Wrist Injuries in Tennis Players

Originally Published Oct 2, 2019

Each tennis player has a unique style: just watch Roger Federer and Rafael Nadal! Understanding the different types of tennis stroke helps us to be more specific when something goes wrong! Today we’ll analyse different tennis strokes, the wrist injuries associated with them, and specific exercises. Other common tennis injuries are shoulder rotator cuff tendinopathy and lateral epicondylalgia (“Tennis elbow”). We will look further into those another day.

In tennis, wrist injuries most commonly occur during forehand groundstrokes. This is the most commonly used stroke and is performed with the dominant forearm in full supination (outward roll) and the wrist flexed in ulnar deviation (fingers bending toward the ulna bone away from the thumb). The ECU tendon is put through a high amount of eccentric load during the forehand swing. Dynamic repetition of this stroke depends largely on the integrity of the ECU tendon and its ability to contribute to wrist flexion and extension. Tagliafico et al. 2009 found that certain grip types increase the risk of ulnar sided wrist injuries.

Federer’s Forehand Style:

• Eastern grip
• Full upper body rotation for forehand stroke preparation
• High to low motion during take back and backswing that stays on the same side of the body
• In front of body contact point, with straight arm due to backswing
• Windshield wiper finish, with the right arm across the shoulder, rather than the traditional “over the shoulder” finish

Nadal’s Forehand Style:

• Full Western grip
• Upper body torso twist with semi open stance for forehand stroke preparation
• Low to high take back and backswing motion
• In front of body contact point
• Windshield wiper finish with powerful acceleration and reverse follow through

During these powerful Forehand swings, the Stretch Shortening Cycle (SSC) is at work. Essentially, the SSC is a passive stretch where the power is generated upon release of the stored energy. Think of it like a rubber band. If you were to pull on a rubber band, the energy would be passively stored from within the band. Once the rubber band is then released from your hand, all of the stored energy is then shot out. During both player’s Forehand strokes, muscles like the bicep, pecs and wrist flexors are put on heavy stretch before contact with the ball, but it is even more pronounced during Nadal’s Forehand because of the increased amount of supination/wrist extension. Muscles like the ECU are put at further risk! Indeed, Tagliafico et al. 2009 found that utilization of Western, semi-Western grip types and double handed backhands increases the risk of ulnar sided wrist injuries.

We see different types of wrist injuries for these styles:

• ECU tenosynovitis
• ECU tendinopathy
• ECU tendon instability/subshealth rupture
• TFCC injury
• De Quervains

For these wrist injuries, we would recommend:

• Rest
• Activity modification
• Splinting
• Wrist Widget
• Surgical repair for a rupture of the ECU
• Strengthening Exercises, such as: Scap setting with theraband pulls at the end of the backswing; Gently bending the wrist down for a mild stretch; Wrist Supination and pronation; and Braces.

If you’re worried that you may have developed a wrist injury through tennis, our Physio Inq physiotherapists can help you learn effective exercises and a specialised treatment plan just for you.

Call us today or book online for your next appointment. We look forward to helping your Forehand tennis stroke improve, and even just to get you back on the court!