Tennis Wrist Injuries

A tennis wrist injuries have forced has forced me to miss tennis since November 2019. The recovery is slow, possibly another couple of months (6-18 months typically), and has required initial rest followed by physiotherapy and a structured rehab program.

The wrist injury was most likely caused by a change in technique combined with an increased workload on the tennis court and… sadly age. I never really dedicated much time to the gym to strengthen my wrists specifically for tennis. I sure am now!

Many pro players including Del Potro, Nishikori, Nadal & Kuznetsova have had time off the tour in recent years due to wrist injuries and even gone under the knife. Nadal missed most of 2016 due to a persistent wrist problem.

Many wrist injuries result from aggressive modern grip types. The semi-western and western forehand grips are associated with injuries to the ulnar (little finger) side of the wrist.

This includes the highly problematic dislocations and degeneration of ulnar wrist tendons (extensor carpi ulnaris tendinopathy) that have plagued players such as Nadal.

The wrist becomes the “meat in the sandwich” at ball contact when it is twisted, cocked, and severely angulated. The tendons around the wrist deal with an incredibly high load of stress when the ball impacts the racket.

As the speed and tennis power of the modern game increase so too do the level of force absorption capabilities modern racquets are equipped to cope with. This is obviously a good thing however, our wrists still bear the brunt of hitting thousands (possibly millions) of balls a year.

The dynamic nature of the modern double-handed backhand also poses problems as players are supinating their top hand so severely that wrist integrity is being compromised. This was the cause of one of DelPotro’s wrist injuries. 

Junior tennis players, recreational players, and professionals should take precautions to bulletproof their wrists in a sport that is increasingly stressful on so many joints.

It is important to strengthen the muscles around the wrist joint to stabilize it and reduce strain on the ligaments and cartilage. Players with a double-handed forehand or a double-handed backhand need to make sure they strengthen both wrists.

Aside from strengthening the wrists technique is also important. Chat with your coach and see if they can film your strokes for analysis and discussion. A few technical tips include:

• Try to hit the ball in front of the body, so it is easier to fully use the shoulder and trunk and to stabilize the wrist.
• Try to use the forearm for racket control only, and not for strength. Strength should be exerted mainly via the shoulder and trunk muscles instead of the forearm muscles.
• Don’t overlook the importance of strengthening and conditioning the wrist to cope with the demands of the sport. Here are several recommended tennis exercises aimed at increasing wrist strength and promoting longevity in the sport:

RECOMMENDED TENNIS WRIST EXERCISES

1️⃣ Weighted static holds - Support forearm on the knee. Hold a lightweight (max 1kg to begin with) in the hand of the supporting arm. Keep the wrist in a neutral position & hold the weight for 45sec. Switch to the other arm. Repeat 5 sets on each arm. The exercise should slowly begin to fatigue the forearm muscles. The last set or two should be challenging. If not gradually increase the weight. Also slowly increase the weight as your strength improves.

2️⃣ Wrist flexor muscles - Start with a lightweight (max. 1 kg) or elastic tubing/band. Support the forearm with a slightly flexed elbow on the knee, palm of the hand facing up. Move the wrist up and down, from a neutral position (2-3 sets of 10-20 repetitions).

3️⃣ Wrist extensor muscles - This exercise is the opposite of the exercise for the wrist flexor muscles. Support the forearm with a slightly bent elbow on the knee, but now with the palm of the hand facing down. Move the wrist up and down from a neutral position. This can be built up to 2-3 sets of 10-20 repetitions. When starting these exercises, it is sufficient to simply hold the weight, without moving the wrist.

4️⃣ Ulnar/radial deviation and pro/supination - Support the elbow on the knee, palm facing down, and lightweight in the hand. Move the hand to the left and right. 3 sets of 10-20 repetitions. Refer to the video above.

5️⃣ Hammer drill - Hold a hammer in one hand and support the arm as shown. Slowly rotate your hand with palm facing up and perform 10 slow small, controlled pulses. Then rotate your hand in the opposite direction palm facing down and perform 10 slow, controlled pulses. Continue for 5 sets in each direction, until you have completed 50 pulses on both sides.
NOTE: Start the exercise by holding the hammer close to the head. Gradually slide your hand down the handle to increase the amount of offset weight increasing the challenge. IF YOU EXPERIENCE PAIN DO NOT CONTINUE.

6️⃣ Plated ball balance exercise - Find a large, flat plate. Spread the fingers of one hand and sit the plate on top of the fingertips as shown. Place a ball, marble or golf ball on the plate and gently roll the ball around the plate making small necessary adjustments with your fingers in order to balance the ball. Don’t let it roll off! This exercise challenges and improves the dexterity of the hand and aims to improve strength in the muscles that stabilize the wrist. A fun exercise!

Refer to the video above for demonstrations of all of the above.

By Mark Jones (Tennis Fitness Sydney Based Trainer)