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Why is Wrist Pain so Prevalent? Millions of Americans suffer from chronic wrist pain that can range from tingling, to throbbing, to sharp and piercing.
The incidence of wrist pain (and hand pain) has been the most common complaint involving the upper extremities ever since we all started spending so much time using computers (and therefore keyboards and mice), according to the American Academy of Family Physicians. Take a simple 3-part test to see if your pain is caused by something that may have even fooled your doctor ... and try these simple solutions!
Computers, of course, are not the only things to blame for Americans' painful wrists. It may simply be that our wrists (all nine tendons, six bones, two nerves, tissue and more) are just not cut out for the rigors of daily life.
"We're taking an anatomy that has evolved over hundreds of millions of years," said Mayo Clinic hand expert Peter Amadio in an NPR article, "but not necessarily for the purposes we're putting it to at the moment. The human hand is doing lots of different things, using lots of different positions, and lifting heavy things, doing fine manipulations, a variety of different activities, and so these tissues need to adapt. And it's not unreasonable that the adaptations might fail in certain cases."
This failure, along with a number of other factors, has left many people searching for answers when it comes to their aching wrists.
Wrist Pain: Commonly Misdiagnosed?
Dr. Justin Tossing, Clinic Director of North Glen Physical Medicine, states, "Most patients with wrist pain are given misdiagnoses to fit the treatments the doctor administers, i.e., drugs and/or surgery, neither of which are appropriate or necessary in majority of cases. Simple noninvasive techniques to alleviate wrist pain treat the cause, eliminating the need for a cure. Myofascial Trigger Points [painful knots in muscles] in the wrist, arm, shoulder, and neck are the true cause of most wrist and hand pain. These [trigger points] can be treated easily even by the patient themselves."
Dr. Tossing goes on to explain that outside of obvious injuries, wrist pain can be difficult to diagnose, and are often misdiagnosed, as follows:
- Carpal Tunnel Syndrome (CTS): "Used by many doctors as a catch-all diagnosis when symptoms are generally described as nerve pain, numbness, and/or tingling in the hands. Most diagnosed cases are NOT true CTS, but rather myofascial dysfunction, such as trigger points [muscle knots]." Other factors that can contribute or aggravate this condition include repetitive movements, being overweight, and injury to the wrist.
- Tendonitis: "Most doctors simply recommend rest, a temporary solution at best. Treating trigger points can solve most of tendonitis cases with no drugs or surgery within 2 weeks or less." Tendonitis occurs when the tendons surrounding the wrist joint become inflamed, causing pain and swelling. Like CTS, tendonitis can be aggravated by repetitive movements. "[This] occurs because trigger points tighten the muscles and pull on the tendons, causing them to become sore and inflamed."
- Arthritis: If you're over 20 years old and have pain in a joint, you've probably been told you have "arthritis." Arthritis of the wrist can take on several forms:
- Osteoarthritis is degeneration of the wrist joint caused by wear and tear. This form of arthritis can be caused by trigger points [muscle knots] that go untreated for years. Eliminating trigger points [muscle knots] through gentle hands-on techniques can greatly alleviate this pain and prevent further destruction of the joint.
- Rheumatoid arthritis (RA) is a condition that affects the entire body, wherein the immune system destroys the joints, causing pain, swelling and stiffness in the wrists. There are many proven successful alternative treatments for RA that involve nutritional and lifestyle changes, which will be addressed in future Sixwise articles.
According to Sharon Sauer, Certified Myofascial Trigger Point Therapist and wrist pain expert: "Trigger Points are the Most Often Missed Cause of Wrist Pain!" Whenever performing a repetitive movement, such as typing, sewing, or painting, take frequents breaks to give your wrists a rest.
Wrist Pain: Trigger Point Tests & Treatment Step-by-Step
Treatment of Trigger Points can be performed easily yourself using simple self-care tools, or by specially trained practitioners (myofascial trigger point therapists). Here is the process: Myofascial Trigger Points are painful knots in muscles where blood flow has decreased and lactic acid has built up. These knots cause tightening of the muscle that increases the pulls on tendons and joints, causing damage and pain. The most amazing fact about trigger points is that they refer pain to areas distant from their own location. Severe pain in the wrist, for example, can be caused by a trigger point in the muscles of the neck or shoulder, explaining why wrist pain is so often misdiagnosed.
