April 11, 2017

Hi Dr. Bell, I have been experiencing wrist pain when performing hammer curls. The pain occurs when I’m lowering the weight, on the side of my wrist. The stricter the form I use, the worse the pain is.

Thank you for providing me a question that enables me to create a “teachable moment” for ALL IFPA Certified Trainers!

First, I want to make a modification to a very old joke.

Patient: “Dr. it hurts when I do hammer curls!”

Doctor: “Stop doing hammer curls!”

As silly and OLD as the joke may be, it is absolutely, 100% unequivocally CORRECT.


Second, I want to take this opportunity to reinforce the FIRST & most important rule for all IFPA Certified Personal Trainers. DO NO HARM!

If it hurts… STOP! All IFPA Certified Trainers have been educated to know that the burning sensation of a muscle targeted with a 15RM set is an absolute necessity. Training our personal training clients to work through the pain of the “burns” is critical to their success, but the pain of damage, especially pain in a joint, tendon, fascia, ligament or bone is to be AVOIDED at all costs.

Anytime and every time it occurs.

Third, you need to review your IFPA Personal Trainer manual, The Book on Personal Training, especially the section of exercise management with special attention to the Safety Guidelines, Injury Management and P. R. I. C. E.

The first moment you felt a “twinge” at the site of the injury and the exact point you felt pain, you should have employed P. R. I. C. E.

Protect: The site of pain/injury by cessation of exercise and protect it from further injury.

Rest: The site by avoiding an exercise or physical activity on the injured site by avoiding pain.

Ice: The site by putting ice, cold pack, etc. directly on the injured area with some cloth or wrap between the ice and the skin to prevent the ice from causing any skin damage.

Compression: Use an ACE bandage to supply pin point pressure to the site of injury without cutting off circulation to distal tissue. In this case if your hand and /or fingers change color, get tingly or numb, then loosen the bandage. One layer of ACE bandage can act as the wrap to keep the ice from direct contact with your skin and prevent skin damage.

Elevation: Elevating the injured area can prevent excessive blood flow to the injury that can cause swelling, inflammation and increased friction in the area that could result in additional damage.

If you follow these steps at the first sign of pain, the healing process is relatively quick and painless. Continuing to train on damaged tissue is the worst thing you can do.

The “General Rule of Thumb” is the more pain you feel, the more damage you have done. The more you continue to “work through the pain,” the more damage you are doing!

If the pain is high and damage is severe, you are advised to see your doctor and let him refer you to the appropriate physical therapist.  Personal Trainers should not be performing physical therapy that is outside their scope of practice.

Unfortunately, the reality for many Americans right now, who have lost their healthcare insurance, lost their doctor and literally cannot afford to see a doctor, I will tell you what I would do personally for myself if I were to experience what you describe.

As previously mentioned, apply P. R. I. C. E. to the painful site post your exercise session.

Cold therapy for 3 sessions of 15 minutes up to 3 times per day for 2 weeks.  During this time, you can continue every other exercise that does not cause pain. You can also incorporate massage therapy to the injured site. After the 2 weeks of cold therapy you will return to performing Hammer Curls, but at a very, very low intensity.  Since you are reporting pain on the eccentric contraction (lowering the weight) you will use a load that will be just barely at the pain threshold on the eccentric contraction. This is a low level of discomfort. You can feel the discomfort at the injured site, but the pain is such that you can “feel the tissue working, but not causing more damage.”  The damaged tissue needs gentle strength and flexibility exercise to stimulate the repair and healing of the damage, but the intensity is required to be low enough NOT to cause more damage.

Every contraction should be slow and controlled. Your motivation is NOT to increase size and strength, but to heal and repair. Use P. R. I. C. E. after every session.

If I were feeling pain, swelling, inflammation or irritation in the area while not exercising I would also take ibuprofen according to directions to reduce the inflammation.

It is a little bit of a challenge to determine the precise tissues you have damaged because of your description and the large volume of muscle, tendon, ligament, fascia and bones in the general area you describe.

Based on your description, I will give you my best guess. As you and all IFPA Certified Personal Trainers know, Hammer Curls target the brachioradialis muscle located in the forearm. The brachioradialis muscle has its origin on the lowest portion of the humerus and travels the entire length of the forearm and inserts into the distal radius at the base of the wrist. This sounds like the site of injury you describe. The muscle is largely located on the proximal end of the forearm and gets thinner as it approaches the mid-forearm.  From mid-forearm down to the wrist it is primarily tendon and the insertion point is very thin. This seems to be the point of damage you describe.

It is possible you have developed a tendonitis, but since you describe a pin point pain at the site of insertion, my best guess is that you have a tear at the site of the insertion. I just wish I could see and palpitate the area to make sure. In any case, I told you what I would do to recover, repair and rehabilitate the area. Gentle strength and stretching (stretching in all range of motions).THE IFPA CERTIFIED SPORTS MEDICINE CERTIFICATION COURSE is an excellent source of information for you to learn the Treatment, care and prevention of all the common injuries, Sports and otherwise. The true value is learning to PREVENT injuries to yourself and your client! Good luck and train safely!

Dr. Jim Bell, CEO, IFPA

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