Author: Dr. Colin Butler, DPT, ATC
Wrist pain, especially on the thumb side of your wrist, can at best be a persistent nuisance, and at worst be debilitating and restrictive.
You’ve tried stretching the muscles on the front of your wrist. You’ve tried icing it. You’ve maybe even tried wearing a splint or a brace, but this tricky condition requires a deliberate examination and prescription to make sure you’re addressing the right components of it at the right time to resolve it.
What’s the first step? Use these quick and easy screens to begin understanding what movement options your wrist, and hand, have available to them so you don’t waste your time chasing the wrong issue.
Understanding How Your Wrist Moves
Here’s some simple self-exams you can use to get an idea of what motion your wrist has, and what movements it might be lacking in.
Wrist flexion and extension, plus radial deviation (movement towards the thumb side, “abduction” in Figure 1) and ulnar deviation (movement towards the pinky side, “adduction” in Figure 1) are the motions that are available at the wrist joint.
The wrist joint itself is the connection of the carpal bones of the hand and the radius and the ulna, or your forearm bones. (Figure 2)
Step 1: Take your wrist through those motions above. Do any of them reproduce your discomfort near your radius? Which ones feel limited relative to the others?
Most of the time, when I’m working with clients with wrist pain near their radius, I find that they are missing traditionally measured wrist extension and wrist abduction.
Now, to really figure out WHY they are missing that, we have to appreciate how the position of the hand relative to the wrist. Enter the Pistol Test.
If you’ve got a positive Pistol Test, as demonstrated above, you’ve got a hand that is positioned more internally rotated relative to your radius. What this means, is your wrist is biased towards already being in a position of wrist flexion, instead of extension!
Most of my clients with this limitation frequently have their wrist pain occur when they’re trying to extend their wrist. Like in the bottom of a push up, or in most weight bearing positions through the hand.
Having a hand internally rotated compared to your wrist is biasing your hand to be starting in a position of wrist flexion. If we can compare your wrist joint to an elevator and say that it is in a ten story building, that’s analogous to starting your wrist on the fourth floor and then asking it to go up ten more floors. You’d hit a constraint at the top of the building, which is happening when you’re trying to challenge your end positions of wrist extension, and then winding up with a jam at the inside of where your wrist meets the hand.
Instead of trying modalities like icing, or wearing a brace that can alleviate your pain by keeping your wrist out of symptomatic positions, let’s address the movement impairments that are causing your issue. Let’s take the elevator back to the ground floor.
First step: we need to get your hand to externally rotate relative to your wrist. I like Staggered Stance Curls to accomplish this. Use a light weight and make sure to hook your thumb behind the bar of the dumbbell to lock in the hand external rotation.
Once you’ve worked on that for a while, recapturing your wrist extension requires you to learn to get your wrist to internally rotate relative to a fixed hand. Enter the Low Oblique Sit with Pronation! This side plank type activity uses a towel to fix your hand while you internally rotate your radius.
We’ve recaptured our hand position, we’ve learned to move our radius relative to our hand, now let’s challenge our wrist position. I like bear crawling to progress to this point.
As you load one side, you want to feel your weight shift from the outside of the hand towards the inside. Don’t lose contact with the outside of your hand when that weight shift happens!
Begin working on appreciating what motions your wrist can or can’t do, and then work on training the movement strategies you need to obtain that motion, so your wrist has plenty of freedom to move.
Using these activities can be a great start towards the end of your wrist pain!