Tennis Shoulder: Why Your Shoulder Hurts When You Serve

If your shoulder feels fine during everyday life but starts aching when you serve, hit overheads, or play a long tennis match, there’s a reason.

And it may not be just your shoulder.

I’m Dr. Stuart Frith, a chiropractor at Restore Body + Joint in Livermore, and when I evaluate a tennis player with shoulder pain, I’m interested in much more than the spot that hurts.

I want to see the serve.

Because a tennis serve is a full-body movement. Your legs, hips, core, shoulder blade, shoulder, elbow, wrist, and racquet all have to work together to generate force.

When one part of that system isn't doing its job efficiently, another part often has to pick up the slack.

And very often, that “other part” is the shoulder.

Why Serving Is So Demanding on the Shoulder

Think about how many things happen during a serve.

You load through your legs. Your hips and trunk rotate. Your shoulder moves into a very large range of motion. Then the arm accelerates rapidly overhead before having to slow itself back down.

And you don't do it once.

During practices, lessons, tournaments, and matches, a competitive tennis player may repeat that motion over and over again.

Research on tennis athletes describes the serve as a coordinated kinetic chain, with energy moving from the legs and trunk through the shoulder and eventually into the racquet. When that chain isn't working efficiently, compensation can increase stress farther up the body.

That’s why simply asking, “Where does it hurt?” doesn't always tell me enough.

I want to know why that area is being overloaded.

The Shoulder Blade Matters More Than Most Players Realize

One of the first areas I look at in a tennis player with shoulder pain is the scapula—or shoulder blade.

Your shoulder blade needs to move and stabilize properly while your arm goes overhead.

If it isn't doing that well, the ball-and-socket portion of the shoulder may have to compensate.

Research in overhead athletes has linked abnormal scapular movement with shoulder problems, although shoulder pain is usually multifactorial rather than caused by one single issue.

In the office, I may look at:

• How the shoulder blade moves when you raise your arm

• Differences between your serving and non-serving sides

• Shoulder rotation

• Thoracic or upper-back mobility

• Rotator cuff strength and control

• Your ability to stabilize the shoulder overhead

But I don't stop there.

Your Shoulder Problem Could Start Lower Down

This is one of the concepts I really want young athletes—and their parents—to understand.

Your body doesn't serve a tennis ball in separate pieces.

It serves as one system.

If you're limited through your hips, aren't generating enough force through your legs, lack trunk rotation, or can't control your core well during the serve, you still have to find a way to get the racquet to the ball.

Your body will compensate.

For some athletes, that can mean asking the arm and shoulder to produce more of the power that should have come from somewhere else.

So if you come into Restore complaining about shoulder pain and I start looking at your hips or having you rotate through your trunk, I haven't forgotten which shoulder hurts.

I'm figuring out how you produce your serve.

What About the Rotator Cuff?

The rotator cuff is definitely important.

It consists of muscles and tendons that help stabilize and control the shoulder joint, particularly during demanding overhead movement.

But I don't like using “rotator cuff” as a catch-all explanation for every tennis shoulder.

Shoulder pain can involve a number of different structures and movement issues, including the rotator cuff, tendons, joint capsule, labrum, shoulder blade mechanics, mobility restrictions, strength deficits, or simply too much workload too quickly.

That's why an evaluation matters.

The goal isn't to guess which structure hurts.

The goal is to determine what movements reproduce the problem and what we can improve.

Young Tennis Players Are Not Just Small Adults

This is especially important with junior athletes.

Competitive young tennis players may be practicing several days a week, taking private lessons, strength training, playing tournaments, and serving hundreds of balls during periods of intense training.

At the same time, they're still growing.

When I work with a young athlete, I'm thinking about their current symptoms, but I'm also thinking long term.

I don't just want them feeling better for Saturday's tournament.

I want them building a body that can tolerate years of tennis.

That may mean working on shoulder mobility.

It may mean scapular control.

It may mean hip mobility, trunk rotation, strength, recovery, or changing how much load they're putting on the body.

Every athlete is different.

Should You Stop Playing Tennis?

Not automatically.

One of the things athletes sometimes fear when they see a healthcare provider is that the answer will simply be, “Stop playing.”

Sometimes rest or temporary modification really is necessary.

But my goal whenever possible is to determine what you can do, what needs to be modified, and what needs to improve so you can safely work toward returning to full activity.

I like to test.

Treat.

Move.

And then test again.

Can you raise the arm more comfortably?

Can you rotate better?

Does the serving position feel different?

Can you perform the movement that was bothering you with less discomfort?

Those changes give us useful information.

What Treatment May Look Like at Restore

There isn't one standard “tennis shoulder treatment” that I give every athlete.

Depending on what I find, treatment at Restore Body + Joint may incorporate:

• Chiropractic care

• Soft-tissue treatment

• Fascial Distortion Model techniques

• Mobility work

• Shoulder and scapular exercises

• Rotator cuff strengthening

• Core and trunk control

• Functional movement

• Sport-specific rehabilitation

The hands-on treatment is only part of the process.

Eventually I want to see you move.

Because if tennis is the thing you're trying to get back to, we need to prepare your body for tennis.

When Shoulder Pain Shouldn't Be Ignored

A little muscle soreness after a demanding practice is one thing.

Persistent pain is different.

If your shoulder pain keeps returning, gets worse as you play, causes significant weakness, limits your ability to raise your arm, follows a traumatic injury, produces a feeling of instability, or is accompanied by numbness or tingling, it deserves to be evaluated.

Especially in a young athlete, don't wait until the player can no longer serve.

Problems are usually easier to address when an athlete speaks up early.

Don't Just Treat the Shoulder. Look at the Player.

That's ultimately how I approach tennis injuries.

If your shoulder hurts when you serve, I absolutely want to evaluate the shoulder.

But I also want to understand how you move.

How does your shoulder blade move?

How does your trunk rotate?

What are your hips doing?

Where are you strong?

Where are you compensating?

What changes when you actually go through your serving motion?

That's the difference between simply treating a sore spot and trying to understand why an athlete keeps irritating it.

If you're a junior tennis player, competitive adult player, or weekend athlete dealing with shoulder pain, mobility restrictions, or an injury that keeps coming back, I'd be happy to take a look.

Dr. Stuart Frith, DC Restore Body + Joint | Frith ChiropracticLivermore, California

Move Better. Feel Better. Live Better.