Introduction
Tennis, a sport renowned for its demands on agility, precision, and endurance, has seen a notable rise in wrist injuries among players over recent decades (4).
Epidemiological data highlights two significant trends: firstly, wrist pain and injuries now constitute a higher percentage of total injuries in recent studies (2014–2015) compared to earlier ones (1986–1995). Secondly, the relative frequency of wrist injuries compared to other common problem areas such as the shoulder, elbow, and lumbar spine has increased, particularly among female players. This indicates that wrist problems have become more prevalent in the modern game (4).
The Mechanics of Tennis and Injury Risks
A typical tennis match involves intense physical activity, with players hitting approximately 70 groundstrokes per set, which translates to around 210 groundstrokes per match. Additionally, players serve about 40 times per set. The repetitive forces and motions required for these actions subject the body to significant stress, especially during serves (1).
Understanding the production of high-energy tennis strokes and their contribution to injury requires an appreciation of the kinetic chain concept of motion. The kinetic chain describes the flow and direction of energy in tennis strokes and serves. Musculoskeletal joints such as the knee, shoulder, and elbow act as links in this chain, absorbing, generating, and transmitting energy, ultimately transferring it from the ground to the tennis ball at impact with the racquet (2). The wrist/hand complex forms the crucial final link in this kinetic chain, playing a pivotal role in the production of all tennis strokes (4).
The Role of the Wrist in Tennis Strokes
During the serving motion, approximately 10% of the force and 15% of the energy involved in the stroke is dissipated across the wrist joint. Most of the power in these strokes emanates from the trunk and lower body musculature, not from the shoulder, elbow, or wrist. Thus, maintaining proper biomechanics of the trunk and lower body is essential in preventing wrist injuries (3).
In the forehand and serve, the wrist often rapidly flexes at ball contact. Conversely, during a ‘conventional’ volley, the upper extremity segments operate as a single functional unit, necessitating effective stabilisation of the wrist at and around ball contact. The wrist is also crucial for orienting the racquet face correctly during all strokes to ensure the ball follows the intended trajectory and possesses the necessary spin (4).
The wrist's range of motion (ROM) varies across different tennis strokes, involving specific movements in flexion/extension, ulnar deviation, and radial deviation:
Flexion/Extension:
The service stroke involves the greatest ROM, encompassing an arc of 90° to 100° of flexion/extension.
The forehand stroke involves a 40° range.
The backhand stroke encompasses a 37° range.
The wrist is in extension at the time of impact on all strokes (3).
Ulnar Deviation (towards the little finger. Figure 1):
During the serve, the wrist is in ulnar deviation at impact.
For both the forehand and forehand volley, the wrist ranges from 15° to 30° of ulnar deviation (3).
Radial Deviation (towards the thumb. Figure 1):
During the backhand and backhand volley, the wrist remains in a neutral position with 2-5° of radial deviation (3).
Understanding these variations in wrist motion is crucial for optimising stroke mechanics and reducing the risk of injuries.
Figure 1. Ulnar and Radial deviation |
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Grip Factors and Their Impact on Wrist Injuries
Wrist pain and injury are relatively common in modern tennis, where the Western and semi-Western forehand grips and a two-handed backhand are predominant. Certain wrist injuries appear to be related to the adoption of different grip styles (4) (Figure 2):
The Western or semi-Western grip tends to cause injuries on the ulnar side, such as extensor carpi ulnaris tendinopathy and triangular fibrocartilage pathology (5).
The Eastern grip is associated with injuries to the radial side, such as De Quervain’s tendinopathy (5).
Figure 2. Grip Styles |
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Mechanisms of Wrist Injury in Tennis
Although occasional wrist injuries from direct trauma, such as fractures from falls or being hit by a racquet, or from sudden, uncontrolled excess forces do occur, traumatic mechanisms are rarely noted in the tennis literature (4,6). The major mechanism of wrist injury in racquet sports is persistent repetitive controlled force, leading to tendinitis and other overuse injuries (4,6).
Overuse injuries generally present when the combination of load and repetition exceeds the tolerance level of the wrist's bony and soft tissue structures, especially when inadequate time is allowed for normal repair and adaptation processes (4). While the loads experienced at the wrist during tennis stroke production are typically below threshold levels for a single event, the cumulative effects of these loads through repetition (remember the 210 groundstrokes per match) are significant factors for injuries.
Conclusion
The rise in wrist injuries among tennis players is a multifaceted issue involving the mechanics of the sport, the kinetic chain concept, grip factors, and the cumulative effects of repetitive motions. By understanding the biomechanics and common injury mechanisms, players and coaches can better prevent and manage wrist injuries, ensuring a longer, healthier career in the sport.
References
1. Myers NL, Sciascia AD, Kibler WB, Uhl TL. Volume-based Interval Training Program for Elite Tennis Players. Sports Health. 2016 Nov;8(6):536–40.
2. Chung KC, Lark ME. Upper Extremity Injuries in Tennis Players. Hand Clinics. 2017 Feb;33(1):175–86.
3. Renström P, editor. Handbook of sports medicine and science. Tennis. Malden, MA: Blackwell Science; 2002
4. Stuelcken M, Mellifont D, Gorman A, Sayers M. Wrist Injuries in Tennis Players: A Narrative Review. Sports Med. 2017 May;47(5):857–68.
5. Peterson L, Renström P. Sports injuries: prevention, treatment and rehabilitation. Fourth edition. Boca Raton London New York: CRC Press; 2017.
6. Cassell E, McGrath A. Lobbing injury out of tennis: a review of the literature. Monash University Accident Research Centre. 1999 Feb;(144).
Understanding the importance of maintaining wrist health is essential to prevent injuries that can hinder your game. Check out the best wrist exercises for tennis players here?  |
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