Pure Sports Medicine

Racket Sport Recovery

Discover how a keen tennis and padel player fully recovered from her elbow pain to return to the court, pain-free and stronger than ever.

At Pure Sports Medicine our goal is to help as many people as we can live the healthy, active life that we all deserve by bringing elite level care to everyone, whether you consider yourself an athlete or not.

Blog by Dr Fahan Shahid:

My name is Dr Farhan Shahid, and I’m a Consultant in Sport, Exercise and Musculoskeletal Medicine at Pure Sports Medicine’s Roehampton clinic based in the Studio at Roehampton Club. I specialise in managing musculoskeletal issues, sports injuries, and exercise-related conditions, helping everyone from elite athletes to recreational players stay active and pain-free.

A great example of how we approach diagnosis and treatment is a recent case involving a passionate tennis and padel player at the club.

A 51-year-old lady came to see me after developing right lateral elbow pain. She had taken up tennis and padel over the last year, playing five times a week. Not only was this a fantastic form of exercise, but it was also an important social activity for her as she loved playing doubles with her friends. However, the gradual onset of pain on the outside of her elbow was starting to interfere with her game.

Upon assessment, the pain was very pinpoint over the outer elbow tendon bulk (lateral side) and the region was painful into resisted wrist extension. An ultrasound scan revealed thickening of the extensor tendon, indicative of tendinopathy — in this case an overuse injury caused by repetitive strain. While the diagnosis was clear, I wanted to dig deeper to understand why this was happening in the first place.

Through a combination of clinic-based and on-court assessment, I noticed that she had reduced mobility in her right shoulder and stiffness in her thoracic spine. This lack of mobility meant she was unable to rotate effectively during her serve, forcing her elbow to compensate and absorb excessive force. Over time, this overload was the likely cause which led to the tendinopathy.

To address this, we took a collaborative approach. Working closely with a physiotherapist and her tennis coach, we developed a targeted rehab program. This involved improving her shoulder mobility and thoracic rotation while also implementing a structured loading program for her elbow tendons.

We carried out three rounds of shockwave therapy to help with her pain symptoms alongside the rehab work and looked to strengthen the left arm to create better balance in her movements. Gradually, her pain improved, and as her technique became more efficient, she was able to return to play—better than ever!

This was a very pleasing outcome for her, however what if there was no improvement?

While most cases respond well to a structured rehab program, some may require further interventions. If symptoms persist, we can consider:

1. Further imaging, such as an MRI, to assess other structures and rule out any additional issues.
2. Injectable therapy such as PRP (platelet-rich plasma) injections, which can aid tendon healing.
3. A surgical opinion, in rare cases where conservative treatment isn’t effective.

This case highlights how important it is to look beyond the site of pain and address the root cause of an issue. A team approach, involving medical professionals, physiotherapists, and sports coaches, ensures a thorough recovery and a strong return to play.

If you’re struggling with any musculoskeletal concerns or sporting injuries, don’t hesitate to reach out. The team at Pure Sports Medicine are here to help you stay active and enjoy playing the sports you love!

Stay tuned for more insights into sports injuries and how we manage them effectively at the club.

If you are experiencing pain in your day-to-day life, or when you play your chosen sports, and would like help getting to the root of the problem, why not get in touch today and speak to a member of our expert team.

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Managing shoulder pain

Dr Farhan Shahid is a Consultant in Sport, Exercise and Musculoskeletal medicine working at the Pure Sports Medicine clinic based at the Roehampton Club. I’m a specialist in managing musculoskeletal issues, sports injuries, exercise related conditions, and treating elite athletes. However we don’t just treat people playing sports or elite athletes, but anyone with musculoskeletal conditions including kids to veteran exercisers.

Sports and exercise medicine specialists manage everything from upper and lower limb injuries, spinal issues, overuse injuries, and anything that may crop up with recreational physical activity. We aim to manage these conditions non-operatively, rehabbing back to a good level and sometimes even stronger. Overall, we want to be in a good condition to be able to do the things that we love and enjoy with friends and family, and have fun in the process. Our aim is to help with this process. Exercise and physical activity can be incredibly protective for our overall well-being as well as being a great source of socialising, getting outdoors and engaging with learning new skills.

We also work very closely with different members of our multidisciplinary team, including physiotherapists, strength and conditioning coaches, soft tissue therapists, podiatrists, orthopaedic surgeons, and many others that can help to get you back up and running.

