(originally published on www.ptstrengthcoach.com, July 2016)
The wrist is an area that we commonly see golfers present with pain in, particularly when the frequency of play increases. It is a relatively smaller joint compared to the other major ones in the body (shoulder, hips, knees, ankles) but a very important one, particularly in the game of golf.
During the golf swing, the wrist is where a golfer is going to be able to manipulate how steep or flat the club is at the top of the swing. The amount of lag that they can create or not create can be manipulated by the wrist as well. If a golfer hits a fat shot, a root or a rock, the wrist is the first joint that has to absorb the brunt of the impact force.
If there are rotary deficits in the shoulders, spine, neck or hips the wrist is a great joint for golfers to compensate with, particularly if they are trying to get the “club into position.” This increases the workload and pressure on the joint putting it at a higher risk for injury. For a smaller joint, there are many technical and physical implications in the golf swing. We need to understand it.
The wrist actually consists of 8 different smaller bones that sit between the end of the radius/ulna (forearm bones) and the metacarpal bones (palm of the hand). When there is an injury to the wrist there are a number of considerations that need to thought of at the bone level; primarily, is it a fracture?
The best way to see if there is a fracture is an x-ray or in the case of some very small hairline fractures, a bone scan may be necessary. If it is a fracture, the only real treatment is rest to let the bone heal. Now if there is significant displacement or chips that come loose, surgery may be necessary, but not often seen as a result of overuse or hitting a fat shot. Definitely more likely after hitting a rock or a root, though.
If the bone checks out OK then the next area to look at is the soft tissue around the wrist. As you can see, there are a lot of little muscles in the forearm that cross the wrist and most of them attach up at the elbow. The flexors (muscles that are on the inside of your forearm) attach to the inside of your elbow and the extensors (muscles that are on the back/outside of your forearm) attach to the outside of your elbow. These muscles can be involved in both tennis/golf elbow (lateral/medial epicondylitis) as well as wrist pain.
There are two more common ones we see in golfers and those are problems with the flexor carpi ulnaris (FCU) and the brachialis. The FCU injury produces pain on the pinky side of the wrist and the brachialis can produce pain on the thumb side of the wrist. By addressing the tissue health with manual therapy or myofascial work and then making sure the tissue is strengthened these injuries are usually pretty easy to manage.
Shoulder or Neck Problems
The final consideration, of course, needs to be a shoulder or neck problem that is referring to the wrist. The two more common shoulder muscles that refer to the wrist are the subscapularis and the infraspinatus. These muscles are on the inside and direct outside of the scapula (shoulder blade). If either of these are involved, no amount of massage to the forearm will resolve the pain. You need to address these muscles directly.
The neck, of course, is where all of the nerve roots come from that innervate the arm. If there is an impingement or some other form of neurologic injury at this level it can again cause wrist pain. Much like the shoulder, if this is the cause of the problem, we need to make sure that address the cause of the problem and not just treat the symptom down in the wrist.
So if your wrist is bothering you from playing you need to ask yourself, “is this a wrist problem or does my wrist just hurt and there is another source of this pain?” The best way to find out is to seek out a medical professional near you. Ortho MDs are great for looking at the bone and Physical Therapists are great resources for looking at all of the other above areas. For more about our Physical Therapy services, please visit our Physical Therapy page.