In this piece I am tackling wrist issues, as this particular issue is common and recurring if the client doesn't have an understanding of how to combat the problem.
I’ve noticed that some clients own neither mobility and/or strength within the wrist. Sometimes, this can be illustrated during the set up of an exercise such as a quadruped (all fours) based exercise. An alternative wrist position can be found and props used (yoga blocks or rolled up towel) to remove the discomfort, but these positions or props have to be obtained the next time the client is placed in this position. This perpetual cycle becomes both physically and psychologically detrimental, as the client is no closer to overcoming this issue and also may feel singled out due to the special adjustments continually being made for them.
The quadruped position is a great example of how the setup position requires a positive range of extension in the wrist. In other words, the client needs to own a certain amount of wrist extension to provide themselves enough support through their shoulders. This is even before the client loads their wrists with the weight of their body. The trainer is likely to give the very valid command of ‘shoulders over wrists’, which will be unattainable if the client doesn’t own enough wrist extension. The rest of the exercise becomes quite uncomfortable, even painful and the demands of the exercise itself are far from achievable.
By the end of this piece, I’m hoping that you, the trainer, will have a better understanding of how to help the client construct a strategy to create longevity in both mobility and strength in the wrist and enable the client to perform exercises with less discomfort.
Please note: I have filmed a video tutorial at the end of this blog to explain the techniques discussed in more detail.
Identifying the problem is relatively simple. We understand the issue, as we, ourselves have experienced similar discomfort. Alternatively, the client ‘bails’ at a particular stage of the exercise, sometimes very early on if the issue is severe. Either way, the client cannot continue to be in the wrist extended position whilst adding the loading of the bodyweight.
When we see these signs, we need to create a short term strategy to enable the client to get through the next few minutes, or at least to perform the exercise with a shorter time under tension strategy (a few seconds on/off).
The choice will vary depending on the client's limitations. An alternate choice of wrist position could be to cup hands over yoga bricks or shoulder pads, thus reducing the increased level of pull that comes through the fascial connection of the fingers also being extended. Maybe a rolled up towel will offer a little relief when placed underneath the heel of the hand by raising this side up and reducing the angle of the wrist. Finally, clenching the fists and placing the knuckles down into the surface will create a biomechanical wrist support. However, the knuckles aren’t by design useful to stabilise the body within a particular position for too long. This too is likely to be a short lived method.
Offer the client a little of your time after the class if you can, as the following steps are relatively simple and no equipment is needed. However, these techniques require frequency, as the joint needs to make particular adaptations over a period of time.
The first is a method called CARs - controlled articular rotations. Essentially, this is the ‘low hanging fruit’ of mobility, providing the wrist with large amounts of neural feedback within this rotational movement. Over time, the range of movement will become greater and as we have actively controlled the movement(s). In other words, we begin to own our own range of movement. The method below can simply take a few minutes to complete, so 2-3 times would be a realistic aim. You could also think of this activity as a mobility routine for the activity which follows.
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This exercise can be completed in a standing, seated or lying position, as long as you’re able to reduce the movement from neighbouring joints. The idea of this exercise is that you’re generating movement from just the wrist. Being seated or standing would be best practice.
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From the chosen position bend both elbows to 90º and lock the upper portion of the arm into the side of the body. This will remove the possible movement that could come from both the elbow and the shoulder.
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If you wear a wrist watch or bracelet, focus on this object becoming stable and prevented from moving. This enables the forearm to become fixed within this position. Begin the movement by clenching the fists and creating a large, very slow, concentrated outer range circular motion within the wrist. Be sure to keep towards the outer limits of the rotation as this will serve as your end ranges.
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Once two large (outer limits) rotations have been created, begin the rotation in the opposite direction twice around.
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This exercise can be completed in a standing, seated or lying position, as long as you’re able to reduce the movement from neighbouring joints. The idea of this exercise is that you’re generating movement from just the wrist. Being seated or standing would be best practice.
