written by Jennifer Taylor
Chartered Physiotherapist and Veterinary Physiotherapist
Wrist injuries are a frequent cause of pain for the polo player. Poor technique is an important factor in wrist pain, especially in females who typically have less muscle bulk and less strength in their forearms than males. Over-gripping the mallet, trying to generate force through the forearm (as opposed to shoulder pendulum swing), dropping wrist into an ulna deviated or radial deviated position at contact with ball (giving neck or open shots) are common bad habits. Swing analysis and forearm strengthening is vital in rehabilitating a wrist in addition to trying to prevent these injuries.
Wrist injuries can normally be divided into two categories: traumatic and overuse. Traumatic wrist injuries can occur from a fall especially landing on an outstretched hand. These normally need to have immediate medical attention to rule out a fracture. Any bone can be broken from a fall but commonly ones are the scaphoid, radius or ulna.
The scaphoid fracture is the most frequently injured carpal bone and can easily be misdiagnosed or ignored as a simple wrist sprain. If missed and not managed properly you can end up with a chronically painful wrist, especially with weight bearing, and a mis-aligned fracture or non healing fracture.
Unlike the scaphoid injury which may not have many symptoms, apart from pain, fractures to the radius or ulna will usually present with swelling, deformity, tenderness ,loss of wrist motion and lots of pain. Patients usually attend hospital quickly with these as they know something is damaged.
If you have a fall
onto an outstretched hand and have pain in the area shown make sure you attend the doctor for XRAYs. Even is no fracture is initially seen they may put you in a splint/ cast for 2 weeks and then re-XRAY. This is not an injury to ignore and hope for the best!!!!!!!!
Another frequent injury I have treated in polo is from hooking, either getting mallets caught up together or from a sudden hit onto the stick forcing the wrist into either a radial or ulna position. What can result is a sprain to the wrist ligaments with cartilage damage. If pain isn’t easing within a few days of rest probably best to have this checked out at the hospital to rule out injury to the bones. Management of this type of injury is normally rest, strengthening exercises and gradual return to sports.
Overuse injuries :
Overuse injuries can occur from poor technique, overtraining, poor recovery, muscle weakness, gradual wear and tear, age etc and are normally one of two types of problem with the tendon (tendons attach muscle to bone). Inflammation of the tendon sheath, tenosynovitis (the surrounding part of the tendon) or failure of the tendon to withstand the high and repetitive loading leading to small micro tears giving a tendinopathy (sometimes called tendinitis).
In the initial stages of tendinopathy or tenosynovitis the management is similar:
- Rest the wrist to try to reduce the pain and inflammation. Regular ice and taking pain relief (eg ibuprofen, an anti-inflammatory, or paracetamol) can also help with this.
- Once pain has reduced then gradually strength exercises are introduced and progressed
- Once it is full strength and pain free there should be a gradual return to sport (as well as making sure technique/ equipment ok)
I would guess that many of the readers who are reading this and have had wrist pain won’t have followed this management plan!!! You will have either jumped from the first stage to return to play leading into a cycle of pain- rest- play- pain- rest-play etc. or just ignored the pain altogether!
Either way (and for either tendon problem) you will only look to physiotherapy for help when your performance gets worse. This may be from not being able to make the shots you normally can, the pain becomes unbearable when you play or you are in pain for days after playing. By this point in time the recovery is a lot longer and you will miss a lot more game time than if you had initially treated the pain
Even knowing what I have just written you will still probably convince yourself that you are the exception to the rule, that eventually the pain will go on its own, “no pain, no gain”. If the load is continually applied to the damaged or inflamed tendon, the micro tears which occur in the tendon can exceed the rate of repair. The damage will progressively become worse causing more damage to the tendon as can be seen from the above picture. Denial about injury and pain is so common with athletes and sports players but hopefully this article will help you to understand wrist injuries and the importance of correct management.
Common areas of tendon pain in polo are at the base of the thumb and on the ulna (littlefinger side) of the wrist. De Quervains is tenosynovitis of the tendons at the base of the thumb and is normally diagnosed following a positive Finklesteins test.
Pain is with gripping and movements such as turning a key in the door. On the other side of the wrist it is the muscles and tendons which ulna deviate and flex or extend the wrist. Pain is aggravated with gripping and then flexing or extending the wrist.
The initial stage of strengthening the wrist is with isometric (static) exercises, focusing on neutral wrist position and can be seen below.
It’s important that during and after the exercises there is no pain or symptoms. Also gentle stretches can help maintain movement.
These exercises are progressed by adding movements in different directions and can be seen below.
Once these exercises can be completed pain free and full strength has been restored gradual return to play can begin!
Chartered Physiotherapist and Veterinary Physiotherapist