Mini Case: When is Wrist Pain Not a Wrist Issue? | Modern Manual Therapy Blog

Mini Case: When is Wrist Pain Not a Wrist Issue?


One of the coaches I work with recently had me take a look at a gymnast with ulnar side wrist pain. Her main complaint was right wrist pain with a back handspring. Upon further questioning, this was specific to the beam and not the floor.

What do you notice about the vids in slow motion below? What are the differences in mechanics between the beam and floor back handsprings?

When is Wrist Pain Not a Wrist Issue?

Other findings
  • DN shoulder IR
  • DN forearm pronation
  • DN wrist extension, radial devation
It would have been easy to measure wrist strength, check mobility of the wrist and leave it at that. However, the limited forearm pronation and shoulder IR were causing her to wrap her right hand/fingers around the beam instead of facing forward like her left hand it. In addition, her right hand is behind the left, most likely requiring more ability to accept load.

After some manual therapy to improve shoulder, forearm, and wrist motion, Sx reduced by 50% on the VAS. I saw her weekly for about 4 weeks and gave her repeated loading of
  • eccentric shoulder IR (resisted with L UE in sleeper stretch)
  • repeated forearm pronation
  • quadruped rock wrist extension with left hand overpressure - making sure her forearm tracks over her wrist straight - think knee tracking over ankle with SL stepdown
Due to the volume of her training, she never became pain free, but Sx reduced from 6-7/10 on average to 2-3/10. Her balance on the beam and form according to her coach was also much better as the lack of forearm, wrist, and shoulder motion was causing her hips/trunk to rotate unnecessarily. She also made it to regionals and got second place all around!




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