CrossFit Wrist Injuries

Hello everyone! I'm Adrià and here we will try to contextualize this joint in the world of CrossFit and teach you exercises to prevent or help you recover from the most common injuries.

The doll is the most complex set of joints in the body and plays a very important role in most of the movements we perform in CrossFit.

First of all, we will talk a little about its anatomy and biomechanics in the shortest and simplest way possible in order to understand why it is such an important joint.

Anatomy

We understand as wrist the anatomical area that joins forearm and hand.

It is formed by several bones which form joints between them. We also find other tissues such as ligaments or triangular fibrocartilage, responsible for cushioning and transmitting the forces received by the bones.

On the other hand, it is also crossed by the vasculonervous bundle, formed by the arteries and veins that ensure the blood supply and the nerves that give us sensitivity and motor capacity (in this case the median, ulnar and radial nerves), as well as the tendons of the forearm muscles that are inserted in the carpus or in the hand and that allow us to perform the different movements.

The bones that make up the wrist are the carpal bones (scaphoid, lunate, pyramid, pisiform, trapezium, trapezoid, trapezoid, large bone and hooked bone), the ulna and radius bones (its most distal part) and we must even take into account the metacarpal bones that form the carpal-metacarpal joints.

This entire joint complex is kept stable by its own anatomical shape, the different ligaments, membranes and the tendons and muscles that pass through the area.

The most important ligaments are the extrinsic ones, which join the carpal bones to the ulna and radius. The intrinsic ligaments join the carpal bones together stabilizing the base of the hand.

Biomechanics

Wrist movements are classified into flexion-extension, adduction-abduction and axial rotation (pronation and supination, which is performed in the forearm and transmitted to the hand through the wrist itself). The combination of these movements can result in movements in different planes and axes that allow us to perform the actions of everyday life or our favorite sport.

Stability and mobility are indispensable factors to be able to perform these movements without altering or jeopardizing the integrity of the different tissues.

The main muscles involved in the control of movements are:

– FlexionUlnar flexor carpi ulnaris, radial flexor carpi radialis and palmaris longus.
– ExtensionUlnar extensor of the carpus, short and long radial extensors of the carpus.
– AdductionUlnar flexor carpi ulnaris and ulnar extensor carpi ulnaris
– AbductionRadial flexor of the carpus, palmaris longus, long and short radial extensors of the carpus.

The muscle belly of all of them is found in the forearm, both in the anterior (ventral) and posterior (dorsal) compartments.

Context in CrossFit

Movements in which it intervenes

Just as we pay close attention to gaining mobility in the shoulders or strength in the legs, we don't usually worry too much about our wrists. Error

This part of our body receives an important load especially in movements with the bar, especially in those that we perform over the head, such as the reception of the snatch PR or the overhead squat, and even more so when performed with a barbell.

• In these two movements the wrist is in extension plus radial tilt (abduction).
• The joint and the different components (muscles, ligaments) are subjected to forces from compression and of traction.
• It is not a very natural position and is difficult to adapt to.
• The more open we grip the bar, the more tilt we cause in the wrist, and vice versa. This is one of the reasons why experienced athletes with sufficient mobility use a narrow grip on the bar. overhead squats. However, we can have a wide grip if we work on the load tolerance of the wrist in that position.

Also in the position of front rack there may be significant stress on the wrist in athletes who do not have sufficient shoulder mobility.

This lack of movement in the shoulder (usually due to limited external rotation) is compensated at the wrist with hyperextension, to hold the bar.

If you are not able to keep your elbows high during the front squat or clean, this may be the case for you.

Another group of exercises that require a good wrist mobility are the following gymnastic movements that we do in the pinafore position. These are the handstand push-ups or the handstand walk.

Here it is necessary to have the flexibility to extend the wrist but above all to be able to exert force in that position.

Last but not least, all the tendons of the muscles responsible for the grip force pass through the wrist.

