This is a story of my own wrists and the pain that I had been suffering for the past 5 years. I began my life’s journey of learning and understanding natural medicine about 8 year ago. I enrolled in a massage therapy program at a local college to begin to understand the wonders of the human body. About a year or so after I completed the program, I began working part-time as a licensed massage therapist. I enjoyed every minute of serving people and watching them heal and remove years and years of pain from their body. But, during my first year of massage practice, I began to develop wrist pain. This was a huge concern and had the potential of taking me away from doing something that I loved.
As an initial investigation into the wrist pain, I looked at all of the things that I was using my hands for. I was a heavy duty martial arts practitioner, hitting the heavy bag 3-4 times a week. I was doing weightlifting, stretching, and yoga exercises in the gym 2-3 times a week. I was turning a wrench and lifting heavy parts on an old 4×4 truck of mine. I was also mountain biking on the weekends whenever I could get out and ride.
All of this was causing me to use my wrists and hands on a daily basis, some of which would have me at full range of motion (ROM) with pressure applied for minutes at a time. The pain would come and go from time to time, but became a constant ache and pain. In the span of a few months, I was unable to rest my palms on the floor and assume a push-up position at all without significant pain. Therefore, I had to scale back on many of my favorite activities to allow the problem to work itself out.
At first, the pain was significant on the right hand and very mild on the left hand. It sounded logical because I do many activities with my right hand. Made sense. But, the fact that the pain was bilateral got me thinking that there was a systemic problem. I thought that I was getting some form of arthritis. Before the age of 30? Crazy to think, but I was recounting to myself the frequency with which I’ve used my hands for so many things. Made sense. I thought that I might have a case or rheumatoid arthritis (RA) due to the bilateral nature of the issue. But, RA usually affects more small joints and is progressive…and I wasn’t that old! Carpal Tunnel Syndrome (CTS) also crossed my mind, but I didn’t have the tingling and numbness in the first 3 fingers usually associated with CTS.
Fast forward a few years and I had modified almost everything that I did with my hands. I knew exactly how to position my hands for the least amount of pain and what my “new” range of motion would be before pain was aggravated. I would never use an open palm to support any weight whatsoever. Push-ups were done closed fisted. Yoga postures were done without an open palm. No more than 3-4 massage clients a day and definitely no more than 8-10 in a week. I got massage on my forearm flexors and extensors regularly and used acupuncture and stretching to keep the wrists limber. But, even with all of the management of my wrist and the care I took to try and heal them, nothing really reduced the pain.
Then last year, I decided to get some x-rays on my wrist joints to see what would come up. Desperate, I was looking for some answers. Of course, something was found. I had the beginning of degenerative joint disease (DJD) on my right hand. The doctor pointed out that there was some DJD that could be giving me wrist pain. But, there was no answer for why my left wrist was in pain. So, I resolved myself to just treating my wrists and hands with care and just trying to reduce the wear-and-tear on the joints.
Fast forward to just a few months ago. I was perusing a trigger point manual and found an interesting piece of information that I know I had overlooked before. There’s a muscle underneath the scapula called the subscapularis. It’s a fantastic muscle that hides underneath the scapula and works with 3 other muscles (supraspinatus, infraspinatus, teres minor) to make up the rotator cuff muscles. A tight supraspinatus can refer pain to the rear shoulder area and to the wrists. A balanced rotator cuff has all 4 muscles with fairly equal musculature to keep the shoulder joint stable and the upper arm in the shoulder socket, so to speak.
Well, I had multiple ortho-neuro tests on my rotator cuff muscles done and there was a fair amount of strength in each. Nothing seemed to be too out of balance. Being a massage therapist that I am, I palpated each of the muscles for tenderness. When I touched the subscapularis, I almost went through the roof. It was extremely tender. So, I got to massaging it once a day and stretching it out 3 times a day. The right subscapularis was much more tender than the left one, but both needed heavy work.
After a week of consistent massage and working to release the subscapularis, the pain in my wrists began to diminish. Today, I can actually do a push-up with my wrists flat on the ground without pain in my left wrist and with very minimal pain in my right. I’ve gotten my hands back. I couldn’t believe the transformation. I no longer feel like my wrists are going to give out. I continue to work on strengthening the supraspinatus, infraspinatus, and teres minor muscles of the rotator cuff and stretching my subscapularis.
So, I guess there are a few things I’ve learned about my situation as well as some other situations that warrants some comments.
1. If you have pain that begins in the back of the wrists that feels like carpal tunnel but isn’t, check the subscapularis muscle for tightness. This muscle usually overpowers the other 3 in the rotator cuff and can refer pain to the back of the shoulder and to the back of the wrist.
2. If you have frozen shoulder (aka adhesive capsulitis) and/or one shoulder is higher than another visually, there could be a subscapularis problem. Don’t forget about it. Just because it’s not a superficial muscle, doesn’t mean that it doesn’t need work. A tight subscapularis does not need strengthening before you release the trigger points. Strengthen the other 3 rotator cuff muscles and work out the trigger points of the subscapularis first.
3. Find a good stretch for the subscapularis muscle. I like the broomstick stretch, personally. Also, look for rotator cuff exercises that work on the lateral rotation of the arm. On most people, lateral rotational strength is much weaker than medial rotational strength of the upper arm.
4. Just because you are active, does not mean that you can’t have this problem. It has more to do with imbalance of muscle structure rather than strength of musculature. I’ve seen subscapularis problems in 60 year olds and also in 30 year olds (myself included!).
5. Many activities will strengthen the subscapularis while neglecting the rest of the musculature supporting the shoulder girdle. Make sure that you make up for weakness in other muscles, by focused weight training.
6. I’m sure this subscapularis scenario gets misdiagnosed often. I can see it getting diagnosed as carpal tunnel syndrome, arthritis, pinched nerve, etc. This is why I’m posting this. I don’t want to see more people get put on medications, or have surgery done, or just suffer for something that can be fixed with a bit of massage and exercise.