A good example of a recent case is when I treated a 53-year-old who enjoyed playing tennis with worsening shoulder pain. She’d recently retired from a high profile job in the city and took up tennis. It was her passion, inspired by her favourite player, Roger Federer, enjoying tennis 4 to 5 times a week. She started to develop some pain around her shoulder, and then then it became suddenly sharp, which stopped her from playing. At this point she booked in for a review. After a thorough history, examination assessment and ultrasound, I noted that she had a calcium deposit around one of her rotator cuff tendons, and an MRI confirmed this whilst also ruling out a tear. This is called a calcific tendinopathy.

Over time, with excessive use the shoulder tendons can become overloaded and thickened. Occasionally at these areas, one can develop calcium deposits, which can end up catching through ranges of movement and become very painful, worsening with strokes such as forehands or serving. And this can be quite painful. I worked very closely with the physiotherapist.
Once we had the diagnosis, there were a few different ways to manage it. We worked together to make a strategic performance plan for their return to tennis. One procedure which I offered the patient was a barbotage, which involves inserting a needle into the calcium deposit via ultrasound guidance and helping to break it down, bringing the calcium deposits up to the surface. In the short term, this can be quite painful, but over time, it relieves the pain experienced. After the barbotage, I injected some steroid under ultrasound guidance to help settle the inflammed region at the shoulder joint.

Following this and a break from tennis, and some focussed and targeted physiotherapy, the patient rehabilitated well and improved significantly. I also updated her tennis coach who worked on her technique which helped to protect her shoulder even more. They were able to get back to their regular tennis pursuits, enjoying doubles matches with friends and family, whilst being relatively pain free. They even began to enjoy golfing sessions with their partner which brought them closer together!

What can you do if you begin to develop worsening shoulder pain?

1. Seek the expert advice from a Sport and Exercise Medicine Consultant who can assess and accurately diagnose the condition and devise a shared performance plan
2. Consider interventions such as ultrasound-guided injections or in this case of calcific tendinopathy, a barbotage procedure.
3. Have regular reviews and monitor the progress of the condition.
4. Work closely with a physiotherapist, strength and conditioning coach and sports coach – to get back to the physical pursuits that you enjoy.
5. To consider onward referral if there are any issues with the progress, for example, to a shoulder surgeon colleague for an opinion.
For more information on different conditions and how we can manage them, look out for more updates on the blog!
If you’re experiencing shoulder pain or would like to speak to a Sport & Exercise Medicine Consultant, click here to book your free 15-minute consultation to see if we can help you get back to your best.

Dr Farhan Shahid

Consultant in Sport, Exercise and MSK Medicine

Managing shoulder pain

Dr Farhan Shahid is a Consultant in Sport, Exercise and Musculoskeletal medicine working at the Pure Sports Medicine clinic based at the Roehampton Club. I’m a specialist in managing musculoskeletal issues, sports injuries, exercise related conditions, and treating elite athletes. However we don’t just treat people playing sports or elite athletes, but anyone with musculoskeletal conditions including kids to veteran exercisers.

Sports and exercise medicine specialists manage everything from upper and lower limb injuries, spinal issues, overuse injuries, and anything that may crop up with recreational physical activity. We aim to manage these conditions non-operatively, rehabbing back to a good level and sometimes even stronger. Overall, we want to be in a good condition to be able to do the things that we love and enjoy with friends and family, and have fun in the process. Our aim is to help with this process. Exercise and physical activity can be incredibly protective for our overall well-being as well as being a great source of socialising, getting outdoors and engaging with learning new skills.

We also work very closely with different members of our multidisciplinary team, including physiotherapists, strength and conditioning coaches, soft tissue therapists, podiatrists, orthopaedic surgeons, and many others that can help to get you back up and running.

A good example of a recent case is when I treated a 53-year-old who enjoyed playing tennis with worsening shoulder pain. She’d recently retired from a high profile job in the city and took up tennis. It was her passion, inspired by her favourite player, Roger Federer, enjoying tennis 4 to 5 times a week. She started to develop some pain around her shoulder, and then then it became suddenly sharp, which stopped her from playing. At this point she booked in for a review. After a thorough history, examination assessment and ultrasound, I noted that she had a calcium deposit around one of her rotator cuff tendons, and an MRI confirmed this whilst also ruling out a tear. This is called a calcific tendinopathy.

