In 2014, a total of 29 pitchers in Major League Baseball (MLB) underwent Tommy John surgery (TJS); also known as ulnar collateral ligament (UCL) reconstruction, is a surgical graft procedure in which the ulnar … read more
The 2014 US Open Tennis tournament was filled with ups and downs this year. Mirin Cilic beat out some top seeded players to win the men’s championship and the favorite on the women’s side, Serena Williams won the title. Years of training, wins and losses have been part of any tennis player’s repertoire, so have injuries.
Wrist injuries are common for tennis players and elite professionals. The anatomic location of the wrist and its major role in the kinetic chain needed in stroke production, it is unfortunately a common site of pain and disability. Often, the pain presents on the pinkie-side, or ulnar side, of the wrist.
Many players experience this ulnar pain in the non-dominant hand during two-handed backhand strokes. In this stroke, the top hand is placed in extreme ulnar deviation and extension, while dynamically moving from supination to pronation. This same motion-type occurs in many tennis strokes, and as such can lead to acute and chronic ulnar wrist injuries.
Tennis players can present with an acute event of sudden onset – either after a violent fall with the wrist in extension and pronation/supination, or after hitting the tennis ball and having an immediate feeling of ulnar wrist pain. According to Dr. Weil, “Ulnar sided wrist pain in tennis players can often be due to tendinitis and can be treated in a conservative fashion. Sometimes degeneration of the cartilage of the wrist can occur.
If you are experiencing pain for more than a few days while playing tennis an evaluation by an orthopedic surgeon is recommended.” When the presentation of pain is chronic and insidious, the ulnar wrist pain arises over the course of days or weeks, and the athlete usually cannot recall a single inciting injury.
Wrist injuries in tennis players often result from over-use, improper technique, and even using the wrong equipment. Also, excessive wrist motion during the stroke will predispose a player to injury. Some things to consider to help prevent ulnar wrist pain:
- Equipment: Using the wrong grip size, wrong strings, and improper string tension can all lead to wrist pain. The grip size can determine the amount of force needed to hold the racket through the stroke, leading to increased firmness of grip and potential injury. Too firm a grip can restrict free movement of the arm. The grip should be only as firm as necessary to ensure proper stroke technique.
- Grip: Extreme grips like a Western will compromise the position of the wrist, forearm, and elbow which places additional stress on the adjacent muscles and tendons. For the two-handed backhand player, use of the continental grip on the bottom hand and the Eastern forehand grip on the top hand is preferable. Players using extreme grips (Western) place their wrist and forearm in positions that place additional stress on the muscles, tendons, and ligaments and can predispose them to injury. Additionally, another breakdown in technique is when the player uses the wrist and hand as primary force generators during ball strike. The wrist and hand must be viewed as links in the kinetic chain whereby large forces generated from the ground, lower extremity, and trunk are transferred.
- Position of wrist at ball strike: In the two handed back-hand, the tendency for some players is to place the top hand in extreme extension and ulnar deviation prior to ball strike. The thought is to power the ball into creating topspin at contact. By using the Eastern Forehand grip in the top hand (left hand in right handed players) and by incorporating the players’ core and lower body/legs into the stroke properly, the lower body/core can load the energy and transfer load and energy up the kinetic chain into the arm and wrist to abate some of the torsional stress on the wrist.
- Physical: Due to the physical demands of tennis and all of the repetition that is involved, tennis play causes the dominant playing side to over-develop which leads to overall body muscle imbalance. Exercises that strengthen the wrist, forearm and elbow include wrist curls, radial and ulnar deviation resistance maneuvers, and ball dribble off the floor then wall to improve both strength and endurance.
Helpful tips to prevent wrist injury:
1) Choose your equipment carefully, take into account level of play and age.
2) Be sure to use proper grip and technical skills, and be open to reviewing these periodically, even using video, making note of changes in swing mechanics pre and post ball strike.
3) Have a daily routine to include strength and flexibility exercises that increase stamina and maintain range of motion; this should include the hands, wrists, forearms, elbows, and shoulders.
4) Have elastic bands in your bag to allow you to perform strength exercises anytime and have them easily accessible; also, you should be able to perform this routine away from the supervision of coaches, trainers, and parents.
5) Perform strengthening exercises after practice or match play or on “off” days where not hitting is done to avoid muscle fatigue during play.
If you believe you are suffering from a tennis-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.
The 2014 Seattle Seafair Triathlon and Kids Seafair Triathlon will take place on July 20, 2014. OSS is the Presenting Sponsor for these events and the orthopedic surgeons would like to congratulate the athletes who are coming out to be part of this event.
Training for a triathlon is tough but that’s part of the challenge. Consider this: Four out of five amateur triathletes are injured while training, and three of those four are injured badly enough to affect their daily activities.
The complexity of the sport and broad range of knowledge needed to train and compete safely are contributing factors. The triathlete must learn about appropriate equipment specifications, proper body mechanics, injury prevention and overall training programs that prepare the body for the stresses of triathlon.
Cross-training for three different events also increases the risk of certain overuse injuries, and an untreated injury in one part of the body can lead to problems elsewhere. For example, a knee injury from running can cause extra stress on the back, leading to lower back pain when cycling; and the cumulative effects of swimming and cycling can fatigue calf muscles, making legs more susceptible to injury during a run.
The good news is, most nontraumatic injuries are related to training errors that can be corrected – and professionals with specialized knowledge in triathlon training and injury prevention can help.
Prevention: Training Smart
The best way to avoid a traumatic injury is a training program that balances strength, flexibility and endurance through appropriate weight-lifting, stretching and cross-training. But training techniques are not one-size-fits-all. Every individual has a unique combination of anatomy, strength, endurance, and flexibility – so what works well for one athlete is not always the best advice for another.
Understanding the complex interactions between musculoskeletal groups related to swimming, cycling, and running is essential in triathlon training. An OSS surgeon can evaluate your physical conditioning, analyze your training techniques and correct errors that can lead to future injuries, and provide a training program optimized for you as an individual.
The best training program can’t prevent all injuries. When injuries do occur, there are three things you need to know: (1) how to evaluate the severity of an injury, (2) how to self-treat an overuse injury, and (3) when to seek professional help.
Dr. Weil has this to say about the upcoming triathlon and words of wisdom when it comes to training for a triathlon, “I’d like to congratulate all the triathletes participating in the 2014 Seafair Triathlon! I’d also like to send a special congratulations to the first time triathletes participating in this year’s event. As you all know training for and participating in the sport of triathlon involves a huge commitment on the part of athletes and their families. Unfortunately, sometimes things don’t go as planned and injury can derail even the most experienced triathletes. I have experienced this issue first hand from all perspectives, as a treating physician, as a 2013 Ironman Canada Finisher, and currently as an injured athlete in rehabilitation trying to get back to the sport. When the unforeseen occurs, it is always best to seek medical evaluation. Often times if issues are addressed early on, they can be treated without significant time loss from training and without surgery. It is my goal as a treating physician to understand athletes needs and to work together with athletes to help them return to sport as soon as possible.”
If you believe you are suffering from a sport-related injury and need specialized orthopedic care, the orthopedic surgeons at OSS provide excellent treatment options for your injury. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.