Podcast 84: Dr. Jack and I are joined by a panel of tennis players (Part 2)
Ian : So Royce –Royce, what type of grip do you use? How extreme is your forehand grip? Royce : Mine is about as close to a full Western as a semi-Western can get. Ian : Alright. So you're pretty far over there. Royce : Yeah. Which could explain , you know, a little bit of the stress I… A little background that some people
know. This is actually going to be a follow-up question as well. Where within that, did it say where the injury was located on the ulnar side? Was it with the UT–the ulnar tri-ligament? Or where was that; the injuries located? specifically?
Dr. Jack : OK. With Western grip s, there were extensor [inaudible] injuries, 11 out of 30. You had [empty] 11 out of 50 injuries to the wrist were the intercorpialnaris, and then the triangular fibrocartilege . There was 3, and then there was 1 extensor –a common extensor injury. And with the semi-Western, the extensor corpial narist had 16 injuries , and it was 2 triangle fibrocatiloginous injuries, and 2 common extensor injuries. So there really were far more on that ulnar side of the wrist . Those were basically the 3 most common types.
Ian : I'm glad that I don't have to go down that list! [laughter] Dr. Jack : [laughter] Ian : Anything else, Royce? Royce : No–all I can tell you Ian is they are not fun. So be thankful! Ian : Yeah. Royce has had a real rough run of it. Physically in his playing career. How many wrist surgeries
specifically have you had , Royce? Royce : I've had –just wrist surgeries, I've had 3. Dr. Jack : Wow. Well you know Royce, this article if you want to Google it, it's called: Wrist Injuries in Non-profession Tennis Players . It's from the American Journal of Sports medicine. This is Volume 37, number 4. I forget what month it was. It was less than a year ago. Royce : OK. Dr. Jack : Yeah. You should be able to find it through the American Journal of Sports Medicine. It should pop up. Royce : OK. Dr Jack : Alright.
Royce : Thank you. Dr. Jack : I think you'll find it very interesting. It's nice–they have a very nice pictorial about … They take the butt handle of a tennis racket, and they assign numbers like that of an hour glass–not an hourgass, but on a clock face . And then they show you where on your base knuckle and heel pad of your hand , where to place it on different numbers to determine where your grips are. It's a very nice picture, and it has a nice breakdown of the different injuries and the different locations with some commentary on why they think this all happens. Not really much about treatment–it was more or less just a showing of what happens with these different kind of grips. It was supposedly the only study of its kind so far.
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Ian : Alright. Well good stuff, Royce. Thanks a lot for your question. And let's go ahead and move on to Angie, who I know has been having some problems with tennis elbow. Angie, go ahead and ask Dr. Jack your question.
Angie : OK. I actually just recently started having that problem
I had kind of changed my forehand, which I changed back to the one that doesn't hurt it. And when I was playing kind of really tight, I had a lot of pain. And so it kind of kept on , so I was wondering about going and practicing, and just having my smoother stroke, which doesn't hurt it. So I went ahead with it, but I was actually kind of worried about it, thinking: ‘Well, when do you decide when to sit out? Because obviously there's going to be sometimes when you play with pain , and occasionally with foot pain or with arm pain –but is there any way to tell when it's dangerous? Dr. Jack : Sure. If you have a tennis elbow injury, when you go to make a fist or a grip or grab something, or pinch something between your fingers and your thumb–your four fingers and your thumb– and that elicits a lot of pain on a regular basis just doing your activities in daily living, then this is something that's becoming something that's more of a progressive problem. The two more common mechanisms of action for a tennis elbow are going to be on your backhand, where your wrist becomes weak and it flips backwards, so you don't have a god firm wrist on your backhand. Or, if you roll your wrist over on your forehand. Ian, anything else to throw into that as far as technique goes? Closing tennis elbow?
Ian : Well, in my experience, most people who experience tennis elbow are not properly making use of the kinetic chain; meaning : they're not radiating their strength or their power from their core outwards . They're not using the biggest parts of their body very well. Because of that, to create spin and power on their shots, they end up using the smaller parts of their body instead: their wrist or forearm are being predominantly used. And when you do that, over and over and over again, it's only a matter of time to get some kind of overuse injury. Dr. Jack : Great. So Angie, what I would say to you, is you've got a pot of boiling water on the stove and you can't pick it up with one hand, it's time to start to go see –to think about seeing somebody. And that's reason enough to curtail your playing for awhile. If you're out playing on a tennis court and initially it's not bothering you, and it begins to both you more and more as the match goes on, then I think you're looking really at a technique problem, because you're obviously doing something that's going to aggravate. If you can't get out there and make one or two shots right off the bat–it's just going to get worse , and you'll really need some attention for that. Angie : Yeah. Actually I played today, and I didn't hurt while I was playing. But I think maybe I'm fixing my technique. There is a little , still a little, kind of residual soreness.
Dr. Jack : When you shake someone's hand, does it hurt? Angie : Umm… I don't shake that many people's hands! [laughter] No, not really.
Dr. Jack : Afraid of the Swine Flu, huh?
Angie : [laughter] If I grasp something, you know, kind of squeeze it, there's just a tiny little dull pain. Right now.
Dr. Jack : OK. And how long have you had this for?
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Angie : It's just been about a month or so. Dr. Jack : OK. So it's probably getting at that point, where it may not be a tendinitis anymore. It may becoming a tendonosis. You know, that flex bar that someone wrote in about recently is a great exercise . If you go read that New York Time's article that was posted, it involves the technique called E-centric Strengthening. So you're stretching the muscles -tendon junction as you're strengthening it. By doing so, you break up some of the scar tissue that forms with the tendinitis. That is, it becomes arthritic and no longer inflamed. So that actually would be something that I, at this point, have you do, because that might be a really, really good exercise for you to prevent it from getting worse.
Angie : OK. And it's called the flex-bar? Dr. Jack : Yes. You can find it online. Because I knew that people were asking about it; I did a little Google search. It came up, and there's one or two online stores, physical therapy stores, that you can get it at. I don't think it was very expensive. And that New York Times article does have a nice video on the proper technique on how to do the exercise.
It's very easy. It makes a lot of sense. We utilize that same principle . And I've talked about this on some of the other podcasts for Achiles tendinitis. Where you stand on your… You stand up on your toes, and then lift up one leg and slowly lower yourself down o n the other leg so that your heel drops over the edge of a step.
That is stretching the tendon and muscle as you're strengthening it. And you do that like 15 times. In this instance, you're doing the same thing. You're loading up that tendon on the wrist, and then you're just relaxing it; stretching it; slowly and you strengthening it. So it's the same concept, and it works really, really nice. Angie : OK. OK, thanks. I'll try that. Dr. Jack : Sure. Good luck with that!
