MOVE: June 12, 2015 - You've Reached the Bottleneck

I hate traffic.  Well, maybe hate is a strong word....I really really dislike traffic....especially the kind that seems to come out of nowhere.  Maybe it's sun glare in the morning, or perhaps the aggressive folks jockeying for position when a lane closure is ahead (potholes!), or maybe it's volume at a toll plaza - no matter, there just always seems to be that little bit of dread in knowing the person behind you is at "ramming speed" and you're not sure they see the brake lights.....and that was just yesterday's commute.

In a sense, this is what happens at the wrist.  A bunch of different tissues (tendons, bones, ligaments, nerves, arteries, veins, etc) all with differing size, structure and function trying to get through a bottleneck....and like any bottleneck, if the flow gets altered too much, it can ruin your day.

Take for example the "simple act" of opening and closing your hand to grasp something. It's something we do thousands of times per day and something that typically doesn't require much thought or effort.  If we have an occupation that requires us to manipulate something in our hands (hand tools for example), we may not only have to do it often but may have to apply force at the same time.  Like any form of exercise, the more we use the tissues (tendons that flex the fingers), the thicker and stronger they get.  Occupationally this is a good thing - it makes the job of gripping more efficient.  Anatomically however, it's a bit more tricky.  If these tissues become too thick, they begin taking up space in the bottleneck and soft/sensitive tissues (nerve, blood vessel) can get compressed or pushed-aside, which alters how we move and might leave us in some discomfort.

Or, consider the bone structure.  We have 8 wrist (carpal) bones and another 5 where the hand begins (metacarpal).  That's 13 different bones all jammed into a very small space.  No different than any area where bones come together to form joints, adequate space between the surfaces (to avoid rubbing and grinding) is a must for proper movement. It's a pretty delicate balance.  Now think about how difficult it might be to maintain that space with all of the challenges we throw at it. Grasp something and the bones compress.  Pull something and they are under tension.  

The golfer who swings a little deep and hits the club against the hard ground can experience serious compression at those surfaces and often pain.  The fitness enthusiast who has begun incorporating the ever-en-vogue "burpee" into his/her routine -- can absorb significant force if they are not using proper form through the hips and core a good thing that can go bad. Or, whether on the job or at home and no matter what the task, the person who positions the hand in a non-neutral wrist alignment, the more uneven (and potentially harmful) the force of the task.  The list could go on and on.

The key to remember at the wrist is - like all parts of the body - it was built to MOVE.  If that movement gets restricted, it can have a significant impact on quality of life. Another recent study  for example showed that grip strength is an incredibly strong health and longevity predictor....in this case, better than systolic blood pressure....so keeping that wrist moving well is important.

Here are three very simple tests you can do to get some information about the condition of the bottleneck:

1. Place your palms together in a "prayer" position and try to raise your elbows up in line with your wrists.  How far can you go?  Are you close near 90 degrees without pain or restriction?  Any discomfort in the hand?

2. Reverse the position so the backs of your hands are together and try to lower your elbows.  Does your wrist allow more than 90 degrees of pain-free motion?

3. Make a light fist with your thumb tucked into your palm (under your fingers). Gently tip your hand toward the pinkie (5th finger) side.  Does it move freely? Do you have to alter your movement because of discomfort?

Although there is no "failing" on these tests, and shouldn't make you worried if they don't go as planned, they can be simple early warning signs that should be addressed.  The earlier....the easier...a few simple tendon and nerve glides can go a very long way.

The wrist is an intricate....but not necessarily delicate part of the body. If we are to keep the structures strong and functioning well, like any narrow passageway, maintaining an organized flow is critical.  Let us know if you need help.

Have a great weekend,

Mike E.