Wrist Pain: Is It a Pinch, Pull, or Pain? The 3 P’s to Mechanical Movement Solutions
Friday, January 05, 2024
Wrist Pain: Is It a Pinch, Pull, or Pain?
The 3 P’s to Mechanical Movement Solutions
Asking your clients about their sensations during movement can provide a faster solution to their movement restrictions.
Often, when a client reports "pain," it may just be a sensation of joint compression or tissue stretch. Therefore, it's important to discern between the two to apply the right solution for correction.
The three main sensations often experienced with mechanical movement restrictions are:
1. Pinch: Typically felt on the closed or compressed side of the moving joint.
2. Pull: A tissue stretching sensation felt on the lengthened or opened side of the joint.
3. Pain: Often mild, a local sharp discomfort felt at the end range but is relieved once the mechanical force is removed.
There are a few other sensations to look out for, such as electrical, burning, or pins and needles that linger even after the mechanical strain has been removed. These may indicate neurological symptoms not covered in this article.
For now, we focus on the mechanical problems associated with the three P’s.
Concerning the wrist, Non-Optimal (NO) movement due to joint or tissue restrictions (Non-Optimal Restricted- NOR) typically stems from either a joint restriction or soft tissue restriction limiting the joint's flexion or extension.
This aligns with limitations in both Active (AROM) and Passive (PROM) range of motion testing. Since mechanical restrictions are consistent with movement testing, a mobility solution is necessary.
If pain is the limiting factor but the range is optimal (Optimal Painful-OP), this is typically due to instability or weakness around the joint.
Inconsistent findings between AROM and PROM testing usually indicate instability or a motor control problem, requiring a strength or stability solution.
To prescribe the best movement plan, it's crucial to know the optimal ranges of the wrist, which you can download from the AMT Optimal Range of Motion Chart below.
Now, let's revisit the 3 P’s and discuss what to do about them.
The first P is Pinch, typically presented with a restricted range of motion in both active and passive ROM, consistent with a pinch or compression feeling on the flexed side of the wrist.
The solution would then be joint mobilization, either done manually or with a band that facilitates the typically arthrokinematic glides (joint glides) coinciding with the movement.
In this case, limited wrist flexion on the left wrist will utilize a posterior glide on the radius and proximal carpal bones to create space for the distal carpals to glide forward.
The 2nd P, being Pull, is caused by tissue stretch, either shortened or hypertonic, limiting movement at the joint.
In this case, right wrist extension is limited in both AROM and PROM, and a tissue stretch is felt on the palmar side of the forearm.
So, a soft tissue solution like fascial flossing with the lacrosse ball in the wrist flexors is used to soften the tissues, allowing them to be more accepting of stretching and lengthening.
Once the inputs around the joints are altered, integrating and reinforcing the new ranges with movement and strength is the best way to "lock in" the new range.
This wrist mobility sequence emphasizes loading up the end ranges of wrist flexion and extension, effectively improving end range control and strength.
It's an active strengthening and stretching sequence that utilizes active muscle contractions to create control in the end ranges.
Adding in some pressing movements on the front and backs of the hands introduces eccentric loading essential for tendon and connective tissue strengthening.
Lastly, check your work with active and functional movements that you found limiting since the end goal of any corrective exercise is to improve overall function and performance.
At the end of the day, it doesn't matter which exercise or corrective you used to attain the result; all that matters is the result was obtained and how quickly you got there.
You can use this exercise formula on many clients with wrist pain or restrictions, and it will likely work on a majority of them. Still, if you want to truly know which tools and techniques work best for each individual client, then you need a system to show you the way.
Remember, methods are many, concepts are few, but a system built on principles will always be true.
Build a method on fundamental principles of human design and function that have not changed over the course of 2 million years and will not change based on the latest research.
Expand your knowledge and critical thinking to new levels and never have to question again whether a certain tool or exercise is worth your time.
Go to AMTcertified.ca and start building your methodology and foundation with the AMT Level 1, and expand your scope and effectiveness with Level 2 to set yourself apart from the herd.
Keep pursuing your greatness.
Tommy
Hi, I'm Tom Swales
Founder of the Advanced Movement Therapist Certification & AMT System
I'm a seasoned Physiotherapist and Strength Coach and on a mission to elevate orthopedic healthcare globally. I love to simplify complex practices and through the AMT system I'm empowering clinicians to deliver precise treatments and speed up patient recovery.
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