Tennis is a popular sport that counts over 75 million players worldwide(1). The risk of wrist injuries affects both professional and amateur tennis players. Indeed, doing sports is good for health but sometimes, the intensity of the practice and poor techniques can cause pain.
EPITACT®, specialist in orthopaedics and involved in the field of sports, describes the most frequent causes of wrist pain in tennis.
Why is wrist pain in tennis so frequent?
Tennis is a pivoting sport, intense and very physical, that uses the whole body. In the upper limbs, the most vulnerable areas are the shoulders, elbows and wrists(2).
The frequency of tennis wrist injuries is mainly due to overuse of the limbs: repetition, intensity and speed of movements. Indeed, tennis requires repeated, powerful and sudden movements that associate flexibility, strength and endurance.
The racket/ball impact combined with the hitting power and vibrations transmitted to the upper extremities affect the shoulder, elbow and wrist. It can explain the increasing risk of traumatic and microtraumatic wrist injuries from tennis.
Risk factors of tennis wrist pain
The causes and aggravating factors of wrist pain from tennis are(3, 4, 10):
- Repetition and intensity of movements lead to wrist overuse.
- Level of the player: poor techniques (excessive flexion or extension of the wrist, hitting the ball incorrectly...) also increase the loads and traumas to the wrist.
- Frequency of practice: it seems that the rate of wrist injuries in tennis increases over 3 hours of play per week(9). In addition, the more people begin playing tennis early, the more they participate in competitions or very intense training. Therefore, the risks of injuries in tennis players increases with the combination of loads, repetition and insufficient periods of rest(4).
- Age: further to the previous point, people aged 5 to 18 are the most affected (29%) by tennis wrist pain. Next come the 19-40 (27%), then the 56 and over and the 41-55 (20%)(9).
- Gender: there is a higher frequency of tennis wrist injuries in men. In general, there are 1.6 injuries in men compared with 1 injury in women for 1000 hours of tennis play(9).
- Former injuries.
- Equipment, especially the quality of the racket.
- Types of grip: the one-handed backhand stroke more often affects the dominant hand whereas the 2-handed backhand especially concerns the non-dominant hand. Also, the Western and semi-Western grips often trigger extensor carpi ulnaris tendinopathy(5). Indeed, these types of grip tend to increase traumas to the external side of the wrist (ulnar side)(4).
What causes wrist pain from tennis practice?
Pain can have several causes according to its location. In tennis, wrist pain mainly comes from overuse. This overuse is itself caused by the repetition of movements involving the wrist, especially during the stroke. Your wrist hurts during your tennis sessions, it might be:
- Extensor carpi ulnaris (ECU) tendinopathy is the inflammation of the sheath surrounding the ECU tendon, characterised by pain on the external side of the wrist. As we’ve said, it is frequent in players using the Western and semi-Western grips(2). The risk increases when transmission of forces to the wrist is excessive during the stroke(5). There is also a risk of subluxation of this tendon, especially because of wrist flexions or ulnar deviations(6).
- De Quervain’s tenosynovitis(2) is one of the most frequent causes of wrist pain in tennis. This inflammation of the sheath surrounding the two tendons of the thumb leads to pain on the internal side of the wrist. Most of the time, it appears in players using the Eastern grip(8). The inflammation occurs due to repetitive flexion movements of the wrist.
- Carpal ligament sprain, mainly due to twisting movements(4, 7).
- Stress fractures can affect the scaphoid, hook of the hamate bone or metacarpal bones(2).
- Triangular fibrocartilage complex injury(2) is also a frequent tennis wrist injury.
Some tips to prevent and relieve tennis wrist injuries
If some risk factors of wrist pain from tennis are inevitable, others are. You’ll just need to know how to prevent or reduce them in order to protect your joints.
If you’re experiencing wrist pain when playing tennis, see a health professional. Your general practitioner or sports physician will choose the best treatment adapted to your activities. Moreover, according to the condition, the treatment is obviously different.
A wrist injury caused by tennis often requires you to stop practising, which is usually difficult to accept for a racket addict. Fortunately, there are several ways of preventing and limiting the risks of wrist injuries in tennis:
- Warm-up and stretching exercises before your sessions;
- Regular rest periods to avoid joint overuse;
- Muscle strengthening exercises of the wrist extensor and flexor(5);
- Improvement of techniques rather than hitting power and speed.
According to your condition, your GP could prescribe you physical therapy and tennis wrist support. Do not hesitate to ask him for advice!
For more details about this general and simplified approach, here are further sources:
(1)Pluim BM, Miller S, Dines D, Renström PAHF, Windler G, Norris B, et al. Sport science and medicine in tennis. British Journal of Sports Medicine. 1 nov 2007;41(11):703‑4.
(2)Patel H, Lala S, Helfner B, Wong TT. Tennis overuse injuries in the upper extremity. Skeletal Radiol. 1 apr 2021;50(4):629‑44.
(3)Girard O, Eicher F, Fourchet F, Micallef JP, Millet GP. Effects of the playing surface on plantar pressures and potential injuries in tennis. British Journal of Sports Medicine. 1 nov 2007;41(11):733‑8.
(4)Stuelcken M, Mellifont D, Gorman A, Sayers M. Wrist Injuries in Tennis Players: A Narrative Review. Sports Med. may 2017;47(5):857‑68.
(5)Chung KC, Lark ME. Upper Extremity Injuries in Tennis Players: Diagnosis, Treatment, and Management. Hand Clinics. 1 feb 2017;33(1):175‑86.
(6)Dines JS, Bedi A, Williams PN, Dodson CC, Ellenbecker TS, Altchek DW, et al. Tennis Injuries: Epidemiology, Pathophysiology, and Treatment. JAAOS - Journal of the American Academy of Orthopaedic Surgeons. march 2015;23(3):181‑9.
(7)Fu MC, Ellenbecker TS, Renstrom PA, Windler GS, Dines DM. Epidemiology of injuries in tennis players. Curr Rev Musculoskelet Med. 1 march 2018;11(1):1‑5.
(8)Perkins RH, Davis D. Musculoskeletal Injuries in Tennis. Physical Medicine and Rehabilitation Clinics. 1 aug 2006;17(3):609‑31.
(9)Kaux J-F, Schaus J, Delvaux F, Forthomme B, Joris M, Crielaard J-M, et al. Traumatologie du joueur de tennis. Journal de Traumatologie du Sport. mars 2016;33(1):43‑7.