Sore Elbow or Shoulder from Repetitive Motion

I've taught tennis for more than 20 years, and the most common complaint I hear from players isn't a pulled muscle. It's the nagging ache that builds up over weeks in the same spot: the outside of the elbow, the front of the shoulder, the wrist, the back of the heel. Usually it comes from doing the same motion over and over, on the court or off it.

Here's what I tell my students when that kind of ache shows up, how I get them back to full hitting, and when I tell them to stop listening to me and see a doctor.

Where repetitive-motion aches usually show up

The spots I hear about most are the ones that take a beating from the same movement thousands of times:

Outside of the elbow: backhands hit late, a grip that's too small, or a stiff new racquet.
Shoulder: serving and overheads, especially after a layoff.
Wrist and base of the thumb: lots of topspin, or gripping too tight.
Knee and back of the heel: hard courts, worn-out shoes, or a jump in how many days a week you play.

It isn't just sports. Gardening, raking, shoveling, painting, scrubbing, carpentry and a long day of typing all do the same thing to the same joints.

Why the same spot keeps flaring up

Almost every time a student tells me "it came out of nowhere," we find something that changed in the two or three weeks before. The usual suspects:

More volume, fast. They went from two days a week to four, joined a second league, or did a weekend tournament after a quiet month.
New gear. A stiffer racquet, a full bed of poly, a pickleball paddle that's heavier in the head, or new court shoes with more grip.
Cold weather. November is when I hear about elbows and shoulders. Cold muscles and a cold ball both make every hit feel heavier.
Life off the court. A week of raking leaves, moving furniture or 10-hour days at a laptop adds load to the same arm before you ever pick up a racquet.

If you can name the change, you've usually found the fix.

What actually helps

1. Cut back the motion that's causing it. You don't have to stop playing, but drop the extra hitting sessions and the serve buckets for a week or two. If one shot hurts, skip that shot for now. Play doubles instead of singles. Hit for 45 minutes instead of 90.

2. Fix the cause, not just the ache. On the court that's usually equipment or technique. Check your grip size, drop the string tension a few pounds, and get someone to watch whether you're meeting the ball late. Off the court, change hands, take breaks, and use a longer tool handle.

3. Ice after you play. Ten to fifteen minutes on the sore spot after a session is an easy habit to build.

4. Warm up before you hit. Five minutes of arm circles, light band work and mini-tennis does more for a 50-year-old elbow than any piece of gear.

5. Use a topical for the soreness. I keep Active 10 cream in my bag. It's a menthol, capsaicin and magnesium cream for the temporary relief of minor aches and pains of muscles and joints associated with simple backache, arthritis, strains, bruises and sprains. It goes on cool, then warms, and it isn't greasy, so I can put it on and get back to work. It helps with the soreness. It doesn't replace fixing your swing or seeing a doctor when you need one.

The 60-second grip-size check

A grip that's too small is the cheapest problem to fix and one of the most common I find. When the handle is too thin, you squeeze harder to keep the racquet from twisting, and that squeeze goes straight to the forearm and elbow.

Hold the racquet in your normal forehand grip. Look at the gap between the tip of your ring finger and the pad at the base of your thumb. You want a small gap, about the width of one finger. If your fingertip digs into your palm, the grip is too small. Add an overgrip and check again. If you're between two sizes, go with the bigger one and build up with overgrips.

While you're at it, check your grip pressure. On a scale of 1 to 10, most of my sore-elbow students hold the racquet at an 8. I want a 3 or 4 between shots, firming up only at contact.

A simple two-week plan to get back to full hitting

This is roughly what I give a student whose elbow or shoulder has been grumbling for a while but who can still play without sharp pain:

Week 1: play every other day at most, 45 to 60 minutes. Doubles over singles. No serve buckets. Warm up for 5 minutes, ice for 10 after. Light band work (pull-aparts and rotations for the shoulder, wrist curls with a water bottle for the forearm) on the days off.
Week 2: if the ache is clearly better, add 15 minutes per session and bring back half your usual serves. If it's the same or worse, stay at week 1 and get someone to look at your stroke or your equipment.
After that: build back by about 10 to 20 percent a week. The players who jump straight back to four days a week are the ones I see again in a month.

The same idea works off the court. If raking or typing is the problem, split it into shorter blocks with breaks, switch sides or hands, and stretch the forearms and shoulders between blocks.

Questions I get about this

Should I wear a brace or strap? Some players like a forearm strap for the elbow, and it doesn't hurt to try one while you fix the cause. Just don't let it become the reason you keep playing through an ache that's getting worse.

Heat or ice? My rule of thumb for players: a little warmth before you play to loosen up, ice for 10 to 15 minutes after. If one feels clearly better to you, use that one.

Can I keep playing? If it's a dull ache that eases as you warm up and doesn't get worse during the session, most players can keep going at a lower volume. If it's sharp, gets worse as you play, or changes how you swing, stop for the day.

Is the roll-on or the tube better for this? Same active ingredients. The roll-on keeps your hands clean, which I like before I pick up a racquet. The tube is better for covering a bigger area like the back or both shoulders.

When to see a doctor

Get it checked if any of these happen:

The pain hasn't improved after a week or two of easing off.
It wakes you up at night.
There's swelling, heat, numbness, or you can't move the joint normally.
It started with a pop or a sudden injury.

A doctor or physical therapist can tell you what's actually going on and what to do about it. That's their job, not a cream's and not mine.

Keep reading

Active 10 is for external use only. Read the product label for Drug Facts, directions and warnings before use. This article is general information from a tennis coach, not medical advice.