Wrists and elbows
The upper extremity chain of command
Dr. Lynn Felege, PT, DPT
We’ve spent a lot of time discussing connections of the lower body chain and how distal position/movement affects proximal position/movement. Similarly, let’s spend some time applying those principals to the upper extremity. Whether the task is squatting, olympic lifting, or gymnastics – from rookies to veterans – it can be difficult to achieve or maintain the correct position due to limitations in wrist or elbow flexibility. The cue “Elbows up!”is often echoed for a multitude of movements, but the cue doesn’t mean much if the athlete can’t execute it. And as with the lower body: distal limitations can lead to proximal injury as we try to compensate for limited ranges of motion.
Love Your Connective Tissues
For all the injuries that could be acquired within a CrossFit box, worrying about one’s wrists may seem silly and wasteful to some…Until you can’t do anything because you hurt your wrist. Much like the ankles, the wrists are a complex matrix of connective tissue – all of which is fair-game for injury. The high-volume loading and explosive movements endured at the box are huge points of pride for a lot of athletes, which is why balancing joint mobility with stability is crucial. Wrists don’t just flex and extend, they also “deviate”(towards the pinky and towards the thumb) to compliment rotation from the elbow. Front squats can collapse, handstands can’t be held, and overhead activity can feel gruesome if your wrists can’t achieve or withstand the proper ranges of motion. Because we as humans are so adaptable, if we lack motion in one place, we’ll compensate for it at another. For example, if you lack wrist extension, your elbow position to squat or press overhead will be down and possibly rotated. Repeatedly assuming these compensatory positions creates an enormously higher risk of injury. Use of the hook grip can also throw a wrench in upper extremity mechanics if time and attention aren’t spent acquiring the proper ranges of motion at the thumb and wrist. We know…hook grip hurts. Use it anyway. Not only does it increase your force output from the pull, but it creates tremendously safer positions for elbows and shoulders as those forces work up the kinetic chain of your arms.
Fixing the Problem Before it’s a Problem
There’s a perpetual theme throughout these articles: Take the time to take care of your body! Connective tissues need the most basic dynamic stretching to improve conditioning and prevent injury. Effective wrist stretching must be done with locked elbows because of the shared musculature between the wrists and elbows. Get soft tissues warmed and minimize the effects of superficial adhesions first with gentle, fisted circles. Closed-chain stretching is always the safest, so spend time pressing your hands to the floor with locked elbows and rotating clockwise and counterclockwise over your wrists, forcing the most range as comfortably possible. Flip your hands over and spend time stretching from the same position but with palms-up. To create the most comfortable hook grip possible, stretch the thumbs, as well. Create a hook grip with your own closed fist and deviate towards your pinky, rocking in and out of the deviation to warm the tissue and optimize the length/tension relationship within the tendons of your thumbs. Never undervalue the importance of warming your connective tissues prior to activity…Strong wrists mean strong lifts!