Sports Injuries

For individuals who lift weights, are there ways to protect the wrists and prevent injuries when lifting weights?

Wrist Protection

The wrists are complex joints. The wrists significantly contribute to stability and mobility when performing tasks or lifting weights. They provide mobility for movements using the hands and stability to carry and lift objects securely and safely (National Library of Medicine, 2024). Lifting weights is commonly performed to strengthen and stabilize the wrists; however, these movements can cause wrist pain and lead to injuries if not performed correctly. Wrist protection can keep wrists strong and healthy and is key to avoiding strains and injuries.

Wrist Strength

The wrist joints are set between the hand and forearm bones. Wrists are aligned in two rows of eight or nine total small bones/carpal bones and are connected to the arm and hand bones by ligaments, while tendons connect the surrounding muscles to the bones. Wrist joints are condyloid or modified ball and socket joints that assist with flexion, extension, abduction, and adduction movements. (National Library of Medicine. 2024) This means the wrists can move in all planes of motion:

• Side to side
• Up and down
• Rotate

This provides a wide range of motion but can also cause excessive wear and tear and increase the risk of strain and injury. The muscles in the forearm and hand control finger movement necessary for gripping. These muscles and the tendons and ligaments involved run through the wrist. Strengthening the wrists will keep them mobile, help prevent injuries, and increase and maintain grip strength.  In a review on weightlifters and powerlifters that examined the types of injuries they sustain, wrist injuries were common, with muscle and tendon injuries being the most common among weightlifters. (Ulrika Aasa et al., 2017)

Protecting the Wrists

Wrist protection can use a multi-approach, which includes consistently increasing strength, mobility, and flexibility to improve health and prevent injuries. Before lifting or engaging in any new exercise, individuals should consult their primary healthcare provider, physical therapist, trainer, medical specialist, or sports chiropractor to see which exercises are safe and provide benefits based on injury history and current level of health.

Increase Mobility

Mobility allows the wrists to have a full range of motion while retaining the stability necessary for strength and durability. Lack of mobility in the wrist joint can cause stiffness and pain. Flexibility is connected to mobility, but being overly flexible and lacking stability can lead to injuries. To increase wrist mobility, perform exercises at least two to three times a week to improve range of motion with control and stability. Also, taking regular breaks throughout the day to rotate and circle the wrists and gently pull back on the fingers to stretch them will help relieve tension and stiffness that can cause mobility problems.

Warm-Up

Before working out, warm up the wrists and the rest of the body before working out. Start with light cardiovascular to get the synovial fluid in the joints circulating to lubricate the joints, allowing for smoother movement. For example, individuals can make fists, rotate their wrists, perform mobility exercises, flex and extend the wrists, and use one hand to pull back the fingers gently. Around 25% of sports injuries involve the hand or wrist. These include hyperextension injury, ligament tears, front-inside or thumb-side wrist pain from overuse injuries, extensor injuries, and others. (Daniel M. Avery 3rd et al., 2016)

Strengthening Exercises

Strong wrists are more stable, and strengthening them can provide wrist protection. Exercises that improve wrist strength include pull-ups, deadlifts, loaded carries, and Zottman curls. Grip strength is vital for performing daily tasks, healthy aging, and continued success with weightlifting. (Richard W. Bohannon 2019) For example, individuals who have difficulty increasing the weight on their deadlifts because the bar slips from their hands could have insufficient wrist and grip strength.

Wraps

Wrist wraps or grip-assisting products are worth considering for those with wrist issues or concerns. They can provide added external stability while lifting, reducing grip fatigue and strain on the ligaments and tendons. However, it is recommended not to rely on wraps as a cure-all measure and to focus on improving individual strength, mobility, and stability. A study on athletes with wrist injuries revealed that the injuries still occurred despite wraps being worn 34% of the time prior to the injury. Because most injured athletes did not use wraps, this pointed to potential preventative measures, but the experts agreed more research is needed. (Amr Tawfik et al., 2021)

Preventing Overuse Injuries

When an area of the body undergoes too many repetitive motions without proper rest, it becomes worn, strained, or inflamed faster, causing overuse injury. The reasons for overuse injuries are varied but include not varying workouts enough to rest the muscles and prevent strain. A research review on the prevalence of injuries in weightlifters found that 25% were due to overuse tendon injuries. (Ulrika Aasa et al., 2017) Preventing overuse can help avoid potential wrist problems.

Proper Form

Knowing how to perform movements correctly and using proper form during each workout/training session is essential for preventing injuries. A personal trainer, sports physiotherapist, or physical therapist can teach how to adjust grip or maintain correct form.

Be sure to see your provider for clearance before lifting or starting an exercise program. Injury Medical Chiropractic and Functional Medicine Clinic can advise on training and prehabilitation or make a referral if one is needed.

Fitness Health

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Erwin, J., & Varacallo, M. (2024). Anatomy, Shoulder and Upper Limb, Wrist Joint. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30521200

Aasa, U., Svartholm, I., Andersson, F., & Berglund, L. (2017). Injuries among weightlifters and powerlifters: a systematic review. British journal of sports medicine, 51(4), 211–219. https://doi.org/10.1136/bjsports-2016-096037

Avery, D. M., 3rd, Rodner, C. M., & Edgar, C. M. (2016). Sports-related wrist and hand injuries: a review. Journal of orthopaedic surgery and research, 11(1), 99. https://doi.org/10.1186/s13018-016-0432-8

Bohannon R. W. (2019). Grip Strength: An Indispensable Biomarker For Older Adults. Clinical interventions in aging, 14, 1681–1691. https://doi.org/10.2147/CIA.S194543

Tawfik, A., Katt, B. M., Sirch, F., Simon, M. E., Padua, F., Fletcher, D., Beredjiklian, P., & Nakashian, M. (2021). A Study on the Incidence of Hand or Wrist Injuries in CrossFit Athletes. Cureus, 13(3), e13818. https://doi.org/10.7759/cureus.13818

Cue sports use a cue stick to strike billiard balls off and around a pool or equivalent table. The most common game is pool. Although these are not contact sports, various musculoskeletal injuries can manifest. Therefore, it is recommended to know the common injuries so that they can be self-treated or treatment can be sought before the condition worsens. Injury Medical Chiropractic and Functional Medicine Clinic can relieve symptoms, rehabilitate the body, and restore mobility and function.

Cue Sports Injuries

Sports medicine doctors say cue sports players suffer from sprains, strains, and fractures, among other injuries. Cue sports players are constantly:

• Bending
• Reaching
• Twisting
• Stretching their arms
• Using their hands and wrists

Performing these constant movements and motions for extended periods increases the risk of sustaining injuries. Common symptoms include:

• Inflammation
• Warmth or heat in affected areas
• Swelling
• Tightness in the affected areas
• Pain
• Decreased range of motion

Injuries

Back and Waist 

The posturing can cause individuals to tense their muscles, increasing the likelihood of injury. With all the bending, waist and back injuries are common. Back issues include:

• Pinched nerves
• Sciatica
• Sprains
• Strains
• Herniated discs

Individuals with existing spine conditions or osteoarthritis have an increased risk of injury. 

Shoulder, Arm, Wrist, Hand, and Finger

• The shoulders, hands, wrists, and fingers are in constant use.
• This can lead to overuse injuries affecting the muscles, tendons, ligaments, nerves, and bones.
• Consistent stress can lead to sprains, strains, or bursitis.

Tendonitis

• Tendonitis occurs when too much pressure is applied, causing tendons to inflame.
• This could lead to swelling and pain and could lead to long-term damage.

Foot and Ankle

• The feet can slip when stretching too far while setting up and taking a shot.
• This injury usually happens when trying to balance on one foot.
• Slipping can lead to a sprained ankle or something worse, like a torn ligament or fractured foot.

