August 20, 2025 • 24 mins
The missing link between shoulder dysfunction and wrist pain might be the key to solving your persistent sports injury. Dr. Kyle dives deep into why non-traumatic wrist pain plagues athletes in sports like golf, tennis, and lacrosse—and why the standard "overuse" diagnosis falls woefully short.
Drawing on his expertise in sports rehabilitation, Dr. Kyle walks listeners through the complex biomechanical relationships that contribute to wrist pain, particularly the often-overlooked triangular fibrocartilage complex (TFCC). He explains how this specialized structure suspends the distal ulna and why it's frequently implicated in clicking, popping, and pain during impact activities. What's fascinating is how structural changes visible on imaging may have existed long before symptoms appeared, suggesting the problem lies elsewhere.
The podcast reveals the critical connection between proximal stability and distal pain. Nearly every case of non-traumatic wrist pain links back to issues in the shoulder girdle, scapular stability, and thoracic spine mobility. When these areas lack proper function, the wrist bears the consequences through compensation patterns that create undue stress on ligaments, tendons, and joint capsules. For golfers specifically, being "too wristy" in technique often stems from limitations elsewhere in the kinetic chain.
Rather than accepting wrist pain as an inevitable part of your sport, Dr. Kyle offers a comprehensive approach addressing the entire body. Through manual therapy, soft tissue work, and targeted corrective exercises, athletes can resolve not just their symptoms but the underlying biomechanical inefficiencies causing them. The result? Return to pain-free performance and often improved function.
Call 561-899-8725 or email team@athleterc.com if you're struggling with wrist pain or other sports-related injuries that haven't responded to conventional treatment. Subscribe and share this podcast to help fellow athletes discover solutions to their persistent pain problems.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up?
Y'all?
It's your man, dr Kyle.
Welcome back to the DrivenAthlete Podcast.
I have not touched on this yet.
I wanted to dive into it alittle bit.
(00:20):
I've been having a couple ofpatients recently with this
issue and I wanted to be like oh, a little bit.
I've been having a couplepatients recently with this
issue and I wanted to be like oh, I wanted to send them content.
I realized I didn't haveanything on the wrist.
So wrist dysfunction, wriststrains, wrist sprains, it's a
common thing with impact racketand club sports, like golf, of
course, tennis, lacrosse barringany like traumatic injury, as
(00:42):
in like they fell on it right orthey banged it on something.
They slipped and fell and thenlanded in an awkward way.
That would be a traumaticinjury.
But barring that, it's likewhere does wrist issues come
from?
Where, um, a young athletewho's training a bunch for golf
literally just called this weekand they were like um, their
parents talked to me.
They were like our kid's beenpracticing a ton and out of
(01:06):
nowhere we've had we've beengetting wrist pain, like she,
this, this, this athlete hasbeen experiencing pain in the
wrist, so nothing happened.
I was like, did anything happen?
This is a classic story we hearpretty often where it's like I
know that we can recall, right,nothing happened traumatically,
where it was like one big swingand boom, hit like a root or hit
(01:27):
a really fat shot and then likesomething sprained right then,
but rather just like anaccumulation of a lot of
repetitions in time.
All of a sudden my wrist hurtsright, that would be
non-traumatic wrist pain.
That's a common thing that wesee.
That is our bread and butter,that's what we do, that's what
(01:48):
we work on.
It's non-traumatic,non-specific pain that seems to
be obscure, not really can'tfind any answers.
The MRI x-rays are unremarkable, but I'm having a lot of pain.
What do you do and why did itstart?
How do we fix it?
And then, how do you prevent itcoming back?
Like what's the underlyingreason for the issue?
Right, so that's our bread andbutter, that's what we do.
(02:09):
Back pain, shoulder pain, wristpain like that, like that's our
wheelhouse, all right, that'swhere we thrive.
We're the specialists thatpeople call to fix that.
So, with this common story.
I've been playing golf a lotand all of a sudden my wrist
hurts.
Or lacrosse, or tennis,pickleball or whatever Like what
(02:45):
do I do Oftentimes with this?
It's a combination in a orstriking of the ball or whatever
you're doing.
So it's undue stress on oneparticular region or area of the
wrist that is overcompensatingand taking the brunt of the
movement or the impact and thestability requirements through
that impact phase of the sportor the swing repetitively.
(03:07):
And if there's mobility andrange of motion, mechanical
disparities of mobility andstrength disparities, muscle
imbalances, what we would callthat.
So there's joint imbalanceslike range of motion,
flexibility imbalances incertain joints elbow, wrist and
(03:30):
shoulder, hips and pelvis andthe trunk that we can't neglect
because it's a full body sport.
It's a full body movement,swing right, and then a lack of
strength and stability wheresome things are required too
much to produce the force andnot enough of other things are
contributing to produce theforce for the swing.
So imagine if one particularjoint is taking on a lot of the
brunt of the impact, not gettinghelp elsewhere or dispersing
(03:53):
the forces through the impact,and then the muscles that
generate the force are allcoming from one particular
region, in one area, what do youthink is going to happen?
That one particular spot isgoing to get overwhelmed and
that's going to cause pain.
So it ends up being the strawthat broke the camel's back over
an accumulation of many, manyrepetitions and episodes.
So it's a recipe of overallflawed mechanics all right,
(04:18):
Joint mobility disparities,muscle strength, stability
disparities, imbalances, withundue stress being placed on one
particular area over and overand over again, and that creates
pain.
In my opinion, a cop-out answer,a weak answer, a lazy answer is
overuse.
My question with that would bewith this, it's a lot of volume
(04:41):
that athletes practice, for sure.
My question would be thisparticular athlete that's
developed this wrist pain out ofnowhere, are they doing an
excessive amount of repetitions,more than their colleagues,
more than their friends, morethan their competitors?
Are they all practicingsomewhat similar?
