I recently received an email from a reader who was diagnosed with Scapholunate Advanced Collapse (degenerative arthritis of the wrist). In her letter, she explained that the only advice her doctor gave her was to avoid exercises that put the wrist into extension, but didn't give her much guidance beyond that." she asked. As a strong, active woman (who wants to keep it that way), she asked: What exercises can I perform without causing additional pain or damage?"
Before I start discussing safe ways to exercise, I need to talk about the anatomy of the wrist and hand.
The wrist joint is made up of eight small bones (the carpal bones) and the two long forearm bones (the radius and the ulna).
The proximal carpal bones articulate with the radius and ulna as well as the distal carpal bones. The distal carpal bones articulate with the proximal carpals and the five metacarpals (long bones in the hand).
The most commonly injured carpal bone is the scaphoid, which is located near the base of the thumb.
Scapholunate Advanced Collapse (SLAC) is the name given to a pattern of degenerative changes that occur in the wrist joint. SLAC can occur as a result of injury to the scapholunate ligament, an intra-articular wrist fracture (fracture of the distal radius), pseudogout, or rheumatoid arthritis.
With SLAC, the scaphoid doesn’t rest in the scaphoid fossa properly; this alters wrist kinematics and can destroy the articular cartilage. In advanced stages, the lunate bone can move dorsally (away from the palm).
Clinical signs and symptoms of SLAC can include decreased range of motion in wrist flexion and radial deviation (moving toward the thumb side of the hand), pain with upper extremity weight bearing (pushing off a chair to stand, or pushups), possible swelling, increased pain at the end range of motion, joint locking, and joint instability.
The diagnosis is usually confirmed by an x ray.
Conservative management can include steroid injections, use of heat, wearing custom splints, and gentle exercises to maintain wrist range of motion.
Patients with SLAC may benefit from a consultation with a Certified Hand Therapist (CHT). A CHT is an occupational therapist or physical therapist who has a minimum of five years of clinical experience, including 4,000 hours or more in direct practice in hand therapy. In addition, the Certified Hand Therapist has successfully passed a comprehensive test of advanced clinical skills and theory in upper quarter rehabilitation.
A CHT can evaluate the patient and make recommendations on splints and non-surgical management of SLAC. A CHT is a vital member of the team for patients who undergo surgical fixation of SLAC. Patients who opt for non-surgical treatment of SLAC will need to modify their training programs to avoid increased pain and dysfunction.
Joint protection techniques are important, and avoiding excessive wrist motion and weight bearing are two ways to protect the joint.
Patients with SLAC should avoid pushups and lifts such as front squats, which force the wrist joint to bear weight in full extension.
Exercises can be modified to avoid these positions (try forearm planks instead of pushups, and back squats instead of front squats).
It's important to maintain the range of motion of the wrist and hand to prevent stiffness, so gentle stretching exercises can be incorporated into your warm up. A consultation with a CHT can be invaluable since you will receive an exercise program developed for your individual situation.
For patients with rheumatoid arthritis and osteoarthritis, there is some emerging evidence that diet can play a part in decreasing inflammation. Some of my patients, especially those with autoimmune illnesses, find that following a diet and lifestyle plan similar to The Whole 30 leads to improved quality of life. You can read more about nutrition and lifestyle changes on the Whole 9 Life website or in their New York Times Bestselling book It Starts with Food.
If you want more information about SLAC, take a look at this article which explains the condition in greater detail.
Note from GGS: A condition such as SLAC may require specific treatment and training protocols. If you are not diagnosed with a particular condition and are simply feeling achy, stiff, or locked up, we strongly recommend including injury prevention strategies in your training program to address mobility, stability, and overall movement.
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