Recently, we’ve seen a noticeable rise in shoulder injuries among racquet sports athletes, especially with the explosion in popularity of pickleball. Whether you’re smashing serves on the tennis court, hitting corner shots in racquetball, or dinking at the net in pickleball, your shoulder plays a vital role in nearly every movement. But with great mobility comes great vulnerability.
Let’s examine what’s going on anatomically, explain why shoulder pain is so common in these sports, and discuss how we treat it effectively and specifically.
Common Shoulder Injuries in Racquet Sports
The shoulder is a complex ball-and-socket joint with an enormous range of motion, which is both a gift and a curse for athletes. Racquet sports require repeated overhead motions, forceful swings, and quick directional changes, stressing several key structures:
Rotator Cuff (Supraspinatus, Infraspinatus, Teres Minor, Subscapularis)
- These muscles stabilize the glenohumeral joint during dynamic movement.
- Overuse can lead to tendinopathy or partial tears, especially of the supraspinatus.
Biceps Tendon (Long Head)
- Especially involved during overhead swings and follow-throughs.
- It can become inflamed (tendinitis) or irritated due to poor mechanics or instability.
Labrum (Glenoid Labrum)
- A fibrocartilage rim that deepens the socket.
- Can be damaged during repetitive overhead motions, especially with forceful serves or smashes.
Subacromial Space
- Narrowing due to poor posture or inflammation leads to impingement syndrome.
Causes & Contributing Factors
- Poor scapular control: Weak serratus anterior, lower traps, or rhomboids.
- Muscle imbalances: Overdeveloped front deltoids and underused posterior shoulder muscles.
- Postural dysfunction: Rounded shoulders and forward head posture.
- Improper mechanics: Swing technique flaws increase joint strain.
- Overtraining without recovery: Especially in older or new athletes.
Assessment & Diagnosis
Before we dive into treatment, a thorough assessment is key:
- Manual muscle testing
- Range of motion analysis (active & passive)
- Special tests: Neer’s, Hawkins-Kennedy, Speed’s test, O’Brien’s for labral tears
- Movement analysis: Watching swing mechanics, serving motions, etc.
- Postural screening
If needed, collaboration with sports physicians for imaging (MRI or ultrasound) helps confirm structural issues.
Treatment Plan: Tools, Techniques & Timeline
A well-rounded shoulder treatment plan targets mobility, strength, motor control, and return to sport. Here’s how we typically break it down:
Phase 1: Acute Phase (1–2 weeks)
Goals: Reduce pain and inflammation, restore basic mobility.
- Modalities: Ice, ultrasound, electrical stimulation (TENS)
- Manual therapy: Gentle joint mobilizations (grade I–II), soft tissue release
- Isometrics: Submaximal holds for rotator cuff and scapular stabilizers
- Postural correction: Stretch pecs and upper traps, teach basic scapular retraction
Phase 2: Intermediate Phase (2–4 weeks)
Goals: Improve ROM, begin strengthening, correct movement patterns.
- Therapeutic Exercise Tools:
- Resistance bands for rotator cuff (ER/IR at side, 90° abduction)
- Wall slides, YTWL exercises
- Scapular clocks on the wall or a foam roller
- Neuromuscular re-education: Rhythmic stabilization drills, proprioceptive taps
- Manual therapy: Continue joint mobilizations (grade III–IV if tolerated)
Phase 3: Advanced Strengthening (4–6 weeks)
Goals: Restore full strength and functional overhead movement.
- Kettlebells & Dumbbells: Controlled overhead presses, carries
- Dynamic Stability: Bosu ball or balance pad activities with arm movement
- Plyometrics: Medicine ball throws, rebounder tosses for power
Phase 4: Return to Sport (6–10 weeks)
Goals: Sport-specific loading, reaction training, and confidence building.
- Swing mechanics retraining (with coach or video analysis)
- High-speed resistance training for overhead motions
- On-court drills with progressive volume and intensity
- Return-to-play testing: Strength symmetry, pain-free ROM, controlled deceleration
Preventive Strategies
Even after recovery, maintenance is key, especially for aging athletes or weekend warriors.
- Dynamic warm-up before matches (arm circles, banded rows, scapular push-ups)
- Cool-down mobility work (shoulder flossing, foam rolling)
- In-season maintenance program: 2x/week rotator cuff and scapular work
- Regular tune-ups with a PT or athletic trainer
Final Thoughts
Shoulder pain doesn’t have to sideline your game. With targeted rehab, consistent strengthening, and a return-to-play approach tailored to the demands of your specific racquet sport, most athletes return stronger than before.
Whether you’re a tennis veteran, a racquetball junkie, or a pickleball newcomer, your shoulder deserves care that’s as strategic as your play.
If you’re dealing with shoulder pain, don’t wait—early intervention makes all the difference. Schedule a visit with a NYC physical therapist at CSC+M and get back to doing what you love, pain-free.
