Post-Match Recovery for the Tennis Shoulder - Part 1
Picture this, you just got off court after a long 3-set battle. You’re tired, exhausted, fatigued (insert any other word you wish). The last thing you want to do is spend another 30 minutes or more recovering from the match. But guess what, if you’re a junior who’s playing another match the same day or a pro playing a match the following day, you’ve got no other choice. Well that’s not entirely true, you do have another choice and that’s to do nothing at all and basically just show up for your next match.
The problem with the latter approach is that not only could it lead to injury, it’ll likely hinder your performance. This is especially evident when it comes to your serve, arguably the most important shot in today’s game. This loss in performance can be attributed to a number of factors. One of those being decreases in shoulder range of motion (ROM). That's the obvious reason, but there are others. With that in mind, we’re going to investigate the importance of a post-match shoulder recovery routine. We'll tackle a few of the common reasons shoulder/arm recovery matters, a scientific rationale to justify immediate care of the shoulder/arm post-match and what we can learn from baseball pitchers. This is a 2 part series - in the 2nd part we'll outline a few strategies that just may accelerate the shoulder/arm’s recovery process.
So Why is a Shoulder Recovery Routine Important Anyway?
The answer to the importance of a recovery routine for the shoulder seems obvious doesn’t it? For starters, let's look at today's tournament structure. In a regular ATP, WTA and ITF event, players usually play 1 match per day. Depending on the length and intensity of the match, players might attempt as much as 120-150 serves - this number can get close to 200 in tight 3-setters (players might attempt as many as 65 serves in sets that go to tiebreakers), and more than that in men’s Grand Slam events. In a regular event, if you make the final, it means you may serve up to 1000 times in one week. And this doesn’t even include any practice serves a player may take in between matches. Compare this to pitchers in baseball who throw on average 90 times per game and have up to 4-5 days rest in between outings. Now I know they do a fair amount of throwing throughout the week to prep for a game AND pitching is more stressful on the shoulder than serving is. I'm not trying to say one is worse than the other, I'm simply highlighting that serving is also potentially harmful (it places the shoulder in the most strain out of any shot in tennis) and in today's game, it’s possible to serve A LOT. That said, certain measures must be taken to offset the potential long-term damages.
There’s another big reason players should have a recovery protocol after tennis, and this one deals more with training. But first, let me ask you a question. Do you know what the most common rally length in tennis is? Take a guess. You probably won’t believe me when I tell you but here it goes anyway. It’s 1. Yes that’s not a typo...1 shot is the most common rally length in our sport….and this goes for both the men’s and women’s games. Don’t believe me? Just ask Craig O’Shannessy, creator of Brain Game Tennis . Craig looked at the data from the 2015 Australian Open and based on the results, almost 30% of the points, from all matches, in both the mens and ladies draws, were 1 shot. That means either the server hit an ace or the returner hit a return error. You may be wondering why this is important. Well, won’t knowing this information potentially change the way you look at your training schedule? Shouldn’t you practice more serves? Instead of a hitting groundies for 75% of your practice, perhaps you serve more and do more situational training with serves for 75% of the practice. If you do take this advice, without implementing a recovery routine, you may be putting yourself at risk. Side note, if you do practice more serves, I strongly recommend implementing some form of an interval serve program - read more about that here.
The Implications of a Tennis Match on Serve Performance and the Shoulder
Researchers (Martin et al 2016) out of the University of Rennes in France conducted a study to find out what exactly happens to both the shoulder and the serve throughout a match. Here’s what they did. They took 8 elite ITF players with an average age of 20 and put them through 3 hours of matchplay. Before the match and at the following intervals - 30min, 60min, 90min, 120min, 150min and 180min - one of the researchers measured both passive internal and external glenohumeral (GH) ROM. They also wanted to know if serve speed would be affected throughout the match, so before playing, at the halfway point (90min mark) and after the match (180min mark), they would test each player’s flat first serve speed.
