Wrist impingement

What it is

Compression of the soft tissue at the back of the wrist when the joint is taken to its end range of extension under load. The tissue between the bones gets pinched repeatedly and becomes irritated and thickened, which narrows the space further. It is a mechanical and load problem rather than damage to a specific structure, which is why it usually responds well to changing how the wrist is loaded.

How volleyball causes it

Blocking puts the wrist into extension with a ball hitting it. Setting loads it at the top of the range hundreds of times a session. Pressing up off the floor after a dig does the same with body weight behind it. It tends to appear in players with limited wrist extension range or weak forearms, and in beach players pushing up out of the sand repeatedly.

BlockingSettingDefense

What it feels like

• A sharp pinch at the back of the wrist when you bend it fully back.
• Worse blocking, setting, or pushing up off the floor.
• Usually little or no pain with the wrist in neutral.
• Sometimes a tender spot or slight swelling on the back of the wrist.
• Grip strength is normal, which distinguishes it from most tendon problems.

Stop and get it seen if

• Pain following a fall onto an outstretched hand, which needs a fracture ruled out, particularly at the base of the thumb.
• Numbness, pins and needles, or weakness in the hand.
• Marked swelling, deformity, or inability to move the wrist.
• Pain that persists at rest or wakes you at night.
• A lump that is growing rather than settling.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Get out of the pinch

   1 to 2 weeks

   Stop repeatedly loading the exact position that hurts.

   • Push-ups and floor presses done on fists or handles rather than flat palms.
   • Setting volume reduced, with bump setting used where it is legal and sensible.
   • Daily activities are comfortable.
   • Symptoms settle rather than accumulate across a week.

2. 2. Build the forearm

   3 to 6 weeks

   Strengthen the wrist through range so the end position is supported rather than raw.

   • Wrist extension and flexion strength work is progressing.
   • Extension range is improving and comfortable.
   • Loaded positions such as a plank on flat hands are tolerable.
   • Blocking a controlled ball does not provoke it.

3. 3. Back to full load

   2 to 4 weeks

Ready to play again when

• Full pain-free wrist extension under body weight.
• Forearm strength comparable side to side.
• A full setting session without pain during or afterwards.
• Blocking hard balls without a pinch.
• No swelling or tenderness at the back of the wrist.

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Build forearm strength in both directions, wrist curls and reverse wrist curls, two or three sets a few times a week. A strong forearm supports the end of the range instead of collapsing into it.
• Work wrist extension range gently and regularly, hands on a table with fingers pointing back, rocking into range without forcing the pinch.
• Press up off a fist or a handle rather than a flat palm when your wrists are sore, so you keep training without repeating the exact provoking position.
• Get setting technique looked at: a set caught deep with the wrist collapsed backwards loads the joint far more than one contacted with a firm, shaped hand.
• Build up beach volume gradually, because pushing out of sand loads the wrist in extension over and over in a way indoor play does not.
• Warm the wrists up before blocking and setting rather than making the first hard ball of the session the first thing they meet.