Movements such as pull-ups or T2B with their progressions or movements in rings are very demanding of the flexor and extensor muscles located in the forearm. Movements with kettlebells and dumbbells (dumbbells) such as snatches, hang clean and jerk, swings, ... can also test the strength of grip, since we usually perform large volumes of repetitions and try to release them as little as possible. And of course when we encounter WOD's that mix several grip exercises, like deadlifts and pull ups for example.

An overload of these muscles can cause pain in the wrist due to their anatomical and biomechanical relationship or referred pain mechanisms (the famous trigger points or hypersensitive areas) as well as inflammatory processes if we overload them too much. In any case, a good differential diagnosis by the physiotherapist will be necessary.

The wrist complex receives tensile and compressive forces, the latter being the ones that usually cause more problems and put more stress on the joint and the different tissues that interact with it. It can take time to adapt to tolerate these loads and there are no shortcuts. With good work and perseverance, we will achieve it.

Let's take a look at how the wrist can influence performance in CrossFit:

Performance

A lack of strength or mobility in wrist extension or a lack of strength in the grip and forearm musculature can decrease efficiency. of the movements and make their execution difficult, in addition to increasing the risk of injury.

As we have said before, one of the movements that can put our wrists in more compromise is the receiving position of the snatch or overhead snatch (to a lesser degree the jerk or strength movements such as the bench press or other types of press).

As in any movement, the most important thing is to adapt progressively to this position. of the wrist controlling the loads and allowing a good recovery.

Movements with bar

In Olympic barbell movements, being able to hold the bar tightly during the front squat, clean or different types of press or jerk will allow us to exert more force by keeping our whole body in tension and being able to transmit more power to the bar.

In this case it is very important the shoulder mobility as we have mentioned before, but the wrist will receive the load of the bar and it is crucial to work its tolerance to the load in these positions.

Dolls in gymnastics

In gymnastic movements, especially in the HS Walk, it is clear that a good control of the CORE and shoulder mobility is crucial to maintain the vertical, but we must remember that in the end it is all about the weight of the body rests on the wrists, which must transmit this force correctly. to the ground while acting as a fulcrum, together with the hands, to be able to apply force.

Keep in mind that the HS Walk is a dynamic movement in which we move forward and requires a higher wrist extension and joint control than an HSPU. It is important to work on this aspect to master the movement well.

Many times, the grip is the limiting factor in movements such as pull ups, chest to bar, toes to bar and the like. Developing a strong grip will allow us to perform a higher volume of repetitions without letting go of the bar.

Dolls in dumbbells and KB

In movements performed with dumbbells and KB the same thing happens. We often release them because of fatigue in the forearms or because we can't maintain the grip. Strength work will also be very useful.

Grip fatigue can also affect barbell movements, especially those that require a pull phase (clean, snatch, deadlift, ...). In this case, in addition to grip strength work, it is highly recommended to perform the hook grip. If you do not use it yet, start as soon as possible because it takes time to get used to it.

In addition, if we combine the hook grip with the ability to grip the bar in the front rack position, we will be more efficient in compound movements performed at high repetitions such as clean and jerk, snatch, hang clean, ... since we will not lose contact with the bar at any time and we will avoid a re-grip that can slow down or hinder the movement.

Finally, when we say that the grip is a limiting factor, it is not only in the WOD's but also when we do strength work at lower repetitions with high loads. For example in the deadlift or barbell rowing. In this case, it can limit the volume or workload and prevent us from getting an adequate stimulus to progress.

For this, in some movements we can use straps (deadlift, clean and snatch pulls, barbell rowing, ...) so that grip strength is not a problem and we can work the muscles that interest us (legs, back, ...) - in the case of the deadlift we can also use the mixed grip - although this does not exempt us from working on grip strength.

Planning workouts well and combining work with different grips and straps when strictly necessary would be a good strategy.

The use of wristbands in CrossFit

For this topic I have created an article exclusively talking about everything you need to know about the use of CrossFit wristbands.

Most frequent injuries

From clinical experience, these are the injuries that most affect CrossFit athletes:

Overload

Overloading is the result of applying a load greater than we can tolerate, maintained for a certain time or applied at a specific moment..

