This is Part 3 of a 3-part series on diagnosing ECU tendinosis and how I managed my injury to be able to play tennis pain-free. In Part 1 we covered the function of the ECU, the symptoms I experienced in my ECU tendinosis and some background on tendon injuries. In Part 2 I discussed how I believe Bikram yoga enabled me to take the stress off of my tendon and eliminate the pain so that I could play tennis while my tendon heals through
- gentle wrist traction and loading of the tendon
- improving the function of my kinetic chain on the tennis court
In this post I’ll be discussing ways to prevent or to minimize wrist pain in existing wrist injuries on the tennis court. These include technique adjustments, optimizing racquet and string set-up, and a great wrist brace.
Update: Also see my post on making your poly strings more comfortable for further info on how softening your polyester string-bed can reduce shock to the wrist.
I want to reiterate that I’m not qualified to give medical advice. I’m just sharing my own story and interpretations of research. Please talk to your doctor if you have wrist pain.
I’ve recorded myself hitting forehands a few times over the years. Looking back at the videos I can see that my early forehand (Winter 2014) was quite terrible and hitting thousands of forehands with this technique most likely contributed to my wrist pain. My wrist is laid back before contact, at contact and after contact with virtually no change in the forearm/racquet angle throughout the contact zone. This means I’m actively contracting my ECU muscle (placing more stress on it and the ECU tendon than I should be), and also contacting the ball with my ECU in this stressed position.
Last year I did an analysis of my 2015 forehand (videos taken in the summer and late fall) compared to Djokovic’s. In this I noticed that my wrist was still above the racquet head and quite laid-back at contact whereas Djokovic’s was much more level. He has started pronating through the contact zone while my forearm is still very much supinated. This means my hand is in ulnar deviation and in extension at contact to a greater extent than Djokovic’s, who’s is much more relaxed and in a neutral position. I noted at the time that I wanted to work on getting my hand and racquet head more level and neutral at contact by pronating through the contact zone.
So while I think my technique had improved since winter 2014, particularly in the fall 2015 picture, it still wasn’t where I wanted it to be. The following images show my forehand compared to Djokovic’s at contact from first the summer of 2015 and then the fall of 2015. You can see how much more laid-back my wrist is at contact compared to Djokovic’s.
The following picture shows the position of my wrist just after contact in my forehand over the years. I think this shows a clear improvement in releasing my wrist and pronating through contact which puts less stress on my ECU tendon and has helped eliminate my wrist pain.
I also noted in my forehand comparison that I didn’t get nearly as much of a unit turn as Djokovic. I think this means that I was generating less power in my legs and trunk and possibly trying to compensate for this later down the chain by producing more force in my arm and wrist. This could also have been contributing to my wrist pain. The following image shows that I had a much less significant unit turn than Djokovic.
Over the last season I’ve been working hard to improve my forehand technique. While I still don’t get as much of a unit turn as I’d like (still working on this), I have noticed that I’m able to pronate through contact so I’m contacting the ball with my wrist in a much more neutral position. This gives me more power and topspin than I had before but feels way easier than it did when I kept my wrist more locked through contact. It seems like I’m releasing my energy into the ball in a natural way as opposed to trying spin my body around really fast with a fixed arm to generate force if that makes any sense. The following image shows a comparison of my forehand unit turn from Fall 2015 to Fall 2016. My shoulders are more square to the sideline in the Fall 2016 picture, indicating a more pronounced unit turn.
I think that the improvements I’ve achieved in my forehand that have reduced the stress on my ECU tendon and helped to eliminate my wrist pain are due to a combination of the following:
- Focusing on my technique and actively trying to change it.
- Improving the mobility in my hips, trunk and shoulders (kinetic chain) so that I’m physically able to get a bigger unit turn and generate more energy in my larger muscles and release it into the ball rather than trying to generate it a lot of it in my forearm (this is discussed in more detail in Part 2 of this series).
In my opinion it’s incredibly important to do periodic video analysis of our strokes, particularly if we play a lot. Good technique is crucial for preventing injury in repetitive motion. My forehand analysis helped identify areas for improvement and track improvements I’ve made over time. I think my early forehand was a major contributor to my wrist injury and improving my technique likely helped fix it.
Equipment Setup for Minimizing Wrist Pain
Wrist Widget (link to Wrist Widget site)
The Wrist Widget is a brace that is specifically designed for injury to the TFCC. The TFCC is a cartilage complex in the wrist that’s also frequently injured in tennis and is closely associated to the ECU. I started using it long before I knew what the actual problem was in my wrist and found it significantly decreased the pain in my wrist.
The brace is affordable and comfortable and really makes your wrist feel supported while playing. The opening over your ulna bone head gives your wrist freedom to move and also anchors the brace in place so it’s not constantly sliding down your arm like I find the drugstore wrist supports do.
