Wrist and elbow physiotherapy

**Wrist and Elbow Physiotherapy** ============================ Wrist and elbow pain is one of the common problems of the musculoskeletal system, which has a significant impact on the quality of life, the ability to perform daily activities, and occupational or sports performance. These types of pain can be caused by many factors, including overuse, repetitive motions, traumatic injuries, inflammatory conditions, and nerve compressions. In today's world, where activities related to computers, mobile phones, industrial tools and special sports have increased, the prevalence of musculoskeletal disorders of the upper limb, especially the wrist and elbow, is increasing. As a result, it is very important to pay attention to prevention, timely diagnosis and basic treatment of these injuries. Wrist pain may be caused by conditions such as tendonitis, carpal tunnel syndrome, or repetitive strain, while elbow pain is usually associated with disorders such as lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), or ulnar nerve compression. Accurate knowledge of these causes helps physiotherapists to design targeted, safe and effective treatment. Stretching and strengthening exercises play a central role in muscle retraining, improving neuromuscular control and preventing the recurrence of pain. Also, electrophysiological interventions such as electrical nerve stimulation (TENS) or ultrasound therapy can be effective in controlling pain and accelerating the process of tissue repair. One of the important dimensions in managing wrist and elbow pain is correcting incorrect postures and using ergonomic principles in the work environment and daily activities. Many injuries can be prevented by teaching how to properly position the limbs, using assistive devices and observing rest intervals in repetitive activities. In this regard, physiotherapists can play an important educational and supportive role in improving patients' lifestyles. ** Common causes of wrist and elbow pain Pain in the wrist and elbow area can be caused by a set of musculoskeletal, nervous and inflammatory disorders that often occur due to repetitive movements, inappropriate positions while doing activities or acute and chronic injuries. Accurate understanding of the common causes of these pains is a prerequisite for designing a targeted and effective treatment program in physiotherapy. In the following, we discuss the most important causes of pain in these two areas. ### **1. Tendonitis and tenosynovitis (inflammation of tendons) One of the most common causes of wrist and elbow pain is inflammation of the tendons of the forearm and hand. In the wrist, inflammation of the flexor (bender) and extensor (opener) tendons can be caused by repeated movements or direct pressure. This condition, which is accompanied by localized pain, sensitivity to touch, and limited range of motion, is commonly seen in people who frequently use their hands to type, use hand tools, or perform sports activities such as weight lifting. ### **2. Carpal tunnel syndrome Another common cause of wrist pain is carpal tunnel syndrome, which is caused by compression of the median nerve in the wrist area. This syndrome is usually accompanied by symptoms such as tingling, numbness, and pain in the thumb, index, and middle fingers, and is especially aggravated at night. Repeating the movements of bending and straightening the wrist, using the keyboard and mouse incorrectly or doing heavy manual work can be the cause of this disorder. ### **3. lateral epicondylitis (tennis elbow) In the elbow area, one of the most common problems is lateral epicondylitis or tennis elbow. This condition occurs due to inflammation of the tendons attached to the external (external) epicondyle of the elbow. It is commonly seen in people who engage in repetitive wrist and forearm rotational movements, such as typists, mechanics, carpenters, or racquetball athletes. Its symptoms include pain on the outside of the elbow, weakness in grasping objects, and sensitivity to touch. ### **4. medial epicondylitis (golfer's elbow) On the other hand, medial epicondylitis or golfer's elbow is caused by inflammation of the forearm flexor tendons in the inner part of the elbow. This problem is often associated with twisting and flexing movements of the forearm, such as throwing or pulling movements in golf, baseball, or weightlifting. The patient may experience pain on the inside of the elbow, decreased grip strength, and muscle stiffness. ### **5. Repeat Pressures (RSI)** Repetitive strain syndromes or RSI include a set of disorders caused by repetitive movements, poor posture, and insufficient rest during activity. Over time, this condition can cause chronic inflammation of tendons, soft tissue damage, or even nerve compression. RSI is a common cause of wrist and elbow pain in office workers, computer users, and industrial workers. ### **6. Ulnar nerve compression In the elbow area, compression or stretching of the ulnar nerve, which runs along the inside back of the elbow, may lead to symptoms such as numbness, tingling, and shooting pain in the little and ring fingers. This condition, sometimes called cubital tunnel syndrome, is usually caused by prolonged bending or leaning on the elbow. Wrist and elbow physiotherapy treatment Physiotherapy for wrist and elbow pain, as a non-invasive and evidence-based approach, plays an important role in reducing pain and improving wrist and elbow function. Physiotherapy treatment is designed based on the type and severity of the injury, the structures involved, and the