It does not usually entail complications but it can limit sporting activity by causing pain in certain gestures or under specific loads.

It usually occurs in both the musculature of the anterior compartment (flexors) and posterior compartment (extensors) of the forearm. An overload of these muscles can cause symptoms in the wrist due to their anatomical and biomechanical relationship or pain mechanisms.

Although sometimes they improve with rest, it is important to find out what has caused it in order to avoid possible relapses or injuries and to schedule the necessary work.

Ligament sprain

Sprain is a partial rupture of the tissue that forms the ligament.. This happens when we subject the ligament to a stretch above what we know as the elastic phase.

The most frequent cause is the realization of an uncontrolled movement where the joint is in a position where we do not have sufficient control.

At the time of injury, some swelling and functional impotence may appear. The palpation in the area of the ligament is painful as well as its putting in tension when moving the wrist. It will usually be accompanied by lack of mobility, strength and control.

A ligament is usually repaired in weeks. During this time we must be careful when applying loads and it is very important to work on the control of that joint to recover the ability to stabilize it in the future.

Crack or fracture

It is a less frequent injury, but it exists. Fractures are injuries that generate total bone discontinuity, they break the bone in two or more parts, while fissures cause a discontinuity without breaking the bone.

In CrossFit, they are usually caused by a collision between bones (usually between the carpal bones - scaphoid and lunate - and the radius) at the moment of receiving the bar in front rack position during the clean movement. There is an uncontrolled hyperextension of the wrist caused by the force of the barbell on the hand and the bones contact violently.

As we have said, it is infrequent and the mechanism of injury is usually due to fatigue or poor technique.

This injury is accompanied by swelling, a sensation of heat, functional impotence in almost all wrist movements and pain on palpation of the area.

The recovery time for an injury of this type can reach 6-8 weeks, even a little longer until you can bear weight again without discomfort. Unlike other injuries, immobilization of the affected area is recommended, especially in fractures.

Currently there are splints made of light materials that can be put on and taken off to carry out the recovery work and shorten rehabilitation times with respect to cast immobilization.

Tendinopathies

Tendinopathies refer to tendon pathologies. They are diagnosed by the patient's symptoms or the clinical presentation (pain), imaging tests are not reliable to diagnose this type of pathology.

The findings found in imaging tests (ultrasound, MRI, ...) are not conclusive and at most will help us to follow up or control during treatment.

Pain in tendinopathies is a localized pain (fingertip, we can mark it), reproduces with load, alters function (ability to generate force), and is usually sensitive to palpation although it is not a reliable method of diagnosis.

The cause of the pain is a loss of ability of the tendon cells to be able to correctly sense and respond to load and is caused by a sudden increase in load over a period of time or at a specific time.

Stenosing tenosynovitis or stenosing tenosynovitis

It is a common type of tendinopathy in the wrist.

This is an involvement of the tendon's synovial sheath. This sheath covers the tendon as it passes through areas of high mechanical stress to protect and lubricate it. Due to overuse or sustained stress, this tissue can undergo structural changes that make the tendon's sliding within the sheaths no longer fluid.

The tendon has a slow metabolism and this means that recovery usually takes up to about 12 weeks. Throughout this time, load control, strength training and workout management are vital to improve tendon load tolerance and recover tendon function.

Neuropathies

Neuropathies are those pathologies that affect the nerve tissue. In the case of the wrist, they are usually a sign of a lack of mobility or tolerance to the stretching of the nerve tissue itself or a too abrupt progression in our workouts.

Although the nerve is not as elastic as the muscle because it cannot be stretched, we can also work on its stretch tolerance and mobility. A lack of these properties can cause limited mobility and/or electrical sensation in a point or area when we reach near the end of the range (front rack position, handstand position, snatch...).

In this case, the symptoms appear when we are in that particular position, producing an electrical sensation in a point or path. It may cause weakness or impotence when trying to exert force in that position. Nocturnal pain is also characteristic of this type of pathology.

