Wrist injuries are a frequent cause of pain for any polo player. Poor technique is an important factor in wrist pain, especially in females who typically have less muscle bulk and strength in their forearms. Over-gripping the mallet, trying to generate force through the forearm (as opposed to shoulder pendulum swing), and dropping wrist into an ulna deviated or radial deviated position at contact with the 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 if 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 common 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 misaligned fracture or non-healing fracture.
Unlike the scaphoid injury which may not have many symptoms apart from pain, fractures to the radius or ulna results in swelling, deformity, tenderness, loss of wrist motion, and lots of pain.
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. This results in a sprain to the wrist ligaments with cartilage damage. If pain isn’t easing within a few days of rest, it’s best to have this checked at the hospital to rule out injury to the bones. Management of this type of injury is rest, strengthening exercises, and gradual return to sports.
Meanwhile, overuse injuries can occur from poor technique, overtraining, poor recovery, muscle weakness, gradual wear and tear, age, and more, and are normally one of the two types of problems 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 leads 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 (ibuprofen, an anti-inflammatory, or paracetamol) can also help with this. Once pain has reduced, strength exercises are gradually introduced and progressed.
Physiotherapy for wrist care is usually only looked into when a player’s performance gets worse. This could stem 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 with this knowledge, you will still probably convince yourself that you are the exception to the rule—that eventually, the pain will go on its own. 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 seen from the picture above. 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 (the side of the little finger) of the wrist. De Quervains is tenosynovitis of the tendons at the base of the thumb and is normally diagnosed following a positive Finkelstein’s test.
On the other side of the wrist, it is the muscles and tendons that ulna deviates 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. It’s important that during and after the exercises, there are no pain or symptoms. Also, gentle stretches can help maintain movement. These exercises are progressed by adding movements in different directions.
Learn more about Physiotherapy at www.pegasusphysiotherapy.co.uk.