Are you experiencing wrist pain from pull ups or even doing bodyweight exercises? A common cause of ulnar sided wrist pain is the TFCC. Find out more to see if this sounds like you!
Body weight exercises and weight lifting where the grip is either pronated or supinated (palm up or palm down) can place a lot of force through the wrist. This force can cause problems with a structure called the Triangular Fibrocartilage Complex (TFCC).
What is the TFCC?
The TFCC is a load bearing structure that consists of cartilage and tough, fibrous tissue. It connects the forearm to the small bones of the wrist, providing stability and mobility. This complex takes a lot of load during weight bearing positions when the wrist is bent and is the culprit for many painful wrist complaints.
How can the TFCC cause wrist pain from pull ups or in the gym?
A TFCC tear can be classified as either acute (an isolated cause of injury such as a fall onto an outstretched hand) or chronic, where damage has occurred through repetitive load bearing. This sort of injury can be seen in sports such as tennis or gymnastics as well as in weightlifting or high repetition exercise such as Crossfit. Repetitive tasks can create micro-trauma to the TFCC, which eventually leads to pain or irritation in the wrist, felt in the ulnar side (near the little finger).
How do you treat a TFCC tear?
Most TFCC tears heal on their own, but they take time as the complex doesn’t have great blood flow. Initial treatment usually involves rest & ice. As it can be difficult to rest your hand, using a splint to immobilise the joint can be useful. Speed of recovery also depends on what part of the TFCC is torn.
Corticosteroid injections sometimes aid in rehabilitation and recovery, but results vary from person to person. Working with a certified hand therapist in order to strengthen the area and regain mobility is important for a good outcome. In some cases, surgical repair is necessary, usually conducted arthroscopically.
How do you know if you have a TFCC injury?
Wrist pain can be caused by a number of factors, not just TFCC injury. If you’re experiencing wrist pain, it’s wise to seek professional advice as soon as possible to avoid making it worse. Initial actions for acute wrist pain can be rest, ice and even anti-inflammatories in the first 48 hours. For older injuries, heat may be beneficial to promote more blood flow.
A TFCC tear can usually be seen on MRI. Your doctor or physiotherapist may also form the diagnosis by palpating the area on the ulnar side. Other diagnostic tools include getting you to attempt weight bearing through your palm or testing grip strength.
Can you work out with a TFCC injury?
With a TFCC tear, it’s generally best to avoid using your wrist initially to allow the tear to heal. Working with a physical therapist during your recovery is a good way to gradually incorporate your workout regime. Following TFCC injury, you may find it’s more comfortable to keep your wrist in a neutral position where possible.
There are a variety of different attachments for cable machines allowing you to perform exercises with a neutral grip. This can inlcude lat pulldowns, rows or chest press. You may find swapping a barbell for dumbbells puts less load through your wrists allowing you to train more comfortably.
Bodyweight exercises such as push-ups can be particularly problematic for those who have had TFCC problems. Push up handles are an excellent tool for any prone position work such as push ups. They can also help with plank holds or for doing yoga positions such as downward dog.
There are also wrist braces available that may provide some additional support for the TFCC when it is under load. Discuss bracing options with your health professional to find out the most appropriate brace for your injury.
Shoulder pain from pull ups is a pretty common complaint that can prove to be a massive deterrent for people. Here, I break down the most common causes of shoulder pain that people notice when they start incorporating pull ups in to their workout regime.
Put simply, the benefits of pull-ups are worth taking the time to get this stuff right. It might mean a slower approach to pull up training, but it will pay off in the long run.
What’s causing shoulder pain when doing pull ups?
First things first – let’s be clear about the different between good pain and bad pain! As with all resistance training, a new movement type or sudden increase in intensity in your exercise regime is probably going to result in some delayed onset muscle soreness, or DOMS. Because pull ups are such a wicked exercise, they incorporate a whole host of muscle groups, including shoulders, back, forearms and even abdominals. If you’re pulling up sore like you’ve had a dust up with a moving vehicle, but it’s your muscles that are causing pain, there’s a good chance you just created some beneficial fibre tears that need a couple of days to recover before they’re ready to do it all over again. DOMS is a healthy sign that muscles are being worked on.
Some muscle pain, however, can indicate a strain or tear injury, so its’ important to pay attention to your body and recognise when something is out of the ordinary. Pain that is isolated to a certain area, side or isn’t getting better is worth seeing a health professional for advice.
If you’re experiencing pain while you are actually performing pull ups, it’s important again to tell the difference between a good old lactic acid burn in your muscles and something that’s your body telling you to stop.
Shoulder pain that isn’t muscular probably relates to either a problem in your technique, or (and most likely) a mobility issue. I’ve got a whole bunch of upcoming posts on the way with shoulder mobility exercises, so watch this space.
Pay Attention to your Pull Up Form:
The best way to start doing pull-ups is by focusing on your form, not your strength. Doing a set of twenty-five fast, improper pull ups is not going to give you results anywhere near as good five proper, controlled pull-ups. There is no competition when it comes to growing your muscles. It is just you and your body – there is no reason to cheat. A proper pull up requires that you always keep your arms shoulder width apart and pull up slowly, focusing on keeping your back straight and isolating your arm and shoulder muscles.
Do not use force or momentum to pull yourself up, rather ease into each pull and that is how you will get stronger. You could be doing pull-ups for months and not see any results or increased strength if you don’t focus on your form. (Not to mention this is how you end up with shoulder injuries or shoulder pain from pull-ups.) They didn’t do it you, you did it to yourself.
How to tell if I have shoulder mobility issues:
The two most issues facing those that lift weights are connective tissue injuries and a lack of mobility and flexibility. Strength is awesome, but if you haven’t got mobility as well, you are a ticking time bomb for injuries AND you’re wasting a lot of your time trying to increase your weight loads. Improve your ankle and hip mobility? Better deadlifts and squats. Improve your shoulder and thoracic mobility? Better overhead lifting and guess what else? Pull ups!