Treatment from physiotherapy

As we have seen, the wrist complex is subjected to various mechanical stimuli applied in different positions and movements to which we must gradually become accustomed. It is therefore important to expose our wrist to all kinds of stimuli that allow us to adapt it to the loads inherent to CrossFit.

Poor management of this aspect can lead to pain or injury in this joint. If this happens, it is very important to make a good differential diagnosis by the physiotherapist. We must take into account the symptoms, mechanisms of injury, context and physical assessment among other things.

A good diagnosis based on clinical reasoning will be key to recovery as it will allow us to apply the treatment that best suits the needs and avoid wasting time. It is very important to avoid the patient or athlete getting frustrated when he/she sees that there is no improvement and cannot train.

Don't stop exercising

Treatment should focus on the improvement of capacities and tolerance to the load. Therefore, active work through physical exercise will be the basis. These exercises should be individualized and adapted to the needs of each patient and the requirements of the activity or sport practiced (in this case, CrossFit).

Therefore, and this is very important, in the face of an injury we should never abandon exercise or physical activity. Recovery, from physiotherapy, we understand it as training in the presence of pain or injury. We can always adapt the exercise and find a way to keep moving.

Throughout recovery, we must apply the principle of progressive overload and monitor certain parameters such as strength, mobility or pain to detect changes and adapt the exercises.

Other techniques, such as manual therapy (mobilization, stretching, etc.) may be useful depending on the context and the injury, but cannot replace exercise.

Invasive techniques such as dry needling or EPI have not proven to be effective in the treatment of musculoskeletal pain or tendon pathologies.for example. Therefore, they are totally dispensable and, in some cases, would be contraindicated.

The exercises prescribed by the physiotherapist should be performed with a frequency, intensity and volume determined by the same. They will not be for life, when we are recovered from our pain or injury we can stop them.

In any case, it is advisable to continue working on the cause that has led us to suffer the injury or pain, keeping some of the physiotherapist's exercises in the planning made by our trainer.

In this aspect, a good communication between physiotherapist and trainer will be key to achieve a good recovery and return to sport.

Proposed exercises

Here is a proposal of exercises, with progressions for the more advanced, so that you can improve mobility and load tolerance of the wrists. As well as working on the strength of the muscles involved in its stabilization and movements (forearms and intrinsic muscles of the hand).

With this work, you will be able to reduce the risk of injury and improve your performance by becoming more comfortable in the execution of the exercises and the ability to perform strength in those positions.

We have separated them into exercises aimed more at strength gains and exercises aimed more at improving mobility. Strength exercises can be performed 2-3 times per week. Mobility exercises can be worked on more frequently, even as part of the warm-up.

Important note: All these exercises are part of a proposal to improve strength and mobility. If you have any pathology, pain or injury, consult your physiotherapist beforehand so that he/she can advise you on the matter. The series and repetitions are also indicative and should be individualized to each case. As well as the progressions, loads and necessary modifications.

Gaining wrist strength

Farmer carry with DB (dumbbell), barbell, KB (kettlebell) or discus

How it is done: It consists of walking while keeping the body in tension and the middle zone activated while carrying a weight bilaterally or unilaterally (increasing the work of the middle zone) with our hands.

Material requiredThe weight can be from a dumbbell to a disc, we can even use loaded bars to increase the activation of the stabilizing muscles.

Quantity: We can start with weights that we can handle well and objects that are easy to carry (KB or DB). 2-3 sets of 50-100m (starting every 10-20m). We will progress in weight and material.

Isometrics in front rack position with a loaded barbell

How it is done: With the bar loaded with weight in front rack position, holding it with all our hand and elbows as high as possible without losing the grip, we perform a muscle activation to try to lift the bar with a flexion movement of our wrists. The bar should not separate from our shoulders, if it does, add more weight to perform the isometric correctly (isometric = muscle activation without generating movement).

Material requiredWe can do it from the rack (support) if we are short of mobility.

