Blog

By Mason Neal - Physiotherapist

Wrist pain can be a major hindrance for athletes, especially when it affects performance and daily activities. A common location of wrist pain is on the dorsal (back / non-palm) side of the wrist. This pain can arise from a variety of conditions, including deQuervain's tenosynovitis, Intersection Syndrome, tendinopathies, TFCC injuries, scapholunate ligament injuries, and Kienböck’s disease. If you are an athlete experiencing dorsal wrist pain, understanding the potential causes, and getting the right treatment is essential to getting back to your sport as quickly and safely as possible, as well as minimising risk of re-injury.

Causes of Dorsal Wrist Pain

Dorsal wrist pain is associated with a few different conditions or can be the result of trauma without actual tissue damage but still affecting the wrist's structures in different ways. Here’s a quick rundown of the most common issues:

1. deQuervain’s Stenosing Tenosynovitis: This condition affects the tendons on the thumb side of your wrist, often caused by repetitive motions, like wrist flicking, gripping, or lifting, causing inflammation and pain as the tendons slide along the wrist. Athletes who use their hands frequently, such as tennis players, gymnasts, and weightlifters, are particularly prone to this injury.

2. Intersection Syndrome: This involves inflammation of the tendons that cross over the top of the wrist. It is similar to but not the same as deQuervain’s and is common in activities that require repetitive wrist pulling back, including rowing and CrossFit. The pain is usually felt at the wrist crease but can extend both into the hand and into the forearm.

3. Tendinitis: This is a general term for inflammation of the tendons in the wrist, as there are more than just the ones involved in deQuervain’s and Intersection Syndrome. It can result from overuse, faltered technique, or sudden increases in training volume or load. Sports like gymnastics, cheerleading, and tennis can put significant strain on the wrist tendons, leading to pain and stiffness, as can some gym activities when intensity and weight is ramped up.

4. TFCC Injuries: The triangular fibrocartilage complex (TFCC) is a structure that helps stabilise the pinky side of the wrist. Injuries to the TFCC often result from a fall on an outstretched hand or from repetitive, forceful twisting motions. This is common in sports that require gripping and twisting, such as tennis, gymnastics, or CrossFit. The TFCC is made up of many structures, and its complex anatomy lends to it often taking longer to recover than other ligament injuries.

5. Scapholunate Ligament Injuries: The scapholunate ligament connects two of the small bones in your wrist (scaphoid and lunate) which provides support when you take weight through the hand. When this ligament is injured, it can lead to sensations of instability when gripping, and sharp pain on the back of the wrist. This type of injury is common in athletes who experience sudden impacts, like gymnasts or cheerleaders, as well as golfers if they hit a divot.

6. Scapholunate Advanced Collapse (SLAC): This is a progressive condition that can develop after a scapholunate ligament injury. Over time, the instability in the wrist can lead to arthritis and chronic pain. Athletes who have sustained previous wrist injuries are more likely to develop SLAC and becomes difficult to manage without use of supports like splints or strapping if left to progress too long.

Why Athletes Are Prone to Dorsal Wrist Pain

Athletes are often more susceptible to wrist injuries due to the varied, repetitive, and high-impact nature of their sports. Activities that involve gripping, weight-bearing, or sudden impacts can put a lot of strain on the wrist. Without proper technique, adequate rest, and appropriate conditioning, this straining sensation (which can be normal and expected, as your training load increases) can lead to injury.

For example, gymnasts place a lot of stress on their wrists during weight-bearing manoeuvres like handstands and round-offs, whereas tennis players may develop wrist pain from repetitive play, particularly quick volleys, and topspin forehand shots. CrossFit athletes also often perform a variety of wrist-intensive movements, like Olympic lifts, Turkish get-ups, and handstand walks, which can lead to overuse injuries if not performed correctly or if performed to excess.

When Should You Seek Help?

If you're experiencing pain in the back of your wrist, it's important to address it early. Ignoring wrist pain can prolong the recovery period and potentially lead to longer downtimes from training or competing.

Signs that you should seek professional help include:

• Persistent pain that doesn't improve with rest
• Swelling or bruising on the back of your wrist
• Difficulty gripping or lifting objects
• Difficulty or pain with twisting or flicking the wrist
• A feeling of instability or difficulty sustaining a position with your wrist
• Pain that worsens with activity

As a physiotherapist with a clinical focus on wrist injuries, I can help you identify the physical (and in some cases non-physical) causes of your wrist pain and develop a treatment plan tailored to your needs.

What to Expect During Your Physiotherapy Session

When you come in for a consultation, after discussing what has brought you in and some factors that may be contributing to the pain, both with your sport and day-to-day life, I'll start by assessing your wrist, including checking for tenderness, swelling, and range of motion, and some special tests that help isolate different structures to determine if there is a specific pathology (like a ligament tear, muscle or tendon injury, or risk of a tear or break). I’ll also ask about your sports activities, training schedule, and any recent changes in your routine. This helps me understand the potential causes of your pain and determine the best course of action.

Once we've identified the issue, we'll work together on a treatment plan. This may include:

• Hands-on therapy to help reduce pain and improve mobility in the wrist.
• Strengthening exercises to target the muscles that support your wrist and improve your overall stability.
• Proprioceptive and control exercises to improve your ability to position and move the wrist in a coordinated manner (as pain often decreases your co-ordination)
• Technique analysis to ensure you are using proper form during your sport and not overloading any structure, reducing the risk of re-injury.
• Activity modifications to adjust your training routine or volume to allow your wrist to settle without losing your fitness or skill level.

Tips for Athletes

Preventing dorsal wrist pain is all about preparation and maintenance. Here are some tips to keep your wrists pain-free while training: - Warm up adequately before any workout or sport, which may be as simple as just wrist circles, loading drills, stretches, or exercises that your physiotherapist shows you to prepare your wrists for your sport - Strengthen your wrists separate to other exercises – even though the wrist gets stronger with exposure to gripping and use while playing your sport, exercises that target the muscles around your wrist should be incorporated into your training routine to assist with durability and endurance - Use proper technique whenever possible, whether you're lifting weights, playing tennis, or doing gymnastics, make sure your technique is solid. Poor form isn’t necessarily going to cause injury if it’s every now and then, but deliberately loading in awkward positions or techniques that make you work harder than you need to can put unnecessary strain on your wrists - Don’t ignore pain that doesn’t settle well. Athletes will often experience a low level of discomfort as they increase their training load, which is expected and not often an issue unless it persists or gets worse. Modifying training load and treatment will help reduce the pain factor, and determine how intensely to train before pain limits you - Consider wrist supports for some activities, particularly with TFCC injuries and scapholunate injuries, the compression can be useful in reducing symptoms while still being able to train – but shouldn’t be relied on wholly and instead an adjunct to other rehab treatments.

How Physiotherapy Can Help

Physiotherapy is an integral part of the recovery process for athletes with dorsal wrist pain. By working with a physiotherapist who understands the demands of your sport, you can get back to peak performance sooner while reducing the risk of future injuries. In addition to treating the current pain, physiotherapy can help you build a stronger, more resilient wrist and hand. This holistic approach ensures that any underlying issues, such as strength or mobility limitations, technique, training load, and non-physical factors are addressed.