Chiropractic Care

Chiropractic adjustments combined with massage therapy and functional medicine can treat these injuries and conditions, relieving symptoms and restoring mobility and function. When the tendons, muscles, ligaments, and bones are properly aligned, recovery and rehabilitation progress faster. A chiropractor will also recommend stretching and exercise programs to help maintain the adjustments and prevent injuries.

Physical Therapy and Exercises

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Garner, Michael J et al. "Chiropractic care of musculoskeletal disorders in a unique population within Canadian community health centers." Journal of manipulative and physiological therapeutics vol. 30,3 (2007): 165-70. doi:10.1016/j.jmpt.2007.01.009

Hestbaek, Lise, and Mette Jensen Stochkendahl. "The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor's new suit?." Chiropractic & osteopathy vol. 18 15. 2 Jun. 2010, doi:10.1186/1746-1340-18-15

Orloff, A S, and D Resnick. "Fatigue fracture of the distal part of the radius in a pool player." Injury vol. 17,6 (1986): 418-9. doi:10.1016/0020-1383(86)90088-4

Bowling is a fun physical activity that is enjoyable for all ages. Today, there are college bowlers, recreational bowlers, amateur, semiprofessional, professional leagues, and tournaments worldwide. Although it might not be the first sport that comes to mind when thinking of injuries and chronic pain conditions, it can place significant stress on the muscles and tendons of the upper and lower body. It is important to know and understand how to avoid injuries. 

How Bowling Injuries Happen

There are two main causes of injuries and chronic pain related to bowling. The first is poor mechanics, and the second is repetitive over-use. Both cause/develop painful symptoms that can turn into injuries that become chronic conditions. Many injuries are caused by:

• Slip and fall accidents
• Players dropping the ball on their feet
• The majority of injuries come from overuse/repetition and improper body mechanics.
• Overuse injuries result from repetitive and/or strenuous actions/movements that place profound stress on the body’s musculoskeletal system.

For example, a semi-pro and professional bowler will play fifty or more games a week. This means throwing a sixteen-pound ball for ten frames per game. When consistently repeated over and over, this can cause serious wear and tear to the body. With amateur and recreational bowlers, they don't play as much, so they don't experience overuse injury as much, but what they do experience is improper/poor form techniques that shift the body in non-ergonomic ways, wrong equipment like oversized/too-small shoes that can cause awkward postures and body motions, a ball that is too heavy causing an individual to overthrow and strain their arms, backs, hips, and legs. Or a ball with small finger holes that get stuck or too large, causing finger, hand, arm, shoulder pulls strains, and sprains.

Common Bowling Injuries

The most common injuries and conditions associated with bowling include: 

• Hand pain
• Finger sprain
• Trigger/bowling finger
• Wrist Tendonitis
• Carpal Tunnel Syndrome
• Medial epicondylitis
• Annular ligament sprain
• Shoulder Tendonitis
• Rotator Cuff Tear
• Shoulder Instability
• Low Back Pain
• Hip Bursitis
• Piriformis Syndrome
• Sciatica
• Herniated Disc
• Low back strain and sprain
• Spondylolysis
• Knee ACL injury
• Knee LCL injury
• Knee MCL injury
• Knee PCL injury
• Knee Meniscus Tear
• Patellofemoral Syndrome
• Illiotibial Band Syndrome
• Arthritis

Many of the injuries can lead to tendonitis or arthritis later in life.

Trigger/Bowler's Finger

Symptoms include:

• Hand pain after bowling, specifically in the fingers
• A clicking or popping when moving the fingers
• A finger gets locked in a bent position

Rest, and no bowling is recommended. How long a rest depends on how long the symptoms have been presenting. Physical therapy, along with chiropractic exercises, can help improve finger strength. Splinting the finger could be required to improve the condition. If all fails or does not generate adequate relief, hand surgery could be optioned with a trigger finger release. The surgery allows the finger to move more freely.

Bowler’s Thumb

This usually happens to bowlers that want to generate a lot of spin on the ball. If the thumb’s hole is too tight, it can pinch the ulnar nerve inside the thumb. If the thumb injury is not serious, rest and getting the correct ball size can correct the issue. This is where purchasing a personal bowling ball can help.

Finger Sprain

This is an injury to one or more of the ligaments in the fingers. It most often takes place in the collateral ligaments along the sides of the fingers inside the ball. The ligament/s gets stretched or torn when the finger is forced beyond its normal range of motion. Common symptoms of a finger sprain include swelling, tenderness, stiffness, and pain in the affected finger. This usually occurs from:

• The weight of holding the ball with the fingers alone
• A poor release
• Using a ball that doesn’t properly fit the fingers
• A finger sprain falls into grades on the severity of how much the ligament is stretched or torn:

Grade 1

Stretching or microscopic tearing.

Grade 2

Less than 90% of the ligament is torn.

Grade 3

More than 90% of the ligament is torn. Grade three sprains can be accompanied by joint instability and immobility.

Herniated Disc

A herniated disc is when the discs get injured/damaged from overuse, wear, and tear, or a traumatic injury to the spine. The disc can dry out, become less flexible, bulge out, or rupture. Bowlers are constantly:

• Bending during the final approach and throw
• Carrying a heavy ball
• Shifting, twisting, and releasing, increasing the pressure within the discs

In bowling, the majority of herniated discs happen in the low back. The most common symptom is backaches and back pain. Lumbar herniated discs left untreated can cause sciatica.

Avoid and Prevent Injury

The best way to prevent injury is to stay aware of body position, mechanics, equipment, and what the body says.

Stretching

Stretching is one of the best things to avoid injury before practicing, competing, or just playing. Stretching will increase flexibility, especially in the wrist, hand, arm, and low back.

Improving technique

Continually using poor techniques over and over is a perfect set-up for injury. Working with a coach will ensure the proper form. This is important when it comes to generating spin on the ball, as well as, making sure the grip does not place too much strain on the hands.

Using the right ball

The ball being used might not be the right fit for your hand or strength. The holes could be too far apart, causing strain on the fingers. Get as much information as possible and try out different styles and weights to get a comfortable feel for the right ball.

Bowling less

Hard-core bowlers could be overdoing it. Cutting back, and creating a balance will allow the body to recover thoroughly and not cause flare-ups.

Getting in shape

Studies show that individuals who bowl and do not exercise significantly increase the risk of a back injury than those who exercise their back and core. Bowling is not as strenuous as other sports, but it still requires the body to be able to handle the stress.

Body Health

Test Body Composition

Testing body composition regularly is the best way to ensure the body stays healthy. Tracking body composition tracks Lean Mass and Fat Mass gain or loss. The information provided allows the individual to make the necessary changes to ensure they stay fit and healthy.

Diet adjustment

Diet needs to be adjusted to match the individual's current activity level, or risk running a caloric surplus. A great way to optimize diet is to use Basal Metabolic Rate which will make sure the body is getting enough nutrients to fuel muscle growth, and lose belly fat.

Physical activity that fits the new lifestyle

Increase physical activity levels that work with current lifestyle. This does not mean performing at high levels every day. Be active on a schedule that works for you. Two days of strength training a week offer great physical and mental benefits. The key is to maintain the balance between food consumption and exercise/physical activity that fits your current lifestyle.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Almedghio, Sami M et al. “Wii knee revisited: meniscal injury from 10-pin bowling.” BMJ case reports vol. 2009 (2009): bcr11.2008.1189. doi:10.1136/bcr.11.2008.1189

Kerr, Zachary Y et al. “Epidemiology of bowling-related injuries presenting to US emergency departments, 1990-2008.” Clinical pediatrics vol. 50,8 (2011): 738-46. doi:10.1177/0009922811404697

Kisner, W H. “Thumb neuroma: a hazard of ten pin bowling.” British journal of plastic surgery vol. 29,3 (1976): 225-6. doi:10.1016/s0007-1226(76)90060-6

Miller, S, and G M Rayan. “Bowling related injuries of the hand and upper extremity; a review.” The Journal of the Oklahoma State Medical Association vol. 91,5 (1998): 289-91.

