Anyone who lifts weights regularly has experienced some sort of injury that has interfered with their training at some stage. A wrist injury is one of the most limiting because it really does prevent you from gripping any sort of weight, whether it’s upper body or leg day. Finding yourself side-lined from your regular fitness routine is incredibly frustrating – we’ve all heard the mantra of “use it or lose it”. The problem is that resuming weightlifting before you’re ready can result in more time off overall and potentially making the injury worse. So, when is it time to be returning to the gym after a wrist injury?
What causes wrist pain?
Is your wrist injury acute or chronic? An acute wrist injury can usually be linked back to a specific event or movement – something that made you go “ouch”! A common cause of acute wrist pain is a fall onto an outstretched hand, but it could also be a result of an uncontrolled twisting motion during sports or a workplace accident. Chronic wrist pain can have a more gradual onset and is often due to repetitive movements such as poor weightlifting technique, ergonomically incorrect workspaces or repeated loading of the joint in sports such as golf, tennis or gymnastics.
Diagnosing wrist injuries
Wrist injuries can cause a range of symptoms including pain, instability, clicking, reduced range of movement, swelling, numbness and tingling. It is important to get an accurate diagnosis of your injury, so you can treat it appropriately so you should see a health professional who specialises in sports injuries or upper limbs. A hand therapist is your best choice, but a physiotherapist with an interest in wrists and hands will often be able to diagnose your particular injury.
Diagnosis is made by taking information about the mechanism of injury combined with a physical examination and assessment. Diagnostic tools such as xrays, CT scans or MRI might also be helpful.
Common types of wrist injury
If wrist pain has come on suddenly, it is likely a result of acute trauma, whereas gradual onset of pain may suggest an overuse or repetitive strain induced injury. It’s important to seek guidance from a health practitioner if you believe you have sustained a wrist injury. Common injuries include:
Sprains and strains:
A sprain refers to the damage of ligaments, whereas a strain is an injury to muscles or tendons. Ligaments are broad connective structures than join bones to one another. Tendons are dense connective tissue than join bones to muscles. Damage can range from overstretching of these structures, to partial or complete tears. Symptoms of a strain vs a sprain can be similar, namely localised pain, swelling and limited range of movement, but the main distinguishing feature is that ligament damage is more likely to result in visible bruising.
Most sprains and strains are a result of an acute event such as an impact or being put under load in an awkward position, although repetitive movements can also cause overuse injuries of the soft tissue.
The most common cause of wrist fractures is a fall, because it is instinctive to stretch one’s arm out to break the fall. This type of event can lead to a distal radius fracture (the main bone in your forearm). Another common fracture is to the scaphoid – a small bone in the wrist, near the base of the thumb. Scaphoid fractures can be difficult to detect on x-ray and are sometimes misdiagnosed as a wrist sprain. This type of fracture doesn’t present with obvious deformity, but can trigger exacerbated pain when pinching or gripping.
The triangular fibrocartilage complex triangular(TFCC) is a cartilage structure that sits between the ulna bone (in the forearm) and the small carpal bones. The TFCC provides cushioning and stability in the wrist and is often compared to the meniscus in the knee. TFCC tears can be either acute or chronic. Acute tears can usually be attributed to a sudden force, whereas chronic or degenerative tears may be a result of either repeated damage or physiological factors. Athletes such as gymnasts and tennis players who repeatedly load their wrists can be prone to TFCC injuries. Those born with underlying conditions such as positive ulnar variance (the ulna bone being longer than the radius) may also be more at risk of damage to the TFCC.
Treatment for wrist injuries:
For acute or sudden onset of wrist pain, initial treatment should be rest, ice, compression and elevation. It’s important to seek advice from your doctor or health professional so that diagnostic exams such as x-rays or MRI can be carried out if necessary. Some fractures do heal on their own with immobilisation and rest, but in some cases where the bones are misaligned, surgery may be required.
Most soft tissue injuries are treated conservatively first, that is, non-surgically. Treatments may involve splinting to immobilise the joint or wearing a supportive wrist brace. You may be prescribed rehabilitation exercises to strengthen the hand, wrist and forearm – focus is usually on regaining full range of motion before introducing any load.
Cortisone/steroid injections are sometimes used to reduce pain and swelling in the joint. This treatment will not increase healing times, but the relief from pain can provide a window for effective rehabilitation to occur, allowing strengthening of the surrounding tissues. A pitfall of steroid injections is that the rapid reduction in pain can sometimes result in a false sense of recovery. By rushing back into activities because pain is not a limiting factor, some people end up causing further damage.
Non-surgical treatment of wrist injuries can take up to 6 months. Soft tissue injuries that don’t respond to conservative measures may require an operation. It’s always a good idea to seek a second opinion before proceeding with surgery, because different specialists may offer a alternative approach or surgical procedure.
Exercising after a wrist injury:
Do not undertake any sort of load bearing or weightlifting until you’ve spoken with your doctor or physiotherapist/hand therapist. Initial exercises may involve the use of resistance bands so you can gradually adjust the level of effort required. Body weight exercises that require you to use your hands can be modified so that you use push up handles or flat edged dumbbells to grip onto instead of putting your palms on the floor. Some people find it easier to do push ups on their knuckles as well. If you return to placing weight through your palms, reduce the load initially by doing push ups on an incline such as the wall or a table.
A neutral wrist position is often the most comfortable when returning to exercising after a wrist injury. Cable machines often have a variety of handle options available for performing movements such as seated rows, lat pulldowns and pectoral flyes. If you are returning to the gym after wrist injury, chat to the trainers there about what equipment is available to assist you. There may be add-ons for some machines that you aren’t aware of!
Straight olympic barbells can put more strain through the wrists than dumbbells because there is no room for adjusting the angle of your grip. If you are recovering from wrist pain, using dumbbells for chest and overhead exercises may be a safer option than a barbell. An ezy-curl bar can also place less load on the wrists.
What about leg day? If you usually use a straight barbell to perform exercises such as squats and deadlifts, you may find incorporating the use of some straps to grip onto is helpful in reducing load through your wrists. There are also barbells with alternate grips such as the Safety Squat Bar or Yoke Bar, which allows you to keep your hands in from of your body in neutral grip during squats or a Trap Bar for deadlifts.
If your looking for a versatile piece of equipment that you can use at home or in the gym, I recommend working with water filled weights or a sandbag. Both of these items feature a variety of grips, which makes them suited to a myriad of exercise movements, but also allows you to find what’s most comfortable if you have had a wrist injury. Sand bags for weight lifting start at a capacity of around 10lb of sand and go upwards of 50lb, but if you want to adjust your weight incrementally, you can also fill them with something lighter that sand such as combining some of the volume with polystyrene foam beads. Water bag weights can be easily increased or decreased by the amount of liquid inside, but the less weight you work with, means the more unstable the weight bag becomes. This is because less water means there is more sloshing around occurring, but can be great for building up stability in your forearms and wrists.
Returning to the gym after a wrist injury is daunting because we literally use our wrists to do pretty much everything! Remember, the key with rehabilitation is to go slow and seek advice. Pushing too hard in a single training session could put you backwards by weeks, even months!
Note: Any reference to treatment options made in this article are general in nature. Seek advice for your specific needs from a registered health professional.