Ask The Doc: Addressing Wrist Pain

If you’ve ever dealt with it, you know that wrist pain and/or injury is among the worst for anyone involved with CrossFit. A majority of the movements involve the wrist in some way (e.g., muscle-ups, cleans, snatches, presses, etc.). It’s no wonder then, that a common complaint among many CrossFitters who train rigorously and regularly deals with the wrist. Being a joint to the very intricate hand, the wrist is like a conduit for some major tendons, ligaments, and nerves; a lot can go wrong here. Today we examine the issue of general wrist pain from weight training and what to do about it.

Today’s question comes from Christina:

I have a question: Just started Crossfit in January. Having trouble with my wrists — left one in particular. It hurts along the outside edge into my little finger and up my arm a bit. I know some of it comes from weakness – working on that – but it’s making writing and typing difficult and I have to do a lot of it. Any suggestions on how to strengthen that area and improve how I hold the bars?

Christina King

Josh says…

Joshua Zavertnik | PT, DPT, FAAOMPT

Hi Christina-
Thanks for reaching out to us! The wrists can easily get into trouble with certain lifts and drills if we are not careful. Based on your question, I would want to know a few more things first: What lifts are giving you trouble and at what point in the lift does it bother you? What is the pain like along the side of your hand and arm? Is there any numbness and tingling? A few things may be contributing to the wrist pain you are experiencing.

The ulnar nerve runs along the inside of our forearm and down our wrist and supplies the outside edge of our little finger. You may have an issue with compression or poor movement of the nerve at either the elbow or at the wrist. To test this, position your arms as if you are performing a front squat — elbows bent with your palms to the ceiling and your finger tips resting on you shoulder. Pull back slightly on the fingers in your left hand to create more tension. Does your wrist, pinky or forearm get worse? Flex your wirst and see if it gets better. Bending the wrist back puts more tension on the nerve; bending it forward takes some tension off. This is not not a catch-all test, but it’s a start to make sure the nerve moves well. If this test is positive, I would suggest you see a health care professional such as a PT or chiropractor.

Technique can have a lot to do with some of the aches and pains we have and more than likely we will find issues in a certain area of our body — like the wrist — is related to lack of mobility in another.

Now the challenge is to determine if it is a mobility issue, a stability issue or a strength issue. As an example, in the catch phase of a clean we need to have adequate wrist extension, forearm pronation and external rotation of the shoulder to allow us to receive the bar on the front of the shoulders and fingertips. If the wrist is stiff, this will place additional stress on the structures of the joint and down the front of your forearm. To help with stretching, you can extend your arm with your palm facing away from you, fingers pointing to the ceiling. With your other hand grab onto the finger tips and pull back slightly until a stretch is felt in the front of your forearm. This is to help stretch the muscles of the forearm and will get a little of the joint.

To address the wrist joint specifically, place your hands palm to palm in front of your face and slowly bring your hands down until you feel a stretch in your wrist (like a prayer). Be sure not to let the palms separate. You can work on your strength with use of a kettlebell or even a dumbbell while performing a waiters carry or a kettlebell rack walk (see video below) with the wrists in neutral. Push ups in the rings are another great way to work on not only wrist stability, but stability through the elbow, shoulder and core.

Grip strength will also be addressed with those exercises, but to really tap into hand/forearm strength you can try kettlebell swings, body weight rows in the rings, or a farmers walk with kettlebells. When it comes to your grip and specific lifts I would suggest you get with your coach and have them take a look at technique to see if they can make any suggestions on the spot. Technique can have a lot to do with some of the aches and pains we have and more than likely we will find issues in a certain area of our body — like the wrist — is related to lack of mobility in another. We are here to help, so please feel free to post again to give us an update and allow us to work through this with you.

Kettlebell waiter’s carry and rack carry:

Whitney says…

Whitney Welsch | PT, DPT, OCS

Hi Christina-

Joshua already hit on a number of key points, but  there are just a few more that are specific to the wrist — especially in barbell movements and pullups — that  I’d like to touch on.

For gripping activities, the pinky assists in closing the grip. Check your hand position and make sure you’re getting the middle knuckle of your pinky over the pullup bar to fully engage your hand.

The speed of these movements requires you to transition very quickly from a neutral wrist position to a flexed wrist position when receiving the barbell at your center mass, making them the biggest culprit of wrist injuries.

For barbell movements there are two wrist specific injuries that are very common. One is on the outside border of the wrist by the pinky and is an issue with the TFCC (triangular fibrocartilage), which typically gets injured with more rotational based movements, but also gets loaded a lot with snatch grip andoverhead squats if your hands are too far toward the caps (normal width is approximately 6-8 inches vertically over your head depending on body proportions). If the pain is more toward the back of the hand there can be an issue at the capitate-lunate junction or the lunate-scaphoid junction(although this is toward the thumb). These two critical joints assist in flexion/extension motion at the wrist, which is the most commonly injured joint in the wrist with barbell movements like cleans and thrusters. The speed of these movements requires you to transition very quickly from a neutral wrist position to a flexed wrist position when receiving the barbell at your center mass, making them the biggest culprit of wrist injuries.

You’ll definitely want to check your ulnar nerve as Joshua described in detail, but you’ll also need to have a proficient Olympic lifting coach check your bar path and timing for barbell movements. Furthermore, you’ll want to double check your hand position of pullups and ring movements.