One area to consider is driving. When it comes to carpal tunnel syndrome pain most individuals think about keyboard typing, as the source of arm, wrist, and hand pain. This is true, but carpal tunnel can develop from:

• Any repetitive motion
• Gripping
• Bending at the wrist
• Vibrations going through the wrist

Long-distance truckers, those who drive for business or regular long pleasure trips on winding mountain roads can take a toll on the muscles, tendons, ligaments of the arms and hands. Combining a regular job, stacking, scanning, lifting, and typing away most of the day, then long commutes, and weekends driving around, an individual can begin to present with arm, hand, and finger pain.

Signs and Symptoms

Carpal tunnel can sneak up when least expected. Most individuals begin to feel a burning, tingling, or numbness in the thumb and first two fingers, and for some, the palm, as well. Discomfort or pain usually presents at night and in the morning. If the condition becomes worse, individuals often feel the need to shake out the hand or wrists, trying to bring relief from the pain and tightness. It can affect one hand or both hands. The pain can continue to increase and climb up the arm. Then normal tasks like pumping gas or writing with a pen become unbearable.

Carpal Tunnel Syndrome

The median nerve controls the sensations to the palm, the thumb, and the four fingers of the hand. The nerve runs through a small passageway in the wrist called the carpal tunnel. Swelling or thickening of the tendons narrow the tight space and irritate the nerve.

Diagnosis

There are different ways to diagnose the condition. To avoid damaging the median nerve, it is important to get a diagnosis as early as possible.

• A doctor or chiropractor may order orthopedic or neurological testing.
• They might perform a nerve conduction study, where small electrodes are placed on the wrists and fingers, then small amounts of electrical current are run through the electrodes.
• The speed at which the nerves transmit the electric conduction is measured.

Treatment

The most common treatment is complete rest of the affected hand/s and wrist/s for fourteen to twenty-one days. Other treatments include:

• Chiropractic
• Physical rehabilitation
• Stretches for the hands, arms, and wrists.
• Strengthening exercises for the hands, arms, and wrists.

There is Still Pain At Night or When Driving

This is common and in many cases is brought on from bending the wrist. Recommended tips to help ease the pain of carpal tunnel include:

• Stretch hands and arms before driving
• Position hands at 3 and 9 o’clock on the wheel
• Wear a brace that will keep the wrist and hand straight
• Keep hands warm by wearing driving gloves
• Apply pain ointment/cream before driving and keep on hand

Chiropractic Help

A chiropractor is a highly trained specialist in the entire body's musculoskeletal system. Chiropractic treatment can help avoid developing chronic pain and surgery in the future. Correcting subluxations and restoring optimal blood and nerve energy flow in the arms, hands, and rest of the body is the objective. Chiropractic investigates and treats the compression of nerves anywhere in the body, including the forearm and wrist. Realigning the spine, shoulder, elbow, and wrist, blood circulation and nerve impulses will flow freely once again. A chiropractor could also recommend:

• Heat/Ice therapy
• Massage
• Physical rehabilitation therapy
• TENS device
• Ultrasound
• Infrared laser treatments

The treatment plan will depend on each individual's unique case and circumstances. At Injury Medical Chiropractic and Functional Medicine Clinic, we care about each individual's situation and are committed to doing whatever it takes to alleviate the pain and get the individual back to optimal health.

Body Composition

Soluble and Insoluble Fiber

All plant-based foods are generally a combination of soluble and insoluble fibers. Soluble fiber dissolves in water and turns into a gel substance when it passes through the gastrointestinal tract. Foods high in soluble fiber include:

• Apples
• Beans
• Blueberries
• Lentils
• Nuts
• Oat products

Insoluble fiber does not dissolve in water. The term roughage generally refers to this type. Roughage speeds up transition time in the digestive system. This is the basis for eating more insoluble fiber, to prevent constipation by helping food move through the system. Foods high in insoluble fiber include:

• Brown rice
• Carrots
• Cucumbers
• Tomatoes
• Wheat
• Whole wheat bread
• Whole-grain couscous

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

References

Savage, Robert. “Re: Carpal Tunnel syndrome and work.” Journal of hand surgery (Edinburgh, Scotland) vol. 30,3 (2005): 331; author reply 331. doi:10.1016/j.jhsb.2005.02.007

Haas, DC et al. “Carpal tunnel syndrome following automobile collisions.” Archives of physical medicine and rehabilitation vol. 62,5 (1981): 204-6.

El Paso, TX's chiropractic scientist Dr. Alexander Jimenez investigates the anatomy, possible causative factors and the pathophysiological basis of intersection syndrome.

Intersection syndrome is an overuse injury of the dorsal aspect of the forearm. It occurs in sports which demand repeated wrist flexion and extension, ie rowing, sailing, racquet sports and weight lifting. It's described as a non-infectious inflammatory process at the intersection of the second and first dorsal extensor compartment(4). It has been suggested that during recurrent wrist flexion/extension friction may grow between both of these pockets in their crossover point, causing intersection syndrome (2).

Anatomy

The first dorsal compartment consists of the muscle bellies of the Abductor Policis Longus (APL) and Extensor Policis Brevis (EPB) whilst the second dorsal compartment comprises the joints of Extensor Carpi Radialis Brevis (ECRB) and Extensor Carpi Radialis Longus (ECRL)(6).) The muscles of the initial dorsal extensor compartment (APL and EPB) originate deep at the side of the forearm and since they course distally they become shallow and crossover the second dorsal compartment (comprising of ECRL and ECRB). Intersection syndrome occurs in the 'crossover' point of the first and second dorsal pockets.

This crossover point is located between 3.5 and 5cm proximal to Lister's tubercle(5) (see Figure 1).

Each dorsal compartment of the wrist tends to get its sheath nonetheless, communication between the second, third and fourth compartments does occur (two). Additionally occasionally each tendon from the second dorsal compartment is contained within its sheath(two). In Draghi's ultrasound study they found that this occurred in 5 of the 21 forearms studied (23.8 percent). They noted that despite these anatomical variations, tenosynovitis of the extensor carpiradialis brevis (ECRB) has been observed in all forearms studied with intersection syndrome (2).

Pathophysiology

Even though the exact cause is unknown historically, the most common concept for its pathophysiological basis of intersection syndrome is that repeated wrist flexion/extension leads to friction between the joints of their first and second compartment leading to tenosynovitis and/or stenosis(3).

Several common standards on US are reported that include:

• peritendinous oedema
• Fluid-filled tendon sheaths of intersection in the point
• Interruption of the hyperechoic plane that separates these two compartments
• Tendon thickening and signals of tendinosis(6).

As a result of friction between the two compartments, a hole in the tendon sheath has been found maybe in a couple of operative cases.

Additional research has to be conducted but the thicker tendon seen on ultrasound in intersection syndrome might be a result of the same cell-driven reaction as seen in tendons of the thoracic in which a unaccustomed load causes an increase in proteoglycans that are hydrophilic (attract water) causing a milder tendon.

Patients may also present with tenosynovitis of the third extensor compartment (which includes extensor pollicus longus -- EPL) as well as the next compartment. This could be because of either tenosynovitis of the EPL or due to communication between the second and third compartments(two). The first compartment and any other compartment of the wrist does not communicate. Interestingly, peritendinous oedema isn't necessarily restricted to the crossover website(4). Lee et al discovered the peritendinous oedema occurred over an area up to 12cm long and could be found to extend distally past the radiocarpal joint that. This implies that these extensor compartments are not bound by the extensor retinaculum(4).