And if they are, then why isthis one athlete developing
(05:01):
wrist pain whereas the otherones aren't?
Then why is this one athletedeveloping wrist pain whereas
the other ones aren't?
If it was overuse, just likeblanket coverage, overuse
diagnosis, then why doesn'teverybody get the same wrist
injury or some kind of an injuryat the same time frame, 12
weeks into the season, sixmonths into the season.
Why doesn't everybody getinjury like that?
(05:22):
If they're all doing kind ofthe same amount of practice and
volume, it's because it's notjust overuse, it's all the other
recipe stuff that we mentionedjust two seconds ago.
All right, flawed mechanics in aswing, which is not what we do.
We're not golf pros or tennispros, but we are biomechanics in
pain and we can pinpoint andisolate an answer in some
structures of like.
This is what the painfulstructure is.
(05:43):
This is the pain generatingtissue and this is why it's
getting overwhelmed.
And watching you move andgroove, I can tell there's joint
disparities of range of motionin your shoulder, scapula,
thoracic spine, pelvis and hipsand disparities in your elbow
and wrist.
All right, for like strengthrequirements and mobility and
stuff, all right.
So all those things kind ofcombined end up being the recipe
that lead to nonspecific,non-traumatic wrist pain,
(06:07):
specifically wrist pain for thisparticular podcast.
So what are those structuresthat get irritated?
People usually ask what's thepain and what they're asking is
like what is the angry tissue?
What's angry?
What's the painful tissue?
Right, and it's usually someligamentous structures, the soft
(06:27):
tissue that spans.
You have tons of bones in there.
Right, you have eight carpalbones.
You have two forearm bones andyou have five metacarpals and
they all articulate together.
All right, the best mnemonicthat I've heard for remembering
the carpal bones is so long topinky.
Here comes the thumb and thoseare the eight carpal bones.
(06:48):
They're like little rocks orpebbles in your wrist that help
with joint, that just producethe mechanical movements in your
wrist, but they articulate withthe forearm bones called your
radius and your ulna, and thenthe distally or further away,
the metacarpals.
All right, and there's five ofthem for each five finger.
So those are the articulationsof the joints.
So between all those joints youhave ligaments that connect to
(07:12):
each individual bone in multipleareas.
All right, so there's a ton ofligaments in your wrist between
the distal forearm bones of yourradius to ulnar, your radial
ulnar joint, the radial carpaljoints, the ulnar carpal joints
and then the metacarpal carpaljoints.
All right, the carpalmetacarpal joints.
So there's a ton of ligamentsand they connect to every single
(07:33):
bone.
Okay, so there's a ton ofligaments in there and they all
can get some of them can getirritated if they're being
chronically overstretched andstrained with the repetitive
impact motions in the positionsthat the wrist is enduring this
impact, all right.
However, ligaments are passivestructures, as in.
They don't produce stability,they just maintain passive
(07:55):
stability.
All right, you can't strengthenligaments with exercise, but
what I mean okay, let me takethis a different way you don't
create more dynamic stabilitythrough ligamentous structures.
The ligaments don't createdynamic stability.
General rule of thumb is ajoint is only as strong as the
muscles that surround it andthat span over the joint.
So it's dynamic musclestability and muscle strength
(08:17):
and activation or timing ofturning things on at the moments
they need to be turned on orturning them off when they need
to be turned off more, andre-regulating the recruitment
patterns.
That's ultimately what createsstability around a joint.
So the ligaments get a lot ofweight.
With diagnosis as in, likewhat's the painful tissue?
(08:39):
Well, it might be someligamentous strain.
For sure we would call that asprain, some ligamentous strain.
For sure we would call that asprain, ligamentous sprain
happening from repetitive, undueoverstretching of the ligaments
that are trying to hang on fordear life.
But too much stress is beingplaced upon them.
And why would be too muchstress be placed on the
ligaments?
Because the muscles thatsurround it aren't producing
enough stability instead.
(08:59):
So it inherently goes to justrequiring the passive stability
of the ligaments that span thejoint to make sure that your
wrist doesn't dislocate, right,it just keeps things intact.
So the ligaments getoverwhelmed for sure.
You also have joint capsules andall around the same areas and
the soft tissue of the jointcapsule is a thin membrane that
unsheathes the joint for anotherlayer of stability and that
(09:21):
joint capsule can get irritated.
And you have nerve endings allup in the ligaments and the
joint capsules, so they're goingto get irritated and they're
sensitive.
And the other thing, of course,you have tendons.
Okay, so the tendons getoverstretched and strained too.
Particularly in the wristthere's another structure called
the TFCC and that stands fortriangular fibrocartilage
complex and that is a web and amatrix of fibrocartilaginous
(09:45):
structure right, collagen fibers, fibrocartilaginous, some
cartilage, fibrocartilaginous innature and makeup, and it
suspends the distal ulnar carpaljoint.
All right, so the ulna is thejoint, the bone, sorry, the
forearm bone, that would be onthe inside If you're staying
with your palms out like this.
The ulna is on the inside andit continues down to your elbow
(10:08):
and that's the point of yourelbow is the olecranon of your
ulna.
So it continues down and itactually does not extend all the
way to meet your carpal bone atyour wrist joint.
It's a little bit of space andthat's on purpose, with
evolution, the way that thehumans developed.
What suspends and maintainsstability for that space is the
TFCC.
So it suspends the ulnar jointto the carpal joints that they
(10:32):
articulate with and it creates alittle bit of passive stability
to allow mobility and range ofmotion.
If you ever notice this iscalled ulnar deviation, where
you bend your wrist towards yourulna and then when you bend
your wrist towards your thumb,that's called radial deviation.
You have a lot less radialdeviation available range of
motion when you bend this way,but you have more range when you
(10:53):
bend to the ulnar side.
Ulnar deviation.
The reason is because the ulnadoes not extend all the way to
the wrist and it's suspended bythe TFCC and it allows more
range of motion and mobility.
