Whether it's a shooting pain or a dull ache, wrist and shoulder discomfort is a common complaint among my clients.
Pain in these areas can present itself in a variety of ways: In a plank position, you may feel a pulling on your wrists or tightness in your shoulders. While lifting dumbbells, you may feel a tingling in your wrists, or hear a clicking or popping sound in your shoulders. Or maybe during a push-up you feel a twinge in your shoulder with every rep. These are just a few examples of the type of pain that can creep up when we are putting strain on the joints.
According to Dr. Stephen O’Connell, chairman at Eisenhower Desert Orthopedic Surgery and director of Hand and Wrist Surgery, approximately 25 percent of all athletic injuries involve the wrist and hand. “The human hand consists of 29 bones, 29 joints, 123 ligaments, 34 muscles and 48 nerves. Combine this fact with an active lifestyle and it’s easy to understand why fractures of the wrist and hand bones are relatively common,” he says. Fractures make up a smaller percentage of athletic injuries; “more ubiquitous are problems we attribute to overuse, which typically involve tendons and ligaments,” Dr. O’Connell explains.
Knowing how much we use our hands in everyday life, it's not surprising that overuse injuries are common. Typing on a computer, holding your phone and any other repetitive movement that uses your hands can cause inflammation of tendons. And if you have inflammation near the wrist joint from everyday activities, they’re already weaker and more susceptible to getting injured in the gym.
Tendinitis (which is inflammation of a tendon) or a sprain can be quite painful and debilitating, leading to time away from the gym, adds O'Connell. Similar to wrist issues, shoulder pain can be a real problem that can be exacerbated by, and also hinder, workouts. O’Connell says the most common shoulder injury is that of the rotator cuff. “There are four muscles that stabilize the shoulder joint. As people get older, muscles get weaker, and this allows for one to get injured from lifting, pulling and pushing movements. And if this area is weaker, people are more likely to have strains, sprains, etc.,” he explains.
But these injuries are often preventable. “The key is recognizing the symptoms of some of these more common maladies so as to intervene in a timely manner and restore function as soon as possible,” says O'Connell.
If an old shoulder injury comes creeping back when you start exercising regularly, or if your wrists ache during workout classes, keep reading. We’ve tapped trainers and doctors to school us on the improper form that can cause this pain, and how to correct common mistakes to reduce your chance of injury.
Not every movement allows for a neutral wrist, so it can be hard to know what the proper positioning is. Jeremy Robinson, certified personal trainer and founder of Austin Holistic Fitness, says that plank, handstand and downward facing dog are examples of exercises that when performed correctly, have the wrist in pulled back position.
Fix: Know proper alignment in each type of movement
“Alignment is the straightest path to strength. Neutral wrist alignment is a wonderful position to be in, but not every movement allows for it,” says Robinson. That’s why it’s important to be mindful of keeping your wrist neutral whenever you can. A neutral wrist is the natural way your wrist extends from your arm, in a flat position. For example, if you lay your arm on a table or hold your arm out in front of you and keep the wrist from bending. When using a dumbbell, barbell or even turning a doorknob, aim for this position.
There are two exercises where it’s especially important to maintain neutral wrist: bicep curls and tricep extensions.
Bicep curl: “It’s very common for clients to bend the wrist during a bicep curl. Be careful not to bend the wrist, keeping it as straight as possible through all the reps,” says personal trainer Swazi E. Taylor. “It’s also useful to squeeze the handle firmly and focus on squeezing the bicep at the top of the movement, rather than turning the wrist as a way to compensate.”
Tricep extension: For a standing tricep extension with a free weight, she warns that if you’re working with a weight that is too heavy, you’re more likely to bend — and strain — the wrist. “Choose your weight accordingly,” Taylor says, “Firmly grip the free weight and look at your hand and wrist. If you see wrinkles where your palm meets the wrist, your wrist is not in the correct position.”
Another everyday activity that can strain the wrists? Driving. Robinson says that a very common habit that causes the wrist to get weaker is holding your steering wheel with your knuckles back (extension). “So try rolling your knuckles up and over and get more neutral as often as possible,” he says.
Some instructors incorporate tons of planks into their workouts and this can be cause for concern. Mechanically, all of the weight is being placed on your hands and toes. So if you’re not engaging your core or if your wrists or shoulders are weak, you may leave the class in pain. Many of my private weight-loss clients don’t evenly distribute the weight in their hands. They press down at the base of their wrists, but their fingers will barely be touching the ground. This puts even more pressure on the wrist joint.
Get the better newsletter.
