Wrist tendonitis

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A week before I was meant to travel to the US and Portugal, I was out paddling my ski, watching whales and really just cruising (recovery session after a hard week of training), when I felt a sharp stabbing pain in my wrist. A familiar stab I should mention. I stopped, stretched my slightly tight forearm (warning sign #1) and pushed on, as I generally do (warning sign #2). It got worse, and memories of the last time surfaced! Could this be the dreaded tendonitis showing its ugly face again?

That was 5 years ago and after 4 weeks of physio, and rest, with no improvement and a race looming (Dusi), I went for the last resort treatment option, Cortisone. It worked. Inflammation gone, paddling could resume, and sanity could return.

So now, with a 4 week trip planned, with about 5 very important races to take part in (read: my salary) I panicked. Time was not on my side, as my flight was in less than a week, so I opted for the “last resort” treatment plan as a “first resort”.

And we know how that story ended up. The cortisone didn’t work this time. A very uncomfortable experience racing with an excruciatingly painful wrist, cancellation of the rest of the trip. No income, and now it’s still trying to heal. I have had to pull out of the SA Team for Marathon World Champs, my plans, and dreams for the main part of my 2011 season are looking bleak. Especially bleak as I have been feeling in the form of my life.

How did this happen? Actually it has been a long time coming. There are many contributing factors that have led to this injury. (Over-training, not enough treatment and prevention measures, too many races, not enough rest and cross training, too many demands on my body, bad posture in the boat). The list goes on.

A few people have asked that I write about the injury, and how I am rehabilitating it. So I will put down a little bit about it over the next few blog posts.

To start off, here is a basic description of the wrist tendonitis I have picked up, and the reasons most likely that have produced it.

Tendon’s are a type of connective tissue that connect muscle to bone. When a muscle contracts, it pulls the tendon which pulls the bone, creating a movement. They have very slight elasticity (5%), which keeps them becoming injured. Imagine you suddenly grab a ball flying towards you. The muscles used to move your arm will pull violently on your arm. Those muscles will pull on the tendons attaching those muscles to the bones of your arm and hand, if there wasn’t some elasticity in the tendons, the force of the muscle would rip the tendon off the bone.

Tendons are covered by a thin soft-tissue layer, called a synovium. This sheath allows the tendon to move smoothly in a low friction manner. The tendonitis in my wrist is called De Quervain’s tendonitis, and is an inflammation of the tendons that move the thumb. The main 2 tendons to the thumb pass through a tunnel located on the thumb side of the wrist. If these tendons become irritated (through over-use) and swollen, it will result in the synovium surrounding the tendons to swell and constrict the gliding motion of the tendon.

This is pretty painful, and you need to stop the inflammation cycle.

I treated my wrist in the following way: (this was after the US Champs, where it got really inflamed and aggravated after the 2 hours of stress it was under).

It is an OVER-USE injury, so the main ingredient to healing is REST. (Something I hate doing!)

I braced my wrist for the initial few days, as I was travelling home, and was carrying my suitcases etc, and my aim was to give it complete rest.

Iced it for about 20 minutes in the following cycle: 4 minutes on 1 minute off.  I did this in the morning and evening. I used an anti-inflammatory herbal cream called Traumeel, which I rubbed into my wrist and forearm after icing it.

I started to stretch my forearm once the swelling and pain had subsided.

It was starting to feel really good after 2 weeks off so I went for a very short paddle, I lasted until 20 minutes pain-free, then it started again, and I went home and had to ice and treat it like i did in the first few days. totally rushed that one!

I then went to a physio in Knysna, he strapped it for 2 days, as well as treating it every 3rd day, and booked me off all paddling for another 2 weeks.

I have been doing eccentric strengthening of my wrist extensor muscles, stretching them, and icing in the evenings if it is swollen.

I am also working on my scapular stabilizer muscles as they are pretty weak, and the physio reckons that is a major contributing factor to my problem. My wrist is pretty unstable, as well as my thumb joint, hence the strengthening exercises.

At this point I still have 5 days of forced rest (paddling wise) so I have been running, doing a bit of swimming and some strength work. My wrist is feeling ok, no pain, and I can’t wait to paddle again.

Email me if you have any questions: michele@multicoach.co.za

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