The inventor, Wendy, is incredibly helpful and will discuss your situation through emails or on the phone. She has a simple test on her site you can do at home to help diagnose your injury and see if the Widget will work for you. Wendy recommends wearing the brace basically 24/7 for a few months to allow your injury to heal (or at least during the day). I did try this but at the end of a few months the pain was the same (maybe because my injury is my ECU, not my TFCC). However it did help significantly with pain during playing and I still to this day wear the brace pretty much whenever I play tennis.
I’ll also mention that you can get the same effect by taking two thin strips of tape and wrapping them around your wrist above and below your ulna bone head. I’ve done this in a pinch (i.e. when I’ve forgotten my Widget at home) but I find the tape can give me blisters on my skin. Also the Widgets costs only around $25 each (you can buy them in packs to get a discount) and I find one will last me about 3 months of playing almost every day before the velcro gives out and I need to start using a new one. So I think taping would end up costing just as much as the Wrist Widget and the Widget is more convenient and comfortable. However the tape is a great way to determine if the Wrist Widget will work for you before purchasing one.
I switched to polyester strings from synthetic gut in the spring of 2015. At the time I loved that I could generate much more topspin with poly strings. At the recommendation of my local stringer I was using Luxilon Alu Power strings strung at 52lbs.
After reading up on tennis stringing I’ve learned that poly strings are much stiffer than synthetic gut and you’ll see a lot of recommendations that people with arm pain shouldn’t use poly strings. I didn’t want to give up on poly just yet, so a little more reading taught me that Lux Alu Power strings are notoriously uncomfortable and there were more comfortable poly strings out there. Based on reviews, I settled on Volk Cyclone in orange which looks ridiculous but is noticeably more comfortable. I’ve also dropped my tension to 48lbs (from low 50s) which makes the strings more flexible and able to absorb more of the force from the ball, therefore passing less on to your arm.
I do find I need to re-string every 10-15 hours of playing. If I don’t, I’ll notice my wrist start to hurt a bit (not to mention a decrease in control). The question of strings becoming more or less comfortable with time and play is controversial, but I found a great article at Tennis Warehouse University that explains the theory and concludes that there are competing changes to softness and stiffness characteristics and the net effect determines how the strings will play and feel. This means that there isn’t one answer to this question. Perhaps your racquet and string setup and playing style result in your strings actually becoming more comfortable with time, but it’s something to keep in mind that your strings could be contributing to your pain as they get older.
Another possible reason that “dead” strings can contribute to wrist pain is that because the string properties and behaviour changes with time and play, you will need to make subtle changes to your swing to maintain your shots. For my setup, string use results in an increase in power and decrease in control. I think this might cause me to revert back to my old habit of tightening up my muscles during my stroke to try to regain some of that control, rather than just relaxing, trusting my stroke, and releasing my energy smoothly into the ball.
In general, here are some considerations for tennis strings for players with arm pain:
- Polyester and Kevlar strings are the stiffest and least comfortable strings. Synthetic gut, multifilament or gut are generally more comfortable (I say generally because tension can greatly affect a string’s comfort).
- If you play with poly strings, try to find some that are more comfortable. Look for softer strings or ones with a softer coating. TW has a page dedicated to soft poly strings here.
- Thinner strings are generally more comfortable so consider switching to a higher gauge (lower diameter) string.
- If you play with poly strings, consider lowering the tension to make them more comfortable
- If you play with poly strings, consider re-stringing frequently if you find they become painful with time (they might actually become more comfortable) or that you change your technique as your strings age and this causes pain.
- Your strings will be stiffer in cold weather and consequently less comfortable. Consider dropping your tension in cold weather.
Update: Also see my post on making your poly strings more comfortable for further info on how softening your polyester string-bed can reduce shock to the wrist.
Stiff, light racquets transmit more force into your arm at contact.
Up until last winter I was playing with the Wilson Juice BLX 100. I’d never played with anything else, and while I’d demo’d a few racquets before settling on one, I was so inexperienced that I didn’t know what I was looking for. In my search to find ways to reduce wrist pain during tennis, I realized that the racquet I was using was very stiff and very light! So I switched this out for a Prince ESP Tour 98, which is more flexible, heavier, head-light, and with an open string pattern, all of which should make it more comfortable on my wrist.
Here are the specs that affect how arm-friendly a racquet should be. Remember that racquet comfort is subjective – individuals perceive the features of different racquets differently – so these are just guidelines to use as a starting point. The best strategy is to demo lots of racquets, playing with each long enough to see if it causes arm fatigue or pain.
- Flexibility/Stiffness: Low RDC index means more flexible and comfortable. Look for a racquet with an RDC in the low 60s or lower.
- Weight: Heavier racquets transmit less energy into the arm, so heavier is better.
- Balance: You want more weight distributed in the handle, or a head-light balance. HH stands for head-heavy and HL stands for head-light. These are typically measured in points, where each point represents a 1/8th inch difference between the racquet’s balance and its midpoint. This can be adjusted after-market using lead tape.
