Sports Medicine or Physical Therapist

[d4mo]

I recently started doing some weightlifting, and my left wrist is pretty sure. It's fine until I flip my palm over(so it's facing up) and it's pretty sore on the knobby wrist bone(pinky side). It seems to feel a bit better the more I move, but when I stop moving it, it get sore again. I want to go somewhere to get it checked before I do permanent damage.

I've been to regular doctors for things like this, and they just tell you to take ibuprofen. So I'm looking for someone that specializes in things like this more. Should I go to a Sport Medicine Doctor or a Physical Therapist?

 

[Miramonti]

It's usually the sports medicine doctor that writes a prescrip for a pt, which sounds like you need.

 

[SociallyChallenged]

It's usually the sports medicine doctor that writes a prescrip for a pt, which sounds like you need.

Well, it's actually any doctor so a general practitioner may be cheaper and easier to get a referral. You simply go in and say, "I have wrist pain with activity. I wanted to see a physical therapist" and they should give you a prescription. Some states don't even require them so you may wanna call a nearby PT clinic and check.

To the OP: the physical therapist can evaluate you thoroughly and assess if you have any serious damage, which would lead to you getting an MRI. Honestly though, the PT will be able to do the most thorough evaluation of your wrist and other contributing factors (like the way you move, compensations for finger, forearm, elbow, or shoulder limitations, weakness, joint laxity, etc). The first plan of care is nearly always conservative care so it's cheaper to get the MRI only if you need it. A PT will know if an MRI is indicated by your responses to special tests, range of motion assessment, strength assessment, pain pattern, etc so it's cheaper and gets you quicker treatment if you see a PT.

Where are you located? I might be able to suggest a clinic for you.

 

[d4mo]

I went to a sports med dr. this morning. They did Xrays and that sort of thing. They said that it was prob just a weak ligament(I can't remember the name, something between the ulna and something else) from a previous injury. Someone put me in a BJJ wrist lock.

He suggested continuing to lift weights, and try to strengthen things, and see if it gets stronger. If not I should see a hand surgeon and see if they think I should have it scoped.

 

[purbeast0]

i've had that same exact pain before, and it happens to me when i put a lot of stress on my wrist. it's usually only my left wrist as well, and the outer side near the pinky as you say. and when i put my palm face up and "stretch" my hand back towards the top of my forearm, that is when it hurts the most.

i am at a computer all day as i'm a software dev, and i think being at a computer typing all day doesn't help at all.

what i got that has helped a lot is those wrist straps that juts give you more support. i wrap them around my wrist on specific exercises that i noticed would hurt the most. this includes pretty much all pressing exercises, and i also use them when i do heavy barbell curls.

it has helped tremendously since I started using those, which was some time ago now. and i don't ALWAYS use them when bench or shoulder presses, but only when it has been bothersome a little bit. i ALWAYS wear them though when i do closegrip bench press as well as skull crushers and barbell curls.

 

[Miramonti]

I went to a sports med dr. this morning. They did Xrays and that sort of thing. They said that it was prob just a weak ligament(I can't remember the name, something between the ulna and something else) from a previous injury. Someone put me in a BJJ wrist lock.

He suggested continuing to lift weights, and try to strengthen things, and see if it gets stronger. If not I should see a hand surgeon and see if they think I should have it scoped.

That doesn't sound very specific or very helpful imo. Hopefully it would be mri'd before a scoping appt. is made, and only after physical therapy is attempted. Each time I've gone to a physical therapist (3 times, back, knee, and ankle), I've had excellent experiences, rehabbed what I needed to rehab, and learned a lot about current treatment to improve, as well as how to take care of the affected area in the long run.

 

[d4mo]

That doesn't sound very specific or very helpful imo. Hopefully it would be mri'd before a scoping appt. is made, and only after physical therapy is attempted. Each time I've gone to a physical therapist (3 times, back, knee, and ankle), I've had excellent experiences, rehabbed what I needed to rehab, and learned a lot about current treatment to improve, as well as how to take care of the affected area in the long run.

Thats kinda what I thought. My plan is to let it rest for another week or so, my try to do some light lifting, and if it is unchanged(or worse) I'm just going to make an appt with a physical therapist. My insurance doesn't require a referral.

I lose more and more faith in doctors every time I go to one.

 

[SociallyChallenged]

Thats kinda what I thought. My plan is to let it rest for another week or so, my try to do some light lifting, and if it is unchanged(or worse) I'm just going to make an appt with a physical therapist. My insurance doesn't require a referral.

