Hello and welcome to Musician’s Maintenance Weekly, where this week it’s my job to answer a question from one of you. The question is: “what are some good exercises for strengthening the wrist extensors to recover from tendonitis?”
To help answer the question I have 1) 11 ways to train your tendons 2) Wrist strength prehab exercises 3) One more wrist exercise.
Before we get started I want to mention that there is a time and place for strengthening after injury. If you consider the water and the cup analogy that I’ve used, you should hold off on strengthening if your cup is still overflowing. In other words, your pain needs to be settled down and stable before starting the loading process, otherwise the exercises below are more likely to flare up your symptoms than they are to improve your tendon health.
With that said, here’s some tips on tendon training.
1. 11 ways to to train your tendons
When using strength training to help any tendonitis, it’s helpful to understand that it’s much more important to improve the resilience of your tendon than make the muscle strong. To help you understand tendon training, I found this nice article on the topic.
The article lists 11 ways to train your tendons. Here are 5 of the ways that I think are most important for musicians with a little of my own commentary.
Eccentrics
Eccentric is just the lowering phase of an exercise. Focusing on lowering is great for tendon health, and the reason that many exercises in the injury prevention program recommend a longer lowering tempo.
Intensity focused exercise
To make a change in your tendons, they need to be exposed to more stress than in your daily life. Yes, the amount of time you spend playing is high, but the loads aren’t that high. Adding load in the form of weights or body weight is crucial to allow the tendon to adapt and become more resilient.
Avoid pain, seek mild discomfort
Tendon training will need to be a little sore as you do it, but you should recover back to your baseline within a few hours after exercising.
Don’t rush, take it easy
Muscles can change their structure after only 8 days of training. Tendons take 2 months or longer. That means you need to train slowly. Here’s a specific recommendation from the article.
“He has them stick with the same weight for 8-12 weeks. The first few weeks are hard. The weight feels heavy. At 4 weeks, it’s a lot easier but still a challenge. At 8 weeks, you start feeling like it’s too easy. And that’s where the tendon-building magic happens. By 12 weeks, what felt tough when you started is now “baby weight.” Your muscles are stronger and your tendons have had enough time to build collagen density.”
Massage and myofascial work
Doing some self massage on the muscles that connect to the tendons you are working on can be helpful. Over at Musician Health Resource, there are finger and wrist recovery rings that look like nice tools to help with this.
Some of the suggestions like plyometrics, explosive isometrics and partial reps don’t apply to musicians, so I would ignore those.
Otherwise the whole article is worth a read, especially if you are interested in learning a little more about tendons.
Read: Why Training Your Tendons is Important (and 11 Ways to Do It)
2. Wrist strength training prehab exercises
Now that you understand a few principles of training tendons let’s get to work with a few exercises for the muscles around the wrist.
Here’s an Instagram post from physical therapist Tom Walters with 5 excellent exercises for wrist strength. They would be a great place to start.
If you like his work, he also has a more comprehensive exercise program for wrist extensor tendonitis that is relatively cheap ($15).
In addition to these basic wrist exercises, there is quite a bit of research out there that shows a link between how well your shoulder and thoracic spine work and how efficiently your wrist muscles work. That means you may want to include exercises for these areas, such as…
- Sidelying thoracic rotation with hand behind head
- Shoulder blade squeezes lying on stomach
- Scapular wall slide
- Sidelying shoulder external rotation
- And probably some first knuckle raises for finger and wrist mobility
Watch: Rehab science wrist strengthening post
3. One more wrist exercise
One of the challenges of wrist extensor tendonitis is that there are several muscles that are involved. Some of the muscles start in the forearm and attach to the base of the wrist (extensor carpi ulnaris and extensor carpi radialis longus if you want to get technical). Another muscle starts in the forearm and goes all the way to the fingers (extensor digitorum).
A common pattern is for the muscle that goes all the way to the fingers get overused relative to the others. So one strategy can be to exercise in a way that minimizes its use and forces the other muscles to do the work a little more to improve the pattern of muscle recruitment.
The exercises above are great for tendon loading, but they all work the different muscles relatively equally, so they won’t help with the pattern of recruitment. Luckily there’s different exercise that can. Click the link below for a video and description and give it a try.