Are You Dealing with a Snapping ECU Tendon?
In the summer of 2009, I injured myself while lifting weights. Specifically, incorrectly performing dumbbell cleans lead me to hearing a “POP” in my wrist, which I later found out to become ECU tendon subluxation.
With ECU tendon subluxation, what happens is that the distal tendon of the extensor carpi ulnaris dislocates out of the tunnel on the ulna bone when performing certain movements, then re-enters the tunnel it was supposed to be held in. Basically, a tendon pops out and pops back in your wrist. Here’s a video I found of someone experiencing ECU tendon subluxation:
As you can see in the video, there is a long “bulge” in the person’s wrist. This is the tendon of the extensor carpi ulnaris dislocating instead of being held into place. The problem with this injury isn’t necessarily impairment of the function of this wrist-extending muscle – one can actually function quite normally if the sensation of snapping doesn’t bother the trainee. The eventual irritation and inflammation of the tendon is what becomes problematic for trainees experiencing this injury – the recurrent snapping probably causes microtrauma to the tendon that never heals properly.
Over time, it makes sense that the tendon can become damaged and degrade, eventually affecting the function of the extensor carpi ulnaris. Until then, it’s just a weird “snapping” sensation and some pain.
I don’t know about you, but I wasn’t willing to deal with the pain and the constant reminder that my wrists were screwed up. So, I sought to fix my injury.
Stabilize the ECU Tendon
Whether the ligament that was supposed to held my ECU tendon in place was stretched or torn, I knew that repeatedly having my ECU slip out of place would prevent this ligament to heal. Each time it pops out of place, the ligament is either stretched (if it is not torn) or its two ruptured pieces are pushed away from each other. Effectively, each subluxation re-injures this ligament.
The first thing I did to fix my subluxating ECU tendon was to prevent further snapping. This meant ceasing any activity or movement that caused any snapping (or that I felt could potentially cause it). This meant substantially less time in the gym for me.
I also had to immobilize my wrist for some time. I first started using basic wrist splints. After a while, I found WristWidgets. This product is a sort of wrist-wrap that applies pressure above and below the head of the ulna bone, but not ON the ulna head itself. This helped keep the ECU tendon from snapping by holding it “in place”, while allowing me more range-of-motion with my wrists. These lasted me a few months until the velcro straps wore out. Honestly, I think they’re a wee bit costly considering it’s just a velcro wrist strap (about $30), but the WristWidgets definitely helped prevent further subluxation of the ECU tendon. If you’re interested in the product, Amazon has WristWidgets for sale online.
In retrospect, the splints weakened the hell out of my forearm muscles and grip strength. I’m not sure if they were the best option to use, or if the WristWidgets would have been better for me right off the bat. Oh well, who knows?
Another tool that helped me prevent recurrent snapping of the ECU tendon was teaching myself to keep my wrist neutral at all times. I basically had to drill it in my head to not use excessive flexion, extension, ulnar deviation, and radial deviation, as extreme ranges-of-motion would increase the likelihood of my snapping.
Use Prolotherapy To Strengthen The Connective Tissue
In early 2011, I found a medical doctor who offered to perform prolotherapy on my wrists. In addition to having the ECU tendon subluxation, I also had lax wrist ligaments from excessive stretching.
In short, prolotherapy is a modality used by medical doctors to quicken (or start-up) the healing of connective tissue. An irritating solution (such as sugar-water or sodium morrhuate) is injected in the damaged areas, which causes an inflammatory reaction. Subsequently, repair and remodeling occurs in the area after some time. Here’s what a session of prolotherapy looks like:
I was unresponsive to the treatments at first, which was totally discouraging. However, months went by after receiving the treatments and my wrists felt more stable and resilient. Healing is a slow process, and you do what you can to facilitate the process. In my case, I’m sure prolotherapy had sped things up a bit for my wrists and snapping ECU tendon.
Gradually Reintroduce Movements and Exercises
As I mentioned before, I removed a bunch of movement and exertion as to let my ECU tendon subluxation subside. This was done with the intentions of being able to do everything again, including lifting heavy weights and such.
I found a lot of exercises to be uncomfortable, and sometimes painful. I did figure out what was easiest to start with, though.
Static holds and exercises similar to them were the easiest to tolerate in the beginning. Simply holding onto a weight (or a gallon of milk, or a bag of groceries) was enough of a challenge. This progressed to pulling-motions that involved a similar grip, such as rows and pull-downs. I was stuck with these exercises for a while. It was around one-and-a-half years that I was stuck in this phase.
This is the following order that I reintroduced wrist movements:
- Static gripping (starting with static holds, then moving on to “pull” movements, as mentioned before)
- Wrist flexion (e.g., wrist curls)
- Wrist extension (e.g., opposite movement of wrist curls)
- Radial deviation (tilting wrist towards the side of the thumb, e.g., hammer curls)
- Ulnar deviation and rotation in both directions.
I found ulnar deviation and rotation to be the most problematic when it came to recurrent subluxation of the ECU tendon, so those movements were introduced last. I was already deadlifting and performing pushups by the time they were re-introduced.
Avoidance of Extreme Ranges of Motion
Even today, I still do not push my wrist into the extreme-ends of flexion (except during pushups), extension, and ulnar deviation.
The number of times I’ll experience ECU tendon subluxation per year can be counted on hand. It is only when I accidentally venture into these extreme ranges-of-motion that I’ll ever feel a bulge or a snap in my wrist. This doesn’t hinder me at all for 100% of my training regimen. The only lift I’m unable to do still is the barbell clean, because having the barbell sit on my delts requires a shit-ton of wrist flexion. That’s okay, I find speed deadlifts and kettlebell swings to be decent alternatives.
There you have it, folks. That’s pretty much how I solved my ECU tendon subluxation on my own.