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  • Writer's pictureRandon Hall, MD

Serena Williams - Why Is A Pectoralis Injury So Critical to Her Serve?

Serena Williams Withdraws From French Open

Serena Williams had to withdraw from the French Open due to a pectoralis injury. Initial reports are not clear, but this could be anything from tendonitis, muscle strain or a significant tear. Based on her ability to attempt to play, it is unlikely that she has a significant pectoralis tear usually referred to as a rupture. Serena has recently returned to tennis after the birth of her daughter and maternity leave to spend time with her family. Her time away from the game, certainly may have played a role in this injury as her demanding training regimen may have been too much stress on the body after such a significant time away. Reports indicate that her primary issue is she is unable to serve due to the injury. Let's take a deeper look at why that makes sense.

The Pectoralis Muscle Plays A Crucial Role in the Tennis Serve

The pectoralis muscle plays a significant role in the tennis serve. The pectoralis major is a broad muscle that includes two major sections. The sternal portion runs from the sternum (breast bone) across to the upper arm, and the clavicular portion runs from the clavicle to the upper arm as well. As the pectoralis attaches to the inner aspect of the upper arm, it is under significant stretch when the arm is up over the head in the racket drop position. As the racket is brought forward to contact the ball the pectoralis is engaged along with the rotator cuff muscles (among others). However, after contact with the ball, the arm continues with internal rotation of the shoulder, and the pectoralis is primarily responsible for bringing the racket across your body to complete the follow through. An injury can occur with excessive stress to the muscle, either causing tendonitis, a strain, or a true a tear within muscle-tendon junction or bony attachment site. I have a break down of pectoralis tears in another post.


The big question is what is going to get Serena back to normal? In general, if rest and physical therapy should dramatically help her symtpoms. If this is in the early stages, then I would assume that she should be good to go within one months time if not sooner. I agree with her scratch from the French Open for several possibilities. If she truly has a tear and it does not heal properly, this can have a significant impact on her game in the future. Secondly, if this is tendonitis and she pushes through the pain, the tissue can undergo changes that cause the tendon to develop a more chronic pain called tendinosis. The changes to the tendon can include degeneration of the tissue and increased nerve and blood vessel growth. The combination of these changes cause the tendon to be unable to handle the same stress it could handle before and be more sensitized to pain. Tendinosis can be notoriously difficult to treat as in the case of San Antonio Spurs' Kawahi Leonard. She is currently scheduled for the U.S. Open starting August 29th and if all goes well, she should definitely be on track to regain her #1 ranking.


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