Classic signs and symptoms forthe TFCC that's involved is
clicking, popping and pain wristclicking and pain with impact
or pain with weight bearing,especially pain when your wrist
(11:14):
is an extension like this, whenit bends backwards and then put
pressure through it.
That would be classic signs oflike the TFCC is involved, right
, so like pushups would hurt orimpact activities in a golf
swing and add clicking with thatand some swelling and pain with
range of motion, that all wouldindicate and lead to us
hypothesizing a diagnosis thatthe TFCC is involved.
(11:36):
I like to say involvement likethat.
It gets involved, it getsfrayed, it gets stressed and it
can get sprained and overlystressed.
Right, we can't structurallychange anything with that from
our standpoint, because we'reconservative sports physios.
(11:57):
Right, wrist surgery is notalways indicated and it's highly
there's not always necessary.
Okay, if we think about, withimaging and an MRI is how you
would get an investigation and adiagnosis to see what
structures in the wrist areinvolved or if they're noticed
(12:20):
to be sprained or torn.
It just involved frayed, right,an MRI is going to be the thing
that's going to indicate thatand discover those structural
abnormalities.
Okay, um, and this just givesus information very often, and
what the research describes isthat a lot of people have, uh,
tfcc or maybe even in the knee,the meniscus in the shoulder,
(12:43):
the labrum, those are all besimilar structures that provide
stability.
The same way, um, that theyhave involvement of those and
they didn't even know they hadit Fraying, tears, a breakdown
that is a super common thingwhere those structures get
broken down with repetitivemicrotrauma and microstress,
injury, microstresses over many,many episodes of sports and
(13:06):
activities.
They get frayed and broken downover a long period of time until
like one aggressive movement orjust one more, one more
practice.
At this point now it's thestraw that broke the camel's
back, to where symptoms and painare coming into the equation.
But not knowing that, like thestructure, the MRI might have
(13:26):
looked the same three years agocompared to now, or even two
years ago, unless they rapidlyramped up their volume of
practice or play or whatever andthey were really aggressive and
super unstable.
Through that, changes canhappen quickly, totally.
But for non-traumatic,non-specific wrist pain, the
TFCC can get frayed and therecould be evidence of micro tears
(13:49):
in there for sure.
The question would be like werethose tears already existing or
did this one movement?
Recently was there one bigimpact where it was like boom,
like oh man, it hurt really bad.
I fell, it was a big twistingmotion in my wrist and like
that's, I heard a clip, I had apop, like it dislocated my wrist
or something.
That would be much different.
That's traumatic versusnon-traumatic, non-specific pain
(14:18):
.
The question would be like werethose tears in the TFCC there
already, and now we're justhaving enough irritation of the
nerve endings in the capsulesand the ligaments and the soft
tissue and the tendons that nowwe're having pain.
So if that's the case and thetears were already present years
prior let's say a year priorbut you've only been having pain
for two months, three months,maybe nothing significantly has
changed in the last 12 months,but you only got a pain for
(14:39):
three months, four months.
What happened the remainingeight months prior to that?
That would suggest that, like,the structure was still the same
and you had no pain then.
The structure is the same andyou have pain now.
So is the structure.
The problem Is the structuraldeformation, the structural
derangement, is the structuralinvolvement of, like tears,
(15:01):
fraying, breakdown.
Is that the actual problem?
Because those breakdown,fraying and structural damage
was already there prior and youhad no pain then, but now you do
so.
Does that require, then, astructural intervention, like a
surgery, to change that?
The suggestion would be no, allright, and we see this very
often.
All right, so we don't have tojump to surgery, all right, but
(15:26):
sprains and strains can happentotally and it would just
indicate that it's repetitivemicrotrauma over many, many
episodes that lead to breakdownand then enough for the nerve
endings involved in theligaments and the capsules and
the tendons to get painfulenough to create pain and then
you have an inflammation eventthat happens, a standard cascade
of inflammatory reactions thatcause more proliferation of pain
(15:50):
and sensitivity and then lackof range of motion and then with
more fluid present in the jointthat can create more clicking
and popping.
So the clicking and popping isusually from more fluid in the
joint versus an actualstructural derangement.
That's a common thing too.
So MRIs would find some microtearing, micro fraying,
increased signaling, increasededema, which is swelling,
(16:10):
increased swelling in the joint.
That's what it's going to find,but not significant enough to
be like.
Here's a glaring problem.
Right there you need surgeryTotally.
That's oftentimes what we findthat the radiologists find in
the MRI that they send to us andwe read it too, of course, and
we check it out.
And then it correlates what wefind clinically with an exam, an
evaluation on the wrist.
(16:30):
So that's what we would findstructurally.
Okay, and that's what the TFCCis.
It's called a triangularfibrocartilage complex.
It just suspends the distalulna on the carpal bones on the
wrist, all right.
So here's something else wefind All right.
Here's the key.
Now, what do you do?
What do you do with thisinformation?
My wrist is still sprained,okay, now what?
Well, we have to identify thebiomechanical faults and the
(16:52):
biomechanical compensationpatterns, and usually there's a
link with the shoulder girdle,the shoulder blade, the scapula
and the shoulder complex that'slacking in some kind of mobility
and strength and stability.
There's usually a scapularshoulder link to distal pain in
the wrist and the elbow for golfand tennis and pickleball,
lacrosse, whatever.
(17:13):
So, speaking of just like thewrist and golf right now,
there's usually a link in theshoulder.
We got to check that thing out.
It's a full body.
Motion in the shoulder is themain proximal stability
requirements for the rest of thearm down the chain that
produces the force when youswing the club.
(17:33):
Okay, so we can't neglect andwe can't leave that stone
unturned, to investigate theshoulder and the scapula and you
know what there's usually.
That's the main.
One of the main things we haveto focus on is scapular
stability or mobility forcertain individuals.
