how to increase strength/endurance with weak ankles & wrists?

February 5, 2013 1:04 PM

I'm looking for suggestions about strength- and endurance-building exercises -- general types or specific motions -- that will either engage my super-weak ankles and wrists in order to strengthen them or avoid using said weak bits entirely in order to avoid exacerbating the existing problems. Preceding that, I am not even sure which route to take in the first place: activate/try to strengthen these weak areas, or avoid/leave well enough alone?

I am not seeking medical advice per se, but let me acknowledge up front: YANMD/PT.

I'm a longtime hatha yoga practitioner looking to increase my overall fitness/cardio endurance and strength levels with a few specific bodily limitations in mind, particularly my wretchedly weak wrists and ankles. In addition, I have a very poorly-healed break in my right hand's fifth metacarpal; I've found out the hard way that this completely eliminates lifting barbells and hand weights from strength training routines.

Ankle business
Major overpronator. In poses like pyramid and wide-legged forward bend, the exterior of both of my ankles develops a very strong burning sensation rather quickly; if I don't come out of the pose right away, my ankles will cramp and lock up so tight that I have to sit down immediately.
I can no longer do eagle pose at all because when I crouch down, pressing all of my body weight down onto that one ankle makes it feel like it is going to shatter. Simple one-legged balance poses (like tree, warrior III, etc.) are usually OK as long as I limit my holds. Unfortunately, I've been doing yoga for years and the ankle cramps have not gotten any better. Running or walking at a brisk pace also causes the same sort of pain, but it takes quite a bit longer for it to kick in -- maybe 45 minutes of jogging, versus a 45 seconds of triangle.
Is there a common area that is "activated" by these exercises? I'm not sure how to describe it other than the "exterior of my ankle" region, but when it's acting up, the pain also extends along the side of my foot and toward the middle of the top of my foot as well.

Wrist business
Recurring ganglion cyst on the top of my right wrist, middling right-side ulnar nerve damage but it's not extensive enough to require surgery yet, RSI/general office monkey injuries up the wazoo. I switched to mousing with my left hand many moons ago, but my job requires extensive keyboard jockeying, and 15+ years of 100+ WPM typing have left me entirely unable to space or shift with my left hand instead of right.
Absolute no-nos, in addition to barbells and such: push-ups, anything even remotely related to an arm balance, plank, upward-facing dog, cobra. Downward-facing dog is OK, apparently due to the angle, the problem seems to be direct vertical pressure on the wrist, forward or backward, which is why the one time I tried to do a bench press, only a kind-hearted spotter prevented the bar from crushing my trachea.

Other business
Gym membership/personal trainer ain't in the cards, but I can definitely seek out a physical therapist through insurance. I have a budget-level spin bike coming my way within the next few weeks and intend to use it for ~30 minutes every morning and evening.
I have no trouble maintaining a comfortable/healthy weight and diet, so I'm not looking to gain or lose pounds at all; I am only looking to build strength and increase my cardio endurance without accidentally effing up my arms and legs any further.

Any tips? To-dos or not-to-dos? For example, would wrist/ankle weights help or hurt? Could I wear them as I ride my spin bike?

Thank you kindly!

posted by divined by radio to health & fitness (14 answers total)

Starting with the first steps on Convict Conditioning (especially the inclined wall press) was huge for me in rehabbing my wrists from weakness and ganglion cysts. It seemed kind of ludicrous to go from able-to-do-many pushups to barely-able-to-finish-a-set wall presses, but the build up really helped my wrists.
posted by bookdragoness at 1:19 PM on February 5

What are you doing to correct your gait problems? Because if you really are pronating that badly without correction then you'll be causing problems all over your body, not just in your ankles. Whereas if you are correcting the issues properly, generally through orthotics but sometimes with the correct shoes or whatever, than you shouldn't be getting these problems during exercise in the first place.

If you haven't been to a podiatrist or whatever the local equivalent is for dealing with gait issues then go and do so and get that sorted. They can also give you advice about how to exercise correctly without causing more damage, because the wear on your joints from incorrect exercise is a good way to damage your joints irreparably. And since none of us can see you move, none of us are qualified to tell you how to exercise safely.
posted by shelleycat at 1:24 PM on February 5

You need a physical therapist so badly. Really. Just go. Stop doing anything else until then.
posted by purpleclover at 1:26 PM on February 5 [1 favorite]

Your ankle issues can be solved with balance work. I suggest slacklining, or one of the fancier balance boards(there are 2D rockers like the indo board, and also 3D rockers which use a spherical balance point). There is also the pro fitter 3d cross trainer, which is EXCELLENT for ankle rehab.