I lose more and more faith in doctors every time I go to one.

I hear this more and more nowadays. Sports med doctors don't really give more helpful advice than orthopedic surgeons. If it's a weak ligament, you can at least get the joint moving in a healthy way, strengthen specific musculature around it, improve the amount of stress the ligament can handle, work on functional goals, etc at PT. For musculoskeletal injuries that don't put you in 7-10/10 pain, just go straight into a PT. If it does, then you should definitely get some imaging done prior to seeing one (an x-ray is typically fine). Either way, I hope you find a good PT - as with any profession, there are differing qualities practitioners. Find one with a good rep and go there. Honestly, a good PT is worth their weight in gold. Let us know how it goes.

PS: Surgery is not an option until conservative treatment is attempted. Don't let him get you into surgery until you've put 4-6 weeks in at a PT clinic (roughly how long it takes ligaments to get on the right track to heal).

 

[d4mo]

I hear this more and more nowadays. Sports med doctors don't really give more helpful advice than orthopedic surgeons. If it's a weak ligament, you can at least get the joint moving in a healthy way, strengthen specific musculature around it, improve the amount of stress the ligament can handle, work on functional goals, etc at PT. For musculoskeletal injuries that don't put you in 7-10/10 pain, just go straight into a PT. If it does, then you should definitely get some imaging done prior to seeing one (an x-ray is typically fine). Either way, I hope you find a good PT - as with any profession, there are differing qualities practitioners. Find one with a good rep and go there. Honestly, a good PT is worth their weight in gold. Let us know how it goes.

PS: Surgery is not an option until conservative treatment is attempted. Don't let him get you into surgery until you've put 4-6 weeks in at a PT clinic (roughly how long it takes ligaments to get on the right track to heal).

Thanks for the reply. I appreciate the help. Would going to a PT next week be too early? Is the PT gonna look at my chart, I wonder why I'm in already and not listening to what the Sports med guy told me to do? It's going to be the same hospital system so they will see it on their charts....haha.

 

[Miramonti]

Thanks for the reply. I appreciate the help. Would going to a PT next week be too early? Is the PT gonna look at my chart, I wonder why I'm in already and not listening to what the Sports med guy told me to do? It's going to be the same hospital system so they will see it on their charts....haha.

That's great if you have coverage for a pt and don't need a script. And it's better that the pt can see the chart and xrays, and they will understand your concern imo. And I guarantee you, they will have much better advice and plan of action than what you got from the sports med.

I have a lot of faith in pt's based on my experiences. I believe experience tends to make better pt's, as with most professions, but overall I've found them very conscientious, methodical, thoughtful, and cautious...and very sensible (atleast for my injuries, which were properly identified and addressed.)

However it's not someone that you go to until you are completely healed. You start with them, make progress, and they give you a plan of action. Successful therapy requires that you do the exercises/treatment at home that you're asked to do and with the frequency you're asked to do them, and not just when you visit them. It also requires patience on your part...there often is a desire to push to fast once things feel better, but the goal is long term recovery and getting the ailment to as close to 100% as possible, not 'wow, you're a fast healer'. So respect their advice, don't do too much too early and overly-risk a setback.

 

[d4mo]

Alright, I think I will give it a week and see where I'm at and if I feel I need to set up a PT appointment. I called my insurance company and the place I want to go to for PT and they said they don't need a referral or a prescription.

Unless you think waiting a week is too long or not long enough to wait? It's not like the pain is horrible, but it's a feeling I know isn't supposed to be there. Also it's keeping me out of the gym.

 

[Miramonti]

Alright, I think I will give it a week and see where I'm at and if I feel I need to set up a PT appointment. I called my insurance company and the place I want to go to for PT and they said they don't need a referral or a prescription.

Unless you think waiting a week is too long or not long enough to wait? It's not like the pain is horrible, but it's a feeling I know isn't supposed to be there. Also it's keeping me out of the gym.

I doubt anything is going to happen by waiting, as long as you don't over exert it and start lifting as usual. PT is generally something someone does when the body won't heal itself in a reasonable amount of time. Sounds like you haven't had it long and didn't sustain a sudden injury to acquire it (indicating perhaps something more severe), so it doesn't sound urgent at all.