So it's either a mobilitydisparity problem, too, and a
stability strength problem.
There's also some soft tissuerestrictions that limit motion
(17:56):
and also play with musclerecruitment strategies.
All right.
So you have a lot of muscles inyour shoulder.
Some muscles are very dominantand strong and some muscles are
inactive and more dormant.
So that would be a recruitmentdisparity problem.
That's what we call muscleimbalance.
It's a muscle imbalance.
It's not like a strengthproblem, it's just more of like
(18:16):
a recruitment problem.
What's recruited first toproduce this torque or this
force, especially rotation forgolf?
So we have to create morebalance in that and we have to
do some soft tissue work on thejoint, on the soft tissue
restrictions that are limitingmotion and keeping things tight
and bound down, and thenstrength activation exercises.
We also can't neglect the joint, the shoulder joint and the
(18:39):
glenohumeral joint and thescapular movement, all right.
So we have to do manual therapy.
We find ourselves doing manualtherapy on the scapula and
manual therapy on the shoulderjoint itself, soft tissue of the
surrounding musculature andsoft tissue restrictions.
And then muscle activation,strength exercises to fix the
underlying problem that'sleading to the compensation
(19:00):
patterns downstream in the wristthat's creating undue stress
repetitively in one particulararea.
All right, that's the link.
All right, let's take it a stepfurther.
We also can't neglect thatspine rotation, mobility, spinal
mobility and range of motion.
There has to be enough of thethoracic spine to create
rotation and enough in the hipsto create unallowed rotation.
(19:22):
Where a lack of rotation,mobility there, something else
is going to make up for that,and it's usually going to be the
shoulder being hypermobile insome directions or hypomobile in
other directions.
And then guess what else isgoing to make up for it down the
chain, the wrist.
And then one more thing on topof that that we can't neglect is
just flawed mechanics.
All right, and that's swingmechanics.
(19:43):
Like in the tennis swing orgolf swing, something mechanical
is flawed and not as efficientas it could be to disperse the
right forces throughout thejoints at impact.
And part of that is a timingissue, as in like, what fires
first, what's moving first inthe golf swing?
(20:03):
And that's not what we do.
We're not golf pros, but we arebiomechanics and pain, and we
can link it back of like oh,this makes sense and this makes
sense.
These movements and mobilitydrills and corrective strength
exercises will help you be abetter golf at your swing.
It'll help amplify andfacilitate the right swing
mechanics that you're working onwith your golf coach.
Does it make sense?
And that's our role and that'sour lane, all right.
So we're not golf pros, but weare biomechanics and pain.
(20:26):
That's what we do, and we canlink together and connect why
certain areas are having painand where the other areas are
being neglected All right, andthose compensation patterns and
disparities and imbalances leadto chronic issues over time.
Anyway, that's what we do.
Okay, so that's a littlebreakdown on the wrist and the
(20:46):
hand of in golf, to be superjust, concise, and a little bit
of education on some of thisstuff and surrounding structures
and I've done another podcastpreviously, so check it out on
golfer's elbow and tennis elbowand the same kind of talk.
Right, usually athletes are too, if they're novices or if
(21:08):
they're changing their swingmechanics or something.
A common theme is they're toowristy, they hit the ball with
their wrist or they try to likefinish the ball, the job, with
the wrist, so they're producingtoo much force with their wrist
because of a flawed swingmechanic thought, but there
might not be able to even andthat causes pain, or they just
they might not be having enoughrange of motion in the hips, the
(21:30):
pelvis, the thoracic spine, theshoulder, to even get in the
right position to have, not tohave the best of swing mechanics
and not have flawed mechanics.
So that's what we investigateand we do and that's what we
intervene with joint mobility,soft tissue restrictions, muscle
recruitment, strengthactivation and timing, and
that's kind of the stuff thatwe'll work on.
But so, anyway, check out thosepodcasts too.
(21:52):
If you're a golfer and if you'vehad elbow pain, wrist pain,
check out the elbow ones.
That I did too.
It's a very similar talk.
There's a scapular shouldergirdle link of lack of
compensation patterns.
And then core right, we talkabout the spine, but also the
core, core stability, rotationalcore strength, rotational core,
production of the force, timingit with the hips and the pelvis
(22:15):
, rotation, enough thoracicspine mobility to allow it to
happen, the right shoulderpositions, the right shoulder
stability and scapular strength,and then that produces the
force to allow the wrist to nothave to take the undue stress
repetitively.
So that's what we do and thenthat's we intervene manually.
But then we also intervene withcorrective exercises, without
(22:35):
doing that, like there is noother solution.
That is the solution.
Like if nothing changes,nothing changes and a person is
just going to repetitively dothe same thing over and over
again.
They're going to reinforce thesame movement patterns
consistently.
What's that look like fiveyears down the road?
More pain, more limitation.
And they're like.
That's not for me.
Every time I play it hurts.
Every time I work out, it hurtsLike there is a solution.
(22:57):
If it's neuromusculoskeletal,there is a solution of why, of
how to fix it, and then ananswer of like why does it hurt?
Versus like I'm an anomaly andit hurts for no reason.
I'm just, I was born to not beactive.
It's not true Ruling outunderlying red flags and
systemic pathology, that wedon't do.
If it's been ruled out, thatmeans it's neuromusculoskeletal
(23:18):
and that's what we fix.
So we'd love to help you.
All right, we're passionateabout helping people and we live
vicariously through ourpatients.
We enjoy what we do and we getfulfillment, which means we try
hard and we critically think tolike actually get the results
people are looking for.
Because ultimately, the proof'sin the pudding If somebody's
seeing a person, if it's anotherpractitioner a surgeon, doc,
(23:41):
other practitioners, whateverand they're not getting better
the proof's in the pudding Ifyou're better or not, that's the
number one thing people arelooking for.
Is the result right.
But anyway, this is what we do.
We're specialists in this.
So we would love to help you andif you have any questions, feel
free to reach out.