Considering these findings intersection syndrome could be considered as having two different kinds of pathology:

1. Tenosynovitis (swelling of the fluid-filled sheath surrounding the tendon) probably because of friction;

2. Tendinopathy (thickened limb) -- cell-driven response to spike in workload.

Clinical Presentation

Athletes with intersection syndrome complain of pain, erythema, swelling, tenderness to palpation and sometimes crepitus(4). Symptoms can present over a period of many weeks but it can also occur as an acute onset(4).

Common causative factors of intersection syndrome include:

• Spike this would include any changes in intensity, quantity or frequency which could overload the joints;
• Muscle Weakness -- due to rest interval can lead to increase load of these muscles of the wrist;
• Equipment -- in rowing a change in handle could be enough to increase the load on the forearm joints if this is done via a training phase that is high;

• Technique errors -- changes or errors may also increase load on these tendons.

On goal assessment, athletes with intersection syndrome may report pain and at times crepitus. The most frequent site of inflammatory change occurs between 4-8cm proximal to Listers tubercle and this can be the website of most tenderness(2) (see Figure 2).

They might have restricted flexion ROM of this metacarpalphalangeal joint of the thumb as well as restricted active extension and passive flexion of the wrist(3). A positive Finkelstein's test can be seen with pain (along the distal forearm) as opposed to radial-sided wrist pain in De Quervain's disease. Pain will be also produced by active wrist extension with frequently no pain on isometric testing of EPB and APL. This further helps to differentiate it in De Quervain's disease.

To exclude Wartenburg's syndrome (entrapment of the dorsal radial sensory nerve) neurodynamic testing should be accomplished with the fist clenched, flexed thumb and ulna deviated wrist(7) (see Figure 3). When neural tissue is included (as in the event of Wartenburg's syndrome) tension is described on the radial side of the distal forearm. This sense of tension is diminished when the shoulder is raised.

Management

For a successful result early intervention is required. Treatment should be directed in settling the part whilst keeping in mind a element may be present. Traditionally management of intersection syndrome has included a combination of relaxation, NSAIDs and splinting and employing this method 60% of individuals have reported improvement within 2-3 months(3). Taping continues to be utilized as a very useful adjunct to treatment with Kaneko et al reporting a 100 percent improvement in five middle-aged females using ulna-directed tape of the dorsal forearm (see Figure 4). They reported progress in crepitus, swelling and tenderness in all five areas(3). CSI shot has also been used with great effect in recalcitrant cases or in the phases.

These modalities help resolve the component of intersection syndrome but do not necessarily handle the any tendinopathy when existing. Inside a tendon which decreases its capability to withstand load both mechanical and structural changes occur in the lower limb. A period of rest, raise the risk of recurrence when the athlete returns to sport and also the load increases and though symptoms would consequently weaken the tendon.

Within an athletic people a strength-based approach in healing tendinopathies of the limb, utilizing the very same principles as would be worthwhile contemplating to initially help to acquire tendon strength then to keep constant tendon load during camp, tournament or a training block.

As with reduced limb tendon injuries, a program ought to be broken into phases.

These phases could be described as:

1. Acute phase;

2. Sub-acute phase;

3. Maintenance phase.

Table 1 summarizes a rehabilitation principle for an athlete having an intersection syndrome.

A graduated return to game can commence once the athlete has pain or crepitus no swelling and full pain- strength on grip or resisted wrist extension. A return to instruction is essential and over a period of time this needs to be performed consequently 75-100% as long as the time they had off training.

As with tendinopathies it is crucial to maintain loading that is consistent after a rehabilitation program that is good has been undertaken and symptoms have resolved. The athlete with a history of intersection syndrome ought to be encouraged to continue to maintain load and prevent spikes in load.

Conclusion

Intersection syndrome is a pathology which has tendinopathy components and both tenosynovitis. As such for a successful treatment outcome rehabilitation programs must deal with these issues both. A rehab program should be divided into three stages to assist progressively load the tendon. Once symptoms resolve the program needs to be repeated to maintain efficacy and help avoid "spikes" in load which is commonly related to onset of symptoms.

References
1. Chauhan A et al, (2014) Extensor Tendon Injuries in Athletes. Sports Medicine Arthroscopy and Review, Vol 22 No1 45-55
2. Draghi F and Bortolotto C, (2013) Intersection Syndrome: ultrasound imaging. Skeletal Radiology, Vol 43, 283-287
3. Kaneko S and Takasaki H, (2011) Forearm pain, diagnosed as intersection syndrome, managed by taping: a case series. Journal of Orthopaedic and Sports Physical Therapy, Vol 21, No7 , 514 – 519
4. Lee R et al (2009) Extended MRI findings of intersection syndrome. Skeletal Radiology, Vol 38, 157-163
5. Lima J et al (2004) Intersection syndrome: MR imaging with anatomic comparison of the distal forearm. Skeletal Radiology, Vol 33 627-631
6. Montechiarello S et al (2010) The intersection syndrome: Ultrasound findings and their diagnostic value, Journal of
Ultrasound, Vol 13 70-73
7. Walker M (2004) Manual physical therapy examination and intervention of a patient with radial sided wrist pain: A case report. Journal of Orthopaedic and Sports Physical Therapy, Vol 34, No12 , 761-769

Studies suggest that between 3 and 9 percent of all sports injuries involve the hand or wrist. Chiropractor, Dr. Alexander Jimenez examines ulnar impaction, among the more common injuries to affect this region, particularly among older athletes...

Ulnar impaction syndrome (UIS -- sometimes called ulnocarpal abutment) is a condition where the ulna of the forearm is too long relative to this radius, resulting in excessive loading on the ulnar side of the wrist. Ulnar impaction syndrome could be secondary to shortening of the radius, although this condition is congenital and present from birth. Regardless of the origin, however, most patients become symptomatic in life, when accumulated and degenerative wear and tear takes its toll on both the ligaments and cartilage, resulting in wrist pain. For athletes whose sports involve loading of their limbs, this can be a problem.

Wrist Stability

To appreciate ulnar impaction may result in ulnar-sided wrist pain, it will help to comprehend the structure and function of the triangular fibrocartilage complex (TFCC) and loading across the ulnocarpal joint (see Figure 1). Wrist stability is improved an arrangement of ligaments and fibrocartilage, via the TFCC arising from your sigmoid notch on ulnar border of the radius and inserting into the base of the ulnar styloid and fovea of the ulnar head.

Studies have shown that there's a direct relationship between raising ulnar length (relative to radius span) and also enhanced force transmission throughout the TFCC. At a neutral wrist, the ulnacarpal joint takes approximately 18 percent of the entire load applied to the wrist (with the radiocarpal joint taking another 82\% approximately). However, a favorable variance of 2mm increases the ulnocarpal load to about 40\%, while a heightened dorsal tilt because of previous injury of this radius may further boost the ulnar load to 65 percent of overall load transferred(1,2). Moreover, thinning of the articular disc (that is common with increased ulnar length) also raises the risk of TFCC wear and perforation (3).

While it connected with congenital or acquired positive ulnar variance, UIS can also happen in ulnar neutral or even negative ulnar variance wrists(4,5). Athletes doing power and/or grasping activities connected with axial loading and rotation are especially at risk of ulnar impaction syndrome because of their 'dynamic ulnar variance' that occurs during tasks requiring maximum traction and pronation(6). More commonly events which set compression and rotation demands on the upper limbs increase the risk of ulnar impaction via traumatic development.

Although symptoms of UIS rarely present in athletes, the risk for all these symptoms in later life could be increased by events during those formative years. One reason for this is that distal radius fractures are the most frequently occurring fracture in children under the age of sixteen. Research shows that when significant radial shortening (5mm or more) happens as a result of these fractures, there's a considerably increased probability of long-term operational impairment (7). Additionally, even in the absence of distal radius fractures, we know that submitting an immature wrist into prolonged compression and insistent micro-trauma has can result in a premature arrest of radial growth plate and following ulnar overgrowth(8,9), and that of course greatly raises the risk of UIS in later decades.