At this point, you don't want pain to continue to exist while 'pushing thru the pain' with strenuous activity imo. If there are exercises that you can do to isolate and strengthen the area without experiencing much pain, such as wrist raises, that may help the affected area. I'm not entirely sure of the exact area you're referring to or had a similar injury, but light exercises, stretching, range of motion, and ice have been a recurring themes in my rehabs, including moderation until things show stability/improvement w/o additional pain or discomfort. Sometimes thats fairly soon, sometimes not.

Of course, these thoughts are based on my experiences tho, and I'm so NOT educated in this, lol.

 

[SociallyChallenged]

Thanks for the reply. I appreciate the help. Would going to a PT next week be too early? Is the PT gonna look at my chart, I wonder why I'm in already and not listening to what the Sports med guy told me to do? It's going to be the same hospital system so they will see it on their charts....haha.

Going to a PT really isn't ever too early. It's pretty much the most conservative intervention and, in a lot of cases, the earlier you get in the better. Sometimes, I question the usefulness of in-house PT clinics. If they don't do any hands-on treatment, you may want to try to find another clinic. Exercises can do a lot, but some clinics rely on it solely (in addition to other easy, not-very-useful interventions like modalities). You should get some joint mobilizations for cartilage and capsular nutrition, potentially along with some massage, exercise, education on fixing your biomechanics, etc.

From my point of view, the patient makes the final decision in their plan of care. I don't really judge patients when they come to PT. Sometimes, surgery is really the only option and we'll continue to reinforce that idea, but we'll treat them and get them stronger, less symptomatic, more flexible, etc because their surgical outcome will be much better if they go through with it.

 

[SociallyChallenged]

I doubt anything is going to happen by waiting, as long as you don't over exert it and start lifting as usual. PT is generally something someone does when the body won't heal itself in a reasonable amount of time. Sounds like you haven't had it long and didn't sustain a sudden injury to acquire it (indicating perhaps something more severe), so it doesn't sound urgent at all.

At this point, you don't want pain to continue to exist while 'pushing thru the pain' with strenuous activity imo. If there are exercises that you can do to isolate and strengthen the area without experiencing much pain, such as wrist raises, that may help the affected area. I'm not entirely sure of the exact area you're referring to or had a similar injury, but light exercises, stretching, range of motion, and ice have been a recurring themes in my rehabs, including moderation until things show stability/improvement w/o additional pain or discomfort. Sometimes thats fairly soon, sometimes not.

Of course, these thoughts are based on my experiences tho, and I'm so NOT educated in this, lol.

I don't necessarily agree with this timeline. The body should run through the inflammatory phase in 3-7 days and pain should start to alleviate from that point forward. If someone has pain for greater than 2 weeks, their body is already showing signs of poor healing ability, whether that's due to overuse, genetic contributions, excess intrinsic stress on the ligament/muscle.

Also, I guess I should make this known. I'm currently a 2nd year PT student. I treat patients full time right now, as part of my program. My interest is in orthopedic PT (pretty much the area that would treat the OP).

 

[d4mo]

Going to a PT really isn't ever too early. It's pretty much the most conservative intervention and, in a lot of cases, the earlier you get in the better. Sometimes, I question the usefulness of in-house PT clinics. If they don't do any hands-on treatment, you may want to try to find another clinic. Exercises can do a lot, but some clinics rely on it solely (in addition to other easy, not-very-useful interventions like modalities). You should get some joint mobilizations for cartilage and capsular nutrition, potentially along with some massage, exercise, education on fixing your biomechanics, etc.

From my point of view, the patient makes the final decision in their plan of care. I don't really judge patients when they come to PT. Sometimes, surgery is really the only option and we'll continue to reinforce that idea, but we'll treat them and get them stronger, less symptomatic, more flexible, etc because their surgical outcome will be much better if they go through with it.

The PT I'm thinking about going to is not an in-house PT at that specific clinic. We have a sports training facility, that has PTs that do alot of rehab on our local sports teams(not national teams if thats what your thinking haha). So I was thinking someplace like that should be helpful.

 

[SociallyChallenged]

The PT I'm thinking about going to is not an in-house PT at that specific clinic. We have a sports training facility, that has PTs that do alot of rehab on our local sports teams(not national teams if thats what your thinking haha). So I was thinking someplace like that should be helpful.

Yeah, those places tend to be higher caliber - that's a good choice. From the sound of things, the wrist isn't killing you, which is good. It will take some time to unload the tissue and get the healing process going, but you'll probably notice differences in quality of movement and discomfort early on.