Any comments, questions,concerns or conflicting opinions
(24:03):
about the podcast, please reachout.
Man, we're always open and takea seat, step into my office,
let's have a conversation, whereI'm always open to having
discussions.
So give me a call.
561-899-8725 is the best way toreach us and have a
conversation about what you'rebattling or what you have issues
with in pain.
If you want to get that fixed.
Or you can reach out to us.
Dom, the best email is probablyour team email, which is team
(24:27):
at athlete rccom.
So we'd love to hear from you.
We hope you do Also subscribe,like, share this podcast with
people that you feel like wouldenjoy it or find it interesting
or might help them.
It'll also help with thealgorithm of like what content
is being shared with the rightindividuals and might help them
Right.
So anyway, we'll, we'll, we'llhopefully hear from you all soon
(24:51):
and we'll catch y'all next time.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up?
Y'all?
It's your man, dr Kyle.
Welcome back to the DrivenAthlete Podcast.
I have not touched on this yet.
I wanted to dive into it alittle bit.
(00:20):
I've been having a couple ofpatients recently with this
issue and I wanted to be like oh, a little bit.
I've been having a couplepatients recently with this
issue and I wanted to be like oh, I wanted to send them content.
I realized I didn't haveanything on the wrist.
So wrist dysfunction, wriststrains, wrist sprains, it's a
common thing with impact racketand club sports, like golf, of
course, tennis, lacrosse barringany like traumatic injury, as
(00:42):
in like they fell on it right orthey banged it on something.
They slipped and fell and thenlanded in an awkward way.
That would be a traumaticinjury.
But barring that, it's likewhere does wrist issues come
from?
Where, um, a young athletewho's training a bunch for golf
literally just called this weekand they were like um, their
parents talked to me.
They were like our kid's beenpracticing a ton and out of
(01:06):
nowhere we've had we've beengetting wrist pain, like she,
this, this, this athlete hasbeen experiencing pain in the
wrist, so nothing happened.
I was like, did anything happen?
This is a classic story we hearpretty often where it's like I
know that we can recall, right,nothing happened traumatically,
where it was like one big swingand boom, hit like a root or hit
(01:27):
a really fat shot and then likesomething sprained right then,
but rather just like anaccumulation of a lot of
repetitions in time.
All of a sudden my wrist hurtsright, that would be
non-traumatic wrist pain.
That's a common thing that wesee.
That is our bread and butter,that's what we do, that's what
(01:48):
we work on.
It's non-traumatic,non-specific pain that seems to
be obscure, not really can'tfind any answers.
The MRI x-rays are unremarkable, but I'm having a lot of pain.
What do you do and why did itstart?
How do we fix it?
And then, how do you prevent itcoming back?
Like what's the underlyingreason for the issue?
Right, so that's our bread andbutter, that's what we do.
(02:09):
Back pain, shoulder pain, wristpain like that, like that's our
wheelhouse, all right, that'swhere we thrive.
We're the specialists thatpeople call to fix that.
So, with this common story.
I've been playing golf a lotand all of a sudden my wrist
hurts.
Or lacrosse, or tennis,pickleball or whatever Like what
(02:45):
do I do Oftentimes with this?
It's a combination in a orstriking of the ball or whatever
you're doing.
So it's undue stress on oneparticular region or area of the
wrist that is overcompensatingand taking the brunt of the
movement or the impact and thestability requirements through
that impact phase of the sportor the swing repetitively.
(03:07):
And if there's mobility andrange of motion, mechanical
disparities of mobility andstrength disparities, muscle
imbalances, what we would callthat.
So there's joint imbalanceslike range of motion,
flexibility imbalances incertain joints elbow, wrist and
(03:30):
shoulder, hips and pelvis andthe trunk that we can't neglect
because it's a full body sport.
It's a full body movement,swing right, and then a lack of
strength and stability wheresome things are required too
much to produce the force andnot enough of other things are
contributing to produce theforce for the swing.
So imagine if one particularjoint is taking on a lot of the
brunt of the impact, not gettinghelp elsewhere or dispersing
(03:53):
the forces through the impact,and then the muscles that
generate the force are allcoming from one particular
region, in one area, what do youthink is going to happen?
That one particular spot isgoing to get overwhelmed and
that's going to cause pain.
So it ends up being the strawthat broke the camel's back over
an accumulation of many, manyrepetitions and episodes.
So it's a recipe of overallflawed mechanics all right,
(04:18):
Joint mobility disparities,muscle strength, stability
disparities, imbalances, withundue stress being placed on one
particular area over and overand over again, and that creates
pain.
In my opinion, a cop-out answer,a weak answer, a lazy answer is
overuse.
My question with that would bewith this, it's a lot of volume
(04:41):
that athletes practice, for sure.
My question would be thisparticular athlete that's
developed this wrist pain out ofnowhere, are they doing an
excessive amount of repetitions,more than their colleagues,
more than their friends, morethan their competitors?
Are they all practicingsomewhat similar?
And if they are, then why isthis one athlete developing
(05:01):
wrist pain whereas the otherones aren't?
Then why is this one athletedeveloping wrist pain whereas
the other ones aren't?
If it was overuse, just likeblanket coverage, overuse
diagnosis, then why doesn'teverybody get the same wrist
injury or some kind of an injuryat the same time frame, 12
weeks into the season, sixmonths into the season.
Why doesn't everybody getinjury like that?
(05:22):
If they're all doing kind ofthe same amount of practice and
volume, it's because it's notjust overuse, it's all the other
recipe stuff that we mentionedjust two seconds ago.
All right, flawed mechanics in aswing, which is not what we do.
We're not golf pros or tennispros, but we are biomechanics in
pain and we can pinpoint andisolate an answer in some
structures of like.
This is what the painfulstructure is.
(05:43):
This is the pain generatingtissue and this is why it's
getting overwhelmed.