- Beam profile: A thinner beam is typically more flexible and more comfortable.
- Head Size: Larger head sizes can result in more off-centre hits which torque the racquet more and place more stress on the arm. So a smaller head size is usually better.
- Racquet Length: Stick with the standard 27” rather than going longer. I think that this would be because a longer lever arm (distance between where force is applied (ball) and where torque is experienced (hand)) increases torque. Minimize this with a shorter racquet.
- String Pattern: An open string pattern allows more movement in the strings and thus more energy absorption from the ball. An open string pattern should be more comfortable.
Here is a comparison of the key specifications that affect comfort between my old and new racquet. In all categories the Prince should be the same as or more comfortable than the Wilson, with the most significant difference being in the stiffness index and beam width where the Prince is heavily favoured.
To Dampen or Not To Dampen?
String dampeners are a controversial subject. I’d always heard that string dampeners do nothing but reduce the sound produced when the ball hits the racquet and consequently, up until last winter, I didn’t use one.
Here’s an article from Tennis.com where string experts weigh in on the subject. The concluding paragraph is:
Bottom Line: Vibration dampeners are somewhat of a misnomer: They quiet string vibrations, not frame shock, and so do not prevent injury. If you’d like to hear a lower-pitched sound on impact, insert a dampener toward the bottom of the stringbed, beneath the last cross string.
I find this a bit misleading, since the experts do agree that the dampeners dampen string vibrations (it says so right in the concluding paragraph), so I don’t see how they wouldn’t at least contribute to a more comfortable experience. I think the article is trying to point out that simply adding a dampener to your set-up most likely will not heal your tennis elbow or whatever pain you’re feeling in your arm. But if vibrations are being reduced I think the must be a good thing. I use a dampener and I would suggest trying one as part of your pain-reduction regime and see if it helps.
Playing Tennis in Cold Weather
I did notice that my wrist hurt ever so slightly this fall, once the temperature stayed below 12°C or so, after a full spring and summer with no pain. Because I was playing far less tennis in the fall (due to cold and rainy weather), I don’t think it was caused by overuse, but instead by the cold weather.
Cold Weather Makes our Muscles Tight
I discussed in Part 2 of this series how, in general, anything that places excess stress on my ECU tendon, particularly at ball contact in tennis, makes my tendon hurt. A tight ECU muscle pulls on the ECU tendon more than a loose one. Cold weather can contribute to tight muscles, particularly before we’re properly warmed up. A solution to this is to make sure to dress warmly and warm up your forearm muscles before playing. You can do this before leaving the house using light dumbbell or band exercises and self-massage. If you have a long drive consider doing this at the court right before playing or at least having the heat on pretty high in your car!
Cold Weather Makes the Balls, Strings and Racquets Stiff
Basically any time the balls, our strings, or our racquets are stiffer, they transmit more energy into our arms. Cold weather causes the molecules in the surface of the balls, the racquets and the strings to slow down and move less, thus making them stiffer. While they will all warm up to some degree while playing, they’ll likely still be relatively stiff compared to warmer weather play which makes it even more important to take measures to help compensate like proper warm up and lowering your string tension. Also, make sure to store your racquet and balls in your house rather than in your cold car so that you’re not starting your session with cold equipment.
This brings us to the end of the series on ECU tedinosis and how I managed to eliminate my pain using a combination of on and off-court activities. It sums up years of searching for a solution to this injury that was keeping me from fully enjoying tennis. Like with so many things, it wasn’t until I addressed the root causes of the injury, rather than just treating the symptoms, that I noticed any lasting change.
Here is a quick summary of my experience:
- I believe that my ECU tendinosis was caused by a combination of poor technique and poor mobility resulting in chronic tightness in my ECU muscle and stress in my ECU tendon.
- I found that doing wrist traction poses in Bikram yoga reduced the stress on my ECU and eliminated the pain. I also believe that Bikram yoga is helping me improve my mobility. This helps my kinetic chain to function properly during tennis and reduces excess stress on my wrist joint.
- I believe that through technique and mobility improvements I’ve learned to transfer my energy properly into the ball during my forehand and make contact with my wrist in a more relaxed, neutral position, thus placing less stress on my ECU muscle and tendon.
- Some additional on-court techniques have also contributed to my being able to play tennis pain-free even with ECU tendinosis. These include wearing a Wrist Widget, changing up my racquet and string set-up, using a vibration dampener and taking precautions when playing in cold weather.
- I believe that reducing the stress on my ECU tendon has allowed me to play pain-free and is giving my tendon the chance to heal and strengthen.
If you haven’t already, check out Part 1 and Part 2 in this series for more information on ECU wrist tendinosis in tennis. I sincerely hope that you find some part of this helpful and would love to hear your experience with this injury and any questions you might have.