Wrist Pain and Hypermobility: Why It Happens and How to Fix It

By Russell Wolfe, MSc PT

So you’ve started a new workout regimen; maybe it’s Pilates, yoga, or just some core strengthening exercises you found on YouTube. The program seems reasonable at first—they’re just bodyweight exercises, how hard can they be? But you quickly start to notice pain developing around the wrists.

Wrist pain is one of the most common issues I see plaguing hypermobile patients. It can be incredibly frustrating, especially since physios and doctors commonly prescribe low-intensity exercise like Pilates and yoga for these populations, which can involve a TON of weight-bearing on the wrists.

Why is wrist pain so common in hypermobile individuals?

In this post, we’re going to talk about some of the reasons this occurs, how to avoid flaring up the wrists when exercising, and some long-term solutions to start bulletproofing your wrists going forward.

Anatomy

So, what’s happening when the wrists flare up? Well, first let’s talk about some anatomy. The wrist is made up of a number of different joints, which are supported by both a passive and an active subsystem. It can be helpful to use the metaphor of a puppet and its puppeteer.

With hypermobility, there is natural laxity in the passive tissues, which compromises stability at hypermobile joints such as the wrist.

The passive subsystem includes ligaments, cartilage, and other connective tissue which hold the bones of the wrist in close proximity to one another and limit/guide movement. It’s called passive because these tissues do not contract. They can be thought of as the puppet and the strings which attach to it.

The active subsystem involves the deep stabilizing muscles of the wrist. When they contract, they pull the bones of the wrist closer to one another, helping the passive subsystem by further increasing stability. This system can be thought of as the puppeteer controlling the strings.

With hypermobility, there is natural laxity in the passive tissues, which compromises stability at hypermobile joints such as the wrist. When the joint is stretched to an end range and loaded, such as when we weight-bear on fully extended wrists, it can irritate the passive tissues, resulting in inflammation and pain.

Modifying

So what do we do with cranky wrists in the case of, say, a plank? In the short term, it’s important to listen to the body and respect the pain signals it’s delivering, which are typically due to one or both of the following:

1. The joint is too close to end-range

2. Too much load on the joint

Bulletproofing

Since the passive subsystems of hypermobile joints are compromised, over the long term it becomes very important to train the active tissues that reinforce stability—they essentially need to do the work of both subsystems! The stronger the muscles are, the more load they can take away from the joints.

Yes, the exercises that hurt at first can ultimately become the ones that bulletproof you for the future!

The first step would be strengthening the gripping muscles in a neutral position (with the wrist straight). Exercises that help accomplish this include farmer carries, dead hangs, and pressing or pulling movements while keeping good wrist alignment in mind. Over time, you’d likely want to challenge the muscles closer to end range. Exercises here would include wrist curls, the Tyler twist, and even gradual loading of the symptomatic exercises from the past (assuming this is done in a safe and pain-free manner).

Yes, the exercises that hurt at first can ultimately become the ones that bulletproof you for the future! The trick is not finding the one magic exercise that fixes you, but finding what’s right for the level you’re currently at and progressing at the right pace. This is where a good physiotherapist can help, and the Stable Foundations course offers a variety of tools to get you strong and stable wrists for life!

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