And watching you move andgroove, I can tell there's joint
disparities of range of motionin your shoulder, scapula,
thoracic spine, pelvis and hipsand disparities in your elbow
and wrist.
All right, for like strengthrequirements and mobility and
stuff, all right.
So all those things kind ofcombined end up being the recipe
that lead to nonspecific,non-traumatic wrist pain,
(06:07):
specifically wrist pain for thisparticular podcast.
So what are those structuresthat get irritated?
People usually ask what's thepain and what they're asking is
like what is the angry tissue?
What's angry?
What's the painful tissue?
Right, and it's usually someligamentous structures, the soft
(06:27):
tissue that spans.
You have tons of bones in there.
Right, you have eight carpalbones.
You have two forearm bones andyou have five metacarpals and
they all articulate together.
All right, the best mnemonicthat I've heard for remembering
the carpal bones is so long topinky.
Here comes the thumb and thoseare the eight carpal bones.
(06:48):
They're like little rocks orpebbles in your wrist that help
with joint, that just producethe mechanical movements in your
wrist, but they articulate withthe forearm bones called your
radius and your ulna, and thenthe distally or further away,
the metacarpals.
All right, and there's five ofthem for each five finger.
So those are the articulationsof the joints.
So between all those joints youhave ligaments that connect to
(07:12):
each individual bone in multipleareas.
All right, so there's a ton ofligaments in your wrist between
the distal forearm bones of yourradius to ulnar, your radial
ulnar joint, the radial carpaljoints, the ulnar carpal joints
and then the metacarpal carpaljoints.
All right, the carpalmetacarpal joints.
So there's a ton of ligamentsand they connect to every single
(07:33):
bone.
Okay, so there's a ton ofligaments in there and they all
can get some of them can getirritated if they're being
chronically overstretched andstrained with the repetitive
impact motions in the positionsthat the wrist is enduring this
impact, all right.
However, ligaments are passivestructures, as in.
They don't produce stability,they just maintain passive
(07:55):
stability.
All right, you can't strengthenligaments with exercise, but
what I mean okay, let me takethis a different way you don't
create more dynamic stabilitythrough ligamentous structures.
The ligaments don't createdynamic stability.
General rule of thumb is ajoint is only as strong as the
muscles that surround it andthat span over the joint.
So it's dynamic musclestability and muscle strength
(08:17):
and activation or timing ofturning things on at the moments
they need to be turned on orturning them off when they need
to be turned off more, andre-regulating the recruitment
patterns.
That's ultimately what createsstability around a joint.
So the ligaments get a lot ofweight.
With diagnosis as in, likewhat's the painful tissue?
(08:39):
Well, it might be someligamentous strain.
For sure we would call that asprain, some ligamentous strain.
For sure we would call that asprain, ligamentous sprain
happening from repetitive, undueoverstretching of the ligaments
that are trying to hang on fordear life.
But too much stress is beingplaced upon them.
And why would be too muchstress be placed on the
ligaments?
Because the muscles thatsurround it aren't producing
enough stability instead.
(08:59):
So it inherently goes to justrequiring the passive stability
of the ligaments that span thejoint to make sure that your
wrist doesn't dislocate, right,it just keeps things intact.
So the ligaments getoverwhelmed for sure.
You also have joint capsules andall around the same areas and
the soft tissue of the jointcapsule is a thin membrane that
unsheathes the joint for anotherlayer of stability and that
(09:21):
joint capsule can get irritated.
And you have nerve endings allup in the ligaments and the
joint capsules, so they're goingto get irritated and they're
sensitive.
And the other thing, of course,you have tendons.
Okay, so the tendons getoverstretched and strained too.
Particularly in the wristthere's another structure called
the TFCC and that stands fortriangular fibrocartilage
complex and that is a web and amatrix of fibrocartilaginous
(09:45):
structure right, collagen fibers, fibrocartilaginous, some
cartilage, fibrocartilaginous innature and makeup, and it
suspends the distal ulnar carpaljoint.
All right, so the ulna is thejoint, the bone, sorry, the
forearm bone, that would be onthe inside If you're staying
with your palms out like this.
The ulna is on the inside andit continues down to your elbow
(10:08):
and that's the point of yourelbow is the olecranon of your
ulna.
So it continues down and itactually does not extend all the
way to meet your carpal bone atyour wrist joint.
It's a little bit of space andthat's on purpose, with
evolution, the way that thehumans developed.
What suspends and maintainsstability for that space is the
TFCC.
So it suspends the ulnar jointto the carpal joints that they
(10:32):
articulate with and it creates alittle bit of passive stability
to allow mobility and range ofmotion.
If you ever notice this iscalled ulnar deviation, where
you bend your wrist towards yourulna and then when you bend
your wrist towards your thumb,that's called radial deviation.
You have a lot less radialdeviation available range of
motion when you bend this way,but you have more range when you
(10:53):
bend to the ulnar side.
Ulnar deviation.
The reason is because the ulnadoes not extend all the way to
the wrist and it's suspended bythe TFCC and it allows more
range of motion and mobility.
Classic signs and symptoms forthe TFCC that's involved is
clicking, popping and pain wristclicking and pain with impact
or pain with weight bearing,especially pain when your wrist
(11:14):
is an extension like this, whenit bends backwards and then put
pressure through it.
That would be classic signs oflike the TFCC is involved, right
, so like pushups would hurt orimpact activities in a golf
swing and add clicking with thatand some swelling and pain with
range of motion, that all wouldindicate and lead to us
hypothesizing a diagnosis thatthe TFCC is involved.
(11:36):
I like to say involvement likethat.
It gets involved, it getsfrayed, it gets stressed and it
can get sprained and overlystressed.
Right, we can't structurallychange anything with that from
our standpoint, because we'reconservative sports physios.
(11:57):
Right, wrist surgery is notalways indicated and it's highly
there's not always necessary.
