Physio’s corner: a brief guide to managing wrist injuries

Sophie Hudson, a certified and registered physiotherapist, explores wrist injuries in rowing and how they can best be managed.

Wrist injuries can be a painful nightmare.

It’s one of those injuries, like low back pain, that most rowers will experience and can affect your ability to perform and do everyday activities.

As a physiotherapist, there are seven common wrist and forearm injuries that I see: exertional compartment syndrome, lateral epicondylitis, medial epicondylitis, de Quervain’s tenosynovitis, wrist impingement syndrome, intersectional syndrome, and “Sculler’s thumb”.

These seven injuries have similarities and differences in how they present – the symptoms, type of pain, where the pain is located, how exercise affects the pain, what movement aggravates and eases the symptoms, and more. 

In order to know how to manage any injury we need to identify our “five Ws”: who, what, where, when, why and how our wrist and forearm move. Identifying where most of the pain and other symptoms are can be an indicator of the type of injury.

Our wrist has four main movements: flexion, extension, abduction and adduction. The forearm has two main movements: pronation and supination. Making sure we can do all these movements is important for a healthy wrist and forearm.

Below is a brief flowchart diagram of how to identify what is going on based on the location of your pain.

Flowchart illustrating how to identify injury based on the location of pain

In addition to using pain location to help identify the injury, physiotherapists also look at how the pain is behaving and its characteristics. A few key examples of this are the type of pain, what makes the pain better or worse, and how exercise affects it.

Below is a simplified and brief flow chart using symptom behaviour and characteristics to help identify the injury or condition. 

Flowchart using symptom behaviour to identify wrist injuries

Here is an example of a wrist injury rehabilitation timeline. In order to move onto the next stage, you need to pass the clinical and functional movements.

Stage 1: manage symptoms and avoid movements that aggravate the pain. 

The pain is relatively new to the body and your body will be sensitive and protective. Pain is an output of the brain. 

Relative rest and activity modification, like swapping an erg for a bike or run, allows the body to recover and doesn’t aggravate. 

Checklist: 

• Your pain is less than 2-3/10. 
• Restore the full range of motion in your wrist and elbow. 

Stage 2: build your capacity and strength of your whole arm. 

Your wrist does not act on its own – how your elbow and shoulder move influences your wrist. Strengthening all your muscles in your arm and upper body are essential. 

Now you have the full range of motion in your joints, we need to start increasing their capacity and strength. This means getting strong.

A combination of high repetitions and light load, slow repetition, and repetitions using a heavier weight is essential for developing good strength.

Checklist:

• Your pain remains less than 2-3/10 and lower than stage 1.
• Your injured side is 80-85% as strong as your non-injured side.
• You can do functional movements without pain, like body weight pushups, movements involving gripping, low intensity sessions on the ergo or in a boat.

Stage 3: re-introducing training volume and plyometrics 

Gradually increasing your training volume is smart and the best approach long term. Speak with your coaches and slowly re-introduce the exercises that were once aggravating.  

Watch how your body responds and allow yourself a decent 3-6 weeks to get back to your normal training volume. Use your pain as a guide and feedback.

Plyometrics is a type of training that requires muscles to reach maximum force in a short period of time and involves fast contractions and stretching of the muscles and tendons. 

Plyometrics can build power, strength, control and coordination. 

Keeping the movement functional and the whole body is good for conditioning and targeting the arm and upper body. Exercise examples include: wall balls, fast throwing and catching movements and power cleans. 

Final thoughts

Don’t forget that your lifestyle also plays a part. 

Factors like your job, desk ergonomics, typing, and physical work add an additional load that your body needs to recover from.

Sleep, nutrition, hydration, active recovery and stress management are ways to recover from this additional load. Don’t neglect it. 

Not all injuries will be treated and managed the same way. This is a generic guideline.

For more information or advice, please contact @sophiehudsonphysio

Diagram credit: Sophie Hudson

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