Thinking about wrist pain

Posted on April 11, 2013

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The most common reason(s) I see causing wrist issues are:

1) Excessive wrist extension

2) Excessive ulnar deviation i.e. the wrist turns out too much.

3) Combination of 1) and 2).

Wrist movements

Example of excessive ulnar deviation of right wrist below:

This post is going to cover scenarios where these two movements happen too much / too often. I’m first going to go over some activities of daily living (ADLs) and then I’ll go over eliminating these movements in the gym (during exercise).

First, some principles.

General wrist talk

In many pain issues, when one movement is excessive the opposite movement is limited. A person has too much extension in a joint; they probably have limited flexion in the same joint. A person has too much anterior glide? They probably lack posterior glide. The shoulder is a great example.

I have not seen this with the wrist.

Wrist issues are often from excessive extension and ulnar deviation, but that doesn’t mean the wrist lacks range of motion in flexion or radial deviation. In wrist issues it means the person needs to simply eliminate the excessive extension and turning out deviation.

In wrist issues it is way more important to focus on what you’re eliminating, opposed to what you’re adding.

Therefore, if you leave a comment on this or email me with paragraphs about all the wrist exercises you’re doing, and don’t even mention how you’re still typing like you just spent way too much time at the Happy Endings massage parlor, I will ignore you.

And now we have our segway into…

Wrist positioning while typing

Correct this and most wrist issues are resolved.

Wrist extension

The first thing we’ll go over is the extension. This is more talked about, and is where the wrist rests come from.

Wrist rest

Without a wrist rest people are more likely to have excessive wrist extension:

Typing wrists extended

Bad.

Typing wrists extended with lines

Typing wrists straight with rest

Better.

The height of the chair relative to the desk can affect things too. The lower the hands have to reach down the more likely the wrist is to extend,

Typing wrists extended low desk

and the higher the hands are the more likely they are to flex.

Typing wrists flexed high desk

Prairie doggin’ it.

We want something roughly in the middle. When in doubt, lean towards having a little too much flexion.

Ulnar deviation (wrist turning out)

This is much less, if ever, talked about.

We want to make sure the wrists / fingers are straight; not turned out.

Typing wrists ulnar deviation

We want to eliminate any curvature on the outside of the wrist.

Typing wrists ulnar deviation with lines

Bad.

In favor of a straight(er) line:

Typing wrists straight

Typing wrists straight with lines

Better.

Typing on your phone

This isn’t just for laptops or PCs, it extends to phones as well.

Phone typing wrist ulnar deviation

Phone typing wrist ulnar deviation with lines

You can simply pull the wrists in a bit,

Phone typing better wrists

Or switch the typing style. Using an index finger on one hand is an example:

Phone typing index finger

Back to your typical desk scenario: Often times the best way to do this is to pay attention to the placement of the elbows. We want to make sure the elbows are close to the torso; not flared out.

Typing elbows out

Bad

Typing wrists straight

Better.

Because as the elbows flare out the wrists will be put in ulnar deviation, but as the elbows come close to the torso the wrists will straighten:

If there’s a proximal correction to make (the elbows in this case), you go with that before you go out distally (the wrists). Correct the proximal segment first and the distal segment often concomitantly corrects.

There is a big caveat here though.

Being overweight changes everything

If you’re someone with a significant amount of weight to lose, and you store a lot of this weight in your stomach, you’re going to run into some issues.

Here’s someone pretty lean with their elbows at their side:

Typing elbows at side

And here’s where the elbows would be if there was a significant amount of weight in their stomach.

Typing overweight person elbow

Right (left in picture) versus left elbow.

Having too much weight in the torso can preclude someone from being able to type without ulnar deviation. If you use a non-laptop keyboard an ergonomic keyboard may be necessary.

ergonomic keyboard

By widening the placement of the hands the wrists are more easily able to be straight. However, beware this is a band-aid and not the best long-term fix, which is to lose the weight so your elbows can be at your side. Even though the ergonomic keyboard will help things while sitting, it isn’t helping while standing.

Wrist extension while in standing

Stop. Standing. Like. This.

Wrists on waist close up

Standing with the hands on the hips is way more common than people realize, and it’s a big way people mess up their wrists, elbows, and shoulders. It just beats the crap out of the joints.

And it doesn’t matter if you’re a female aged 18-30 years old, you know, the demographic where it’s apparently a rule at least one hand MUST be on the hips for any picture taken.

Girl “But I look skinnier when I stand like that!”

Me “I don’t care. Go take more pictures of food instead. I hear Instagram needs more of those.”

Stand with your hands down at your side.

Limiting wrist extension / ulnar deviation in the gym (exercises)

I’ll give various examples of exercises and adjustments to still perform the same, or very similar exercise, but without the extension / ulnar deviation. Because these movement issues are so common (everybody is at a computer for hours a day) these are adjustments I make nearly with everyone, regardless whether they have wrist issues or not.

Goblet Squat

Box Squat goblet grip

Adjustment: Carry Grip

Box Squat carry grip

DB Row

DB Row wrists extended

Happens more often at the top of the movement.

Adjustment: Straighten / curl wrist

DB Row wrists straight

Front Squat

Front squat wrists extended

Adjustment: Cross Grip

Front Squat cross grip

Straight Arm Plank

Push ups wrists extended

Adjustment: Go on the fists

Push ups on knuckles

Or go into a plank on the elbows. More on this below.

Barbell Squat

Barbell squat wrists bent back

Adjustment: Straighten wrists

Barbell squat wrists better

Push ups

Push ups wrists extended

Adjustment: Use barbell or dumbbells

Push ups wrists straight with bar

Front Plank (ulnar deviation)

Plank bad wrists

Adjustment: Turn palms up; slightly flex wrists

Plank better wrists

Bicep Curls

Adjustment: Straighten / slightly curl wrists

Pulldowns

Pulldowns wrists bent

Adjustment: Straighten wrists, which may need to be done by first making sure the elbows don’t travel behind the torso

Pulldowns wrists straight

Or, flip the grip. Making it extremely hard there will be a wrist issue.

Pulldowns underhand grip

There are more examples, but you get the idea.

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Posted in: Pain, Wrist Pain