Symptoms Of Ulnar Impaction Syndrome

UIS's development Results in the degeneration and abutment of TFCC or the ulna against the ulnar carpus. Although any athlete could suffer from this racquet, gymnasts, boxers, illness and adhere sport athletes are particularly at risk, together with symptoms of pain particularly occurring during wrist rotation. It is important to comprehend, however, the development of this problem is not always linear; the load-bearing demand put on the TFCC means that there is a heightened susceptibility towards an acute traumatic injury, in addition to the secondary degenerative concerns implicated with ulnar impaction(10).

Common symptoms of ulnar impaction syndrome include the following:

• Pain (especially during spinning), aggravated with activity and (normally) relieved with rest;
• Painful bending or clicking during pronation and supination;
• Occasional edema;
• Reduced wrist Assortment of motion;
• Decreased forearm rotation;
• Tenderness to palpation dorsally, just distal to the ulnar head and just volar into the ulnar styloid process;
• Each of the above tend to be aggravated by forceful grip, forearm pronation, and ulnar deviation.

What tends to differentiate chronic ulnar impaction syndrome by a serious TFCC injury (which may itself be made more likely by ulnar impaction) is the insidious, progressive nature of the pain, which slowly limits range of motion, grip strength, and performance. In 1981, Palmer and Werner introduced (a now widely utilized) classification system to help clinicians determine if it's the TFCC injury is mostly innovative and degenerative or acute in character (or indeed both). This is shown in Box 1.

Diagnosis

When attempting to make a diagnosis of UIS, a thorough wrist examination is necessary, together with a comprehensive patient history (as an example, has the individual suffered a radius fracture previously?) . Regrettably, however, there's no single clinical test that can completely diagnose UIS, not least since most tests conducted in the clinic are inconclusive as to whether TFCC- related pain is acute or degenerative in nature (see Box 1). For this reason, diagnostic imaging (eg MRI) should be conducted to confirm the findings in the clinical examination. Having said that, the clinician can gain valuable supporting evidence from a comprehensive examination that includes the following:

On palpation, is there:

• Tenderness just distal to ulnar head?
• Tenderness just volar to the ulnar styloid process?
• Positive ulnar variance, while stationary or dynamic?

Do range of motion tests show:

• Painful ulnar deviation and forceful pronation?
• Decreased flexion, extension ulnar deviation?

Does a power measurement reveal:

• Reduced grip strength in comparison to the wrist if using dynamometer?

Is an ulnocarpal stress test positive? (see Box 2)

Is The Gripping Rotary Impaction Exam

(GRIT) positive? (see Box 2)

The ulnocarpal stress test described in box 2 was initially introduced by Nakamura and his coworkers(13). In the writers' unique study, 33 of 45 patients (73%) with favorable ulnocarpal stress test results revealed positive ulnar variance of 1mm or more about the wrist. In the 33 patients that had a positive ulnar variance, 19 (58%) were confirmed as suffering from course II TFCC lesions resulting from ulnocarpal impaction. The vast majority of those patients suffered a spontaneous onset of pain, and so were diagnosed with course IIB lesions involving TFCC wear with lunate and/or ulnar chondromalacia (see Box 1). Generally, a history of spontaneous ulnar sided wrist pain combined with testing should prompt the astute clinician to seek additional evaluation utilizing imaging.

Treatment Options

When treating athletes sooner is better; studies reveal that early diagnosis and intervention may significantly lessen the danger of long-term disability and injury progression(14,15). Treatment should be attempted before surgery and can include limiting movements such as pronation, gripping and ulnar deviation for 6-12 weeks or immobilization. After immobilzation/restriction, other conservative treatment choices include, non-steroidal anti- inflammatories (NSAIDs) and corticosteroid injections.

However, while conservative therapies such as anti-inflammatories limiting range of motion or combined with immobilization may be effective for the overall populace, they are frequently insufficient for athletes because they do not deal with the fundamental biomechanical variables that predispose the athlete to UIS. Therefore, when conservative management fails to produce a substantial improvement, evidence indicates that surgery is indicated(16,17).

When surgery is required Athletes opt to postpone surgery before the season's finish, permitting recovery from operation to take place. In terms of surgical possibilities, this is determined by the surgeon following screening that was comprehensive. These options may include:

• Ulnar shortening osteotomy -- that the ulna is abbreviated by 2-3mm of shaft and fixated using a tubular or compression plate. This choice is indicated when there is ulnar wrist pain worsened a positive stress test by turning and ulnar deviation, and positive ulnar variance with or without changes.

Following operation, athletes may expect to experience at least 3-4 months or recovery/ rehabilitation. Depending on the surgical process and individual response, this period will generally include:

• Weeks 1 & 2 -- control pain and swelling with ice/anti-inflammatory medication. Wearing a sugar-tong splint or long-arm cast to protect the surgical site while maintaining as much selection of movement (ROM) from rigid joints.
• Weeks 3 to 6 -- Shield site and continue to maintain ROM in joints. Switch into a detachable splint or wrist cock-up brace. Try to boost wrist & knee ROM. Attend to scar management.
• Weeks 7 & 8 -- Alter to removable splint worn in the nighttime. Progress to ROM present isometric elbow flexion/extension and supination/pronation and exercise for wrist & elbow.
• Weeks 9 onwards -- continue with Stretching and mobilization. Introduce low-load resistance exercises to develop strength.

Athletes should anticipate a return to complete activity around 3-4 months following an arthroscopic wafer procedure, and around six months following an ulnar shortening osteotomy.

Summary

Although ulnar impaction syndrome is often congenital in its etiology, Athletic activity and years can combine to produce progressively more debilitating symptoms . For the clinician diagnosis is desirable but not always straightforward; even if scope of motion tests imply UIS, imaging will be asked to ascertain if intense or degenerative affects treatment options. Unless the UIS Is mild or the athlete is able to significantly modify his/her activity may be that treatment is unsuccessful and surgery is required. The choices will be different based on the person but in many cases- term results are favorable despite the requirement for recovery that is protracted and rehab after surgery.

References
1. Hand Clinics. 2005: 21; 567 – 575
2. Clin Orthop Relat Res. 1984; 187: 26 – 35
3. J Hand Surg. 2013; 38(7): 746 – 750
4. Br J Hand Surg. 1998; 23(6):754 – 757
5. Magn Reso Imaging Clin N Am. 2004; 12: 281 – 299
6. J Hand Surg Am. 1993; 18(4): 713 – 716
7. Prim Care Clin Office Pract. 2013: 40; 431 – 451
8. J Med Sci.2001; 64: 81 – 91. J Ped Orthop. 1989; 9: 23 – 28
9. Hand Clin. 1990; 6: 493 – 505
10. Hand Clinics. 2005: 28; 307 – 321
11. J Can Chiropr Assoc 2014; 58(4)
12. J Hand Ther. 2001; 14(3): 173-179. J Hand Surg. 1997; 22B: 719–723
13. Br J Hand Surg. 1991; 16: 84 – 88
14. Arthroscopic Rel Surg. 2004; 20(4): 392 – 401
15. Hand Clinics. 2005: 28; 307 – 321.2,6,8,31
16. J Hand Ther. 2001; 14(3): 173-179.
17. J Hand Surg. 2008; 33A: 1669-1679

Golfing wrist injuries are common with treatment requiring 1-3 months of rest and immobilization and if tears are present surgery. Can chiropractic treatment help avoid surgery, expedite recovery, and rehabilitation?

Golfing Wrist Injuries

Golfing Wrist Injuries: According to a study, there are over 30,000 golf-related injuries treated in American emergency rooms every year. (Walsh, B. A. et al, 2017) Nearly a third are related to a strain, sprain, or stress fracture.

