Introduction
When we're climbing, we're constantly putting stress on our hands, wrists, and forearms. And if we're not careful, we can develop injuries like De Quervain's tendinitis.
This kind of tendinitis, as I mentioned in my other article, occurs when the tendons from two thumb muscles are compressed. These tendons run over the wrist bone on the side of the thumb. This compression can cause pain, swelling, and limited mobility.
A drawing of a hand showing two inflamed tendons passing under the extensor retinaculum on the thumb side of the hand.
Affected muscles:
Extensor pollicis brevis
Abductor pollicis longus
So how do we treat this pesky injury? Well, it depends on how long you've had it and how severe it is. If it's acute, meaning it's a new injury, you may need to immobilize your wrist with a splint or brace for a short period of time to reduce the inflammation and allow the tendons to heal.
But don't stop there! You should also start some gentle range-of-motion exercises as soon as possible to prevent stiffness and maintain strength.
If your De Quervain's is more chronic, meaning it's been bothering you for weeks or even months, you may need more aggressive treatment. This can include physical therapy, massage, and specific exercises to strengthen the muscles and tendons in your hand, wrist, and forearm. It's important to work with a physiotherapist who can guide you through the rehab process and help you progress at a safe and effective pace.
But let's not forget about prevention! One of the best ways to prevent De Quervain's and other climbing-related injuries is to focus on developing well-rounded strength and mobility in all the muscles and joints used in climbing.
This means paying attention to your shoulders, elbows, and wrists, as well as your fingers and forearms. Incorporate exercises like push-ups, pull-ups, dips, and wrist curls into your training routine to build strength and reduce your risk of injury.
But this article is about the rehabilitation of De quervain's syndrome, so let's get back on topic and continue with taking a deeper look at the biomechanics and the symptoms, before I introduce a rehab strategy that has proved effective in treating De quervain's tendinitis (you'll find it at the end of this article).
2. Biomechanics of De Quervain syndrome
De Quervain's syndrome is caused by overuse or repetitive movements of the wrist and thumb. This can lead to irritation and inflammation of the tendons that run through a narrow tunnel at the base of the thumb, called the extensor retinaculum. The tendons become swollen and thickened, making it difficult for them to move smoothly through the tunnel.
When the tendons move through the tunnel, they rub against the walls of the tunnel, which can cause further irritation and inflammation. This can result in pain, swelling, and difficulty moving the wrist and thumb.
Certain activities can increase the risk of developing De Quervain's syndrome, such as repetitive gripping, twisting, or pinching with the thumb and wrist. This can be seen in activities such as using a computer mouse, playing a musical instrument, performing manual labor tasks, and of course climbing.
3. Symptoms
Some common symptoms of De Quervain's syndrome include pain and tenderness in the wrist and thumb, on the thumb side of the hand.
In climbing, it is often in pinch grip and undercling that pain is worse, but in engaging in all forms of gripping can provoke pain.
You may also experience swelling or a lump on the thumb side of the wrist, as well as a clicking or catching sensation when moving the thumb.
If you have De Quervain's syndrome, you may find it difficult to perform everyday activities that require grasping or pinching, such as opening a jar, turning a doorknob or typing on a keyboard.
List of symptoms of De Quervain's tendonitis:
Pain and tenderness in the wrist and thumb
Difficulty moving the wrist or thumb
Swelling or a lump on the thumb side of the wrist
Clicking or catching sensation when moving the thumb
Difficulty grasping or pinching objects
Difficulty performing fine motor tasks with the hand
4. Rehabilitation
Step 1: Rest and Immobilization
The first step in treating De Quervain's syndrome is to rest the affected area and immobilize the wrist and thumb. This can be achieved by wearing a splint or brace that immobilizes the thumb and wrist, allowing the tendons to rest and heal.
Step 2: Ice and Compression
Applying ice to the affected area for 15–20 minutes, two to three times a day, may help reduce pain and inflammation. Additionally, wrapping a compression bandage around the wrist can help reduce swelling and provide support.
Attention: The use of ice is being heavily debated in the world of sports therapy and rehabilitation, as recent research has questioned the effectiveness of this approach. Go to my article: Does ice help in the management of acute injuries? To get up to date on the topic.
Step 3: Gentle Range of Motion Exercises
After a period of rest and immobilization, gentle range of motion exercises can be started to help maintain flexibility and reduce stiffness. These exercises include:
Wrist Flexion and Extension: Make a fist with your thumb outside your fingers and move your wrist up and down.
Radial and Ulnar Deviation: Keeping your wrist straight, move your hand towards your little finger (radial deviation) and towards your thumb (ulnar deviation).
Thumb Flexion and Extension: Move your thumb away from your hand (extension) and back towards your palm (flexion).
Thumb Abduction and Adduction: Move your thumb away from your fingers (abduction) and back towards your fingers (adduction).
Perform each exercise for 10-15 repetitions, two to three times a day.
Step 4: Strengthening Exercises
Once range of motion has been restored, strengthening exercises can be started to improve the function of the wrist and thumb. These exercises include:
Wrist Extension with a Resistance Band: Attach a resistance band to a stable object and hold the other end with your affected hand. Keeping your wrist straight, move your hand up and down.
Thumb Opposition: Place your hand flat on a table and move your thumb towards your little finger, then back towards your index finger.
Pinch Grip with a Ball: Squeeze a soft ball between your thumb and fingers.
Perform each exercise for 10-15 repetitions, two to three times a day.
Step 5: Gradual Return to Activity
Once the pain and symptoms have improved, gradually return to activities that previously caused pain. It's important to start slowly and gradually increase the intensity and duration of activity over time.
If pain persists, modalities like anti-inflammatory medicine, cortisone or surgery are treatment options which should be considered.
So there you have it, climbers!
De Quervain's tendinitis may be a pain, but with the right treatment and prevention strategies, you can get back to crushing those projects in no time.