Glenohumeral Gurus #49: High Performance Shoulder: Tennis from the ground up with Natalie Myers

What does a shoulder actually need to do to perform at a high level in tennis? In the first episode of our High Performance Shoulder series, Margie Olds is joined by Natalie Myers to explore the biomechanics and physical demands of the tennis shoulder. Natalie takes us beyond the glenohumeral joint and into the whole kinetic chain. The tennis serve is a complex, highly sequenced movement — and changes at the feet, knees, pelvis or trunk can alter the forces experienced at the shoulder. The conversation gets particularly practical: Can clinicians actually assess this in the clinic? Natalie discusses her work translating 3D biomechanical research into an observational assessment of the tennis serve, including foot position, knee bend, pelvic and trunk rotation, sequencing and timing. Simple clinical measures such as the countermovement jump, medicine-ball throw and trunk rotation can also provide useful information about the athlete. The discussion then turns to shoulder pain and injury across the lifespan — from growth-plate injuries in young players and partial-thickness cuff findings, through to posterior instability and age-related rotator cuff changes. And finally, Margie and Natalie tackle a particularly important question for clinicians: Should we really be trying to restore symmetrical shoulder rotation in tennis players? Natalie explains why loss of internal rotation can be a normal adaptation to overhead sport, the role of humeral retrotorsion, and why external rotation — rather than internal rotation — may sometimes be the more important movement to consider. 🔑 Key Takeaways for Clinicians • Start beyond the shoulder. The tennis serve depends on force generation and sequencing through the feet, lower limbs, pelvis and trunk. • Foot position matters: Natalie suggests it is one of the first things clinicians should observe when watching a player serve. • Reduced knee bend and altered timing between pelvic and shoulder rotation can increase forces at the shoulder. • You don't necessarily need a biomechanics laboratory. Slow-motion video and a structured observational approach can provide clinically useful information. • Counternovement jump, rotational medicine-ball throw and trunk rotation are simple measures Natalie has used alongside observational serve assessment. • In younger tennis players, keep growth-plate injury high on the differential diagnosis — particularly in athletes around 10–14 years presenting with shoulder pain. • Posterior shoulder instability deserves a place on the clinician's radar, given the repeated horizontal adduction and internal rotation demands of tennis. • Reduced internal rotation on the serving side isn't automatically pathological. Some change is a normal adaptation to repeated overhead loading. • Humeral retrotorsion matters. Athletes who begin overhead sports while their growth plates are open can retain greater retrotorsion, allowing more external rotation but less internal rotation. • Trying to restore internal rotation without considering these bony adaptations may be inappropriate — and Natalie raises the possibility that excessive posterior shoulder stretching could potentially contribute to posterior instability. The bigger message: before treating a tennis player's shoulder, understand the adaptations and whole-body demands that allow that shoulder to perform.   To Follow Natalie Myers: LinkedIn:   / natalielmyers02   Research gate: https://www.researchgate.net/scientif... Natalie’s Research Myers et al., 2016. Volume based internal training program for elite tennis players https://pmc.ncbi.nlm.nih.gov/articles... Myers et al., 2017. Reliability and validity of a biomechanically based analysis method for the tennis serve https://pmc.ncbi.nlm.nih.gov/articles... Myers et al., 2019. The Sony Smart Tennis Sensor accurately measures external workload in junior tennis players https://journals.sagepub.com/doi/abs/...