Over time, with excessive use the shoulder tendons can become overloaded and thickened. Occasionally at these areas, one can develop calcium deposits, which can end up catching through ranges of movement and become very painful, worsening with strokes such as forehands or serving. And this can be quite painful. I worked very closely with the physiotherapist.
Once we had the diagnosis, there were a few different ways to manage it. We worked together to make a strategic performance plan for their return to tennis. One procedure which I offered the patient was a barbotage, which involves inserting a needle into the calcium deposit via ultrasound guidance and helping to break it down, bringing the calcium deposits up to the surface. In the short term, this can be quite painful, but over time, it relieves the pain experienced. After the barbotage, I injected some steroid under ultrasound guidance to help settle the inflammed region at the shoulder joint.

Following this and a break from tennis, and some focussed and targeted physiotherapy, the patient rehabilitated well and improved significantly. I also updated her tennis coach who worked on her technique which helped to protect her shoulder even more. They were able to get back to their regular tennis pursuits, enjoying doubles matches with friends and family, whilst being relatively pain free. They even began to enjoy golfing sessions with their partner which brought them closer together!

What can you do if you begin to develop worsening shoulder pain?

1. Seek the expert advice from a Sport and Exercise Medicine Consultant who can assess and accurately diagnose the condition and devise a shared performance plan
2. Consider interventions such as ultrasound-guided injections or in this case of calcific tendinopathy, a barbotage procedure.
3. Have regular reviews and monitor the progress of the condition.
4. Work closely with a physiotherapist, strength and conditioning coach and sports coach – to get back to the physical pursuits that you enjoy.
5. To consider onward referral if there are any issues with the progress, for example, to a shoulder surgeon colleague for an opinion.
For more information on different conditions and how we can manage them, look out for more updates on the blog!
If you’re experiencing shoulder pain or would like to speak to a Sport & Exercise Medicine Consultant, click here to book your free 15-minute consultation to see if we can help you get back to your best.

Dr Farhan Shahid

Consultant in Sport, Exercise and MSK Medicine

Getting back on the court was a great feeling; she had made some great friends and enjoyed the social side as much as she enjoyed working on her game. She played regularly and had some competitions coming up shortly. Additionally, it was a great endorphin boost, helping her cope with the demands of modern life. She had also recently bought a dog and was walking a lot more than usual.

Tendon Health

Tendon problems can generally be classified in two stages: irritable or stable. Following our assessment, I determined that her tendon appeared to be stable, meaning she could still play tennis but experienced mild discomfort, about 3 out of 10 on the pain scale (with 10 being the worst possible pain). The pain was present at the start of her match and her tendon was slightly tender afterward, but it didn’t last long.

In line with the current research on tendon pain, I gave her some strength exercises for her calf, together with a demonstration of the exercise programme and then provided her with advice and education regarding the nature of tendon problems and how much she should be playing over the next few weeks.

As we started the session, I asked her a few questions to understand how the pain in her tendon was behaving and how it was affecting her daily life and function.

Fast forward a few months…

Our patient did her exercises sporadically and kept playing tennis. She was getting hooked and had even started playing some singles matches. Unfortunately, her Achilles pain had worsened. When we finally sat down to discuss it, she revealed that the pain was now constant and worse in the mornings. It was so bad that she had to stop tennis and walking the dog over the last week, and she was understandably frustrated.
This story is common and highlights how tendons can deteriorate. Her once stable tendon had become irritable, now preventing her from tennis and walking. This is often when people seek help, after struggling with the pain for a while and only stopping once it interferes with their ability to exercise.

Key Lessons

1. Exercise Guidance: It’s difficult to fully grasp the right exercises, frequency and progression with a one-off consultation, the internet, or a generic handout from the GP. It’s difficult to know if you’re doing the exercises correctly or how to progress your programme, which can lead to discouragement and eventually giving up. Many people are given the right exercises but often stop because they don’t know how long or how intensely to perform them.
2. Exercise Prescription: Tailored exercise prescription is crucial for tendon health, and that’s why I enjoy working with them. As a clinician, it’s important to assess the tendon’s stage and prescribe appropriate exercises. If you push the tendon too hard, the pain worsens, but if you don’t apply enough load, you’ll see minimal improvement. This is why review appointments are essential. People all have different demands on their bodies and different capacity to reduce their activity level. A review appointment allows the clinician to assess the person’s response to exercise and progress or modify their exercise programme accordingly.
3. Consistency in Execution: Another key factor is ensuring you manage the exercises properly—knowing how long, how often, and how intensely to do them. Strict adherence to this plan is what leads to improvement. Even though exercises for Achilles issues can seem standard, the management of these exercises is individualized. If you’re not seeing progress from exercises found online, it’s definitely worth seeing a physiotherapist, preferably someone like me!

