Carlos Alcaraz: How damaging is wrist injury and are they becoming more common?
When Carlos Alcaraz walked off the court at Rod Laver Arena in January, he was on top of the world.At 22, he had just completed the career Grand Slam, beating all-time great Novak Djokovic in the Australian Open final to claim his seventh major title.A few months earlier he had decimated his rival Jannik Sinner in the US Open final in what was one of most the impressive performances of his illustrious career to date.But the Spaniard has now missed the French Open and Wimbledon, going 114 days without playing a competitive match due to a wrist injury he suffered in April.After returning to training, he has now withdrawn from the upcoming Cincinnati Open, and with the US Open less than a month away, Alcaraz's ability to defend his title is in serious doubt.So, why exactly is Alcaraz's injury proving so troublesome, and how problematic can wrist issues be for tennis players in the long run?Alcaraz has been suffering from tenosynovitis - a painful inflammation of the fluid-filled sheath that surrounds the tendon on the inside of the wrist.Tenosynovitis is typically caused by repetitive movements like gripping and swinging a tennis racket, and can lead to swelling and ongoing tenderness.Minor cases can take weeks to recover, mostly managed by rest, but more severe issues can require significant physiotherapy and potentially even surgery, with recovery taking up to a year.Alcaraz has not undergone surgery, but his latest withdrawal will take him to over four months out injured, and for a portion of that he was unable to use a racquet at all.Wrist injuries are particularly worrisome for tennis players. The joint plays a key role in every contact between the racquet and ball - the way the wrist rolls through a shot helps generate power, and its dexterity is vital for delicate touches like drop shots, which are a key part of Alcaraz's all-court game.The lack of muscle surrounding the bones and tendons in the wrists also makes rebuilding strength difficult, meaning the length of absences can be difficult to predict."It's really hard to cope with", says CiCi Bellis, a former world number 35 who retired aged 22 after suffering from recurring wrist injuries."The wrist is one of the places you fear hurting the most. With lower body injuries you can still be on court swinging but with the wrist it's so tough mentally because you can't. I definitely had distrust in the joint when coming back."Time is the biggest healer from a rehab standpoint and building back your confidence."For somebody like Alcaraz who has maybe the best forehand in the world, the wrist is so core to his game and he plays with a lot of spin using the wrist a lot. It's one of the biggest parts of his body he relies on."As tennis has become quicker, with the majority of players on both tours hitting hard from the baseline and using a double-handed backhand, the ability to generate power and top-spin has become even more important, increasing the strain on players' wrists.Grand Slam winners Dominic Thiem and Juan Martin del Potro both suffered recurring wrist injuries throughout their careers."Wrist injuries are becoming more significant in the game," says James Ross, a physiotherapist who works with players at Grand Slams and other tournaments."A big factor is technological improvements - racquets and strings are better, so the ball is coming at you with more force and you've got to be able to absorb that."Tennis players also have a more gruelling schedule than ever before, putting more strain on the joints, and the balls are inconsistent between tournaments - changes like that mean the body has to adapt and that presents an injury risk."Alcaraz won his last match against a qualifier in the opening round of the Barcelona Open, but was in visible discomfort and withdrew before his next match.Photographs and videos on his social media channels show him in a training session in Murcia on Tuesday, sporting the longer hair he has grown out during his absence.A competitive return is still a few weeks off at least, however, meaning he will at best be carrying almost five months' worth of rust into the US Open if he plays.But with wrist injuries in tennis, waiting longer can help prevent the problem recurring."The biggest risk of injury is a previous injury - if you have had it once, you are more likely to have it in the future," Ross adds."If a player can get back over a period of a few months and they don't have a reoccurrence, generally they will be OK."But some things can become chronic and the pressure of the sport to come back, earn money by playing, and keep your ranking points, is a risk."One of the key challenges of a wrist injury is psychological - once a player has suffered a painful injury in the joint that controls so much of their technique, it can be difficult to fully trust it again."Wrists aren't easy", said Sir Andy Murray, having suffered injuries in both wrists in his early 20s."When the ball is low you know you really have to use your wrist to get the ball up and down, or when the ball is coming fast and quite high you need to use your wrist a lot to bring the ball down."It's difficult when you try to come back [from a wrist injury], because the pain that you feel when you initially hurt it, mentally it's very difficult to let go of."Before his injury, Alcaraz had been performing at an extremely impressive average of two Grand Slam titles per year. Continuing at that pace would have him level with Novak Djokovic's record of 24 by 2034, when he will be only 31.Alcaraz will hope to return to top form as soon as he is back on court, but reaching the same level of performance following a wrist injury isn't easy."The wrist doesn't get great blood supply and it doesn't heal very quickly," says Ross. "It takes real time to build strength in it and the management is very complex."Restoring confidence is down to how rehab goes - you can feel amazing and then get a setback, and it's how you deal with that."We also treat injuries as windows of opportunity - you might not be able to hit a tennis ball right now, but let's work on your cardiovascular fitness, work on the core and lower body, or see how you mentally decompress and cope with having a holiday."You really have to keep the player motivated."
