Wrist pain from pull ups? How to recognise a TFCC injury.

Article updated April 2023.

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).

wrist pain from pull ups

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 include lat pulldowns, rows or chest presses. 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.

Pull up bars come with different grip options so you can find a position that works best for your wrists.

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.

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