Wrist and return

Lining up for a forehand, it is not uncommon to see a player significantly drop the racquet head then whip it up-and-over like a windscreen wiper. This movement produces increased spin – but also places a lot of stress on the wrist. It requires extreme end-of-range positions in both the wind-up and follow through stages on structures that are designed to support and limit such movement.

Wrist injuries in tennis
Typically there are two types of wrist injuries – ulnar (little finger) side and radial (thumb) side. According to an American Journal of Sports Medicine study published in 2009, radial-sided injuries often common to players that use an Eastern forehand grip, with ulnar-sided injuries more common in players with a Western or Semi-Western grip. Players that use a doublehanded backhand also have a tendency to develop ulnar-sided wrist pain in their non-dominant hand due to the amount of wrist extension and deviation that is required to drop the racquet head in preparation for the shot.

Why do they occur?
When players make a change to their technique or equipment, this can lead to injury. As the muscles and tissues around the wrist become conditioned to a repetitive amount and frequency of strain, even small changes can have profound effects. Making alterations to the weight of the racquet, string tension, or grip size need to be made slowly, allowing the tissue time to adapt to the change. This process should happen steadily over a period of four-to-six weeks, permitting any soreness to settle over two-to-three days.

Prevention
Strengthening wrists, both for power and endurance, is vital. Although injury often occurs when muscle support has been weakened through fatigue. The muscles and other soft tissues require time between each bout of loading to recover and to rebuild themselves to grow stronger. Strengthening should begin with light resistance, focusing on high repetition (x30–40 repetitions) as this is the type of strain the muscles need to endure with tennis. Strengthening also needs to include movements not just in the up-and-down plane of the wrist, but also the side-to-side motion along with rotation and twisting motion. Overall grip strength is important too. Perfecting technique is another preventative measure. It is important not just to focus on what the wrist is doing, but also the entire upper limb and trunk. The wrist is the last link in a long chain which generates the force that needs to be transmitted to the racquet. It should be used to transmit rather than create force.

Return with caution
There are a number of precautionary measures that can be taken when returning to the court post injury:
— Taping is a good way of assisting an injured wrist in a return to play. Often a degree of looseness in some of the ligaments around the wrist is associated with these injuries, so taping the wrist can increase support while strength is being regained. This can help a return to court earlier and also limit pain intrusion.

— Keep initial on-court sessions shorter to allow for recovery. Take extra care when practising volleys as they require a greater amount of strength to absorb impact through the racquet. This can lead to more rapid fatigue in the surrounding wrist muscles.

— Try to avoid other activities that place the wrist in extreme positions. This includes pushups with the palm flat on the ground, or doing weights in the gym with the wrist in end-of range extension.

Rob Brandham, APA Sports Physio, BPhysio, MPhysio (Sports), has experience managing musculoskeletal injuries in AFL, soccer and rugby. He has worked at the Australian Open and Tennis Australia. Rob is based at the St Kilda Road Sports and Physiotherapy Centre.