Tuesday, June 23, 2015

Wrist Pain

Have you ever suddenly realized that you’ve been taking a body part for granted? You know, you try a new workout and the next day you’re saying to yourself (or anyone who will listen), “Muscles I didn’t even know I had are sore!” Or you stub your little pinky toe and end up walking with such a limp that those around you think surely you’ve broken your leg instead. Well, that’s how I feel about wrists and wrist pain. I was a gymnast growing up and wrist pain has bothered me on and off since then. Every time it flares up though, I’m always shocked by it. I’m surprised at just how many little tasks cause pain and remind me that my wrist hurts. Then, undoubtedly the pain goes away and I forget all about it until the next episode. Smart, I know. Anyway, all day everyday we use our wrists for billions (ok maybe that’s an exaggeration) of movements and tasks, and it’s not until you have pain that you realize just how heavily you rely on them.  Lifting, grasping, typing, writing, working out…even flipping pancakes…all require healthy, mobile, pain free wrists. I mean in all seriousness, if you can’t scoop ice cream or pick up your kids without pain then we’ve got a problem. Let’s talk about one cause of wrist pain and how it can be treated. But first, some anatomy….

Now the wrist itself may look like a pretty small, simple joint, but in reality it’s like the major highway of body parts.  In one very small space you’ve got 8 wrist bones, a bunch of muscle tendons, arteries, nerves, and veins. You’ve also got a band of ligament squeezing most of this into a very tight space, with very little wiggle room. When you take all of this into consideration, you can imagine that there are a ton of structures that can actually cause your wrist pain. Surprisingly enough, the first cause of wrist pain that we’ll talk about today hardly involves the wrist at all.  

You’re probably thinking, “What could possibly go on OUTSIDE the wrist that gives me pain IN my wrist. That’s just silly.” Well maybe you didn’t think that at all but let’s talk about it anyway. One of the most prominent wrist injuries actually comes from the forearm. You’ve basically got two compartments of muscle in the forearm: the flexors and the extensors. If you sit and lay the backs of your hands on your thighs, palms up, and bring your hands/fingers toward your body, you are activating the flexor muscles. Each of the muscles in this group start at the bony point on the inside of your elbow when your palm is up, and travel through the forearm until it attaches down in the hand/wrist. If you turn your hands over, palms down, and lift the fingers/hands back up toward your body, you are engaging the forearm extensors. These muscles all start on the outside of the elbow and travel down the forearm into the wrist/hand. The tricky part of all of this is that when a muscle or a tendon becomes irritated, you usually feel it wherever it attaches to the bone/joint and not necessarily in the muscle belly itself.  This means that you can have a problem with your forearm muscles and have wrist pain. What a sick joke huh? This also means that if you overuse your forearms by say, typing all day long at your desk, or working with your hands, or using all of your electronic devices, you can end up with wrist pain. Not too many people spend a day at their computer right? Or on their phones or ipads? No way!

So how does this all happen? To provide you with one example: you sit at your computer typing all day long, with your forearms working hard to allow you to keep your hands in the proper position. Over 8 hrs a day, 5 days a week, for however many years, your forearm muscles makes sure your wrists can move. Just like any muscle, when they’re overused they can start to build up scar tissue, adhesions, or trigger points (irritated bundles of muscle that can refer pain other places). To these muscles, repetitive typing or overuse is a form of trauma. It’s a very small trauma, but a trauma nonetheless. Eventually, your muscles aren’t moving the way they should because of the scar tissue or the adhesions or the trigger points. The muscles start tugging in weird ways on the tendons down at the wrist and the tendons become irritated. Irritation leads to inflammation (think tendonitis) and inflammation leads to poor wrist range of motion and pain. As if that weren’t enough, some of these muscles attach to the small wrist bones themselves, and may start to tug on those bones. This doesn’t allow the bones of the wrist to move like they should, causing more inflammation and restriction and pain.

Not so coincidentally, strain on these muscles can also cause pain on the inside/outside of the elbow itself through the same mechanism. If you’ve got some elbow pain take a look at Dr. Piretti’s article here.

But back to wrist pain. What can you do to address wrist pain coming from your forearms?

·             Rest: We can’t avoid some of the activities that cause our wrist pain, but there are a few that we can go without. That may mean you take a couple of weeks off from the gym or the sport that is flaring things up. I know that’s not what anyone wants to hear but sometimes you have to quit aggravating the area in order to let it heal. While you’re resting though:
·             Ice: Ice the forearm, ice the wrist, then ice them both again a couple more times. Part of the reason you have pain is because of the inflammation and one of the best ways to squash inflammation is to cycle ice on and off so the blood vessels change size and pump inflammation out. Usually 10min on, 20min off 3-4 times/day is a good place to start.
·             Muscle work: The muscles of the forearm should be evaluated for trigger points, spasm, and fascial adhesions/scar tissue. These sensitive spots in the muscle can be worked out by hand by your massage therapist or chiropractor, or a technique called Graston can be used to break up all the grit in the muscle and restore function. Ask your chiropractor if he or she is familiar with the Graston technique and can evaluate your forearms/wrists. It won’t be the best 5minutes of your day, but it’ll probably be the most productive. It’s a great way to get the muscles of the forearm to calm down and start functioning properly again.
·             Adjustments: Getting the bones of the wrist/elbow moving properly is crucial to decreasing potential inflammation in the surrounding area, and allowing the muscles to heal and do their jobs. Your chiropractor can assess these joints for you and restore motion to them if needed.

·             Ergonomics: If you can’t change the fact that you’re on your computer/ipad/phone all day, or the fact that you work with your hands, and those activities seem to be exacerbating your pain, it might be necessary to evaluate HOW you carry out these activities. Changes to your desk/computer set up can help take pressure off the forearms, elbows, and wrists. The same can be true for how you use your phone or other electronic devices. Sometimes the smallest tweak to your set-up or how you move can make all the difference. Both google and your chiropractor probably have some pretty good suggestions for you in this area.

When my gymnastics-induced wrist pain flares up, I go to all of these things to treat the problem. It may not be the most comfortable avenue but it sure is effective and gets me back on track quicker than anything else I’ve found. As we said before though, that wrist pain of yours can come from plenty of other places. We’ll be sure to explore those options in the coming weeks. Until then, see if it’s “just” some stubborn old forearm muscles and have someone evaluate them for you!