Why do my wrists hurt in Pilates? The why behind weight-bearing exercises

Hands down, weight-bearing is an important part of Pilates!

There are plenty of exercises that ask your hands, arms and shoulders to support your body weight. And while your wrists might not always be thrilled about it, there are some very good reasons we do it.

Weight-bearing is an important part of a well-rounded Pilates practice because it helps to:

• Build upper body strength by challenging the muscles of the arms, shoulders and back to support the body against gravity.

• Develop whole body stability by asking the muscles of the spine, shoulders and pelvis to work together to maintain postural control while forces are transferred through the body.

• Develop capacity for daily demands because we regularly use our arms to carry, push, pull, reach and catch. Training these movements in weight-bearing positions prepares us for the demands of everyday life.

• Provide loading to the bones. We now know that weight-bearing, weight-training and resistance type exercises can maintain and even improve bone mineral density, which is increasingly valuable as we age.

Why can weight-bearing hurt your wrists?

Many Pilates exercises including planks, push-ups and side work (e.g. Leg Pull Front, Star, Side Bend), require your hands to press into the floor while your wrists are bent backwards to support your body weight. This is known as wrist extension which is completely normal for the wrist, but it can be uncomfortable when the joint isn’t accustomed to taking load in this way.

Wrist pain shouldn’t be ignored. One study of people experiencing wrist pain during weight-bearing with the wrist extended, found an identifiable abnormality on MRI in 84% of participants*. This is a reminder that persistent wrist pain may sometimes have an underlying cause that deserves assessment.

There are also some common pathologies that can make it challenging to load your wrists such as: carpal tunnel syndrome, tendinopathy, arthritis and previous injuries or fractures. If in doubt, please see a healthcare professional.

Sometimes it isn’t even your wrists that are the problem!

Your wrists don’t work in isolation. When you weight-bear on your hands, forces are transmitted through the wrist, elbow and shoulder, while the muscles around the shoulder blades and your trunk (serratus, trapezius, spine stabilisers and abdominals), work together to hold the body up against gravity.

When your Instructor won’t let you start your push-up until your head, shoulders and spine are optimally aligned, there’s a good reason! It’s to help you organise your body efficiently during the weight-bearing movement, rather than asking one part of the body (enter the wrist) to do more than its fair share.

So next time you are holding a plank, don’t only focus on your wrists but consider for a moment, are you actively engaging the muscles of your shoulders, arms and abdominals as well?

So what can you do to be free from wrist pain?

Keep weight-bearing in your Pilates practice, but change the way you load your wrists.

1. Change the amount of force

A plank on your feet is more demanding than a plank with your knees down. You can also place your hands on an elevated surface, such as a Pilates box or Reformer bar, or even against a wall, to change the angle at which load is being transferred through the wrist.

Have you tried push-ups against a wall recently? (stand away from wall, lean forward placing hands shoulder width apart on the wall). Wall push-ups are surprisingly challenging, but much kinder to the wrists. If you really want to challenge yourself, try one arm!

2. Change the wrist position

Using a prop that allows the wrist to stay closer to neutral, such as a wedge, Makarlu, 1/2 foam roller or push-up handles, can make a big difference.

Research has found that push-ups performed with a neutral wrist, distribute forces differently from those performed with the wrist in hyperextension**.

3. Change the movement strategy

Your hands shouldn't be passive points of contact.Try spreading your fingers and actively ‘push the floor away’. This engages support through the hands and shoulders rather than sinking into the wrists.

Weight-bearing shouldn’t be left to the wrists alone! Your Instructor may say; ‘widen across the back of the shoulders’, ‘lengthen the collar bones’, ‘point your elbows outwards and soften’, ‘stack your shoulders over wrists’. These are cues to help you distribute load more evenly through the shoulders, elbows and hands, which can make a significant difference to how your wrists feel.

4. Build overall arm and shoulder strength

We also need the muscles of the shoulders and arms to be strong enough to support us.

Stepping away from weight-bearing exercises and strengthening the body in other positions can be a great way to build this capacity. Exercises such as kneeling arms on the Reformer or standing arms on the Tower can strengthen the arm, back and shoulder muscles. The stronger these muscles become, the more effectively they can contribute when you return to weight-bearing. So the next time you find yourself in a plank, your wrists don’t have to be ‘the heavies’!

5. Ask your Instructor for a modification

A good modification doesn’t necessarily make an exercise easier, it simply changes the exercise so you can achieve the same movement goal with a load your body can currently manage. Moving from straight arms to your forearms in a plank is a good example. In a side plank, bending the bottom leg can also reduce the demand on the wrist.

The good news? With regular and progressive load practice, your weight-bearing capacity will improve.

The takeaway

• Weight-bearing is an important part of every Pilates practice but it doesn't look the same for everyone.

• If your wrists are uncomfortable, don't push through the pain or assume planks are no longer for you. Instead, change the load, position, movement strategy or modify the exercise to find a version that does work for you.

• If wrist pain is persistent, worsening or affecting your everyday activities, have it assessed by a healthcare professional.

• Your Pilates practice should challenge your capability, not fight it!

Evidence

• *Dorsal wrist pain in the extended wrist-loading position: An MRI study

https://pmc.ncbi.nlm.nih.gov/articles/PMC5658215/?utm_source=chatgpt.com

• **Force transmission through the wrist during performance of push-ups

https://pubmed.ncbi.nlm.nih.gov/28684196/

• Effects of wrist position and support surface location on muscle activation during push-up exercise

https://journals.sagepub.com/doi/abs/10.1177/09593020261436169?utm_source=chatgpt.com