• One of the most common causes of wrist pain is overuse. (Moon, H. W. et al, 2023)
• Repeated swinging generates added stress on the tendons and muscles, leading to inflammation and pain.
• Improper swing techniques can cause the wrists to twist uncomfortably, resulting in inflammation, soreness, and injuries.
• Golfers who grip the club too tightly can add unnecessary strain on their wrists, leading to pain and weakened grip.

Wrist Tendonitis

• The most common wrist injury is an inflammation of the tendons. (Ray, G. et al, 2023)
• This condition is often caused by overuse or repetitive motion.
• It usually develops in the leading hand from bending the wrist forward on the backswing and then extends backward at the finish.

Wrist Sprains

• These can occur when the golf club hits an object, like a tree root, and makes the wrist bend and/or twist awkwardly. (Zouzias et al., 2018)

Hamate Bone Fractures

• When the club hits the ground abnormally it can compress the handle against the bony hooks at the end of the smaller hamate/carpal bones.

Ulnar Tunnel Syndrome

• This can cause inflammation, and numbness, and is usually caused by an improper or loose grip.
• It causes nerve damage to the wrist from repeated bumping of the golf club handle against the palm.

de Quervain's Tenosynovitis

• This is a repetitive motion injury below the thumb at the wrist. (Tan, H. K. et al, 2014)
• This causes pain and inflammation and is usually accompanied by a grinding sensation when moving the thumb and wrist.

Chiropractic Treatment

Given the nature of these injuries, medical attention should be sought out for image scans to look at any damage and properly immobilize the wrist. Once a fracture has been ruled out or healed, golfing wrist injuries can benefit from chiropractic and physical therapy. (Hulbert, J. R. et al, 2005) A typical treatment may involve a multifaceted approach involving various therapies including:

• Active release therapy, myofascial release, athletic taping, corrective exercise, and stretching. 
• A chiropractor will examine the wrist and its functioning to determine the nature of the injury.
• A chiropractor may recommend using a splint to immobilize the wrist, particularly in cases of overuse.
• They will relieve pain and swelling first, then focus on strengthening the joint.
• They may recommend a regimen of icing the hand.
• Adjustments and manipulations will relieve pressure on the nerves to reduce swelling and restore mobility.

Peripheral Neuropathy Successful Recovery

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Walsh, B. A., Chounthirath, T., Friedenberg, L., & Smith, G. A. (2017). Golf-related injuries treated in United States emergency departments. The American journal of emergency medicine, 35(11), 1666–1671. https://doi.org/10.1016/j.ajem.2017.05.035

Moon, H. W., & Kim, J. S. (2023). Golf-related sports injuries of the musculoskeletal system. Journal of exercise rehabilitation, 19(2), 134–138. https://doi.org/10.12965/jer.2346128.064

Ray, G., Sandean, D. P., & Tall, M. A. (2023). Tenosynovitis. In StatPearls. StatPearls Publishing.

Zouzias, I. C., Hendra, J., Stodelle, J., & Limpisvasti, O. (2018). Golf Injuries: Epidemiology, Pathophysiology, and Treatment. The Journal of the American Academy of Orthopaedic Surgeons, 26(4), 116–123. https://doi.org/10.5435/JAAOS-D-15-00433

Tan, H. K., Chew, N., Chew, K. T., & Peh, W. C. (2014). Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture. Singapore medical journal, 55(10), 517–521. https://doi.org/10.11622/smedj.2014133

Hulbert, J. R., Printon, R., Osterbauer, P., Davis, P. T., & Lamaack, R. (2005). Chiropractic treatment of hand and wrist pain in older people: systematic protocol development. Part 1: informant interviews. Journal of chiropractic medicine, 4(3), 144–151. https://doi.org/10.1016/S0899-3467(07)60123-2

Skateboarding is a popular activity among children, teenagers, and young adults. It is recreational, competitive, fun, and exciting but, like any sport, carries a risk of injury. There are around 70,000 skateboarding injuries requiring a visit to the emergency room every year. The most common injuries involve the shins, ankles, forearms, wrists, elbows, face, and skull, with many left untreated that worsen as they heal improperly, leading to further damages and complications. Chiropractic can treat the injuries, rehabilitate the muscles and joints, and strengthen the body to get the skater back on their board. 

Skateboarding Injuries

Skateboarding injuries can range from scrapes, cuts, and bruises to sprains, strains, broken bones, and concussions.

• Shin injuries often happen during flip/twist tricks where the board or axle hits the shin causing bruising and swelling.
• Shoulder, wrist, and hand injuries are common when skaters lose their balance and fall with outstretched arms.
• Ankle injuries include rolls/sprains, as well as dislocations and fractures.
• Dislocations usually happen to the shoulders, wrists, and fingers.
• Facial injuries include teeth knocked out, broken nose, or jaw are typically caused by fast forward hard falls.
• Severe injuries include concussions and head injuries.

Injury causes

Skateboarding injuries typically occur from:

• Skating on irregular surfaces locks up wheels and affects balance, causing falls.
• Losing balance or losing control of the board and falling hard/slamming into the pavement.
• Inexperience, slow reaction times, and less coordination lead to falls and slams.
• Skating into another skater, a person walking or cycling, a car, or a road hazard.
• Trying an advanced trick/maneuver too soon and beyond their skill level.
• The inexperience of knowing how to fall to prevent injuries.

Chiropractic Therapy

A chiropractor can work with other doctors and specialists to:

• Assess and treat the skateboarding injury/s.
• Reset the spine, hips, arms, hands, and feet.
• Rehabilitate and strengthen the body.
• Recommend safety and prevention education.
• Help prevent further injuries and long-term effects.

Chiropractic Skateboarding Injury Treatment 

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Forsman, L, and A Eriksson. “Skateboarding injuries of today.” British journal of sports medicine vol. 35,5 (2001): 325-8. doi:10.1136/bjsm.35.5.325

Hunter, Jamie. “The epidemiology of injury in skateboarding.” Medicine and sport science vol. 58 (2012): 142-57. doi:10.1159/000338722

Partiali, Benjamin, et al. “Injuries to the Head and Face From Skateboarding: A 10-Year Analysis From National Electronic Injury Surveillance System Hospitals.” Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons vol. 78,9 (2020): 1590-1594. doi:10.1016/j.joms.2020.04.039

Shuman, Kristin M, and Michael C Meyers. “Skateboarding injuries: An updated review.” The Physician and sportsmedicine vol. 43,3 (2015): 317-23. doi:10.1080/00913847.2015.1050953

Tennis is an intense sport that requires strength, agility, flexibility, stamina, endurance, and conditioning. And it’s a great way to stay in shape. However, with all of this intensity is the risk of injuries. Although they are lower compared to other sports injuries, injuries are more cumulative/repetitive based and wear and tear over time type. Tennis injuries can be painful and impair daily life. They can be treated and prevented with chiropractic medicine and strength training. Chiropractic can help the body heal quicker, and address underlying issues that led to the injury. This will help to worsen and prevent re-injury. The most common tennis injuries include...

Wrist Tendonitis

This is an injury that can happen to beginner players that don't have a great deal of arm/wrist strength, use a racquet that is too heavy, and begin developing an improper form to compensate. But it can also be caused by repetitive/overusing the wrist instead of the whole arm.  Symptoms are chronic stiffness and pain in the area surrounding the wrist joint. Chiropractic sports massage, physical rehabilitation, and learning proper form will help alleviate the pain and prevent worsening or developing new injuries.

Tennis Elbow

Tennis elbow is a condition that is caused by inflammation of the outside muscles in the forearm and tendons. This is usually an overuse injury from all the swinging and hitting, but using the improper technique could also be a cause. Chiropractic adjustments are highly recommended instead of steroid injections and other anti-inflammatories. The adjustments and massage relieve the discomfort and pain by naturally relaxing, stretching, and strengthening the muscles and tendons.

