If you play tennis or golf, you may be familiar with the injuries named for the games. Tennis elbow, or lateral epicondylitis, is inflammation of the tendons on the outer elbow (that help to extend the wrist).
Golfer’s elbow, or medial epicondylitis, is inflammation of the tendons along the inner elbow (that flex the wrist). Factors that contribute to the development of these conditions are poor posture, poor strength in the arm and trunk muscles, lack of flexibility through the hips, trunk, and upper extremities, and incorrect technique.

As a PT I can work with patients with these conditions to correct the existing postural dysfunction and muscle imbalances, teach them the appropriate stretches and strengthening exercises, and help to reduce inflammation. I am not a golf or tennis pro, and though I play both sports recreationally, you don’t want me to give you advice on improving your swing. It’s important to seek out the help of a professional who can help evaluate your swing, stance, and posture, and make recommendations that will improve your game, and will likely also reduce the likelihood of recurring musculoskeletal injury.

The wrists are very complex anatomically, with lots of little bones, ligaments, muscles, and nerves running through it. It is also subject to a lot of use, particularly in our age of technology. I remeber from the old Jetson’s cartoons George Jetson used to get a big swollen finger from all the button pressing, and we’ve seen that really happening..well not so much with fingers, but more often with wrists.

If due to trauma or overuse you begin to experience acute wrist pain, it’s important to follow the RICE protocol.

Rest: try to limit motion at he involved wrist. This may be best accomplished by wearing a wrist splint, which will immobilize and protect the wrist as it heals.

Ice: Using an ice pack or performing ice massage to the affected area using ice cubes will help to reduce both pain and swelling.

Compress: compression helps to provide warmth, comfort, and protection to the wrist and limits swelling. Some neoprene splints provide compression. You may also use an ace bandage or the self adhesive ace wraps available at most drug stores.

Elevate: If there is very significant swelling, such as from a fracture, it’s important to elevate the wrist and hand above the level of the heart (after emergency medical treatment and care are administered). This will help prevent complications during healing and speed up the recovery process.

If possible, try to prevent wrist injuries by keeping the wrists in a neutral position, using good posture, and taking frequent breaks to stretch the muscles of the wrist and elbow.

Tennis elbow, AKA lateral epicondylitits, can strike tennis players and anybody who uses a computer or performs manual labor. This condition is characterized by pain and inflammation along the outer elbow, and is usually worse with gripping, lifting, and repetitive motions of the hand, wrist, and elbow.

One great technique for reducing pain and promoting healing of the elbow tendons is performing cross friction massage (in a direction perpendicular to the direction the connective tissue fibers travel). This type of massage helps to break up scar tissue and adhesions, and also helps realign collagen fibers to promote healing and return of strength and function. I do cross friction massage for all of my tennis elbow patients, in conjunction with stretching, ice and other modalities to reduce inflammation as necessary. At first, it may feel sore to do, but after a few minutes, the soreness subsides and people usually experience some improvement in pain and flexibility following a few treatments. I also teach my patients how to do self massage at home.

It is best to learn this technique from a trained professional, such as a physical, occupational, or massage therapist. You can also work with one of these health care providers to come up with a comprehensive program that includes stretching, strengthening, posture improvement, splinting/bracing, modalities, and ergonomics. I highly recommend if you have symptoms of tennis elbow you seek professional treatment. It can progress to a chronic tendinitis which is much harder to manage.

Wrist pain is often a result of cumulative stress, or overuse, and can contribute to conditions such as carpal tunnel syndrome, tendonitis and wrist strains or sprains. Activities such as typing, mousing, using vibrational power tools, knitting, and any other activities requiring repetitive wrist motion can create tiny microtears in the muscles and tendons of the forearm and wrist. These tears can be accompanied by inflammation, pain, and sometimes a loss in strength, mobility, and function.

The following tips are helful in reducing the likehood of trauma to the tissue and will help facilitate healing of these conditions.

1. Keep the wrist neutral.

When you perform activities where the wrist is tilted up or down, there is more strain on the muscles, tendons, and ligaments. Keeping the wrist level will help to reduce this stress. For example, on the underside of most keyboards there are little feet that are often lifted up. With the keyboard angled in this way, the wrist tends to be in a position of extension. If you pop these legs down, the wrist is able to remain in a more neutral position. In addition, using a gel wrist suport allows you to intermittently rest the wrists and forearms so your muscles aren’t constantly working to hold them up.

2. Watch your posture.

Believe it or not, your posture from the head and neck will impact your wrist. If you sit at a computer or perform a manual job where you are repeatedly slouching or looking down, the shoulders tend to round forward and the neck and chest muscles get tight. This can cause compression at the area in the neck/shoulder known as the thoracic outlet and result in reduced circulation to the elbows, forearms, wrists, and hands. In the presence of microtears of the muscles or tendons, it is important to have good blood flow to these tissues for healing to occur. With a reduction in blood flow due to poor posture, the tissues are more likely to sustain further damage, slower healing, and the likelihood of developing a chronic problem may increase.

So if your job or hobby requires you to sit for sustained periods, use a lumbar support cushion to help maintain good alignment of the head, neck, and spine. If you stand, be aware of your posture and use a counter that is at a height that allows you to remain upright.

3. Change your position or take stretch breaks every 30-60 minutes.

Even with ideal posture, perfect chairs, and ergonomic products at hand, any posture that is sustained for long periods can cause muscle imbalances. To help prevent this, change your position or stretch every 30-60 minutes. If you sit for long periods, even just standing up, walking around for 30 seconds and arching your spine will help counteract the forces created while sitting. In the long run you may be more efficient as well. If you stand for long periods, taking a moment to stretch forward and bend the knees can relieve pressure on the spine and legs.

Specific stretches for the wrists, such as the wrist flexor and extensor stretches can be helpful as the stretch allows the muscles that are being worked to stretch, get a break, and breathe a little. This will help to minimize cumulative trauma and facilitate healing in the case of an existing condition.

Always listen to your body. As soon as you feel a hint of discomfort, stop the activity you are doing, try to gently stretch, and follow with icing to reduce pain and inflammation. Here’s to safe and healthy wrists!