What are the treatment options for wrist pain resulting from physical exercise (Physical Activity)?

From the Guidelines

To treat wrist pain from exercise, start with the RICE method and consider consulting a healthcare provider if pain persists, as the most recent and highest quality study suggests that radiography is usually appropriate as the initial imaging study in the evaluation of chronic hand or wrist pain 1. When experiencing wrist pain from exercise, it is essential to prioritize rest, ice, compression, and elevation to reduce pain and inflammation.

• Rest your wrist by avoiding activities that cause pain
• Apply Ice for 15-20 minutes several times daily
• Use Compression with an elastic bandage or wrist brace
• Elevate your wrist above heart level when possible Over-the-counter pain relievers like ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours or naproxen (Aleve) at 220mg every 8-12 hours can reduce pain and inflammation, as supported by general medical knowledge. Gentle stretching and strengthening exercises, such as wrist flexion/extension and grip exercises with a stress ball, can help recovery once acute pain subsides. Modify your exercise technique by ensuring proper form, using wrist wraps during weight-bearing exercises, and gradually increasing intensity. If pain persists beyond 1-2 weeks, worsens, or includes symptoms like numbness or severe swelling, consult a healthcare provider as you may have a more serious condition like tendonitis, carpal tunnel syndrome, or a sprain that requires professional treatment, as suggested by the American College of Radiology Appropriateness Criteria 1. Wrist pain often occurs due to overuse, improper form, or excessive load on the joint structures, so addressing these underlying factors is crucial for both recovery and prevention. In the setting of chronic wrist pain with normal or indeterminate radiographs, US area of interest or MRI area of interest without IV contrast may be appropriate as the next imaging study when there is concern for CTS, as stated in the 2023 update of the ACR Appropriateness Criteria 1. However, the most recent and highest quality study should be prioritized, which is the 2023 update of the ACR Appropriateness Criteria 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of ibuprofen tablets and other treatment options before deciding to use ibuprofen tablets. Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain.

For mild to moderate wrist pain from exercise, ibuprofen can be used at a dose of 400 mg every 4 to 6 hours as necessary for relief of pain 2.

• The dose should be tailored to each patient, and may be lowered or raised depending on the severity of symptoms.
• It is recommended to use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
• If gastrointestinal complaints occur, administer ibuprofen tablets with meals or milk.

From the Research

Causes of Wrist Pain from Exercise

• Wrist and hand pain can be caused by various factors, including soft-tissue mobilization, which was the most frequently cited causative factor in a study of orthopaedic physical therapists 3
• Increasing age, decreasing experience, female gender, performing more manual therapy, and working more than 40 hours per week were also associated with an increased risk of moderate to severe wrist and hand pain 3

Prevention and Treatment Strategies

• Altering body mechanics and technique was the most commonly mentioned strategy for prevention of wrist and hand pain 3
• Managing expectations for manual therapy by patients was also highlighted as an important factor in preventing wrist and hand pain 3
• Formal injury prevention programs for individuals who perform manual therapy, such as orthopaedic physical therapists, are recommended to focus on improving body mechanics and technique, attention to workload, careful selection of manual techniques, and managing expectations for manual therapy 3

Reducing Wrist Pain

• Reducing the frequency or intensity of manual therapy and taking regular breaks to rest the wrists and hands may help to reduce the risk of wrist and hand pain 3
• Careful selection of manual techniques and attention to proper body mechanics and technique may also help to reduce the risk of wrist and hand pain 3