Shoulder Rotator Cuff Tendonitis

The rotator cuff belongs to a group of tendons and muscles that surround the shoulder joint. This allows the shoulder to perform 360-degree arm circles and is what stabilizes the shoulders. Tendonitis happens when the tendons inside the rotator cuff become inflamed. The inflammation causes pain with movement, especially overhead motions decreasing the range of motion in the shoulder. This injury is often caused by serving and hitting overheads with an improper technique. Chiropractic adjusting, heat and ice therapy, and electro-muscular stimulation loosen and stretch the muscles/tendons back to their proper form.

Knee Sprains and Strains

The knee goes through a lot in sports. And tennis is no exception, much like basketball and volleyball with all the jumping, pounding, shifting, twisting, losing balance, or extending beyond the normal range of motion causes injuries that result in:

• Pain
• Swelling
• Bruising
• Loss of the ability to move ​

Chiropractic will help relieve that pain and relax the damaged muscles. It also speeds the healing process by addressing the underlying issues.

Ankle Sprain

An ankle sprain also known as a twisted ankle happens when the ligaments attached to the joint become over-stretched or partially tear. These sprains happen from the:

• Quick start and stop movements
• Changing direction rapidly
• Quick sprints all around the court
• Causing the ankle to roll and/or twist.

A chiropractor will realign the ankle and provide physical therapy massage to allow the ligaments to heal properly and faster. Chiropractic treatment will allow the player to return to play quicker and prevent reinjury that if not treated correctly can become chronic. Having the proper personalized treatment plan will ensure the body heals correctly, prevent misalignments, loss of functionality, and/or range of motion.

PUSH Fitness

Aerobic Training

Aerobic exercise is a cornerstone for weight loss. Having the heart rate elevated for a continuous amount of time is the key. This is how calories are burned. Research has found that individuals involved in aerobic training lose more weight overall, including more fat mass than resistance training alone. When combined, aerobic and resistance training individuals gain more fat-free mass, including lean muscle. Aerobics causes the cardiorespiratory system to adapt. Maintaining heart function and health and keeps the body's energy metabolism system running at optimal levels. Aerobic exercise for fitness and weight loss is a key element of maintaining the body's health.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Dines, Joshua S et al. “Tennis injuries: epidemiology, pathophysiology, and treatment.” The Journal of the American Academy of Orthopaedic Surgeons vol. 23,3 (2015): 181-9. doi:10.5435/JAAOS-D-13-00148

Minghelli, Beatriz, and Jéssica Cadete. “Epidemiology of musculoskeletal injuries in tennis players: risk factors.” The Journal of sports medicine and physical fitness vol. 59,12 (2019): 2045-2052. doi:10.23736/S0022-4707.19.09842-6

Stuelcken, Max et al. “Wrist Injuries in Tennis Players: A Narrative Review.” Sports medicine (Auckland, N.Z.) vol. 47,5 (2017): 857-868. doi:10.1007/s40279-016-0630-x

Willis, Leslie H et al. “Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults.” Journal of applied physiology (Bethesda, Md.: 1985) vol. 113,12 (2012): 1831-7. doi:10.1152/japplphysiol.01370.2011

El Paso, TX. Scientific chiropractor Dr. Alexander Jimenez discusses an unusual injury incurred by a skilled powerlifter...

The Patient

A 29-year-old powerlifter presented to the clinic. The pain was a continuous annoyance with sharp pain episodes during weight training. It had started insidiously as a vague ache that was intermittent. As he had previously been able to train through the pain, he'd noticed it penalizing over a couple of week she was unable to strongly grip during sessions. He maintained that as this seemed to exacerbate the issue, he had been forced to rest the wrist from movements that were heavy and that medications did help. No wrist trauma had been suffered by him, but he'd suffered a strain on the side.

On the radius, he had a somewhat inflamed lateral wrist upon demonstration. The and the pain place appeared to be concentrated around abductor pollicis longus and the extensor pollicis brevis. All his movements of radial extension and ulnar deviation and wrist flexion appeared to be normal and all thumb movements appeared to be normal also. The location of the pain was highly suspicious. He was provocative on the 'Finkelstein test' and this proved positive (see diagram of test right). Palpation of the tendons provoked pain and palpation of the scaphoid bone proved unremarkable.

Upon questioning the patient about adjustments to his training program, he had fluctuated his loadings as per his normal program and denied that he had incorporated any movements in his sessions. He denied any change in behavior or work pattern aside from possibly working because of the birth of his second daughter and worked as a fitness expert.

It had been discovered that he was helping his wife frequently and nappy-changing the youngest whilst spending more and more time with the older child. When asked if he had been picking up the infant and older sister he agreed that this was certainly true. He explained how he picked up child and the infant as putting the hands to lift with the horn abducted and extended. He concurred that the pain had started after his daughter was born.

The pathology of the injury and the factors that were mechanical were explained to the patient. It was explained that this would settle in 4-6 weeks if the offending movement was removed and time was spent managing the tendon pain. He asked a quicker fix, as the patient had a lifting competition fast approaching. There was A sports doctor consulted as well as an ultrasound guided corticosteroid injection into the tendon sheath was administered. He was back lifting in the gym pain-free. He wore a protective strap and he altered his way of picking up his kids to avoid the radial deviation movement of the wrist.

What Is De Quervain's Syndrome?

Also known as 'mummy thumb' and 'Blackberry thumb', the condition is an overuse inflammation of the tendon sheaths of the extensor pollicis brevis and abductor pollicis longus tendons. It is classified as a tenosynovitis. It generates an situation whilst the thumb is held in abduction/extension. This is normal in activities like picking up a baby, using bigger screen phones such as iPhones Blackberrys and other phones and gaming consoles.

Signs & Symptoms

The patient will complain of pain, swelling and tenderness on the side of the wrist just above the 'snuffbox' .

It will most likely be a onset with the patient not remembering the activity. Strength will be affected and the Finkelstein test will be positive. This test is performed moving the wrist to ulnar deviation that was active and by gripping the thumb.

Causes/Pathophysiology

The cause of the problem is repetitive wrist extension with deviation. It's a common overuse or repetitive strain injury which affects computer/mouse consumers, some athletes such as tennis players and rowers, players, mothers and tradesmen such as carpenters. Women appear to be more affected than men.

Both tendons involved in the pathology would be the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) muscles. Both of these muscles and cross the wrist joint to fit into the thumb and their joints run down the surface of the wrist. The function of these muscles is to move the thumb abduct and extend. When the sheath of the tendon becomes inflamed then this pathology is called 'tenosynovitis'.

The tendons are covered in sheaths which prevent friction between the bones and the tendon below and contain them. This allows the tendons to function with no friction between bone and the tendon.

Evaluation of specimens shows a thickening and myxoid degeneration consistent with a degeneration.

Treatment

The usual time course for an acute tenosynovitis is if the individual protects and knowingly rests the tendon. They need to prevent the thumb extension/abduction moves in a radial deviation position.

Treatment usually includes rest, a thumb splint that avoids the movements and shields the tendons. Local treatment to manage the inflammation includes icing the tendon (best performed with two cubes of ice in a wet tea towel), neighborhood anti-inflammatory gel application, managing the muscle tone through the EPL and APL through massage and dry needling and gradual re-strengthening of the wrist away from maximum radial deviation. When the steroid is injected into the sheath area rather than the tendon, corticosteroid injections have been demonstrated to be effective in handling the inflammation.

Conclusion

This case study presents a instance of an injury affecting an sportsman. Even though active participation in the sport that is chosen not itself caused the injury, the case study highlights how the athlete can be impacted on by activities of daily living and masquerade as a 'sports injury'.

Wrist injuries are discussed by Chiropractor, Dr. Alexander Jimenez, with emphasis on the participation of the bone capitate, and how you can modify your training with a wrist injury.

