Wrist Pain after Climbing? It might not be your TFCC

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Due to the location of the pain, it is a natural assumption of climbers that the TFCC is the source of their wrist pain. Nearly all climbers experience wrist pain after climbing at least once in their climbing journey. It is nearly a rite of passage. While TFCC is one of the causes of your wrist pain, it might not necessarily be so. In this article, we share more about TFCC and two other common causes of wrist pain among climbers.

Your TFCC (also known as the Triangular Fibrocartilage Complex) is a load-bearing structure, with its main role as a stabiliser for your wrist. It is very strong and is often injured by a compression type mechanism, e.g., falling onto an outstretched wrist. The majority of climbing movements involve hanging off your fingers and in turn opening, rather than compressing the joint.

wrist pain climbing

Two common causes of wrist pain after climbing

Mechanism of wrist climbing injuries tends to fall under two categories; traumatic and non-traumatic. Traumatic injuries will tend to link to a particular event, coupled with a sudden onset of pain. On the other hand, non-traumatic injuries tend to present gradually with long term overuse. 

Scenario 1 (traumatic)

You grab onto a small crimp, feel your foot slip but you continue to grab on to stop that barn door. You feel a pop or click, and it feels very sore now. Moving at certain angles is very uncomfortable. You are starting to lose range of motion as the outside of your wrist is starting to swell and it is tender to touch.

In this scenario, it is likely you suffered a ligament sprain in the wrist. Ligament sprains happen when the joint is being forced outside its usual range of motion and the joint capsule is excessively stretched. A sprain can range from mild tearing of a few fibres to a more severe complete rupture. At the acute stage, it may be difficult to identify the severity of the injury due to swelling and pain. At initial injury, it is best to come in for an assessment to get a better idea of what we are dealing with. 

Barring complications and prior injuries, you will be able to return to sport in a few weeks with a mild sprain. However, a more severe sprain will likely require immobilisation of the joint, to allow the tissue to recover and restore passive stabilisation in the joint. 

Scenario 2 (non- traumatic)

You have been having that nagging wrist pain for the last few years. It usually comes on when you are holding a gaston, awkward angles of under clings and slopers. You are always taping up your wrists with rigid tape; it will hold up during the climb but will feel sore post-session. The wrist may also click when you rotate it, and you feel like you have to ‘jiggle something loose’ at times. Outside climbing, you likely also spend a lot of time on the computer. However, it is not severe enough to stop you from climbing so you keep going on.

In this scenario, it is likely you are having tendinitis at your forearm flexors from chronic overload. To find out more on tendinopathy, click here (link to tendinopathy article). Given this is a chronic condition, it is not enough to just offload and wait for the pain to settle. The recurrent strains in your wrist will cause scar tissue to build up between the individual bones, which will affect your joint mobility and stability. In summary, with chronic wrist conditions- pain should not be your indicator of recovery! After the episode settles, it is best to get a consult for advice on further rehab you can do to better manage and prevent future flare-ups. 

Common questions regarding wrist pain after climbing

“I am experiencing wrist pain after climbing and have been told to rest- what else can I do to help my wrist recover faster?”

The most common advice in rehabilitation for nagging injuries in any region would be to “go train your antagonist muscles”. This is not wrong; however, there are a few things we must consider when it comes to the wrist.

  1.       Relationship between your finger flexors and extensors

Unlike your biceps and triceps, your finger flexors and extensors do not share the same agonist and antagonist relationship. (An agonist is a muscle that contracts, while your antagonist is the muscle that relaxes when you perform a movement). Instead, they co-contract together to generate maximal force.

Try this- make a fist with your wrist in full flexion and squeeze hard. Now, repeat the same movement with your wrist in full extension. Which position are you able to generate the most force! Hint: wrist extension. This is because your wrist and finger extensors act as antagonist stabilizers for your finger flexors. This is also why you ‘chicken wing’ when you start to fatigue (refer to picture below); as your wrist extensors are trying to put you in a position to generate more force for you to hang on! However, repetitive load into this position will cause potential issues such as elbow pain.

rock climbing
Photo: Alton Richardson

Here are some examples of exercises you can do to increase wrist stabilization in various positions!

  1. a)       Isometric holds on bumper plates with wrist and fingers in extension
Source: Training for Climbing

Recommended parameters: 5 x 30 seconds isometric hold. Vary between closed and open hand grips!

  1. b)     Reverse wrist curls with your fingers in crimp

Recommended parameters: a) 8-12 x 3 sets with 1-2kg dumbbell, b) 5 x 30 seconds isometric hold with 5kg dumbbell

  1.       Kinetic chain involvement

 The next time you are in the gym, take a quick scan of the climbers in the gym- does this look familiar to you?

Fig. 1 “Climbers back”.
Source: Semanticscholar

Contributing factors to injuries down the chain tend to involve both a lack of thoracic mobility and weakness in the shoulder stabilisers. If your shoulders are not able to keep you in these positions (refer to pictures below), your wrist will be forced to deviate and placing excessive load on the active tendons and stress on the passive ligaments.

Here are some examples of exercises you can do to train your shoulder stabilisers!

wrist pain climbing

Recommended parameters: 8-12 x 3 sets. Do remember to keep your wrists in neutral positions when you are doing the exercises. This will help to prime your system when you go climbing next.

Physiotherapy treatment for Wrist Pain

Given the nature of athletes, we all know how hard it is to take a break. However, the climber having the most fun is the one pain and injury free. The sooner you know what is going on and get treatment, the faster you can get back in the game. If you are experiencing wrist pain after climbing, book an appointment with our team of physiotherapists.