individual needs of the patient, and usually includes careful assessment, manual therapy techniques, electrophysiological modalities, corrective exercises, and the prescription of supportive devices. In the following, we discuss the most important treatment methods used in wrist and elbow physiotherapy. - **Preliminary evaluation and functional diagnosis:** Before starting the treatment, the physiotherapist diagnoses the type of injury and estimates its severity by examining the range of motion (ROM), muscle strength, joint stability, movement patterns and performing specific neuromuscular tests (such as Phalen's, Tinel's or Finkelstein's). This assessment will be the foundation of a personalized and effective treatment plan. - Manual therapy techniques: manual therapy plays a central role in reducing pain, improving joint mobility and facilitating tissue repair. In wrist treatment, the following methods are used: - Joint mobilization: controlled and gradual movements in specific directions are used to increase the sliding of joint surfaces, reduce stiffness and reduce pain. - Myofascial release and soft tissue massage: reducing tension in forearm and wrist muscles, improving local blood flow and speeding up the tissue repair process. These methods are especially effective in cases of tendinitis or tenosynovitis. - **Physiotherapy Modalities: (Electrophysical Modalities)** In acute or chronic stages of wrist pain, the use of auxiliary modalities can help reduce inflammation and relieve pain: - **Electrical stimulation (TENS):** Stimulation of peripheral nerves with mild electrical pulses to inhibit pain messages and release endorphins. - **Ultrasound therapy:** Using high-frequency ultrasound waves to increase deep blood flow, reduce inflammation and improve the repair of tendons and ligaments. - **Stretching Exercises**: Basic stretching exercises help to restore range of motion and reduce tissue stiffness. The following exercises are commonly used in treatment protocols: - Stretching the wrist flexor: straighten the hand, palm up and slowly pull the wrist back with the help of the other hand. This exercise stretches the forearm muscles. - Wrist extensor stretch: palm down, bend the wrist down and hold it with the opposite hand. This movement has an effect on the muscles behind the forearm. - Tendon Gliding: A set of finger movements including open fist, hook, straight and bent is very effective to reduce the adhesion of tendons, especially in carpal tunnel syndrome. - **Strengthening Exercises:** Strengthening forearm and wrist muscles is one of the important principles in rehabilitation and prevention of return of pain. These exercises are usually done gradually and under the supervision of a physiotherapist: - Resistance band exercise: bending and opening the wrist against resistance to strengthen the flexor and extensor muscles. - Isometric exercises: keeping the wrist in a certain position without moving the joint to strengthen the muscles in painful phases when full movement is not possible. - **Supporting devices and posture correction:** Wrist splint: In cases such as carpal tunnel syndrome or tendonitis, using a special splint to stabilize the wrist in a neutral position, especially while sleeping, reduces pressure on the involved structures. Kinesio Taping: An auxiliary method to reduce pressure, facilitate movement and support the wrist joint in daily or sports activities. General tips to improve and prevent wrist and elbow pain Successful treatment of musculoskeletal injuries is not limited to physiotherapy interventions; Rather, making sustainable changes in lifestyle, correcting movement patterns, and observing ergonomic principles play an essential role in preventing the recurrence of pain. In this section, we discuss the most important general and specialized recommendations to maintain the health of the wrist and elbow, reduce unnecessary pressure, and prevent the recurrence of injuries. **1. Improving posture and workplace ergonomics One of the most common causes of wrist and elbow pain is improper use of the joints during daily tasks or occupational activities. In order to prevent repeated pressures, it is necessary to observe the following points: Adjust the height of the table and chair so that the forearms are horizontal and the wrists are in a neutral position (not bent up or down). - The keyboard and mouse should be in line with the elbow and avoid bending the wrist to the sides. Using an ergonomic keyboard and wrist pad for the mouse can help. - Avoiding long-term sitting in one position: constantly changing body position and doing simple stretching exercises can prevent muscle cramps and joint fatigue. **2. Short and regular breaks Repetitive movements and continuous use of wrists and elbows in tasks such as typing, writing or working with hand tools, over time cause soft tissue damage. For prevention: - Every 30 to 45 minutes of continuous work, rest for 5 minutes. - During these breaks, do simple stretching movements such as opening and closing your fingers, turning your wrists and shaking your hands. - Let the muscles rest and increase the blood supply. **3. Maintaining physical fitness and strengthening muscles The weakness of the muscles around the wrist and elbow causes more pressure on the joints and tendons. To prevent pain and possible injuries: - Do regular strengthening exercises for forearm, wrist and arm muscles. It is useful to use resistance bands or light weights. - Include isometric and stretching exercises in your weekly schedule to maintain the flexibility of the muscles and prevent