and a clicking or popping sensation in the shoulder.
Labral tears often result from sudden, forceful movements, or repetitive overuse, especially in the shoulder’s overhead position. Symptoms of a labral tear can include pain in the front or back of the shoulder, a sense of instability, and difficulty with activities that require shoulder rotation. You may also notice clicking or grinding sounds when moving the arm.
The Role of Muscle Weakness and Movement Dysfunction
While each of the conditions listed above can individually cause shoulder pain, it’s important to understand that the development of shoulder injuries is rarely the result of one single issue. Muscle weakness, scapular dyskinesis, and thoracic mobility restrictions are often underlying factors that contribute to or exacerbate these injuries. In fact, it is common for players to experience pain from a combination of issues. Here’s how these factors play a role:
Muscle Weakness
Weakness in the rotator cuff muscles, scapular stabilizers, or core can significantly alter the mechanics of shoulder movement. When muscles are weak, other structures in the shoulder, such as the tendons and ligaments, take on more stress and strain. This can lead to increased wear and tear, ultimately contributing to conditions like tendinopathy or impingement. Strengthening the rotator cuff muscles, scapular stabilizers, and the muscles of the core and legs can provide better stability and help reduce the strain on the shoulder joint.
Scapular Dyskinesis
The scapula (shoulder blade) plays a crucial role in shoulder function, particularly in stabilizing the shoulder joint during dynamic movements like swinging or serving. Scapular dyskinesis refers to abnormal movement or positioning of the scapula, often caused by imbalances in the muscles around the shoulder blade. When the scapula doesn’t move properly, it can lead to abnormal mechanics in the shoulder joint, increasing the risk of impingement, tendinopathy, and other injuries. Improving scapular control and stability through exercises like Wall Angels, Scapular Push-Ups, and Prone Y/T/Ws can help reduce the likelihood of injury and improve overall shoulder function.
Thoracic Mobility Restrictions
The thoracic spine (mid-back) plays a vital role in shoulder movement, especially in racket sports. The ability of the thoracic spine to rotate and extend allows for efficient transfer of power from the lower body to the upper body during a swing. When the thoracic spine is stiff or lacks mobility, the shoulder compensates by taking on more rotational movement, which increases the risk of strain on the shoulder joint. Thoracic mobility restrictions can contribute to shoulder pain by forcing the shoulder to work harder and move inefficiently. Exercises like foam roller extensions, seated T-spine rotations, and cat-cow stretches can help improve thoracic mobility and reduce stress on the shoulder.
Often Multiple Factors at Play
Shoulder pain from racket sports is often caused by one or more of the conditions mentioned above. Supraspinatus tendinopathy, infraspinatus tendinopathy, biceps tendinopathy, subacromial impingement, and labral tears are all common injuries that result from repetitive overhead motions, poor technique, and overuse. However, these conditions are rarely isolated; multiple factors such as muscle weakness, scapular dyskinesis, and thoracic mobility restrictions often contribute to the development or exacerbation of these injuries.
By addressing these underlying factors—through proper warm-ups, strength training, mobility exercises, and maintaining good mechanics during play—you can reduce your risk of shoulder injuries and keep yourself in the game. If pain persists, consulting with a skilled physical therapist can help you identify the root cause of the problem and develop an individualized treatment plan to get you back on track. A proactive approach to shoulder care will help ensure that you continue playing your favorite racket sports without the sting of pain.
Warm-Up: Get Your Shoulder & Spine Moving
Proper warm-up before playing is essential for preventing shoulder injuries. A comprehensive warm-up should focus on improving joint mobility in both the shoulder and thoracic spine while activating the rotator cuff and periscapular muscles. Warming up properly ensures that these structures are engaged and ready for the intensity of racket sports.
1. Thoracic Mobility Drills
To ensure the shoulder is moving as efficiently as possible, start with exercises that promote thoracic spine mobility.
Open-Book Stretch: This stretch involves lying on your side with your arms extended in front of you. Rotate your upper back to open up the chest and shoulder, hold for a few seconds, and then return to the starting position. Repeat this on both sides to mobilize the thoracic spine and prepare for rotational movements.
Quadruped T-Spine Rotations: Begin on your hands and knees in a tabletop position. Place one hand behind your head and rotate your upper body towards the ceiling, aiming to increase the mobility of the thoracic spine with each repetition.
2. Shoulder Activation & Stability Exercises
Activating the muscles that stabilize the shoulder is crucial for preventing injury.