- Perform a simple test to identify which muscles have the trigger points.
- Warm up the area to be treated (where the trigger points are)
- Use a simple tool to compress the trigger points for 3-7 seconds each
- Stretch the muscle that you just treated
- Perform the simple test again to see if the treatment was successful
While there are many tests to determine which muscles have trigger points causing your wrist pain, here are three you can easily perform to determine if trigger points are causing your wrist pain.
For each test that you fail, you need to perform the corrective self-care techniques associated with that test in order to achieve lasting wrist pain relief. You will know if you treated the right areas by decreased pain and better self-retesting. If you do not achieve relief or better self-test results, you are advised to seek further evaluation from a physician or therapist trained in myofascial trigger point therapy. Myopain.com can help you find a practitioner in your local area.
Test #1: Wrist and Finger Flexors Test
Test: Bring your arm in front of your body to shoulder level with the elbow straight. Use your other hand to pull your upper palm and fingers back in towards you.
Results: If you cannot bend the wrist up to 90 degrees or if there is any pain, this indicates you may have trigger points in the muscles that flex your wrist and/or fingers causing wrist pain. Congratulations! Your wrist pain may be easy to fix.
Warm-up: Gently massage the forearm or wrap in a moist warm towel for 5-10 minutes.
Compression Technique #1: Here is the compression technique that will deactivate trigger points (irritable tight spots) in your hand flexors.
Stand facing the wall. Rotate the hand and arm so that your palm faces the wall. Let your arm rest against your torso. Place the Jacknobber II tool just at the elbow crease. Lean your body towards the wall, compressing with mild to moderate pressure your arm into the tool. If the spot is tender and/or you feel pain radiate into the wrist, you are pushing on a trigger point! Continue to apply pressure for 3-7 seconds. Pain level should be mild to moderate. Take two or three deep slow breaths. Focus on being relaxed. Then move the ball or Jackbobber II tool down the forearm and repeat. As the ball or Jackbobber II tool gets closer to your wrist, allow your arm to rest against the hip and thigh.
Stretch Technique #1: Now that your muscles are properly warmed up and have been pressed on (compressed), they are ready to be gently stretched and encouraged to return to their normal resting length and function. Always follow the compression technique above with the following stretch:
Pull the palm back. Vary the stretch by deviating to the each side of the hand (ulnar and radial). To stretch the finger flexors, pull each finger back individually. Hold for 2 seconds.
An alternative is to put your fingers together as if you were, "praying," Then use the fingers of one hand to push and stretch the flexors of the opposite hand.
Test #2: Wrist and Finger Extensors Test
Test: Bring your arm in front of your body to shoulder level with the elbow straight and the wrist flexed down.
Results: If you cannot bend the wrist down to 90 degrees or if there is any pain, this indicates you may have trigger points in the muscles that extend your wrist and/or fingers causing wrist pain.
Warm-up: Gently massage the forearm or wrap in a moist warm towel for 5-10 minutes.
Compression Technique #2: Here is the compression technique that will deactivate trigger points (irritable tight spots) in your wrist and finger extensors:
Rest your arm on a flat surface such as a table with your palm facing down. Holding the Jacknobber II tool with your opposite hand, press the tool into the muscles of the forearm just at the elbow crease. As in the above example, search for a spot that is tender and/or causes pain to radiate into the wrist. Hold it for 2-3 deep slow breaths while relaxing. Move the Jacknobber II tool down the forearm and repeat.
Stretch Technique #2: Always follow the compression technique above with the following stretches:
Gently stretch your hand extensors by using one hand to press the other hand into downward (into flexion). Modify by stretching the hand toward each side.
Then make a light fist. Using the opposite hand, gently flex the wrist and vary the stretch by giving deviation to each side.
Test #3: Cervical Lateral Flexion Test
Test: Try to press your ear to your shoulder without raising your shoulder. How close to your shoulder can you get? Do you experience any pain when doing this test?
Results: If you cannot bend your neck to the side to 3 inches from your shoulder, or if there is any pain, this indicates you may have trigger points in the scalene muscles on the side of your neck that stabilize your spine at the neck. When the scalene muscles have trigger points, they often send pain down to the wrist. Whichever wrist has pain, the scalene muscle on the same side must be treated.
