Wrist Pain? Check Out These Quick Cases! | Modern Manual Therapy Blog

Wrist Pain? Check Out These Quick Cases!


A few years ago, I found a new directional preference for a common wrist problem – my own severely limiting and painful DeQuervain’s. You can check out my first and second solutions here and here.

Since then, I have seen several lateral wrist pain (DeQuervain’s) like presentations both at courses and at my practice. Recently, I saw one with medial wrist pain. Here are the differences

Medial Wrist Pain Case
  • Pain for 6 months
  • Onset from slipping on ice and landing on his wrist in extension in the winter
  • Unable to WB or perform push ups without severe “burning” complaints
  • No improvements since onset
  • Better with avoiding wrist extension and WB, worse with forearm pronation, wrist extension
Lateral Wrist Pain Case
  • Pain for 7 months
  • Onset insidious
  • Worse with almost any wrist motion but worst with wrist extension and forearm supination (gymnastics coach – spotting consistently hurts her wrists), better with rest, avoidance of aggravating factors, positions
  • No improvements since onset
Medial Wrist Pain Case – Treatment Summary
  • The medial wrist pain case had pain with forearm pronation, “stretching the muscles,” that burned with wrist extension
  • I described how slacking an area that the brain is trying to protect is often a novel solution as it is already “tight” from a lock down the brain has been placing on it for months
  • Directional preference turned out to be wrist flexion with ulnar deviation – I tried this based on slacking the painful area, plus it being almost the opposite of the directional preference for a DeQuervains case
  • After loading this to end range about 30 times, wrist extension was pain free actively and passively and push ups were 90% improved
  • Homework was repeated wrist flexion and ulnar deviation with overpressure ten times hourly
  • Follow up 2 weeks later, his wrist is still coming along, but he has not been back to see me, he is able to do pushups now, with minimal to no pain, but is now limited by strength
Lateral Wrist Pain Case – Treatment Summary
  • For the lateral wrist pain case, pain was mostly with forearm supination, but all wrist motions hurt, with extension and grasping hurting the most
  • A similar explanation was given, except more emphasis was placed on slacking the tight muscles, and needing a novel solution
  • She was continuously trying to “stretch” out her tight thumb and wrist extensors with various positions of ulnar deviation
  • Her directional preference was wrist flexion and radial deviation, similar to my own wrist
  • After end range loading, and some light IASTM along her anterior and posterior forearm patterns, she reported at least 95% improvement
  • Homework was repeated wrist flexion with radial deviation with end range overpressure hourly normally, except when working out and spotting gymnasts, then 3-5 times every 5-10 minutes
  • When I followed up with her in the gym, a few days later, she was back to working out, spotting gymnasts and performing everything but pull ups pain free
Summary

Both cases had a directional preference that quickly reset months of severe pain that was limiting many of their ADLs and exercise. Where would I go next? If still not fully recovered, either make sure they are really pressing to end range, show them how to tape the area using Kinesiotape for more novel stimulus, and then make sure to add isometrics and/or eccentrics in opposing ranges to the DP so that all motions can get to end range safely. The medial wrist pain is slightly limited in push ups, and the lateral wrist pain is slightly limited in pull ups. Perhaps they also just need a little bit more graded exposure back to these activities before capacity exceeds training instead of vice versa.


Interested in live cases where I apply this approach and integrate it with manual therapy and repeated motions? Check it out Modern Manual Therapy!

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