Case Study: Medial Elbow Pain on Tennis Serve

I saw a 14 year old boy who plays competitive tennis, last week.  He has experienced medial elbow pain on his serve intermittently for the last 18 months.  He has been getting conventional treatment with little relief.

I asked him to show me how he serves and the reason for the elbow pain was apparent immediately.  His knees were a long way forward with the hips tucked under in the action with the shoulders well behind the hips.  This means that hip extension is not possible in this type of action.  The only segment available to accelerate the racquet was the arm, and in his action he was using elbow extension rather than horizontal abduction with internal rotation, as in an ideal throwing motion.

This case study throws up an interesting paradox.  In order to make the serve non-symptomatic there is a need to change the action.  In order to change the action, there needs to be motivation to change.  Also the injury cant resolve through on-going treatment, if the action is not changed, as the arm is not capable of producing and decelerating the level of force required to hit a competitive serve. and be pain free.

The reason I am posting this case study is to highlight the separation that exists between the view of rehabilitation and doing no harm, with specific ideas around technique and how certain shots should be hit.  These areas are non-communicative except in rare cases where a coach will work openly with an exercise professional, or where the resources allow it.

A common understanding is possible using a movement perspective, because if you draw a big enough circle its all movement.  There would need to be a big emphasis on experiential education for this to happen.  Is this likely?  It is possible in any situation where there is a curiosity to be balanced in movement, clear in the task, and a willingness to explore with openess.

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