Warm-up: Gently massage the side of the neck or wrap in a moist warm towel for 5-10 minutes.
Compression Technique #3: Here is the compression technique that will deactivate trigger points in your scalenes:
Press the Backnobber II tool into the muscles along the same side of the neck that you are having wrist pain (see photo). Start at the base of the neck and work upwards towards the just under the ear. Apply just enough pressure to feel mild to moderate tenderness in the muscle you are compressing. When you find a trigger point, as noted by tenderness and/or radiating pain into the hand/wrist, hold the compression for 2-3 deep slow breaths while relaxing. Then move to the next spot and repeat.
Stretch Technique #3: Always follow the compression technique above with these stretches:
First, pull your chin in and move your head back.
Next, place your hand over your head just above the ear. Pull your head slowly down towards your shoulder. Breath, relax and feel the muscles in the side of your neck stretch.
Now, vary this stretch by looking up slightly as you do it.
Repeat while looking slightly down.
Did you pass all three tests above but still have wrist pain? If so, your wrist pain may still be caused by trigger points in yet another muscle. There are 11 other muscle groups that also refer pain to the wrist! You may need to get a myofascial trigger point evaluation by an experienced practitioner. Don't give up!
Note: If any of these self-treatments cause increased pain or problems, do not continue performing them and see a qualified physician. Increased wrist pain is a sign that trigger points are a part of your problem, but they may need to be further evaluated by a practitioner trained in myofascial trigger point therapy. Myopain.com can help you find some of the best myofascial trigger point therapists in your area.
Reprinted with Permission from the SixWise.com
Security & Wellness e-Newsletter by www.SixWise.com
Anyone who has worked as a manual therapist for any amount of time knows how physically demanding this kind of work can be. Manual therapists often use repetitive movements combined with hand force in their work; they may hold pressure or stay in one position for a long time, causing static loading to their tissues; fatigue may cause them to end up working in awkward postures that stress vulnerable parts of their bodies. Repetitive movements, hand force, static loading and awkward postures are all recognized risk factors for developing musculoskeletal disorders (MSDs). The therapist’s age, general health, previous injuries and other personal physical and emotional factors are additional risk factors that can increase their injury risk. Given all of these risk factors, it is not surprising to learn that recent studies have shown a high rate of symptoms and MSDs among manual therapists as a result of their work. A 2006 study of massage therapists and bodyworkers showed that 77 percent had experienced pain or other musculoskeletal symptoms related to their work, and 41 percent were diagnosed with an MSD.1 High rates of symptoms and injury were also reported in other studies among PTs, PTAs, hand therapists and chiropractors.2, 3, 4, 5
Before you start thinking about putting your treatment table up for sale, it’s important to understand that injury is NOT inevitable. Many professions have inherent risks, and many people in these professions have successful, long-term, healthy careers. There is a great deal you can do to prevent injuries from occurring in the first place, and to minimize their effects if they do occur. The key to managing your risk of injury is to reduce your exposure to risk factors as much as possible. You can do this by modifying the risk factors you can change (like repetitive movement or awkward postures), and maintaining awareness of and developing coping strategies for those you can’t change (like your age or previous injuries).
Proven methods exist to lower the incidence of work-related injury. Many of them involve making simple but important changes to your activities, both at work and elsewhere; others will take more thought and practice to apply. But taking the necessary steps to prevent injury is much easier and less disruptive to your career than dealing with an injury once it has occurred.
Developing Your Multifaceted, Holistic Injury Prevention Strategy
It would be wonderful to find a single solution to preventing injury. But decades of research have shown that reliance on just one tactic, like improving your body mechanics or doing strengthening exercises, is rarely effective in preventing MSDs. Since multiple factors are involved in causing work-related injuries, a successful prevention strategy must be holistic and multifaceted, combining many of these tactics to address all of the potential causes.
There are five primary steps to injury prevention:
- Maintaining awareness of the risk of injury in your work
- Understanding how risk factors cause injury
- Reducing risk factors through ergonomics
- Developing good body mechanics and work practices
- Taking care of your general physical and emotional health, including physical conditioning.
