Does your wrist pain always come only from the wrist?

A stable &  pain-free wrist is foundational to performing the motions needed for daily living as well as sporting activities.

The combination of wrist motion and stability (dynamic stability) provides the fundamental basis to maximize hand function and enable a wide range of tasks: from precise fine motor control to power grip activities. Dynamic wrist stability is influenced by proprioceptive and neuromuscular activity.

Proprioception is considered a subcomponent of the body’s senosry + motor systmes. It contributes to postural control, joint stability, and movement control. Proprioception consists of 3 sub modalities:

  1. Kinaesthesia,
  2. Joint position sense (JPS), and
  3. Sense of force or resistance.

 Prevelence of chronic mechanical neck pain has increased in the last two decades because of the changed work environments and lifestyle.

Cervical stiffness & dysfunction are major contributing factors for this neck pain, with or without pain in the upper limb.

Research suggests that cervical muscle fatigue and neck pain can negatively influence shoulder & elbow proprioception, affecting the scapular and humeral kinematics i.e., the mechanics of movement of your shoulder complex.

If neck pain & dysfunction or fatigue influence upper-limb proprioception, it is possible that inward inputs from the neck also affects wrist proprioception.This may affect wrist function and lead to instability.

Some studies suggest that subclinical neck pain & cervical extensor muscle fatigue affect the wrist joint position sense. Improper signals from the wrist can cause a lack of or altered body schema, this lead to suboptimal motor recruitment and early fatigue of muscles. Chronicity of this condition can affect wrist stability and function and may lead to chronic non-specific wrist joint pain.

Clinically, manual cervical spine joint mobilization & soft tissue release clinically improve clients’ wrist proprioception, function and pain. For research-based evidence, the intervention has to implement in a larger population, and follow-ups of clients have to be done.

The influence of cervical joint health significantly impacts wrist function and pain.
Cervical joint health is multifactorial and complex, several mechanisms liked muscle imbalances, altered biomechanics, central sensitization, and other factors like occupation, life style, repetitive movement individual difference can contribute to chronic nonspecific wrist pain.

Hence, when facing a non-specific wrist pain, never to miss out evaluating the cervical compenets.

Sumesh A
Sports physiotherapist

Reference:
1. Reece A, Marini F, Mugnosso M, Frost G, Sullivan P, Zabihhosseinian M, Zenzeri J, Holmes MW. Influence of Neck Pain, Cervical Extensor Muscle Fatigue, and Manual Therapy on Wrist Proprioception. Journal of Manipulative and Physiological Therapeutics. 2022 Mar 1;45(3):216-26.
2. Hayat R, Akbar U, Perveen W, Ali MA, Anwar S, Asif R. Comparison of Mulligan Traction and Neural Mobilizations in the Management of Pain in Patients with Cervical Radiculopathies; A Quasi-Experimental Study. Journal Riphah College of Rehabilitation Sciences. 2022 Dec 9;10(02).
3. Zabihhosseinian M, Holmes MW, Howarth S, Ferguson B, Murphy B. Neck muscle fatigue differentially alters scapular and humeral kinematics during humeral elevation in subclinical neck pain participants versus healthy controls. Journal of Electromyography and Kinesiology. 2017 Apr 1;33:73-82.

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