Here's a summary of what they found:
There was a huge and significant drop in dominant shoulder internal rotation ROM after 3 hours (a 21% reduction).
After 90 minutes, the drop in dominant shoulder internal rotation ROM was significant (15% reduction).
Total ROM of the shoulder saw a big drop after the match (25%) while already after the 30min mark there was a significant 8.2 degree drop in total ROM.
There was a drop in serve velocity at both the 90 minute mark along with the 180min mark (along with a significant drop in velocity from 0 to 180 and 90 to 180).
Recall from a previous post that total ROM is likely a better predictor of injury risk in elite tennis players. And in this study, total ROM dropped by nearly 25%! These results shouldn’t be surprising. Other tennis studies have reported similar findings and this seems to be consistent across various overhead sports, like baseball, volleyball and handball. As for the serve, this isn't the first study to report a drop in performance - decreases in serve speed, drops in ball impact height & angular velocities along with an increase in perceived exertion have been noted elsewhere (Martin et al 2016).
The authors of the ROM study offer 3 interesting conclusions: 1) A loss of internal rotation of more than 20 degrees or a total ROM loss of more than 10% is unacceptable and could increase risk of injury; 2) Although not measured, losses in ROM like the ones in this study, could last as long as 72 hours post competition/training; 3) Fatigue of the rotator cuff muscles impedes effective use of the stretch shortening cycle (essential for big bombs) and hence contributes to decreases in serve speed throughout. From my perspective, the solution seems clear, ROM better be restored BEFORE (yes you heard me) the next match or training session.
What Can We (the Tennis Community) Learn from Baseball?
Before we get into the various strategies that may be implemented post-match to restore ROM, let’s look to baseball and see if there's something we can learn. We’ve all seen the typical pitcher post-game with a bag of ice covering their entire pitching arm/shoulder. Whether effective or not (a topic for part 2 of this series), it does highlight the fact that pitchers don’t just go home after they pitch. They are actively doing something to promote tissue healing and regeneration. And although there are some tennis players out there that take care of their shoulder after a match, they’re the exception, not the norm.
There’s more to restoring ROM, attenuating DOMS (delayed onset muscle soreness) and returning strength levels to 'normal' than simply icing your arm. Here's some research out of the baseball world. After 2 simulated pitching games, elite pitchers participated in 2 different recovery sessions (Kawamura 2015). The first recovery protocol included shoulder stretches along with cryotherapy (‘cryo’ meaning ‘cold’). This group was called the SC group. The second recovery protocol (LSC group) included stretches, cryotherapy AND light shoulder exercises. The primary finding was that glenohumeral shoulder strength improved more in the LSC group compared to the SC group. Internal passive ROM (remember it’s significance from earlier), was significantly better in the LSC group compared to the SC group. More importantly, the SC group’s internal rotation did not return to baseline after 48hrs while the LSC did. Lastly, DOMS was significantly reduced/inhibited in the LSC group at the 24 & 48 hour mark while the SC group saw no significant decrease in DOMS even at the 48 hour point.
In another study (Yanagisawa et al 2003), light exercise seemed to help restore ROM more than ice therapy BUT light exercise combined with ice therapy had the greatest impact on both restoring shoulder ROM and rotator cuff strength. While ice may have the greatest benefits when it comes to DOMS, light shoulder work is best for muscle and joint health. Lastly, Laudner et al 2008, found that posterior shoulder tightness and internal ROM can increase with as little as 3 sets of 30 second sleeper stretch holds in baseball players. Although stretching is critical for the restoration of shoulder ROM, the former studies reveal that stretching may not be enough to restore ROM to an acceptable level post-match/training. Other modalities, including strengthening exercises, also play a role. Although it’s unknown, including a variety of modalities may provide an additive effect - where one feeds off the other - to further accelerate the recovery process.
In the next post, we'll take a look at the practical implications of a post-match shoulder routine by outlining the various modalities and providing evidence to support their use. We'll also share a few examples and argue that a post-match recovery routine is just as, if not more important than a pre-match warm-up