Quantity: 2 sets of 8-12 repetitions of 5".

Support variations (internal/external shoulder rotation):

How it is done: The idea is to change the support of the hand on the floor when performing planks, push ups or their regressions. To do this, we internally or externally rotate the shoulders making the fingers point in different directions while performing the exercises mentioned.

Quantity: 2-3 sets of 8-10 repetitions in the position we want to work.

Overhead farmer carry

How it is done: This is the "overhead" version of the farmer carry mentioned above. The objective is to walk a certain distance with a weight on top of the head.

Material requiredWe can also load unilaterally or bilaterally all kinds of objects. From KB or dumbbells, to weighted bars (being able to play with the grip to make it more transferable to the jerk or snatch movement) or hang weights by means of rubber bands to make the task of stabilizing the load more difficult.

Quantity: We can start with weights that are easy to handle and easy to load (KB or DB). 2-3 sets of 50-100m (starting every 10-20m). We will progress in weight, grip and material - accessories.

Dead hang

How it is done: In this exercise we simply hang from the pull up bar and hang for a certain time activating our whole body and keeping the middle zone in tension. We can use a prone grip (as in the usual pull ups), supine, mixed or more or less wide.

Material requiredWe can progress using only one hand or move on to doing it in rings. If it is too hard, it can be done in the initial position of "ring row" or by placing a barbell on the rack and getting into the inverted rowing position.

Quantity: We can start holding as long as we can until we feel we are close to failure and rest 1x to 2x the time we have held. Repeat until completing 8-10 rounds. Another way to do this is to apply the tabata method.

Handstand hold

How it is done:  We will maintain the handstand position, or its regressions when necessary (pike push ups position with feet on the box or floor), and from there we will vary the surface where we place the hands or their position.

Material requiredWe can use parallettes, switch to one hand or do shoulder taps, introduce an inclined plane, ... Whatever it takes to work the support we need.

Quantity: Accumulate 1-2min in handstand position, 2-3 sets.

Increased bar diameter or material

How it is done: It is a very useful strategy to dramatically increase the activation of the forearm musculature. I recommend using it in advanced athletes or in a progressive manner.

Personally, I use a tool called "fat gripz" which is nothing more than a pair of hard rubber pieces that fit over conventional diameter bars and increase their circumference. There are different levels. We can use them in movements such as deadlifts, strict press, barbell rowing, ...

Material required:

Quantity: Between 3-5 sets of 8-15 repetitions at a feeling of effort of 7-8 out of 10.

More details on the benefits of Fat Gripz in the following article:

Push up variations

How it is done: We will change the surface on which we rest our hands while performing push ups. To begin with, delaying the hands a little more than usual or making them face outward or backward can already be a challenge.

However, we can progress with parallettes, using our fists instead of our hands, doing fingertip push ups or even placing an unstable object such as a medball.

Quantity: Between 3-5 sets of 8-15 repetitions at a feeling of effort of 7-8 out of 10 and progress as needed.

Wrist flexion and extension with dumbbell or disk

How it is done: With the forearm resting on our thigh, seated, we load a dumbbell and perform a wrist flexion (supine forearm) or extension (pronated forearm) movement.

We can increase the weight of the dumbbell, hold the dumbbell by one of its two heads or use a disc.

Quantity: Between 3-5 sets of 10-15 repetitions at a feeling of effort of 7-8 out of 10 and progressing as needed. 3 seconds of concentric phase and 4 seconds of eccentric phase.

Picking up/releasing weighted rope with pike

How it is done: We can use a resistance band instead of a rope. We attach a disc or weight to one end of the band and pass it through the pike. We take the pike with both hands and hold it in front of us at chest/shoulder level and perform wrist extension movements to pick up the weight and then release by flexing the wrist.

Quantity: 2-3 sets of 10-12 repetitions.

Wrist abduction

How it is done: This exercise is the same as the one we use to work the wrist flexion/extension but this time we rest the ulnar edge of the forearm on our thigh (palm of the hand facing inwards). From there, we load the disc or dumbbell and perform the wrist abduction movement (bring the weight towards us).

