Wrist pain in gymnastics

Ask any senior gymnast, and they will tell you - wrist pain is almost gaurenteed within a gymnasts career. The wrist and hand together make up approximately 25% of all injuries in men’s gymnastics and can cause time away from training in both Men’s and Women’s artistic gymnastics.

But where is the line between wrist discomfort and injury? When should a gymnast or coach be worried about wrist pain? And ultimately, what can we do to reduce and prevent wrist injuries in the weight bearing gymnast.

The wrist is a complex joint. In fact, there are multiple joints within the wrist itself, along with countless ligaments, tendons and other soft tissues. All of which are susceptible to injury.

Below are a few of the common examples of injuries we see and some strategies to avoid wrist injury:

Dorsal wrist impingement: This condition presents with pain on the dorsal (back) side of the wrist when the hand is moved into extension (like in a handstand). We can develop a dorsal wrist impingement from a 'one off' injury where our hand is moved forcefully into extension causing 'impingement' of boney and soft tissue structures.

If the injury is severe, it could need up to 6 weeks of rest to let the boney bruising settle. However - If pain is mild, it may be a simple matter of waiting for the acute pain to settle and ensuring a good warm up before restarting weight bearing activities.

If this persists, further irritation of the soft tissues on the dorsal side of the wrist can cause inflammation and scar tissue to form - this may cause ongoing wrist impingement pain.

Gymnasts wrist: Yes. There is a condition named after the sport itself. This problem only affects the adolescent gymnasts as ‘gymnasts wrist’ is an overuse condition of the distal radial growth plate. It effects up to 40% of all gymnasts and has the potential to become a long term issue. Symptoms may include:

  • Bony tenderness on the back side of the wrist

  • Pain which may “warm up” but returns after activity has ceased

  • Reduced range of motion - particularly when bending the hand back into wrist extension

  • Swelling

Repeated stress and inflammation to the growth plate could lead to bony stress reactions and even growth disturbances.

Treatment depends on the severity and if load reduction can’t settle symptoms, bracing and anti-inflammatory medication may be utilised.

Positive ulnar variance (PUV): This doesn't roll off the tongue quite as well as ‘gymnasts wrist’. But it is important to talk about, as it may be closely related to repetitive trauma at the radial growth plate which is experienced in 'Gymnasts wrist'.

Although complex to understand, the simple way to think about PUV is that our radial growth plate (as mentioned above) has taken such a beating that it’s growth ceases early. Meaning it’s partner bone (the ulnar) continues growing and sits closer to the smaller bones of the wrist - potentially causing a whole new set of overuse injuries (see below).

Triangular Fibrocartilaginous Complex Injuries (TFCC Injuries): These types of injuries could be a result of developing a PUV and typically affect the older gymnasts >16 years+.

This injury can be identified by pain on the ulnar side of the wrist (under the pinky finger).

Acute injuries of the TFCC can happen from a fall on the outstretched hand or a rotation while weight bearing on the hand. Chronic tears of the TFCC are more common in older gymnasts.

Treatment depends on severity and may include taping/bracing, wrist strengthening, technique adaptation etc.

Wrist ganglion: A non-cancerous fluid filled sac on the tendons or joints of the wrist. It’s unclear what causes these and they often resolve without intervention.

If a ganglion is interfering with training - it can be removed or drained. Bracing and focusing on mobility may help to reduce symptoms.

Tendinopathy/Tendonitis: Less common - tendonitis of the wrist is more likely to be caused from excessive gripping as opposed to weight bearing - tendonitis of the wrist can occur in the flexor (palm side) or extensor (back of hand) compartment of the wrist.

Graded exercises and load modification as prescribed by your physio are the best fix for this issue.

Injury prevention

It’s impossible to prevent all injuries, but these are strategies I would encourage young gymnasts and their coaches to implement to help mitigate the risk.

  1. LOAD MANAGEMENT: Sudden increases and changes in training load are likely the biggest factor in wrist pain.

  2. Proper warm up including stretching of the wrist and gentle weight bearing.

  1. Stretching/mobility: of the shoulders and mid back: poor shoulder/mid back mobility can increase extension stresses on the wrist in back handspring skill.

  2. Bracing/Taping: only when recommended by coach/physio.

  3. Nutrition: a balanced diet - plenty of protein, carbs and fluids after training for tissue repair and recovery.

  4. Sleep: 8 hours of sleep per night - gives you body a chance to rest and heal.

  5. Strengthening: Maintain strength of the entire upper limb - especially the muscles around the wrist which help us with gripping.

If your child complains of wrist pain and you would like them assessed in the clinic - you can book an assessment at Warringah Physiotherapy on 0499 037 569.

Aaron Bruce (Physiotherapist, ex competitive gymnast)

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