A Growth Plate Under a Bodyweight Load, and What Happens If It Closes Early
Gymnasts, cheerleaders, tumblers and breakers do something almost nobody else does: they stand on their hands.
A wrist that was designed to grip and position is instead taking full bodyweight, repeatedly, with the wrist bent right back. In a fully grown adult that causes wear. In a child it lands on a growth plate.
Growth plates are cartilage, and cartilage is weaker than the bone around it, so in a growing athlete the growth plate is where the injury goes.
Same principle as little league elbow.
Different joint, same rule: in a young athlete, the weak link is the part that’s still growing.
The symptoms
- Pain on the back of the wrist with weight-bearing. Handstands, back handsprings, vaulting, tumbling, push-up positions.
- Worsens the further the wrist bends backwards, which is why handstands and vaults hurt most.
- Sore afterwards, sometimes fine during, and settling with a few days off, which is precisely why it gets ridden out.
- Tenderness pressing over the back of the wrist, an inch or so above the joint line on the thumb side.
- Sometimes swelling, and sometimes reduced wrist extension compared with the other side.
X-rays in an established case show a growth plate that looks widened and irregular rather than a crisp line, and they should be compared with the other wrist.
Why it matters more than it sounds
Ridden out for long enough, the growth plate at the end of the radius can close early, meaning that the bone stops growing before it’s finished growing!. This is a worrisome statement, by the way.
The ulnar bone beside it keeps growing on schedule.
So you end up with two forearm bones that no longer end level. The ulna now sits proud, driving into the wrist on the little-finger side and taking load it was never meant to carry.
A few millimetres of difference in where two bones end, created in a teenager, becomes a lifetime of ulnar-sided wrist pain in an adult.
The consequences show up years later as TFCC problems, chronic pain on the little-finger side, and sometimes surgery to shorten the ulna to undo a difference that didn’t need to happen.
That’s the argument for taking a teenager’s sore wrist seriously even when they can still compete on it.
Treatment
Unglamorous and effective, provided the first item is actually done.
- STOP weight-bearing on the hands. Not “reduce”. Not “light play or duty” – FULL Stop it, for a minimum of 4 to 6 weeks and sometimes up to 3 months depending on how long it’s been going on. This is the treatment; everything else is support.
- Keep training everything else. Legs, core, flexibility, conditioning, bars work that doesn’t load the wrist in extension. This matters for compliance as much as fitness, because an athlete who is still training will accept a rest from tumbling far more readily than one who has been benched.
- Splint if it hurts in daily life, though many don’t need one once the loading stops.
- Then rebuild. Wrist and forearm strengthening through range, progressive loading from partial weight-bearing towards full, and only then back to skills.
- Then change what caused it. Training volume, the number of high-impact repetitions, wrist supports for tumbling, and technique on landings.
Returning to a full handstand program with the same volume that caused it is how these recur, and each recurrence adds risk to that growth plate.
Other things that cause wrist pain in young gymnasts
Worth ruling out rather than assuming:
- A scaphoid fracture after a fall, which hides on first X-rays at any age.
- Pain on the little-finger side, which suggests the ulnar side of the wrist rather than the growth plate, and can mean the process above has already progressed.
- A ganglion cyst, which is common in this age group and usually harmless.
- Pain at rest and at night, which doesn’t fit a loading injury and needs looking into properly.
The short version
A young gymnast with back-of-wrist pain when weight-bearing has a growth plate problem until someone proves otherwise.
It’s treated by stopping the loading for weeks, not by strapping it and continuing.
And the reason to be firm about that isn’t this season. It’s the wrist they’ll have at thirty.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Tens of thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Persistent wrist pain in a growing athlete needs assessing rather than managing around.