When Wrist Pain Is Not Just Practice Soreness: Gymnast’s Wrist in Growing Athletes

Gymnast’s wrist, medically known as distal radial physeal stress syndrome, is an overuse injury of the growth plate at the end of the radius (the forearm bone on the thumb side).^[1]

In growing children and teenagers, the distal radial growth plate is made of softer cartilage that allows the bone to lengthen. When a young gymnast repeatedly loads the wrist in extension – for example during handstands, walkovers, back handsprings, vaulting and bar skills – large forces travel through this vulnerable growth plate. Over time, that repeated stress can cause inflammation, microscopic damage, and eventually structural changes in the growth plate.^[2]

Studies suggest that wrist pain from overuse is very common in youth gymnastics, and gymnast’s wrist may affect up to about forty percent of young non-elite gymnasts.^[1] Wrist pain overall has been reported in as many as forty six to eighty eight percent of gymnasts, highlighting how heavily this sport loads the wrist joints.^[3]

Because the radius bears the majority of weight when a gymnast is on their hands (often around eighty percent of the axial load), the distal radial growth plate becomes a prime site for overuse injury.^[4]

Growth plates are weaker than the surrounding bone and ligaments in children and adolescents, especially during peak growth spurts between roughly ten and fourteen years of age.^[1]

During these years, gymnastics training often becomes more intense:

• Moving up competitive levels
• Adding more difficult skills
• Increasing weekly training hours

This combination of vulnerable growth plates and rapidly rising load is a perfect storm for distal radial physeal stress syndrome.^[5]

Most sports use the hands for grip and manipulation. In gymnastics, the wrists regularly act like ankles: they are weight-bearing joints for landings, tumbling passes and powerful vaults. Impact during some skills can put one to more than two times body weight through each wrist.^[2]

Repeated loading in wrist extension and compression across the distal radial growth plate – especially with limited recovery – drives the stress reaction that becomes gymnast’s wrist.^[1]

Catching gymnast’s wrist early is critical. In the beginning, symptoms may be subtle and easy to dismiss as “normal” soreness. But persistent wrist pain in a growing gymnast is never something to ignore.

Parents and coaches should be alert to:^[2]

• Pain on the thumb side of the wrist (distal radius), especially with weight-bearing on the hands
• Pain that is worse during or right after practice, particularly after tumbling, vaulting or bar work
• Ongoing wrist soreness from practice to practice, rather than soreness that fully resolves with rest days
• Tenderness when pressing over the distal radius near the growth plate
• Mild swelling or fullness around the wrist joint
• Stiffness or discomfort when extending the wrist, for example when doing a push-up position

Young athletes may not always verbalise pain clearly. Indirect clues can include:

• Reluctance to perform handstands, back handsprings or vaults
• Changing hand placement or technique to avoid loading the painful wrist
• Complaints of “weakness” or “collapsing” on that side

Some features suggest more advanced or severe injury and should trigger early specialist review:^[3]

• Pain that persists at rest, at night, or outside of training
• Visible deformity of the wrist, such as the ulna (little finger side) appearing relatively longer or more prominent
• Significant loss of wrist range of motion, especially extension
• Pain severe enough to limit daily tasks like writing, lifting objects, or supporting body weight during everyday activities
• History of wrist pain continuing for months despite “training through it”

Early recognition and rest at this stage can prevent progression to growth plate arrest and long-term deformity.

A sports medicine physician or paediatric orthopaedic surgeon will start with a detailed history and physical examination. Key points include:^[3]

• Type, duration and severity of wrist pain
• Training volume, recent increase in hours, or move up in level
• Skills that aggravate symptoms (for example tumbling, vaulting, bars)
• Whether rest improves symptoms or pain persists

On examination, there is typically:

• Localised tenderness over the distal radial growth plate
• Pain when loading the wrist in extension (for example pushed-up position, handstand simulation)
• Possible loss of extension and sometimes subtle swelling

Plain radiographs (X-rays) are usually the first step. Classic findings of distal radial physeal stress syndrome can include:^[6]

• Widening and irregularity of the distal radial growth plate
• Blurring or ill-defined borders of the growth plate
• Beaking, sclerosis, or cystic changes at the distal radius
• Evidence of positive ulnar variance (the ulna appears relatively longer if radial growth slows)

In early stages, X-rays may appear normal. Magnetic resonance imaging is more sensitive and can reveal stress-related changes in the growth plate cartilage and surrounding bone marrow before clear radiographic abnormalities are present.^[7]

Advanced imaging helps distinguish distal radial physeal stress syndrome from other causes of wrist pain in young athletes such as ligament injuries, carpal osteochondral lesions, or acute fractures.

The most serious concern with untreated distal radial physeal stress syndrome is damage to the growth plate that alters how the radius grows over time.

Chronic overload can eventually result in partial or complete premature closure of the distal radial growth plate.^[3]

Consequences can include:

• Shortening of the radius relative to the ulna
• Positive ulnar variance, where the ulna ends up longer than the radius
• Increased load passing through the ulna and ulnocarpal joint
• Development of deformities reminiscent of conditions like Madelung-type wrist changes, with altered alignment and prominence of the distal ulna^[8]

When the radius stops growing normally but the ulna continues, the altered mechanics can lead to:^[3]

• Ulnocarpal impaction syndrome (excess load on the ulna side of the wrist)
• Triangular fibrocartilage complex tears or degeneration
• Chronic wrist pain and reduced grip strength
• Early degenerative changes and limited range of motion in late adolescence or early adulthood

These complications can be painful, may require surgical correction, and can permanently affect the athlete’s ability to participate in high-level sport or even everyday tasks.