Band-Resisted External Rotations: Attach a resistance band to a fixed point and hold the other end in your hand. Keep your elbow bent at 90 degrees, and rotate your arm outward against the resistance. This exercise strengthens the rotator cuff muscles and improves shoulder control.
Banded Scapula Angels: Attach a resistance band to a stationary object at about shoulder height. Stand with your back against a wall, holding the ends of the band in each hand, and bend your elbows to 90 degrees. Position your arms at shoulder height with your palms facing forward. While keeping your arms in contact with the wall, slowly slide them upward in an arc, mimicking an overhead movement pattern. Focus on maintaining control as your arms move, engaging the muscles around your shoulder blades to stabilize the scapula. This exercise strengthens the scapular stabilizers, improves shoulder mobility, and enhances control during overhead movements.
Serratus Push-Ups: Perform a regular push-up, but focus on protracting the shoulder blades (pushing them away from each other) at the top of the movement. This activates the serratus anterior, a key muscle for stabilizing the scapula and shoulder joint.
Prevention: Smart Training for a Pain-Free Shoulder
While warm-up exercises are essential, long-term prevention involves incorporating specific exercises to build strength, improve mobility, and maintain proper movement mechanics.
1. Strengthen the Rotator Cuff & Scapular Muscles
A strong rotator cuff and scapular stabilizers are vital for preventing injuries. Focus on exercises that improve endurance and strength in these muscles.
Exercises to include:
Prone Y/T/Ws: Lying face down, raise your arms into a Y, T, or W position. This targets the lower traps and rhomboids, crucial muscles for scapular control and shoulder stability.
Band Pull-Aparts: Hold a resistance band with both hands and pull it apart, keeping your arms straight. This activates the posterior shoulder muscles, which help balance out the chest and anterior shoulder muscles.
Dumbbell External Rotations: Hold a dumbbell in each hand and externally rotate your arms. This strengthens the rotator cuff muscles, helping them endure the repeated stresses of racket sports.
2. Improve Thoracic Mobility
Maintaining mobility in the thoracic spine is crucial for reducing the strain on your shoulders. Include exercises that focus on improving rotational movement and flexibility in the mid-back.
Exercises to include:
Foam Roller Extensions: Lie on a foam roller placed across your mid-back, and gently extend backward to improve thoracic mobility.
Seated T-Spine Rotations: Sit upright and rotate your torso to one side, stretching and strengthening the muscles of your thoracic spine. Repeat on the other side.
3. Use Proper Technique & Don’t Overload Too Quickly
Proper technique during play is essential for preventing injuries. Many players get injured due to poor mechanics, overuse, or by returning to the sport too quickly after time off.
Ease Into Play: If you’re getting back to racket sports after a break, avoid going straight into long, intense sessions. Gradually build up your playing volume.
Use Your Whole Body: Focus on using your hips, legs, and core to generate power, rather than relying solely on your shoulder for force.
Grip & Paddle Positioning: Avoid gripping the paddle too tightly, as this can increase tension in the shoulder and arm. A relaxed grip allows for more fluid, efficient strokes.
When to See a Physical Therapist
Despite your best efforts, pain can sometimes creep in. If you experience persistent shoulder pain, a skilled physical therapist (PT) can assess your condition and help you develop a personalized rehabilitation plan.
Why PT is Essential for Shoulder Pain in Racket Sports
Accurate Diagnosis: Physical therapists have the expertise to differentiate between rotator cuff injuries, impingement, labral tears, and other conditions.
Individualized Rehab Plans: A PT will create a tailored program based on your unique biomechanics, movement patterns, and level of play.
Biomechanical Corrections: A PT can analyze your swing mechanics and suggest changes to reduce strain on your shoulder.
Hands-On Treatment: Techniques like manual therapy, soft tissue mobilization, and joint mobilizations can address underlying issues and reduce pain.
When to See a Physical Therapist
Despite taking proactive measures to prevent shoulder pain, sometimes discomfort can still creep in. If your shoulder pain persists, worsens over time, or limits your ability to perform your daily activities or enjoy racket sports, it’s important to seek help from a skilled physical therapist (PT). Ignoring ongoing pain or relying solely on rest may only lead to further injury or chronic issues. A PT is trained to accurately diagnose shoulder conditions, identify contributing factors, and guide you through an effective rehabilitation process to get you back to doing what you love, pain-free.
What to expect from Physical Therapy (PT) for Shoulder Pain in Racket Sports
When shoulder pain arises from racket sports like tennis or pickleball, it’s often the result of repetitive motions, improper biomechanics, or muscle imbalances that overload the structures in the shoulder. Physical therapy offers targeted solutions to address these issues and ensure long-term recovery.