Okay, if we think about, withimaging and an MRI is how you
would get an investigation and adiagnosis to see what
structures in the wrist areinvolved or if they're noticed
(12:20):
to be sprained or torn.
It just involved frayed, right,an MRI is going to be the thing
that's going to indicate thatand discover those structural
abnormalities.
Okay, um, and this just givesus information very often, and
what the research describes isthat a lot of people have, uh,
tfcc or maybe even in the knee,the meniscus in the shoulder,
(12:43):
the labrum, those are all besimilar structures that provide
stability.
The same way, um, that theyhave involvement of those and
they didn't even know they hadit Fraying, tears, a breakdown
that is a super common thingwhere those structures get
broken down with repetitivemicrotrauma and microstress,
injury, microstresses over many,many episodes of sports and
(13:06):
activities.
They get frayed and broken downover a long period of time until
like one aggressive movement orjust one more, one more
practice.
At this point now it's thestraw that broke the camel's
back, to where symptoms and painare coming into the equation.
But not knowing that, like thestructure, the MRI might have
(13:26):
looked the same three years agocompared to now, or even two
years ago, unless they rapidlyramped up their volume of
practice or play or whatever andthey were really aggressive and
super unstable.
Through that, changes canhappen quickly, totally.
But for non-traumatic,non-specific wrist pain, the
TFCC can get frayed and therecould be evidence of micro tears
(13:49):
in there for sure.
The question would be like werethose tears already existing or
did this one movement?
Recently was there one bigimpact where it was like boom,
like oh man, it hurt really bad.
I fell, it was a big twistingmotion in my wrist and like
that's, I heard a clip, I had apop, like it dislocated my wrist
or something.
That would be much different.
That's traumatic versusnon-traumatic, non-specific pain
(14:18):
.
The question would be like werethose tears in the TFCC there
already, and now we're justhaving enough irritation of the
nerve endings in the capsulesand the ligaments and the soft
tissue and the tendons that nowwe're having pain.
So if that's the case and thetears were already present years
prior let's say a year priorbut you've only been having pain
for two months, three months,maybe nothing significantly has
changed in the last 12 months,but you only got a pain for
(14:39):
three months, four months.
What happened the remainingeight months prior to that?
That would suggest that, like,the structure was still the same
and you had no pain then.
The structure is the same andyou have pain now.
So is the structure.
The problem Is the structuraldeformation, the structural
derangement, is the structuralinvolvement of, like tears,
(15:01):
fraying, breakdown.
Is that the actual problem?
Because those breakdown,fraying and structural damage
was already there prior and youhad no pain then, but now you do
so.
Does that require, then, astructural intervention, like a
surgery, to change that?
The suggestion would be no, allright, and we see this very
often.
All right, so we don't have tojump to surgery, all right, but
(15:26):
sprains and strains can happentotally and it would just
indicate that it's repetitivemicrotrauma over many, many
episodes that lead to breakdownand then enough for the nerve
endings involved in theligaments and the capsules and
the tendons to get painfulenough to create pain and then
you have an inflammation eventthat happens, a standard cascade
of inflammatory reactions thatcause more proliferation of pain
(15:50):
and sensitivity and then lackof range of motion and then with
more fluid present in the jointthat can create more clicking
and popping.
So the clicking and popping isusually from more fluid in the
joint versus an actualstructural derangement.
That's a common thing too.
So MRIs would find some microtearing, micro fraying,
increased signaling, increasededema, which is swelling,
(16:10):
increased swelling in the joint.
That's what it's going to find,but not significant enough to
be like.
Here's a glaring problem.
Right there you need surgeryTotally.
That's oftentimes what we findthat the radiologists find in
the MRI that they send to us andwe read it too, of course, and
we check it out.
And then it correlates what wefind clinically with an exam, an
evaluation on the wrist.
(16:30):
So that's what we would findstructurally.
Okay, and that's what the TFCCis.
It's called a triangularfibrocartilage complex.
It just suspends the distalulna on the carpal bones on the
wrist, all right.
So here's something else wefind All right.
Here's the key.
Now, what do you do?
What do you do with thisinformation?
My wrist is still sprained,okay, now what?
Well, we have to identify thebiomechanical faults and the
(16:52):
biomechanical compensationpatterns, and usually there's a
link with the shoulder girdle,the shoulder blade, the scapula
and the shoulder complex that'slacking in some kind of mobility
and strength and stability.
There's usually a scapularshoulder link to distal pain in
the wrist and the elbow for golfand tennis and pickleball,
lacrosse, whatever.
(17:13):
So, speaking of just like thewrist and golf right now,
there's usually a link in theshoulder.
We got to check that thing out.
It's a full body.
Motion in the shoulder is themain proximal stability
requirements for the rest of thearm down the chain that
produces the force when youswing the club.
(17:33):
Okay, so we can't neglect andwe can't leave that stone
unturned, to investigate theshoulder and the scapula and you
know what there's usually.
That's the main.
One of the main things we haveto focus on is scapular
stability or mobility forcertain individuals.
So it's either a mobilitydisparity problem, too, and a
stability strength problem.
There's also some soft tissuerestrictions that limit motion
(17:56):
and also play with musclerecruitment strategies.
All right.
So you have a lot of muscles inyour shoulder.
Some muscles are very dominantand strong and some muscles are
inactive and more dormant.
So that would be a recruitmentdisparity problem.
That's what we call muscleimbalance.
It's a muscle imbalance.
It's not like a strengthproblem, it's just more of like
(18:16):
a recruitment problem.
What's recruited first toproduce this torque or this
force, especially rotation forgolf?
So we have to create morebalance in that and we have to
do some soft tissue work on thejoint, on the soft tissue
restrictions that are limitingmotion and keeping things tight
and bound down, and thenstrength activation exercises.
We also can't neglect the joint, the shoulder joint and the
(18:39):
glenohumeral joint and thescapular movement, all right.