The good news: when gymnast’s wrist is identified and treated early, most young athletes heal fully with rest and proper load modification.^[2]

Management of distal radial physeal stress syndrome focuses on two priorities:

1. Unload and protect the injured growth plate
2. Address the factors that caused the overload in the first place

In the acute or painful phase, standard recommendations typically include:^[2]

• Stopping impact and weight-bearing skills on the hands (tumbling, vault, handsprings, handstands, bars)
• Using a wrist splint or cast if advised, to limit movement and protect the growth plate
• Applying ice and using pain relief strategies as recommended by the physician
• Temporary cross-training that avoids wrist loading, such as stationary biking, some lower-body conditioning, or carefully selected core exercises

The length of rest depends on severity and imaging findings, but several weeks of reduced or no wrist loading is common. The key is that pain should substantially improve before progression.

Once pain has settled and the physician confirms that healing is progressing, a physiotherapist or athletic trainer can guide a structured rehabilitation programme. Components often include:^[5]

• Gentle range of motion exercises for the wrist and forearm, respecting pain limits
• Progressive strengthening of the wrist flexors and extensors, forearm muscles, shoulder girdle, and core to better distribute loads
• Proprioceptive and control drills, such as closed-chain weight-bearing on soft surfaces in a controlled, low-load way
• Technique refinement, focusing on safe alignment in handstands, springboard take-offs, and landings

A key aim is to build tolerance to controlled wrist extension and loading without re-triggering pain.

A safe return-to-sport plan for gymnast’s wrist should be gradual and criteria-based, not purely time-based.^[5]

Typical principles:

• No significant pain with daily activities and low-level loading drills
• Near-normal wrist range of motion when compared to the opposite side
• Adequate strength in forearm and shoulder muscles

Then, supervised progression might follow this type of pattern:

• Basic support positions: modified hand support on inclined surfaces or padded blocks, short holds only
• Controlled handstands on soft surfaces with strict technique and limited repetitions
• Low-impact tumbling drills with hands on soft surfaces (for example wedge mats)
• Gradual reintroduction of vaulting drills and bar skills, starting with low forces and lower volumes

The athlete should move to the next step only if the wrist remains comfortable during and after training, with no flare-up the next day.

Coordination between the medical team, coach, parents and athlete is crucial. Rushing back to full routines too early is a common reason for recurrence.

Use this checklist during the season to spot gymnast’s wrist early:

• Do you feel pain on the thumb side of your wrist when you do handstands, tumbling, or vaults?
• Does your wrist hurt from one practice to the next, even after a rest day?
• Do you feel like your wrist is weaker or “gives way” during skills?

• Skipping or modifying skills that require full wrist extension
• Shaking out the wrist frequently during practice
• Using tape or wrist guards more often without clear explanation

If the answer to any of these is “yes” and symptoms persist for more than a couple of weeks, a sports medicine evaluation is warranted.^[2]

Prevention is not about eliminating wrist load completely – gymnastics by nature is a high-impact sport. The goal is smart, age-appropriate, and growth-aware training.

1. Monitor Training Volume and Growth Spurts

   Coaches and parents should be especially cautious when:^[1]

   • A child suddenly increases training hours or competitive level
   • The athlete is in a rapid growth spurt (clothes and shoes suddenly becoming small, rapid height changes)

   Building regular rest days and off-seasons into the training year allows the skeleton to adapt.

2. Emphasise Technique and Surface Choices

   • Teach proper wrist alignment in handstands and tumbling to avoid extreme end-range loading.
   • Use softer training surfaces (for example foam pits, resi mats) when learning new or high-impact skills.
   • Limit repetitive high-impact drills in a single session, especially for younger gymnasts.

3. Strength and Conditioning for the Upper Body

   Progressive strength training for shoulders, forearms, and core can help distribute forces more evenly and reduce the load on the distal radial growth plate.^[9]

4. Early Reporting Culture

   Create an environment where young athletes feel safe saying “my wrist hurts” without fear of losing their place or disappointing their team. Normalising early reporting of pain is one of the most powerful prevention tools.

• Gymnast’s wrist (distal radial physeal stress syndrome) is a growth plate stress injury of the distal radius in young gymnasts caused by repetitive loading in wrist extension.^[1]
• It is common, especially between the ages of about ten and fourteen, and is linked to rapid increases in training volume and difficulty.^[1]
• Persistent thumb-side wrist pain from practice to practice is not normal “soreness” in a growing gymnast and should not be ignored.^[2]
• If left untreated, distal radial physeal stress syndrome can lead to growth plate arrest, deformity, ulnar-sided overload and early degenerative changes, sometimes requiring surgery.^[3]
• Early diagnosis, a period of rest and protection, structured rehabilitation, and a carefully planned return-to-sport pathway allow most young athletes to return safely to gymnastics and other sports.^[2]

For parents and coaches, the guiding principle is simple: if a young gymnast’s wrist keeps complaining, listen early. Acting on those early warning signs is the best way to protect both their current performance and their long-term wrist health.