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Prevention of Injury

Q. The repetitive demands placed upon the wrist of elite players frequently lead to injury. Loads placed upon the wrist can result in the development of tendonitis in the muscle tendon units that cross the joint and provide both stability and movement of the forearm wrist and hand.

Additionally, stress fractures, ligament sprains, and tears in the cartilage at the end of the forearm bone (ulna) can also occur and limit performance.

A. Several important factors can be applied to prevent wrist injuries. The first and most important is the use of proper technique.

Players using extreme grips place their wrist and forearm in positions that place additional stress on the muscles, tendons, and ligaments and can predispose them to injury.

Additionally, the use of the wrist and hand as primary force generators also can lead to injury. 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.

The reasonably delicate tendons crossing the wrist cannot be asked to generate the forces required for powerful strokes in tennis without injury occurring.

Other factors in preventing wrist injury are to increase strength and range of motion using specific exercises which will form the basis for discussion in this article.

The muscles that control forearm, wrist and hand movement actually originate near the elbow joint. Hence, strengthening the wrist involves the use of exercises typically thought to increase elbow strength and prevent tennis elbow.

These exercises include wrist radial deviation (figs. 1a-1b) and ulnar deviation (figs. 2a-2b) and wrist flexion and extension (figs. 3-4).

Use of these four exercises will stimulate muscle development of virtually all the muscles that support the wrist joint. Note that the forearm is stabilized during the performance of the wrist flexion and extension exercises, and that the radial and ulnar deviation exercises are done in standing using one end of the weight to produce a bit of a counter-balance.

Start by using three sets of 15 repetitions of each exercise. Typically a 3-5 pound weight will produce fatigue of these muscles initially, or light to medium resistance elastic tubing which is easier for players to travel with.

Avoid doing these exercises immediately before playing tennis as pre-fatiguing the muscles prior to play is not recommended.

An additional exercise that can also improve the strength and endurance of the wrist and forearm muscles is the ball dribble (fig. 5).

Dribbling a basketball or exercise ball first against the floor and then against a wall at approximately eye level rapidly for 30 seconds or more creates significant fatigue of these muscles. Performing these exercises should be a regular part of a tennis players program.

In addition to the strengthening exercises, stretches to ensure optimal range of wrist motion are important. Research has shown that tennis players often lose elbow and wrist motion on their dominant side from long-term play. Stretches to improve the flexion and extension of the wrist can be done with the elbow in an extended (straight) position in front of the player.

Bending the wrist downward (with the palm down) and rotating the fingers outward using the other hand stretches the muscles on the top side of the wrist and forearm, while repeating a stretch with the elbow straight and hand in the palm up position bending it downward and rotating the forearm inward will stretch the muscles on the underside of the forearm.

Holding each stretch for 15-30 seconds will help to maintain and even improve wrist range of motion. Remember, it is very important to stretch after you play when the muscles are very warm and optimal gains in flexibility can occur.

Following the simple use of exercises to increase wrist and forearm strength and endurance as well as flexibility exercises to prevent range of motion restrictions in the wrist can help to minimize the risk of an injury from the demands of repetitive tennis play. Coupled with proper stroke mechanics, these exercises can help to enhance performance.

Q. What are the most appropriate exercises to prevent ilio-tibia band syndrome or to alleviate it?

A. The ilio-tibial band (IT band) is not a muscle but rather a thick band of fascia that originates at your hip and attaches on the outer side of your knee. If not stretched during your cool down this band will actually shorten and can cause pain at either your hip or your knee.

To prevent this pain you should perform thorough static stretching of this area (holding 20-30 seconds).

My favorite way to stretch this area is to lie on your back with the knees bent and the feet flat on the ground. Cross the right leg over the left (to stretch the left IT band) and pull the left leg towards the ground (See the picture).

Keep both shoulders on the ground and hold this position for 20-30 seconds-using your opposite leg to assist in the stretch. You should feel a stretch in the outside of the left leg. Switch and repeat.

Another effective way of stretching the IT band, and reducing pain in this area, is to roll over a foam roll. Lay on your left side (again to stretch the left IT band) positioning the foam roll under your left hip.

Slowly move your body so the foam roller “rolls” towards the knee and then back to the starting position. Perform several repetitions in this way. Your body weight provides the necessary force to “massage” and stretch the IT band.

Stretching after the muscles are warm (e.g. at the end of practice) is much more effective and will lead to an increased lengthening of the fascia and a decrease in pain.

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