Fix #1: Maintain proper form
To properly perform a plank: Press down firmly through all 10 fingers and your palms; this takes pressure off of the wrists by dispersing your weight evenly throughout your hand. Spread your fingers wide, and make sure your wrists are parallel with the front of your mat. Then, reach your heels towards the back of the room as if you’re trying to press your heels through the wall behind you. Lengthen through the back of your legs, while also reaching your head towards the front of the room. “The eyes should aim forward, about a foot in front of the fingertips,” says Taylor. “Make sure the wrists, shoulders and arm pits are stacked, one on top of the other.” If you have tight shoulders, you can turn your wrists out slightly and fan your fingers out to the sides so that the wrists are a little bit wider than the shoulders, which will help you maintain proper form.
Fix #2: Focus on your core
While your body is suspended, keeping the core strongly engaged is key to taking pressure off of the wrist and shoulder joints. Pull your naval in towards your spine, and tilt your tailbone towards the back of the room and slightly downward. This will prevent your low back from rounding and ensure that it stays flat.
Fix #3: Modify or eliminate
If these techniques and cues still don’t alleviate pain in a plank, it’s time to modify! Doing a forearm plank is one modification. Instead of your hands being the base of the front of the plank, your forearms will act as the base which provides a larger surface area upon which to distribute the weight. For another modification, you can practice plank on your knees and forearms, or your knees and hands.
Keep in mind that not every exercise or position is right for everybody: As a Pilates and yoga instructor myself, I avoid plank as much as possible because it just doesn't feel right to my body. I encourage all of my clients to make adjustments, but then eliminate the exercise if they can’t find a way to perform it that feels comfortable.
Shoulder presses, lat pull downs, shoulder extensions and other upper body exercises that require your arms to be overhead can sometimes be too much for the shoulders — especially if you already have persistent pain. The last thing you want to do is aggravate an existing condition, but many times people want to “push through the pain” even if it’s chronic. This is not the solution!
Fix: Do alternative exercises and use less weight
“Many of my clients come to me with shoulder issues already,” says Kim Kelly, personal trainer and certified yoga, barre and Pilates instructor. “I give [them] alternative exercises like bicep curls, triceps extensions, narrow or wide rows, serve a platter and hug a tree — just to name a few.” Ask a personal trainer for modifications or alternative exercises that will work the same muscles from a different angle (i.e. not overhead).
If you are able to perform overhead weighted exercises, do it mindfully. For proper form, soften your knees, slightly tuck your pelvis, choose the correct size weight for your ability, and pay close attention that you do not hyper extend the arms, says Kelly. I recommend people start with 3- or 5-lb dumbbells for an overhead shoulder press. A common mistake is to shrug the shoulders up to the ears on this exercises (which recruits the neck muscles); relax the shoulders down so that they are not hunching up towards your ears. If this is impossible, that is your sign to grab a lower weight.
When one part of the body is underdeveloped, another part has to overwork to compensate. Noam Tamir, fitness coach and founder of TS Fitness, explains that poor shoulder mobility can cause injuries when it requires other muscles to compensate. “Short chest muscles can create this by pulling the shoulder joint forward,” he says. A weak rotator cuff can also cause imbalances and lack of function in the shoulder capsule. “Over time this can cause inflammation in the joint because it is not functioning properly,” Tamir says.
Fix: Add stretching and recovery into your routine
“Address range of motion and do some soft tissue work to create more blood flow to keep a shoulder joint healthy,” advises Tamir. Massages help increase blood flow, as does foam rolling. Try getting a regular massage with a focus on the upper body, or lie down on a foam roller or tennis ball to massage your upper back. Kelly suggests stretching and lengthening the muscles with yoga or barre. “Your body will respond by better performing for you,” she says.
The following shoulder and wrist stretches can also help increase your mobility and lengthen muscles:
On your hands and knees, shoulders over your wrists and knees under your hips, turn your right hand 180 degrees so that it faces towards the back of the room. Press down through the base of your hand, and feel a stretch behind your wrist. Hold for 20 seconds, then release and shake it out before moving on to the other side.
While standing or sitting, reach your right arm out in front of you as if you’re going to high five someone. Then turn your wrist to the right until it is facing towards the ground. Grab onto your fingers with your left hand and gently pull them back to stretch out the under side of your wrist. Hold for 20 seconds, then shake it out and switch sides.
Sitting or standing, cross your right arm across your body and hold onto your right arm with your left hand. Gently pull the arm across the body to feel a stretch in the top of the shoulder, side of the shoulder and in the upper back. Hold for 20 seconds, then shake it out and switch sides.