1. Accurate Diagnosis
A PT is highly skilled in differentiating between various shoulder injuries, such as rotator cuff tendinopathies, impingement, labral tears, and scapular dysfunction. Through a thorough physical assessment, including movement analysis, special tests, and a review of your medical history, the PT can pinpoint the exact cause of your pain. This is especially critical, as many of these conditions share similar symptoms, such as pain with overhead movements, but each requires a different treatment approach. An accurate diagnosis helps avoid unnecessary treatments and ensures that you are addressing the root cause of the problem rather than masking the symptoms.
2. Individualized Rehab Plans
Once a diagnosis is made, the PT will develop a customized rehabilitation plan tailored to your unique condition, playing style, and overall goals. Whether you're a recreational player or a competitive athlete, your PT will design a program that addresses your biomechanics, movement patterns, and shoulder stability needs. The PT will assess how your body moves during your specific racket sport and identify any faulty mechanics or areas of weakness that might be contributing to your shoulder pain. Your rehab plan will include a combination of strengthening exercises, mobility drills, and proprioceptive training to improve muscle balance, joint function, and overall performance.
One of the most important aspects of a personalized rehab plan is progression—starting with low-intensity exercises and gradually increasing difficulty based on your body’s tolerance and recovery rate. This approach helps avoid re-injury and ensures a full, sustainable recovery.
3. Biomechanical Corrections
Physical therapists are experts in biomechanics, which involves understanding how the body moves and functions during activity. If you’re experiencing shoulder pain due to poor technique or inefficient movement, a PT will evaluate your swing mechanics to identify any issues that may be straining your shoulder. In racket sports, improper mechanics, such as excessive upper body rotation or overuse of the shoulder during a swing, can lead to muscle imbalances, increased joint stress, and ultimately, injury.
Through targeted interventions, a PT can suggest adjustments to your swing mechanics, posture, and body positioning to reduce strain on your shoulder. These biomechanical corrections can be the difference between recovering fully and continuing to experience pain during play. Additionally, a PT will focus on improving your core stability and lower body strength, ensuring that your shoulder isn’t compensating for weakness or instability in other areas of your body. By optimizing your technique, you’ll not only prevent pain but also enhance your performance on the court.
4. Hands-On Treatment
A significant part of physical therapy is hands-on treatment, which can be particularly beneficial in addressing shoulder pain. Manual therapy techniques such as soft tissue mobilization, joint mobilizations, and myofascial release can be used to alleviate tension, reduce inflammation, and improve mobility in the shoulder joint and surrounding tissues.
Soft tissue mobilization targets the muscles, tendons, and fascia around the shoulder to reduce tightness and promote healing. If scar tissue or adhesions are contributing to your pain, manual techniques can help break these down and restore normal function. Joint mobilizations involve gentle, controlled movements of the shoulder joint to improve its range of motion, alleviate stiffness, and restore normal movement patterns. This is especially useful if your shoulder mobility is restricted due to an injury or compensatory pattern.
By incorporating these hands-on treatments, your PT can directly address any soft tissue restrictions, joint limitations, or muscle imbalances contributing to your pain. These treatments not only provide immediate relief but also enhance the effectiveness of your rehabilitation program, allowing you to recover more efficiently.
5. Preventative Care and Education
Another critical benefit of seeing a PT is preventative care. Once the initial injury has been addressed, your PT will provide guidance on how to prevent future shoulder injuries. This includes teaching you proper posture, warm-up routines, and stretching techniques to prepare your shoulder for activity. Additionally, your PT may educate you on modifying your training intensity, allowing for adequate recovery time between sessions to prevent overuse injuries. Learning how to protect your shoulder during play and making these adjustments can significantly reduce the likelihood of re-injury.
Final Thoughts: Play Smart, Stay Strong
Racket sports should be fun, not painful. By focusing on proper preparation, strengthening key muscle groups, and maintaining optimal technique, you can keep your shoulder resilient and free from pain. If pain does creep in, don’t ignore it—seek out a skilled physical therapist to get back to the game with long-term health in mind. Treat your shoulder well, and it will keep you swinging strong for years to come!
If you have questions about your shoulder health or want to ensure you stay active and pain-free on the court all season, schedule a phone consultation with one of our experts at Rise. Our team of professionals is here to provide personalized advice, address your concerns, and help you optimize your performance while preventing injuries. Don't wait for pain to slow you down—reach out today and take the next step toward a healthier, stronger shoulder!