Over time (depending on the severity, frequency and technique), the wrist will adopt its newly learnt range of motion. However, as we are all aware, very little happens with only one format of activity. Let’s now look at delivering ‘end range’ exercise to the joint. Teaching the joint to provide strength to the joint at an (extension) end range, replicates what the joint is being asked to do within a quadruped position.
The terminology for the steps below is called
PAILs and
RAILs.
- PAILs - Progressive Isometric Angular Loading
- RAILs - Regressive Isometric Angular Loading
This technique takes around 8-10 mins. Therefore, can be done once a day and again, needs no specific equipment. I’ve chosen the quadruped position as it becomes more relatable to the client's problem and enables them to become more in control over solving this issue.
If discomfort is felt within the process, be sure not to force the joint into a position where the directional force is increasing. This could potentially create pain and/or inflammation, resulting in creating an ill-functioning joint.
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Take a collapsed quadruped position (sitting back into the heels and hands down/arms extended on the floor).
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Turn the wrist forwards with the fingers turned back towards yourself. This can be done bilaterally (both hands), but if this is the first time, then I would advise this to be done unilaterally (single wrist). Work the wrist into position while leaning into the shoulder side of the body.
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Ease into a position that enables you to feel the stretch a little more. This may require you to ease back into the hips incrementally.
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Use this method for around 2 minutes (minimum), as this enables the stretch to take place and settle down. Use deep diaphragmatic breathing to help with any (stretch) discomfort. Use this 2-minute period to ease further into the stretch and acknowledge that the stretch reflex will offer a degree of additional movement.
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Create a little tension in the body to prevent any unwanted movement.
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After the 2 minute duration, start to gradually add the PAILs component of pressing the palm of the hand down into the floor. Use the guide of percentages of maximal workload. Start with 20% effort and work your way to 80-100% effort. Imagine trying to press the floor away, with the wrist only. Countdown from ten seconds after hitting the desired max effort and then follow the next step.
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Ease back down as opposed to releasing the tension immediately. However, remain in the same position you have been, in preparation for the next part of the exercise (RAILs).
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Begin trying to lift the fingers and palm from the floor whilst easing a little further forward into the shoulders. This will create an immovable effect so that there will just be the intent to move, but little/no movement is likely to occur. This is due to the inability of the tissues to contract. It’s important to acknowledge that things are still happening internally even though little is visually happening. Similar to the PAILs technique, reach your desired max effort and countdown from ten seconds.
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Ease down the intensity and begin step 3 again. This time remove step 4, as the second set doesn’t require the excitability within the muscles. Pick up from the fifth step.
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After this is completed, then move across to the opposite wrist. Or, if you have completed this bilaterally (both wrists simultaneously), then you have completed this exercise.
- It’s important to recognise that without the correct mobility (regular CARs) prerequisite, the client cannot apply load and in the case of the quadruped position, their own bodyweight.
- Within a class environment, we can help create short term solutions to provide inclusive methods for our clients. However, it’s important to understand that short term solutions should not be continuously applied and that eventually, the problem needs to be addressed.
- End range training (PAILs and RAILs) is a method that enables the joint to recognise load/weight/resistance when it is being stressed within a particular angle.
- It is a safe method if applied gradually and if the client is acknowledging feedback from their body, especially signs of discomfort.
- By applying both CARs and PAILs and RAILs within your daily routine, they will begin to create a firm base of which they will be able to build from. They’re like to become more mobile within the wrist and be able to gradually increase the load onto the wrist.
Please feel free to communicate with us to share your thoughts and experiences that you may have had teaching your clients. We’d love to find out what you need to perform your role and if indeed LPA can help support you, by providing you with the correct tools.
Thank you,
Neil
*Techniques have been developed by Functional Range Systems, within their Functional Range Conditioning component. To learn more about their practices, visit:
Kinstretch.com