Wrist injuries are underestimated within sport; however, they could account for between 3-9 percent of all athletic injuries (1). Injury can occur from repetitive overuse, or can occur from a single traumatic event, such as falling on an outstretched hand, or impact from a ball or racquet. Regardless of whether it is directly used, the wrist is vulnerable to injury in any sport.

The wrist joint is not supposed to withstand weight bearing or heavy loads like the joint is tight also, though these joints are often thought of in a manner due to the size and distal origin of those limbs. Regardless of this, exercises and many sports involve weight bearing through the wrists or higher impact directed to the joints, ie gymnastics, racquet and hand ball sports, strength training including press-ups, boards, and yoga poses. Sports played hard surfaces can also traumatize the wrist since the body weight of the athlete can land upon the joint, and the difficult surface (astro turf, ice, or racquet court will not absorb the shock as much as a forgiving ground surface). These activities all require wrist extension (the bending of the wrist backwards) and also pain from this is often localized to the dorsal surface (rear of this hand/wrist). Because they are the most commonly encountered this guide will focus on extension accidents.

The wrist is a joint is complex and has a variety of muscles, ligaments and bones inside its space, which should work together for function. Simply diagnosing an injury as a "wrist sprain" is not accurate and additional identification should confirm the exact structure damaged to direct mechanism of treatment.

The "wrist joint" is more anatomically called the radiocarpal joint. This is the connection between the radius (forearm bone) and the proximal row (closest to the forearm, where the wrist crease happens) from the cervical bones. The main job of the radiocarpal joint is to allow motion of the hand upward (extension) and back (flexion). This can be stabilized by the radioulnar ligaments which connect ulna forearm bones and the radius anteriorly and posteriorly.

The bones are then divided into two rows. The proximal row consists from lateral (external nearest the thumb) into medial of scaphoid, lunate, triquetrum, and pisiform. The row is made up of trapezium, trapezoid, capitate, and hamate. Various small ligaments join the carpal bones into each other, permitting fine motions around each other whilst being kept securely in position(3). These connections allow the wrist to have the fine motor control that tasks demand, in addition to the power for heavy gripping tasks.

The wrist joint is capable of roughly 85 degrees of wrist flexion and extension, and this movement happens at the radiocarpal joint and the midcarpal joint (between the proximal and distal rows). It can also move side to side with 15 degrees of radial deviation (towards the thumb) and 45 degrees of ulnar deviation (towards the fifth finger)(2).) These movements again result from the radiocarpal joint but require the accompaniment of the midcarpal joint and intercarpal joints (joints in between the carpal bones). Some movement is required between those bones, but movement becomes problematic.

Common Wrist Problems

Wrist injuries may be continued into the bones, tendon or soft tissues, muscle, or even the cartilage. Within these categories a wealth of injuries may pose. Bones can sustain stress fractures (lean hairline breaks), or entire avulsion or dislocation. Each bone presents if it become sterile and those are often related for their own blood supply to interruption. Due to the inherent tight arrangement of the carpals the flow can quickly become impaired and lead to avascular necrosis (3). Tendons and ligaments may develop tendinitis or tendinopathy. Ligament strains may cause nasal bone instability and extra motion or may occur. At length, the triangular fibrocartilage complex (TFCC), which articulates the distal radius and ulna (forearm bones), as well as the ulna to the carpals and might tear and again pose with uncertainty of the wrist.

Capitate Subluxation

The scaphoid and hamate bones are associated with fractures due to their location on effect nevertheless, the capitate bone is significantly more vulnerable to other athletic trauma, mostly subluxation, due to its substantial size, elongated silhouette using a narrower distal end, along with its central position, which makes it articulate with seven of those other carpal bones. These properties can encourage subluxation to occur with wrist trauma, Pressure to just laxity and instability or the joint around the bone.

Carpal bone instability may be misdiagnosed, or even overlooked, but a capitate subluxation has a presentation that was typical. The individual clunking at the wrist joint on loading bearing exercises and usually does not have any history of trauma but complains of protracted weeks of pain. After exercise there is annoyance or an irregular niggle from the region of the capitate.

Wrist extension would be restricted and painful every time, whereas flexion wouldn't be limited. Flexion can become debilitating over time since the ligaments become pulled on account of the subluxation causing them to stretch that is over. There may be a dip in the end and a bulge at one point where the bone has moved out from its groove that is carpal.

Solutions To Wrist Extension Problems

Rehabilitation of a wrist injury should firstly concentrate on reducing inflammation and pain so that therapy can proceed efficiently. This may involve the use of in ice and severe conditions, immobilization of the wrist to permit no strain and for the recovery process to begin. Range of motion should be increased where possible, and this might involve manual treatment (as described below) if there's a physical block to motion. Progression then should concentrate on strengthening the weakened ligaments and muscles and restoring the wrist to sports specific conditioning, coordination and flexibility (5). A return to game ought to be executed and this may require the use of splints or grips originally to gauge the suitability of wrist recovery for your sport's demands.

1) Manual Therapy

If the capitate has subluxed then it ought to first be reduced (put back in position) by an experienced orthopedic physiotherapist. They will bend the wrist to relax the ligaments and also apply a surprising push whilst applying grip the distance. A palpable clunk will signify the decrease in the capitate and ordinary carpal alignment should then be felt (6). The athlete may feel an immediate relief of symptoms and once is sufficient to restore normal function and recover wrist extension. Based on the laxity of the carpal ligaments, subluxation may re-occur and the procedure should be repeated, as well as following the following steps for prevention.

2) Soft Tissue Stretching

Stretching of some of the upper limb since we discussed intricately linked fascia and the body's connective tissues are muscles would be of benefit. One muscle will have consequences elsewhere. Particular care ought to be taken to the forearm flexors and extensors and these may be elongated holding for 30 minutes and by placing the wrist into extension or flexion.

Global stretching for the upper limb can be performed utilizing the stretches pictured below.

3) The Use Of Hand Bars

Where flooring strength work is vital to training, like press-ups and boards, rather than force the wrist can utilize hand bars. This keeps the wrist in a neutral position and allows you to grasp the handle. This could be recommended for people who have a capitate subluxation also to prevent future injuries and to minimize the strain.

4) Wrist Splints/Supports

For activities occur frequently, the use of a splint or support can decrease. This may be a viable option if the injury is secure and will not receive loading splinting isn't the solution to unstable or severe injuries where certain treatment should be the priority over all instruction (3). The type of support will depend on the harm, your sport, and movement you need to continue looking for advice will be valuable here.

5) Strengthening Exercises

Strengthening the surrounding muscles the wrist is needed to take care of but in addition to further absorb the shock to the wrist in effect and increase its own protection.

Ball Squeezes -- This can be made sports- Specific by using your own sports racquet, ball or similarly. Squeeze the object in your hands for five seconds and then release; replicating for 3 sets of 10. By holding the thing in exactly the positions you'd in game eg holding your tennis racquet at the position as well as in front of you this may be defined.

Wrist Flexion -- Start by holding a little Weight on your hands with your arm down by your side and the palm facing you. Raise the hands upwards into wrist flexion and repeat for three sets of 10.

Wrist extension -- Repeat the above possess the palms although description Body that increasing the back of the hand The wrist is brought by upwards into expansion.

References
1. Am J Sports Med. 2003; 31(6), 1038-1048.
2. Maitland’s Peripheral Manipulation (2014). 5th Ed. Vol II. Churchill Livingstone. Elsevier. pp 327.
3. Sports Health. 2009; 1(6), 469-477.
4. Anatomy Trains (2013). 3rd Ed. Churchill Livingstone. Elsevier.
5. Prim Care Clin Office Pract. 2005; 32, 35-70.
6. Curr Orthop Pract. 2012;23(4), 318-321.