3 Ways To Start Improving Your Wrist Pain

Author:  Dr. Colin Butler, DPT, ATC

Wrist pain, especially on the thumb side of the wrist, can range from a persistent nuisance to something truly limiting. For some people it is an annoyance, while for others it becomes debilitating and interferes with daily activities.

You may have already tried stretching the muscles on the front of the wrist, icing the area, or even wearing a brace or splint. While these strategies can provide temporary relief, wrist pain often requires a more deliberate assessment to ensure you are addressing the right components at the right time.

So where do you start? Use the simple screens below to begin understanding what movement options your wrist and hand currently have available. This helps prevent wasting time chasing the wrong issue.

Understanding How Your Wrist Moves 

Below are simple self exams you can use to get a clearer picture of how your wrist moves and which motions may be limited.

The wrist is capable of flexion and extension, as well as radial deviation, which is movement toward the thumb side, and ulnar deviation, which is movement toward the pinky side.

The wrist joint itself is formed by the connection between the carpal bones of the hand and the radius and ulna of the forearm. (Figure 2)

Step 1: Assess Your Wrist Motion

Take your wrist through each of the motions listed above. Pay attention to whether any movement reproduces discomfort near the radius. Also notice which motions feel limited compared to the others.

In many cases, wrist pain near the radius is associated with limited wrist extension and limited radial deviation.

To better understand why those limitations exist, it is important to consider the position of the hand relative to the wrist. This brings us to the Pistol Test.

If you have a positive Pistol Test, your hand is positioned in more internal rotation relative to the radius. This biases the wrist toward flexion rather than extension.

Many people with this presentation notice wrist pain when trying to extend the wrist, such as at the bottom of a pushup or during weight bearing positions through the hands.

When the hand is internally rotated relative to the wrist, it is like starting wrist movement partway up the range instead of from neutral. Imagine the wrist as an elevator in a ten story building. Starting on the fourth floor and trying to go ten floors higher quickly leads to a hard stop. That same type of constraint can create a jam where the wrist meets the hand when end range extension is challenged.

Instead of relying solely on icing or bracing to avoid painful positions, it is often more effective to address the movement limitations creating the problem. In other words, take the elevator back to the ground floor.

Step 2: Restore Hand Position

The first goal is to improve the ability of the hand to externally rotate relative to the wrist. Staggered stance curls are a useful exercise for this.

Use a light weight and hook your thumb behind the dumbbell handle. This helps lock in external rotation of the hand while you perform the movement.

Step 3: Rebuild Wrist Motion and Load Tolerance

Once hand position improves, restoring wrist extension requires learning how to internally rotate the radius relative to a fixed hand. The low oblique sit with pronation is a helpful drill for this. This side plank variation uses a towel to keep the hand fixed while the forearm rotates.

After you have recaptured hand position and learned to move the radius relative to the hand, it is time to challenge wrist position under load. Bear crawling is an effective progression at this stage.

As you load one side, focus on feeling your weight shift from the outside of the hand toward the inside without losing contact along the outside edge of the hand.

Start by understanding what motions your wrist can and cannot perform, then train the specific movement strategies needed to restore those motions. Giving your wrist more freedom to move is often the key step toward lasting wrist pain relief.