Every year I treat players competing in the Manly Seaside Tennis Tournament in Sydney, held from boxing day to new year’s eve. This year I saw a couple of cases of wrist pain. Both players were male between 25-30 years old and of a very high standard of play.
In each case, pain was located on the ulnar aspect of the wrist at the triangular fibrocartilage complex [TFCC]. You can locate this structure by looking at the back of your hand. If you follow the pinky finger side of your hand down towards the wrist, the TFCC exists just before you reach the bony bump of your forearm bone, the radius.
The TFCC’s main functions are to:
- transmit load across the wrist joint.
- partially absorb load across this joint.
- facilitate forearm pronation and supination by giving a strong but flexible connection between the two bones of the forearm.
How do you get TFCC wrist pain?
Tennis players are at risk of injuring the structure due to the nature of how the modern day forehand is produced. Everyone knows that players are hitting harder, but they’re also hitting with more spin. Hitting with more spin has resulted in a more “wristy” approach to hitting the ball.
I have made mention of the “windscreen wiper” type forehand in previous posts on medial epicondylitis (Golfer’s elbow). It is at the time of impact with the ball, when the wrist is extended and ulnarly deviated, that the TFCC will experience a “squashing” force. This force multiplied many times shot after shot will eventually see this structure crying out in pain.
As mentioned above, one of the functions of this structure is to absorb this load so whilst it functions to cope with these loads, it does have a shelf life. In the same way that you can break a coat hanger by repetitively bending it forwards and backwards, you could also “break” the TFCC.
How to test yourself for TFCC pain
The load test – there are two ways of doing this test. Either push upwards on the underside of a desk, or push downwards on the surface. This test might not always seem very predictive of wrist pain, you will need to experiment with the degree of extension you hold at your wrist. You should find some positions may prove more painful than others during this test.
Other every day indicators for TFCC irritation include;
- pain on a firm hand shake
- pain on feeding a tennis ball or hitting a forehand
- pain either in the push up position or when doing a push up
- pain during a bicep curl
How to fix it?
Sadly, if you love tennis as much as I do, you won’t like what I’m about to say. As this injury is a classic repetitive strain injury (RSI), rest is the best medicine.
Assuming you are in fact suffering this pain from playing tennis it’s quite possible that it is simply from hitting so many balls – the rest will give the structure time to repair itself. It may however be a flaw in your technique and therefore worthwhile having someone assess your strokes (try videoing yourself).
Strapping is very helpful. This will immobilize your wrist to some degree so that you will not be at risk of subjecting the joint to ranges of motion where the TFCC will become painful. So long as you can avoid the painful positions during this period of rest, you can rest assured that the healing process will be successful.
Your chiropractor or physical therapist can strap the wrist using non-elastic tape, alternatively you can purchase a specialized wrist guard which is highly effective, easy to use on your own. You can purchase these wrist guards through Cartwright Physicaltherapy by emailing firstname.lastname@example.org.
How to prevent it?
- Never play with wet balls, they are heavier and will thus “squash” your TFCC more.
- Equipment – have your racket suitably customized with favorable weight and string specifications
- Have regular treatment on your body – joint mobilization and soft tissue work on the forearm muscles will relieve the body of a build up of tightness and restriction in these areas that would otherwise lead to injury.
Finally, it is worthwhile noting that your wrist is essentially the last major joint in a chain of joints in the upper limb. It is possible that your wrist pain may be a compensation pattern for joint restrictions or muscle injuries residing more proximally, for example in the elbow or shoulder, or even as far away as your back and pelvis.
Chiropractors make great body mechanics and are an excellent resource for treating these potential underlying causes of wrist pain. Of course, your wrist will need some attention too, so choose your therapist wisely, ensuring they are competent in treating these more specific injuries.
*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.