Adelaide Clinic Case Study: The Making of A Squash Injury
Roger is a 35 year old HR director at a software company. He has been having 6 months of right elbow and wrist pain. He loves to workout. He wakes up at 5 am to weight train 3x/ week and plays squash once a week. He has been finding gripping dumbbells and barbells during his workouts increasingly painful in his wrist and elbow. Now even simple activities such as typing, opening a jar or washing dishes aggravate his wrist. Lifting his work bag and carrying groceries aggravate his elbow. He loves to work out and play sports. He wants to get his arm back to normal in time for the start of his spring beach volleyball league.
To begin the assessment I looked at the angle of his elbow joint and I saw that it is slightly laterally deviated. This type of injury can be common among squash players. The repetitive forehand shots taken by squash players can cause a deviation outwards in the elbow joint leading to the pain Roger is complaining of. The elbow joint is essentially a hinge joint where the ulna (one of the two forearm bones) hooks onto the humerus (the upper arm bone). I tested the movement in the elbow joint by gliding the joint side to side. As I did so I noticed a restriction in range of motion gliding the joint outwards.
I then looked at Rogers wrist and elbow range of motion. Fully bending his elbow reproduced his elbow pain. I asked Roger to perform a bicep curl with resistance and this also hurt. When the elbow is out of alignment the strength of the elbow will be reduced and it would also hurt to perform such movements. I then examined Roger’s wrist bones which are a made 2 rows of 4 little bones. These bones must move fluidly relative to one another in order to have full range of motion. I tested each of these bones and found a few restrictions in mobility of each bone. His forearm muscles were also really tight and the tendons of these muscles travel down past these wrist bones and attach into the hand. Tension in these muscles and tendons can cause further compression along these wrist bones.
I performed joint mobilizations, gliding the joint outwards, to correct the alignment of Roger’s elbow. After performing a few sets of these mobilizations I retested his elbow strength and it was much improved.
Then I mobilized the restricted joints in his wrists, stretching the little bones to promote movement relative to one another. Utilizing active release I stretched the various muscles in the forearm which decreased tension in the muscles, tendons, and therefore the wrist. Acupuncture was also used to decrease pain in the elbow and wrist.
I saw Roger for physiotherapy a couple of times a week for the first 3 weeks. During this period of time I explained to Roger he could continue weight training and playing squash but should decrease the intensity of the sessions.
After a few weeks of treatment Roger reported that his elbow pain was significantly reduced. He was now able to train heavier at the gym and was able to perform his forehand shots during squash pain free. His wrist pain also decreased with typing at work and washing dishes at home. Roger continued treatment once a week for week 4 and 5 and by then he was able to return back to his workouts, squash, and work duties pain free.