Because a manual therapist’s work is so physically demanding, workplace risk factors play a primary role in causing MSDs among these practitioners. The science of ergonomics provides proven and remarkably effective ways of addressing these risk factors to help you prevent injury.
The main goal of ergonomics is to find ways to make the work environment better fit the worker. Designing your treatment space to fit your body characteristics and the type of work you do makes it possible for you to use good body mechanics. You need enough space to move freely around your table to avoid static positioning and awkward postures. Your table needs to be adjustable so you can work comfortably and efficiently as you change techniques and move from one client to another (a power-adjustable table is ideal for this purpose). Equipment like hydroculators or massage stone heaters can be raised to waist level so you can avoid bending to reach them or having to lift their heavy contents in awkward postures. Each change adds up to make your treatment space a safer place to work.
Your work schedule can also benefit from some ergonomics help. To avoid injury, you need to balance periods of exertion with periods of rest and recovery. You’ll need to schedule breaks that are long enough for you to do some stretches, breathe and relax your mind and muscles. To not overload your body, you will also need to limit the number of treatment sessions you do in a day and in a week. The goal is to have a consistent, manageable workload from day to day and week to week, to avoid any sudden increases in workload, a situation that can increase your injury risk.
Developing good body mechanics is an important part of any injury prevention strategy. Your goal, however, is to have “good” body mechanics, not “perfect” body mechanics. In the real work world, no one uses perfect form at every moment. The idea is to continue to use your body in a natural and efficient way, while doing your best to maintain an approach that maximizes your strength and avoids overloading the most vulnerable parts of your body. You will need to modify or eliminate any technique that causes you pain or discomfort; plainly speaking, if it hurts, don’t do it.
Your general health plays a major role in your ability to prevent injury. Maintaining good physical conditioning, getting enough sleep, eating well and avoiding unhealthy habits like smoking can have a direct effect on your ability to withstand the rigors of your work and heal tissue damage before it progresses to the point of injury.
Sometimes, despite your best efforts to avoid injury, you may find yourself developing symptoms. In real life, it is difficult to always avoid every risk factor and perfectly control your work environment to stay 100 percent symptom-free. If symptoms occur, recognizing them and getting appropriate treatment as early as possible is the best way to minimize interruption to your work and get you back on the road to health as quickly as possible.
Injury prevention is a concern you share with all manual therapists. Meet with your colleagues regularly, talk openly about your injury concerns, watch each other work and support each other’s efforts to reduce injury risk. Give your own physical and emotional needs the same care and consideration that you give to your clients. Learn to be good to yourself, and a long, healthy career will be within your grasp.
1.Lauriann Greene and Richard W. Goggins, “Musculoskeletal Symptoms and Injuries among Experienced Massage and Bodywork Professionals,” Massage & Bodywork, 2006; Dec-Jan: 48-58. 2.Nicole L. Holder, et al, “Cause, Prevalence and Response to Occupational Musculoskeletal Injuries Reported by Physical Therapists and Physical Therapist Assistants,” Physical Therapy, 1999; 79(7): 642–652. 3.Suzanne Caragianis, “The Prevalence of Occupational Injuries among Hand Therapists in Australia and New Zealand,” Journal of Hand Therapy, 2002 Jul–Sep; 15(3): 234–241. 4.Dennis M. J. Homack, “Occupational Injuries to Chiropractors in New York State,” (Masters’ Thesis, Graduate School of Cornell University, 2004). 5.Wayne J. Albert, et al., “A Survey of Musculoskeletal Injuries Amongst Canadian Massage Therapists,” Journal of Bodywork and Movement Therapy, 2007: 1–8 6.Jean E. Cromie, et al, “Work-Related Musculoskeletal Disorders in Physical Therapists: Prevalence, Severity, Risks, and Responses,” Physical Therapy, 2000; 80(4): 336–351.
Portions of this article reprinted from Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition, Copyright © 2008 Gilded Age Press, Inc. All rights reserved.
About The Author
Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP are co-authors of the all-new 2nd Edition of Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, the leading self-care textbook used by schools throughout the U.S. and Canada, and worldwide. Lauriann and Richard have published numerous articles in national magazines on this subject, co-authored the first comprehensive statistical study on injury among massage therapists, and offer consulting and training services to clinics, spas and schools to help manual therapists prevent workplace injury.