Strength program modification with De Quervain’s tenosynovitis

Training Q&A [Moderated]
1

Dear team,

Apologies in advance for what feels like me post-spamming you guys for advice of late.

Heading into Week 4 of Strength I, I’ve picked up a very sudden-onset case of De Quervain’s in my left wrist. I’m familiar with the condition, I am aware it is likely to be self-limiting, and I am familiar with your guidance on pain in training etc. Incidentally, having looked at recommendations on this forum re: specific physio for De Quervain’s, I’m not sure that the suggested exercises (resisted pincer grip and finger abduction/extensions) will be helpful as I don’t have any discomfort in those movement ranges.

I’m mainly concerned about the priorities with load and rep modification in these circumstances.

  • benching anything more than ~80% e1RM which passively extends a partially-abducted 1st proximal phalanx (i.e. a thumb around the bar) causes too much pain to lock out cleanly. Trying close-grip makes the bottom position too painful to press out. The only grip that seems to work is a modified unilateral suicide grip with thumb and index not gripping, which is clearly not a great thing to do (though I do bench with safeties and am confident I’ll keep my teeth and thyroid cartilage intact in the event of a drop). Unfortunately, I don’t have a neutral/football bar or similar to try. Maybe I could try a strap on the bad side?

  • OHP is even weirder in that I’m trying my odd lay-backed wide-grip press with reverse grip. I’m much less confident about bailing this so I’m not really pushing too hard.

So, should I just do what is tolerable grip-wise, keep the programmed rep ranges and accept it is going to feel a bit easy for a while, or should I add some reps to get towards the prescribed RPE?

Or could/should I just switch to a more unfamiliar similar movement e.g. neutral-grip dumbbell bench/OHP, which might let me reach higher relative intensity but be perhaps less directly transferable to the comp barbell movements?

Thanks for your time in considering this. I’m usually fine with subbing movements and managing tweaks, but this is by far the most annoying lifting impediment I’ve had and I’ve not previously considered how this ties in with overall programming aims.

2

DJ,

Sorry to hear about this. I am hopeful you’ve seen a medical professional about this, as there’s more that can be done for this condition than activity modification. A hand specialist may be beneficial.

I am not sure whether a strap would work or not, though you could certainly try. Fat grips would be another way if the ergonomics are better. If load related, I would go lighter and not change much else in order to go a little heavier. In this example, 70% and 80% would work about the same. Dumbbells for bench and/or OHP may work.

If nothing is working satisfactorily, this situation may require more dialogue via a consultation to find something suitable.

-Jordan

3

Dear Jordan,

Thanks for your concern and advice. I guess I should worry less about missing the heavy singles and go lighter to get the work in. Even at lower intensity, the e1RM for some affected exercises seems to be holding within 5% so hopefully the program is doing its thing.

I’m awaiting a hand consult to see if I’m a good candidate for medical treatment options but I’ll definitely be in touch officially if things continue to impede progress in the medium term.