My Wrist, By Request: Trigger Points and Tendinitis

The dadao can really wreck your wrist if you're not careful, as can some of the other practices if you repetitively overdo them like I apparently did in London. My left wrist, which I've mentioned a couple of times already, has been unduly sore and less training-worthy ever since I got back. Since I got asked what I've done to help it, since I have helped it a lot, I decided to make a post about it.

The culprits that cause joint pain in the wrist are usually limited to three or four things: broken/dislocated bones, torn ligaments (sprains), tendinitis, and trigger points. I suppose you could do those first two with the saber or training, but I see those as being more likely by doing applications irresponsibly than by doing the training regimens. The last two, however, are more common, and luckily, one is easily treatable. In fact, if you have tendinitis, it's a virtual certainty that a fair proportion of your limitation in movement, discomfort, (abnormal) weakness, or pain is caused by trigger points in some nearby muscles as well. Treating those trigger points can relieve you of some of that trouble. Since all you can really do for tendinitis (if it really is just tendinitis) is ice it and rest it, eventually starting some stretching after time goes on, there's not much to say about that treatment. It is the case, however, that as often as not (probably more often, actually) trigger point issues create symptoms that are nearly identical to tendinitis that doesn't really exist.

I'm not going to detail tremendously here what trigger points are or how they arise, but knowing a little about them helps quite a bit. Essentially, if you overwork or misuse a muscle in any way, the potential to develop a trigger point is there. Even excessive resting can cause them, particularly if the muscles aren't taken through their natural ranges of motion (sitting is an example of this which causes many trigger points in the iliopsoas muscles --which cause stiffness and low-back pain-- just due to the fact that sitting in a chair naturally shortens those muscles and lets them stay that way). Trigger points are like tiny bands of contracted muscle fibers within your muscles, and they almost never resolve themselves on their own. They do, however, have two phases: active and latent. In their latent phase, they slightly restrict movement and have a high potential for becoming suddenly active, though they don't usually hurt much. In their active phase, they create tremendous discomfort. More often than not, the following truth should rule your thinking about trigger points: trigger points almost always refer pain to a place other than where they are, i.e. the problem isn't always where it hurts.

How can you get rid of trigger points? There are a few methods, none of which are fun: certain doctors can inject them with salene or procaine, they can be made very cold and then stretched (under the supervision of a trained professional), or they can be massaged (for free at home!). The massage is quite painful. In fact, you can identify where a trigger point is in your musculature because it's a spot that is inordinately painful ("exquisitely tender" is the term used by Davies, an expert in the field -- this book is almost a must-buy for anyone that does anything remotely athletic or abjectly unathletic). Once you find the spot and make it hurt with the massage, you have to hold onto it until it doesn't hurt. Basically, the process sucks, but you're looking at a few minutes of rather big discomfort to cure you of possibly months or years of increasingly degenerative discomfort and restriction in range of movement. The choice is pretty clear.

For the wrist, most of the time the problem isn't in the wrist, although it can be. It's usually reassuring to poke around the area that hurts and see if anything local is causing the problem. Depending on what hurts, it very well may be (the ligaments in the wrist can contain trigger points as well, notably the one between the thumb and the radius bone). More often than not, though, wrist pain arises further up in the forearm in the muscles that flex and extend the wrist and fingers (flexors, extensors). If your symptoms more strongly match "tennis elbow of the wrist," then your extensors are more of the problem. If your symptoms more strongly match "golfer's elbow of the wrist," then your flexors are more of the problem. In either case, rather aggressive, deep-tissue massage (typically using tools like balls or sticks) on the bellies of those muscles as well as (especially!) their attachments near the elbows will help. The massage is painful and slow, so you might need to set aside ten minutes to a half an hour to do it, and you should do it at least twice daily for a week to see really big improvement. After massaging, whenever possible, it is extremely helpful to ice the areas that you massaged for a few minutes.

My basic suggestions to anyone with wrist pain is that you search thoroughly in your forearms (extensors are on its back and flexors are on its front) for tender knots in the muscles and then press them hard, especially if they reproduce your wrist symptoms in any way (those are the main things you're looking for). That's not the whole ball of wax, unfortunately, for wrist pain.

You might find trigger points further up that cause pain in the wrist as well. Some examples of places to look might surprise you. This list isn't exhaustive, but here are some suggestions: brachialis, brachioradialis, pectoralis minor, subclavius, and the scalenes. You might also check the musculature of the thumb and, again, the local tissue in the wrist. The best massage technique I've experienced is to press hard enough so that the pain index (scale of 1-10, 1 being essentially no pain, 10 being unbearably excruciating) hits between 6 and 8 and then hold it long enough so that the pain diminishes to the 3-5 range. It seems like that will probably never happen, but it will... just keep breathing and trying to relax, and eventually your muscle relaxes and the trigger points let go. After treating and before icing, stretching those muscles is also advisable, though stretching trigger-point-afflicted muscles without massage first tends to make the problems worse, not better. You may find many, even dozens of such spots in your forearms if your wrists hurt. Sorry, but that's just how that works.

A last note: you will probably try to guard against the invasion of the massage tool (tennis balls and golf balls are particularly good, placed in a sock and then leaned upon against a wall). That's natural, but you want to try to breathe, focus, and let those muscles relax. Guarding will not help you as much and can create other problems (trigger points in other muscles). Also, you may bruise from the treatment, and if you do, then you should not continue pushing on that spot until the bruise goes away. Finally, don't interrupt the blood flow in main arteries or push hard on nerves. The first is identifiable by feeling a very strong pulse and then when you let go a flood of warm liquid inside your skin. The second is identifiable because it causes a lot of local pain (usually) and distal numbness. If leaning on a ball is making your fingers go dead-numb, that's bad.

Good luck and happy hunting!