Arm pain is common and can occur with many different occupations or hobbies, such as with fly fishing. This month's Trifecta shows 3 simple ways to maintain a healthy hand, wrist, and forearm. If you're curious about why these exercises are important, you've come to the right place!
IT’S OPPOSITE DAY!
The hand, wrist, and elbow have a lot in common. In fact, most of the muscles that control the hand are housed in the forearm and attach to the elbow. For example, the muscles that extend (bend backwards) your fingers and wrist attach on the outside of the elbow, and those that flex (bend inwards) your fingers and wrist attach on the inner side of your elbow.
But what about the “big bad wolf” carpal tunnel (CT)? It isn’t as scary as it sounds. In short, the CT is simply an anatomical “tunnel” along the palm side of the wrist formed by bones and ligaments, where tendons, arteries, and nerves (median) run. Carpal Tunnel "Syndrome" (CTS) occurs when something within your CT is irritated, but it doesn't tell us what is irritated. When we participate in activities that require repetitious gripping or wrist bending, the tendons at your elbow or wrist can become inflamed, causing irritation and even fluid build-up. Additionally, these motions can create excessive pressure in the CT which can lead to pain, numbness/tingling, and sometimes weakness in the hand.[2,3]
Commonly we are told that a bent wrist is a bad "posture" for the wrist and can lead to CTS. A bent wrist is NOT inherently bad – our hands and wrist are built to withstand a variety of movements. We only determine this to be concerning if you are holding your wrist in a bent position for extended periods. There is a known association between CTS and occupations that require prolonged or repetitive wrist flexion/extension, use of vibratory tools, assembly work, and food processing/packing.[6] If you have a job that requires movements such as this, embracing the Law of Opposites can be helpful. The “law” is simple: move in the exact opposite direction from what you do all day. This means if you have a bent wrist for an entire shift at work or at the gym, we want you to learn to frequently stretch your wrist the other direction to counteract this single position.
WHAT GETS TIGHT?
As mentioned above, maintaining a bent wrist (in either direction) throughout the day negatively effects the muscles around the wrist and elbow. Ultimately, we have 3 muscles that pass through the CT that help our wrist and fingers flex (bend inward).[1] The outside of the elbow, where Tennis Elbow (TE) can occur, has 4 muscles that help us to extend our wrist (bend back) and all attach near the elbow at what is known as the "common extensor tendon".[1,8] The inside of the elbow, where Golfer's Elbow (GE) can occur, has 4 muscles that help us to flex our wrist (bend inward) and all attach near the elbow at what is known as the "common flexor tendon".[1,8] CT, GE, or TE can begin with the same problem - overuse of the tendons or constant positioning of the wrist either inwards or backwards that leads to compression and irritation of the tendons or nerves.
STRETCH, STRENGTHEN, AND SOOTHE
Our wrists are meant to be mobile and help us interact with our environment. We use them for many things: activities include lifting weights, carrying boxes, playing guitar, fishing, woodworking, typing, throwing, sewing...and the list goes on. So, what do we do about CT, GE, or TE? Reducing repetitive flexing, extending, or prolonged positioning of the wrist is a great place to start.[7] An example would be to use a hand pad while typing which helps to keep a “neutral” position (straight). Further, try to avoid extra pressure or leaning on your wrists.[3] It has been shown that stretching of our wrist and hand flexors, strengthening of wrist and hand flexors, splinting (for CTS), and massage of the wrist flexors all significantly reduced symptoms of CTS.[8]
Addressing these concerns can be daunting when we think about all the different muscles involved - but thankfully there are common techniques to help reduce the strain we put our hands, wrists, and elbows through. In fact, 80% of those suffering from CTS have a positive response to conservative treatments, avoiding the need for surgery.[2] Both stretching and massaging are useful ways to reduce tension and muscle knots. The executive stretch helps to stretch the finger/wrist flexors to reduce the effects of CTS discomfort at the wrist and GE discomfort at the elbow. To help reduce pain even further, we recommend massaging the inside and outside of your forearm just below the elbow and the palm-side muscles inside the hand/thumb to reduce cramping. Strengthening is often overlooked when treating hand, wrist, or elbow pain, which is why we like using the hammer exercise to strengthen the rotators of our wrist/elbow to further reduce the strain on the flexing/extending muscles and improve joint mobility.
References
Presazzi A, Bortolotto C, Zacchino M, Madonia L, Draghi F. Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique. Journal of Ultrasound. 2011;14(1):40-46. doi:10.1016/j.jus.2011.01.006
Donnelly B. Understanding Carpal Tunnel Syndrome. Hand, Wrist & Elbow Surgery. https://brandondonnellymd.com/understanding-carpal-tunnel/
Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal Tunnel Syndrome: A Review of Literature. Cureus. Published online March 19, 2020. doi:10.7759/cureus.7333
Knight J. How To Prevent Carpal Tunnel Syndrome. The Hand and Wrist Institute. https://handandwristinstitute.com/prevent-carpal-tunnel-syndrome/#:~:text=You%20can%20also%20prevent%20carpal%20tunnel%20syndrome%20by,how%20fast%20the%20nerves%20travel%20to%20your%20hand.
Miller TT, Reinus WR. Nerve Entrapment Syndromes of the Elbow, Forearm, and Wrist. American Journal of Roentgenology. 2010;195(3):585-594. doi:10.2214/AJR.10.4817
Feger J, Radswiki T. Carpal tunnel syndrome. In: Radiopaedia.Org. Radiopaedia.org; 2010. doi:10.53347/rID-12632
Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occupational Medicine. 2006;57(1):57-66. doi:10.1093/occmed/kql125
Boyd M. Elbow Pain. Collegiate Sports medicine. https://collegiatesportsmedicine.ca/elbow-pain/
Sevy JO, Varacallo M. Carpal Tunnel Syndrome. In: StatPearls. StatPearls Publishing; 2022. Accessed May 2, 2022. http://www.ncbi.nlm.nih.gov/books/NBK448179/
Burke FD. Primary care management of carpal tunnel syndrome. Postgraduate Medical Journal. 2003;79(934):433-437. doi:10.1136/pmj.79.934.433
Healthy Is Wellness, LLC (“Healthy Is Wellness”) is not a health care provider, and does not provide professional medical advice, diagnosis, and/or treatment. THE INFORMATION PROVIDED BY HEALTHY IS WELLNESS IS FOR INFORMATIONAL PURPOSES ONLY.
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