So we have to do manual therapy.
We find ourselves doing manualtherapy on the scapula and
manual therapy on the shoulderjoint itself, soft tissue of the
surrounding musculature andsoft tissue restrictions.
And then muscle activation,strength exercises to fix the
underlying problem that'sleading to the compensation
(19:00):
patterns downstream in the wristthat's creating undue stress
repetitively in one particulararea.
All right, that's the link.
All right, let's take it a stepfurther.
We also can't neglect thatspine rotation, mobility, spinal
mobility and range of motion.
There has to be enough of thethoracic spine to create
rotation and enough in the hipsto create unallowed rotation.
(19:22):
Where a lack of rotation,mobility there, something else
is going to make up for that,and it's usually going to be the
shoulder being hypermobile insome directions or hypomobile in
other directions.
And then guess what else isgoing to make up for it down the
chain, the wrist.
And then one more thing on topof that that we can't neglect is
just flawed mechanics.
All right, and that's swingmechanics.
(19:43):
Like in the tennis swing orgolf swing, something mechanical
is flawed and not as efficientas it could be to disperse the
right forces throughout thejoints at impact.
And part of that is a timingissue, as in like, what fires
first, what's moving first inthe golf swing?
(20:03):
And that's not what we do.
We're not golf pros, but we arebiomechanics and pain, and we
can link it back of like oh,this makes sense and this makes
sense.
These movements and mobilitydrills and corrective strength
exercises will help you be abetter golf at your swing.
It'll help amplify andfacilitate the right swing
mechanics that you're working onwith your golf coach.
Does it make sense?
And that's our role and that'sour lane, all right.
So we're not golf pros, but weare biomechanics and pain.
(20:26):
That's what we do, and we canlink together and connect why
certain areas are having painand where the other areas are
being neglected All right, andthose compensation patterns and
disparities and imbalances leadto chronic issues over time.
Anyway, that's what we do.
Okay, so that's a littlebreakdown on the wrist and the
(20:46):
hand of in golf, to be superjust, concise, and a little bit
of education on some of thisstuff and surrounding structures
and I've done another podcastpreviously, so check it out on
golfer's elbow and tennis elbowand the same kind of talk.
Right, usually athletes are too, if they're novices or if
(21:08):
they're changing their swingmechanics or something.
A common theme is they're toowristy, they hit the ball with
their wrist or they try to likefinish the ball, the job, with
the wrist, so they're producingtoo much force with their wrist
because of a flawed swingmechanic thought, but there
might not be able to even andthat causes pain, or they just
they might not be having enoughrange of motion in the hips, the
(21:30):
pelvis, the thoracic spine, theshoulder, to even get in the
right position to have, not tohave the best of swing mechanics
and not have flawed mechanics.
So that's what we investigateand we do and that's what we
intervene with joint mobility,soft tissue restrictions, muscle
recruitment, strengthactivation and timing, and
that's kind of the stuff thatwe'll work on.
But so, anyway, check out thosepodcasts too.
(21:52):
If you're a golfer and if you'vehad elbow pain, wrist pain,
check out the elbow ones.
That I did too.
It's a very similar talk.
There's a scapular shouldergirdle link of lack of
compensation patterns.
And then core right, we talkabout the spine, but also the
core, core stability, rotationalcore strength, rotational core,
production of the force, timingit with the hips and the pelvis
(22:15):
, rotation, enough thoracicspine mobility to allow it to
happen, the right shoulderpositions, the right shoulder
stability and scapular strength,and then that produces the
force to allow the wrist to nothave to take the undue stress
repetitively.
So that's what we do and thenthat's we intervene manually.
But then we also intervene withcorrective exercises, without
(22:35):
doing that, like there is noother solution.
That is the solution.
Like if nothing changes,nothing changes and a person is
just going to repetitively dothe same thing over and over
again.
They're going to reinforce thesame movement patterns
consistently.
What's that look like fiveyears down the road?
More pain, more limitation.
And they're like.
That's not for me.
Every time I play it hurts.
Every time I work out, it hurtsLike there is a solution.
(22:57):
If it's neuromusculoskeletal,there is a solution of why, of
how to fix it, and then ananswer of like why does it hurt?
Versus like I'm an anomaly andit hurts for no reason.
I'm just, I was born to not beactive.
It's not true Ruling outunderlying red flags and
systemic pathology, that wedon't do.
If it's been ruled out, thatmeans it's neuromusculoskeletal
(23:18):
and that's what we fix.
So we'd love to help you.
All right, we're passionateabout helping people and we live
vicariously through ourpatients.
We enjoy what we do and we getfulfillment, which means we try
hard and we critically think tolike actually get the results
people are looking for.
Because ultimately, the proof'sin the pudding If somebody's
seeing a person, if it's anotherpractitioner a surgeon, doc,
(23:41):
other practitioners, whateverand they're not getting better
the proof's in the pudding Ifyou're better or not, that's the
number one thing people arelooking for.
Is the result right.
But anyway, this is what we do.
We're specialists in this.
So we would love to help you andif you have any questions, feel
free to reach out.
Any comments, questions,concerns or conflicting opinions
(24:03):
about the podcast, please reachout.
Man, we're always open and takea seat, step into my office,
let's have a conversation, whereI'm always open to having
discussions.
So give me a call.
561-899-8725 is the best way toreach us and have a
conversation about what you'rebattling or what you have issues
with in pain.
If you want to get that fixed.
Or you can reach out to us.
Dom, the best email is probablyour team email, which is team
(24:27):
at athlete rccom.
So we'd love to hear from you.
We hope you do Also subscribe,like, share this podcast with
people that you feel like wouldenjoy it or find it interesting
or might help them.
It'll also help with thealgorithm of like what content
is being shared with the rightindividuals and might help them
Right.
So anyway, we'll, we'll, we'llhopefully hear from you all soon
(24:51):
and we'll catch y'all next time.
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