wrist pain

Due to change in nature of work in recent times, most people working from home with different postures, uncomfortable work desks, long work hours, excessive use of phones and computers, hand, elbow pains are quite common occurrences.

Hand therapy is a specialized healthcare service provided mainly by occupational therapists which focuses on the rehabilitation of the upper limb (elbow, forearm, wrist, hand, fingers and thumb).

The hand is one of the most important parts of our bodies, responsible for completing most of our daily tasks, such as self-care, work and leisure activities. 

The aim of hand therapy is to promote healing and maximize the function of the hand and upper limb, allowing individuals to return to performing activities (e.g. work-related activities, sports and hobbies) which are meaningful to them.

For upper limb conditions or injuries that do not require surgery, hand therapy treatment may include :

• Splinting
• range of motion exercises
• strengthening
• therapeutic modalities such as wax bath therapy and ultrasound therapy.
• post-operative management of hand and upper limb injuries.

Common conditions/injuries of hand and upper limb include:

• Fractures and/or joint dislocations of the elbow, forearm, wrist, palm, fingers and thumb
• Joint or ligament injuries (e.g. TFCC injury)
• Nerve compressions, injuries and repairs
• Tendon injuries and repairs (e.g. mallet finger, tendon lacerations)
• Repetitive strain injuries (e.g. trigger finger, carpal tunnel syndrome, De Quervain’s tenosynovitis, tennis elbow, golfer’s elbow, tendinitis)
• Crush injuries, nail bed injuries, finger amputations
• Sports injuries to the upper limb
• Pain, myofascial and overuse conditions
• Arthritis
• Dupuytren’s contracture

A hand therapist will customise therapy plans based on the condition, symptoms and needs. Treatment options may include:

• Heat therapy
• Ultrasound therapy
• Exercises to improve joint and muscle movements
• Management of swelling
• Scar management and desensitization
• Strengthening exercises
• Soft tissue, manual and trigger point release therapy
• Sensory re-education following nerve compression/injury
• Pain relief/management
• Functional retraining and preparation for return to work
• Ergonomics advice on posture on workstation set up
• Personalised home exercise program
• Customized splinting services for both upper and lower limbs.

There are many benefits to doing sports and physical activity and more and more people are getting into it. Be it cardio, lifting, competitive sports, almost anyone who exercises on a regular basis will develop an ache, pain or sports injury at some time or another.

Different types of sports are predisposed to certain types of injuries because of the mechanics of the movement and the repetitive strain in certain movements.

Sports injuries result from acute trauma or repetitive stress associated with athletic activities. Sports injuries can affect bones or soft tissue (ligaments, muscles, tendons n nerves).

These Injuries can be classed as chronic or acute.

Understanding the mechanics of the body is important to know what are the optimum positions for the body to function in and the consequences if these positions are not followed through in sports and exercise.

Acute injury is due to an impact from a direct force by collision, being hit by an object or fall and if the injury is less than 2 weeks old. E.g. Sprains/strains, fractures, dislocations, hamstring tears, ACL tears.

Strained (pulled) muscles result from muscles being suddenly and forcefully overstretched.

This tears the muscle fibres, usually where they attach to the tendon. The muscle is painful and its strength is reduced.

Bruises and strains should be treated with ice to reduce the swelling

Sprains are different to strains – they involve ligaments rather than muscles and tendons.

Sprained/ twisted ankle Sprains occur when ligaments at joints get stretched and torn. A sharp twist of the foot can give you a sprained or twisted ankle. Severe sprains result in torn ligaments.

Sprains are more serious than strains, and result in considerable pain and loss of function at the joint. The symptoms are similar to a fracture or dislocation.

Sprains should be treated with ice and rest.

Chronic injury represents Tendonitis, joint instabilities, strained muscles and is generally a pain which has lasted more than 6 weeks and is caused by:

• Overuse or repetitive stress of muscles
• instability
• Insufficient warm-up with lack of stretching and conditioning
• training too hard

• not allowing time for recovery
• Improper sport gears or footwear
• bad sporting technique

Common chronic sports injuries are: Tennis elbow, golfer’s elbow, carpel tunnel syndrome, shin splints, general muscle ache/tightness.

Golf and tennis put a lot of strain on the elbow. In golf and tennis elbow, the tendons that attach muscles to the elbow joint become inflamed, sore and painful.

These injuries should be treated by applying an icepack and resting for several weeks.

Physiotherapy treatment will be helpful to relieve the pain

Shin splints are pains in the lower leg, caused by continuous stress over a long period of time.

Either the tendons around the tibia become inflamed, or ‘stress fractures’ develop – these are cracks along the length of the bone.

Shin splints should be treated with ice and plenty of rest. Cushioned footwear and special insoles or orthotics and strengthening exercises can help to prevent the injury returning.