Quantity: Between 3-5 sets of 10-15 repetitions at a feeling of effort of 7-8 out of 10 and progressing as needed. 3 seconds of concentric phase and 4 seconds of eccentric phase.

Supination - pronation

How it is done: We can do it sitting as the previous exercises or standing keeping the arm fully stretched at chest level (more difficult). We take a dumbbell or disc and perform rotational movements of the forearm.

We can progress by adding weight or by holding the dumbbell by one of its two heads. In the initial stages, we can even use a PVC spike, since it is already sufficient to provoke an effective stimulus.

Quantity: 2-3 sets of 8-12 repetitions.

Rice bucket movements

How it is done: A classic. We fill a bucket of rice big enough to put the whole hands inside and that covers us above the wrists. With the hands inside, we can make rotational movements, close and open the fingers, extend and flex, ... those movements that we want to strengthen.

Quantity: 2-4 sets of 30 seconds to 1 minute performing movements inside the bucket.

Gaining wrist mobility

Mobilizations to flexion and extension on the floor or drawer

How it is done: In quadruped position we mobilize our wrists moving our body forward and backward, sideways or making circles. We can rest our hands on a step or drawer to remove compression from the wrists if it is painful.

We can also vary the position of the hands to have more impact on certain structures not only in the direction but also by supporting the back of the hand instead of the palm. In this way, we mobilize towards flexion and extension.

* We can also mobilize the fingers (metacarpo-phalangeal joint) by lifting the palm of the hand when mobilizing towards extension while keeping the fingers in contact with the ground.

Quantity: 2 sets of 10-12 repetitions.

Isometrics with rubber

How it is done: We pass a resistance band around our hand, resting the arm on the floor or an elevated surface to make it more comfortable. We will look for a maximum flexion, extension, radial or ulnar deviation of the wrist and we will make it coincide with a tension received by the rubber that makes it difficult for us to maintain the position. We will maintain that position for a certain time and perform repetitions. Interesting to activate before training. It is important that the rubber forms an angle of 90º with respect to our hand.

Quantity: 2 sets of 10-12 repetitions with 5" of isometrics at the end of the range of motion.

Forearm myofascial self-release

How it is done: We perform a massage with the foam roller (foam or rubber roller) or lacrosse ball (or similar) along the forearm musculature. To do this, we put the roller or ball between the forearm and a surface (drawer, bench or floor). With this we can improve the perception of pain or overload before and/or after training or recovery exercises. Avoid acute pain or discomfort during the performance of this exercise.

Quantity: 2-3 minutes per zone.

Wrist extension with the aid of an elastic band

How it is done: In quadruped position we rest our hand on a disk and pass an elastic band around the wrist (making contact with the dorsal area) and hook it to the rack or support. From there, we perform mobilizations of the wrist towards extension bringing our body forward while the tension of the rubber facilitates the movement.

Quantity: 2 sets of 10-12 repetitions holding the maximum position for a couple of seconds and trying to increase the range if possible in each repetition.

Wrist flexion with elastic band support

How it is done: In quadruped position, we rest the back of the hand on a disk or on the floor and pass an elastic band around the wrist (making contact with the ventral area) and hook it to the rack or support. From there, we perform mobilizations of the wrist towards extension, taking our body backwards while the tension of the rubber band facilitates the movement.

Quantity: 2 sets of 10-12 repetitions holding the maximum position for a couple of seconds and trying to increase the range if possible in each repetition.

Isometrics at end of range

How it is done: In this case the proposal is to do it in quadruped, hands open on the floor, and we are carrying weight on the wrists moving our body forward until we reach a position of tension.

There we perform the muscle contraction as if we were pressing against the floor (wrist flexion) for 2-3 seconds and undo the movement trying to take the hand off the floor (wrist extension) until we really lift the hand, hold that position 2-3 seconds and repeat.

Quantity: 2 sets of 10-12 repetitions.

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