Here’s some simple tests for you: 1. Standing up with your arms by your sides, try bending your elbow and running the back of your hand up your back, aiming to touch the opposite shoulder blade with your hand. Do it on both sides and have someone take a video. Is there a difference in the two sides?
2. Next, raise your arm straight up above your head alongside your ear and bend at the elbow, so your hand comes down behind your head. Try to touch your opposite shoulder blade again. Repeat on the other side.
3. Put both arms straight up in the air, palms facing forwards. Can your get your arms behind your ears?
4. Sit on the floor, with your knees bent and feet on the ground. Reach your hand behind you as though to support yourself and try to touch your little fingers together. Can you wiggle your hands further away from your butt?
What causes poor shoulder mobility?
For some people, a past injury or musculoskeletal problem may be the obvious cause of poor shoulder mobility and therefore pain when doing pull ups. Dislocation, shoulder impingement, mastectomy, nerve damage and shoulder reconstructions can all impact on shoulder function down the track, especially if good physical therapy is not undertaken during recovery. The great news is that many people with significant shoulder restrictions have made massive improvements years, even decades later with the right exercises and rehabilitation programs.
Rotator cuff injuries and pull ups:
If you encounter pain in the front or outside of your shoulder, it could be a rotator sleeve tear or damage. The ligament situated inside the rotator sleeve in a standout among the most regularly injured ligaments. The rotator sleeve is the protective cover over the shoulder attachment and arm bone framed by a gathering of muscles and ligaments. The acromion ligament, situated between two bones, is effectively squeezed, prompting irritation. This sort of damage is frequently caused by repetitive arm exercises and lifting, particularly when both are finished by lifting your arms over your head. It’s said that roughly that 50 percent of rotator sleeve injuries mend without any interference.
Tendinitis is genuinely well-known issue that can influence about any ligament in the body. Simply tendinitis alludes to an aggravation of the ligament. The biceps ligament is the one most generally influenced because of excessive and repetitive weightlifting. Like rotator sleeve impingement, biceps tendinitis is, for the utmost part, an after effect of the ligament rubbing against bone. In many cases, the pain feels worse when the arm is elevated far from the body or over the head.
How to do pull ups without pain:
If you can find a variation of pull ups that causes you no pain, then it’s probably safe to do so. Obviously run this past a trained professional, but a general rule of thumb, when working around injuries or restrictions is that is it feels ok, it probably is.
Working out pull-ups with neutral grip is termed suitable if one can’t access rotatable handles, rings or TRX straps. This hinders the path of stress concentrating in your elbow which is derived from firm wrists lacking flexibility.
Chin ups are also an alternative movement that targets slightly different muscle groups, but may be able to be performed without discomfort while you work out how to return to pull ups pain free.
Consider some good quality resistance bands that your can step in to while you perform pull ups. The bands will assist you by taking some of the load. You can often purchase packs of bands with varied resistance levels to gradually increase your load when ready.
Back to Basics:
For those who can already perform a pull up, this can feel frustrating, but it’s so worth it. Go back to performing a 30 sec dead hang every day for a week. If you’re getting pain from this, then go no further until you’re worked on your shoulder mobility. The next step from here is a dead hang with an isolated retraction of your shoulder blades. (This means without moving your arms.) Check out my articles on pull ups for beginners. Nail the basics before worrying about massive reps.
How to avoid injuring your shoulders doing pulls ups?
Warm up! I understand the temptation to get straight into the stuff that actually produces results, but guess what? You aren’t going to be producing many results when you’re injured! Take the time for a decent 5-10 minute cardio to get yourself warm and moving. Add on to this a further 10 minutes of mobility work before you get stuck in to your workout. I can’t stress this enough. A few minutes opening up your shoulder and thoracic area before putting it under load will go a long way.
Don’t over train. As much as I love pull ups, I don’t do them every day. Give yourself a rest every other day. A cardio, core or legs session will give your muscle groups a chance to recover. In fact, your pull ups will improve faster by allowing your body to rest between sessions. I also recommend alternating between chin ups to pull ups as well to increase the variety and promote recovery.
Check your form. Video yourself or have someone who knows what they’re talking about watch you while you do pull ups. Something as simple as adjusting to a wider grip solves a lot of your shoulder pain issues. (But you probably need to do some mobility work as well… am I starting to sound repetitive?)
What type of pull up is best for working your shoulders?
A chin-up is a variation of a pull-up. I suggest you do them both to get a comprehensive work out, but the chin-up will work out the upper shoulder muscles more. Pull ups targets your back a little more instead, so if it’s shoulders you want to target, you will notice results faster with chin-ups. Pull ups target the back muscles more. Remember though, that you want to vary these exercises in order to let the muscles grow and prevent injury.
What is the difference between a pull-up and a chin-up?
A chin-up is a variation of a pull-up. The main difference between a pull-up and a chin-up is the type of grip used for each. A pull-up requires an overhand grip, where your palms face away from you. Pull-ups work out the muscles near the elbows like the brachialis, muscles on the lower shoulder area like the latissimus dorsi, as well as your biceps.
I hope this article has been helpful. The main takeaway I hope to convey here is that pull ups don’t cause shoulder pain. What this exercise does do is highlight underlying shoulder issues when it can’t be performed pain free. A huge percentage of people who experience pain during pull ups have poor shoulder mobility. It’s worth taking time to work on your mobility issues because not only will it reduce your risk of injury, but it will improve your performance more than you might expect! Don’t shy away from pull ups – let them be a tool that shows you where your weaknesses are and grow from that.