General Tips to prevent injuries during sports:

• Overuse of muscles or muscle weakness/imbalance. – Ensure your exercise program exercises all the major muscle groups working both the agonist and antagonist muscles.
• Poor training methods – When starting a new exercise regime always seek advice from a trained professional in that field.
• Postural defects– Hyper mobility puts you at increased risk of injury, consider leg length differences, scoliosis etc. 
• Improper training equipment – Choose the right weight and number of repetitions for your ability.
• Level of fitness/aging- Take in to consideration what you can realistically achieve.
• An ideal posture –is when your joints sit and are worked in a neutral position. Poor alignment may result in frequent injuries. To train muscles most effectively you need the joints to be in their optimum alignment.

As experienced physiotherapists with sports injuries we believe:

PREVENTION IS BETTER THAN CURE

Effective planning with your physiotherapist at Physio Asia:

• Commences immediately following injury
• Integrate pain relief for sports injuriesand activities accordingly
• Stages – initial, intermediate, advanced and return to sport
• Look for and correct any biomechanical abnormalities

Physiotherapist will advise you on:

• Warm up
• Stretching
• Taping and Bracing
• Protective Equipment
• Suitable Equipment
• Environmental factors
• Appropriate Training
• Nutrition

Sports injuries

Do you exercise regularly but find yourself sustaining injuries, aches and pains with your daily activities or sometimes even after your workout?

Injuries can push us back in our fitness journey progression. However, they can also be indicative of an existing problem or an absence in our exercise routine.

Here are some reasons why you might be getting injured even though you keep fit and exercise regularly.

1. Lack of warm up and cool down

It is not uncommon to hear recounts from patients telling me that they go for 5km runs or go to the gym after they get off from work. Diving straight in to your work outs and exercises after sitting at your desk the whole day is a precursor of an injury or strain just waiting to happen.

Sitting for long hours causes our muscles to get shortened and stiff. Warm ups help to increase the circulation to our muscles and warms it up, making them more elastic and ready for them to work more efficiently which helps to prevent injuries.

A proper warm up only takes about 10-20mins. You can start off with a slow 5-10min walk, jog or cycle, followed by a series of dynamic stretching exercises to get your joints mobile and well stretched out for the exercise ahead. Performing static stretches BEFORE your physical activity can actually cause reduction in muscle strength as your muscles are not yet warmed up to be stretched to its limits and can potentially cause injuries.

Static stretching is best for AFTER your work outs when you are COOLING DOWN. At this stage, your muscles have been contracting and are coursing with warm blood and nutrients. Static stretching helps to lengthen your muscles and restores them back to its natural length and speeds up recovery time. If this step is skipped, your muscles can remain in that shortened contracted length, resulting in tightness and pulling on other structures in your body, changing the biomechanical alignment of your body. Hence the importance of cooling down is as important and vital as warming up before your work outs for injury prevention

2. Muscle Imbalances

No one has the perfect body, but it becomes an issue and a precursor to injuries when there are distinct muscle imbalances in your body.

A left to right muscle imbalance can be easily identified. Usually our dominant hand or leg will be slightly stronger and we might be weaker and tighter on the other side. These imbalances will cause our bodies and joints to take on different stresses during exercises. This can result in one sided pains/injuries initially. If we don’t correct this imbalance, the joints in your body would continue to take on more stress and be prone to repetitive wear and tear and injury.

Other kinds of imbalances involve global muscles and stabilizers. Global muscles are larger muscle groups which produce a greater force but fatigue easily, whereas stabilizers do not produce great force but are enduring muscles. When our stabilizers are weak, our global muscles tighten up to compensate for the lack of the ability to contract over a long period of time. As mentioned earlier, tight muscles are a precursor for injuries. Therefore, with these kind of imbalances, it is important to consult a physiotherapist that can get you on the right track to strengthening your stabilizers and releasing those tight global muscles.

3. Poor Form

Poor form can be a result of muscle imbalances, poor body awareness, or the lack of knowledge on the exercise you are doing. Performing the exercises with a poor form will most definitely lead up to an injury. Talking more on biomechanical alignments, our weight distributes and our joints are built to take on weights. However, when you perform exercises in a poor form it leads to a change in your biomechanical alignment and force distribution in your body. This causes increased stress and strain on different joints and muscles groups which will result in sprains, tears and degeneration over a period of time.

Thus, it is important to get yourself educated with the knowledge on performing your exercises correctly. Be it walking, running, squats or lifting weights, a physiotherapist can advise and equip you with knowledge and the technical skills you need to prevent such injuries when you exercise.

Now that you know what are the common causes that leads up to an injury even though you exercise regularly, be sure to make these corrections as soon as you can and seek help to prevent yourself from getting hurt!

Rane Ng

Physiotherapist

Physio Asia Therapy Centre