Take Action Before It’s Too Late

The other major takeaway is to address your Achilles pain before it forces you to stop doing the activities you love. Managing tendon issues can take up to 12 weeks, with constant progression being key. If you stop your exercise programme and management too early, you risk setting yourself back.
Lastly, a note about tendons: once a tendon problem, always a tendon problem. You’ll likely need to maintain some form of exercise to keep your tendons functioning well, even when you’re able to run again. A good physiotherapist will design a program that works for your whole body and incorporates exercises you enjoy.
Once we started a programme again, settled the tendon pain and discussed proper management, she finally started improving and got back to tennis.

Are you experiencing tendon pain or pain in the Achilles and would like help and support to get to the root of the problem and fully recover? Get in touch today to speak with one of our specialist clinical team.

Written by Jehan.yehia@puresportsmed.com

Getting back on the court was a great feeling; she had made some great friends and enjoyed the social side as much as she enjoyed working on her game. She played regularly and had some competitions coming up shortly. Additionally, it was a great endorphin boost, helping her cope with the demands of modern life. She had also recently bought a dog and was walking a lot more than usual.

Tendon Health

Tendon problems can generally be classified in two stages: irritable or stable. Following our assessment, I determined that her tendon appeared to be stable, meaning she could still play tennis but experienced mild discomfort, about 3 out of 10 on the pain scale (with 10 being the worst possible pain). The pain was present at the start of her match and her tendon was slightly tender afterward, but it didn’t last long.

In line with the current research on tendon pain, I gave her some strength exercises for her calf, together with a demonstration of the exercise programme and then provided her with advice and education regarding the nature of tendon problems and how much she should be playing over the next few weeks.

As we started the session, I asked her a few questions to understand how the pain in her tendon was behaving and how it was affecting her daily life and function.

Fast forward a few months…

Our patient did her exercises sporadically and kept playing tennis. She was getting hooked and had even started playing some singles matches. Unfortunately, her Achilles pain had worsened. When we finally sat down to discuss it, she revealed that the pain was now constant and worse in the mornings. It was so bad that she had to stop tennis and walking the dog over the last week, and she was understandably frustrated.
This story is common and highlights how tendons can deteriorate. Her once stable tendon had become irritable, now preventing her from tennis and walking. This is often when people seek help, after struggling with the pain for a while and only stopping once it interferes with their ability to exercise.

Key Lessons

1. Exercise Guidance: It’s difficult to fully grasp the right exercises, frequency and progression with a one-off consultation, the internet, or a generic handout from the GP. It’s difficult to know if you’re doing the exercises correctly or how to progress your programme, which can lead to discouragement and eventually giving up. Many people are given the right exercises but often stop because they don’t know how long or how intensely to perform them.
2. Exercise Prescription: Tailored exercise prescription is crucial for tendon health, and that’s why I enjoy working with them. As a clinician, it’s important to assess the tendon’s stage and prescribe appropriate exercises. If you push the tendon too hard, the pain worsens, but if you don’t apply enough load, you’ll see minimal improvement. This is why review appointments are essential. People all have different demands on their bodies and different capacity to reduce their activity level. A review appointment allows the clinician to assess the person’s response to exercise and progress or modify their exercise programme accordingly.
3. Consistency in Execution: Another key factor is ensuring you manage the exercises properly—knowing how long, how often, and how intensely to do them. Strict adherence to this plan is what leads to improvement. Even though exercises for Achilles issues can seem standard, the management of these exercises is individualized. If you’re not seeing progress from exercises found online, it’s definitely worth seeing a physiotherapist, preferably someone like me!

Take Action Before It’s Too Late

The other major takeaway is to address your Achilles pain before it forces you to stop doing the activities you love. Managing tendon issues can take up to 12 weeks, with constant progression being key. If you stop your exercise programme and management too early, you risk setting yourself back.
Lastly, a note about tendons: once a tendon problem, always a tendon problem. You’ll likely need to maintain some form of exercise to keep your tendons functioning well, even when you’re able to run again. A good physiotherapist will design a program that works for your whole body and incorporates exercises you enjoy.
Once we started a programme again, settled the tendon pain and discussed proper management, she finally started improving and got back to tennis.

Are you experiencing tendon pain or pain in the Achilles and would like help and support to get to the root of the problem and fully recover? Get in touch today to speak with one of our specialist clinical team.

Written by Jehan.yehia@puresportsmed.com