their stiffness. - In athletes, before starting sports activities, it is important to warm up, especially for the upper body. **4. Correct use of accessories Many injuries are caused by improper or prolonged use of tools and equipment. To reduce pressure: - Use ergonomic and standard tools. A mouse, keyboard, joystick, or sports equipment should fit the size and shape of your hand. - Splint or splint of the wrist in special cases such as carpal tunnel syndrome or chronic tendonitis, helps to reduce the pressure at night. - Therapeutic tapes (Kinesio Tape) can distribute the incoming load by supporting the joint and help functional stability. **5. Attention to early symptoms and early treatment Most people ignore the initial symptoms of pain or numbness and do not take action until the injury progresses. To prevent chronic pain: - If you feel pain, numbness, tingling or muscle weakness, see a physiotherapist immediately. - Early detection of muscle or nerve damage prevents the problem from becoming chronic and requiring long-term or aggressive treatments. - Even mild wrist and elbow pains can be warning signs that should not be ignored. **6. Continuing exercises after the end of physiotherapy treatment One of the reasons for the recurrence of wrist and elbow pain is the sudden stop of therapeutic exercises after the symptoms have subsided. For long-term prevention: - Continue the home exercise program even after recovery. - Exercises should be done gradually and continuously to maintain muscle strength and flexibility. - If the symptoms return, resume corrective exercises as soon as possible or consult a physiotherapist. **7. Active and balanced lifestyle Proper nutrition, adequate sleep and stress control also play an important role in the recovery and prevention process: - Nutrition rich in vitamin D, calcium and protein helps the health of bones and connective tissue. - Quality sleep at night (7 to 8 hours) helps cell regeneration and reduce inflammation. - Chronic stress can increase muscle tension and decrease pain threshold; Therefore, it should be managed with methods such as meditation, deep breathing or light exercise. Stretching exercises for wrists and elbows In the following, we present some effective, comfortable exercises without the need for special equipment for the treatment and prevention of wrist and elbow pain that patients can easily perform at home. ### 1. Wrist extensor stretch How to do it: Hold your arm out in front of you, palm down. Pull the fingers down with the other hand. Duration: Hold for 20 to 30 seconds, repeat 3 times. Advantage: reducing the tension of the extensor muscles that play a role in tennis elbow and wrist pain. ### 2. Wrist flexor stretch How to do it: Hold your arm forward, palm facing up. With the other hand, pull the fingers back (towards the floor). Duration: Hold for 20 to 30 seconds, repeat 3 times. Advantage: reducing pressure on the flexor muscles, effective in treating golfer's elbow and RSI. ### 3. Nerve Glide for the median nerve (carpal tunnel syndrome) How to do: 1. Keep your arm straight beside your body. 2. Palm facing up, fingers open, wrist stretched back. 3. Turn the head to the opposite side. Repetition: 5 times back and forth, without pain. Advantage: reducing the compression of the median nerve and improving sensation in the fingers. ### 4. Ulnar nerve stretch (for medial elbow pain or little finger numbness) How to do: 1. Put your palm on your face as if you are going to apply a mask. 2. Bend the elbow and bring the little finger closer to the shoulder. 3. Turn the head in the opposite direction. Repetition: 5 times, without pain. Light strengthening exercises for forearms and wrists ### 5. Wrist extension with water bottle How to do it: Hold a half-liter water bottle in your hand, place your forearm on the table, palm down. Just raise the wrist. Repetition: 10 to 15 times, 2-3 sets. Benefit: strengthening extensors for tennis elbow. ### 6. Wrist flexion with a water bottle How to do it: As before, but with the palm facing up. Move the wrist up and down. Repetition: 10 to 15 times, 2-3 sets. Benefit: Strengthening the flexors, useful for golfer's elbow. ### 7. Forearm rotation (pronation/supination) How to do it: Take the small bottle, rotate the forearm on the table, palm down and then up. Repetition: 15 times, 2 sets. Advantage: improving forearm muscle balance and range of motion. ### 8. Squeezing a ball or soft towel How to do it: Squeeze the sponge ball or rolled towel in your hand. Duration: Hold for 5 seconds, repeat 10 times. Advantage: strengthening grip and muscles involved in the wrist and fingers. ### 9. Isometric exercise for the elbow How to do: 1. Bend the elbow 90 degrees. 2. Give resistance to the painful hand with the opposite hand (without movement). Duration: Hold for 5 seconds, repeat 10 times. Advantage: Strengthening without moving the joint, suitable for the initial phases of pain. **Key points:** All exercises should be done without pain. It is better to start strengthening exercises after stretching exercises or with a little warm-up. Daily continuation for at least 3 to 4 weeks will cause noticeable improvement. **Summary Preventing wrist and elbow pain requires a series of conscious, regular and continuous actions. Many musculoskeletal problems can be prevented by correcting body posture, observing ergonomic principles, performing strengthening and stretching exercises, and paying attention to warning signs. Patient education and adherence to treatment recommendations is the key to achieving optimal performance and pain-free living.