For your wrists, I recommend either a flexbar or perhaps you can try one of those hand gyros.

A few minutes a day of balance / wrist work will do wonders.

EDIT: OH I almost forgot, you can try this simple pushup variation for your wrists. Basically, if you do a pushup or plank on the back of your hands, it strengthens the wrists tremendously.
posted by jalitt at 1:43 PM on February 5

First, a mistake: Major underpronator, not over.

* I do have custom-fit orthotics for my shoes, but I do all of my yoga (and most of my other exercising) sans footwear altogether. Should I start wearing my orthotics for yoga? Go back to the podiatrist? Or is there a way to correct gait problems barefoot?

* My insurance requires a "Treatment Plan" to cover physical therapy. Is this something that would come from my general practitioner, the folks I saw about my ulnar nerve entrapment, the would-be physical therapist themselves, or does it depend on the insurance provider? (When I got my weirdo nerve zaps to confirm cubital tunnel syndrome, they just told me to take ibuprofen, even when I asked for a PT referral.) Also, do PTs have specialties, or is any given PT likely to be a one-stop full-body shop?

* I don't have any pain/twinges/any type of issue in any area of my body at all except wrists and ankles, I'm extremely flexible and very healthy altogether, so being told that I may have been seriously and permanently damaging my body every time I've exercised without professional guidance has freaked me out more than slightly. I'll call my doctor tomorrow.

Thanks so much!
posted by divined by radio at 1:51 PM on February 5

Have you ever seen an orthopedist? I know the recommended path is always GP->specialist->treatment plan, but I regret every time I have ever gone to a primary care doc about an orthopedic issue and not gotten a referral to an actual orthopedist. Basically, if I didn't have an obviously broken bone, GPs are all, "Rest, ibuprofen." Which means that the ankle tendon I injured in 2008 is still bothering me (rest did not fix it); I finally got into an ortho and am doing PT.

For my recent bout of PT, the ortho doc recommended eight sessions, and I called a PT office from a list the doctor gave me. They asked what the injury was and assigned me to a therapist. They do all kinds of PT, but I looked for one that was more sports oriented because I do work out regularly (but am not a Serious Athlete or anything.) But for me, walking without pain is not enough; I need to be able to run and jump.
posted by purpleclover at 2:07 PM on February 5

or does it depend on the insurance provider?

In all likelihood, that. Start with your GP, and get a referral to a podiatrist and/or physical therapist. It's probably that any "treatment plan" will have to start with a diagnosis, but I don't know if your particular insurance company will accept a diagnosis from a physician-referred PT, or if it must come from the MD first.
posted by rtha at 3:02 PM on February 5

Not sure if this would be -very- helpful (at the very least, not as helpful as a PT), but I strengthen my ankles by laying down, pointing my toes, and writing out the alphabet, rotating from the ankle. Seems pretty easy at first, but can get tough as you go on.
posted by jorlyfish at 3:12 PM on February 5

I used to have issues with my wrists when I was shoveling (had to move 8 tons of gravel by hand). Then I researched how those muscles work. It's weird. Those muscles reside in your forearms. What I did was started just doing straight forearm lifts while sitting around. Grab a 5lbs bag of rice, rest your elbow on something firm, then lift that bag of rice. A lot. That will help your wrist muscles.

Now, if I'm chilling and watching TV, I grab about a 20lbs weight and use it to work my wrist muscles.
posted by BenevolentActor at 7:55 PM on February 5

Nthing physical therapy.

YMMV, but when I had weak wrists and grip I found hanging from a pull-up bar and fingerboard helped immensely. But I don't know anything about your wrist condition so proceed with caution!

For ankle/wrist weights, I'd see a PT before buying any of those.
posted by zennish at 10:04 PM on February 5

Having custom orthotics, which presumably are doing their job, means the likelihood of joint problems goes way down, so that's good. I asked because you mention similar pain when running, and that shouldn't happen with orthotics that are doing their job (I walked an entire marathon in mine, and I can't walk for more than ten minutes without pain without them). But hopefully your podiatrist has assessed everything so your gait is fixed as well as it can be. Being flexible isn't actually a good thing for gait problems really, it just lets your joints flop around more moving in incorrect directions and increasing wear. Apparently this is more commonly a problem for females since our ligaments tend to be loose for popping out babies, and I've been told regularly that mine are contributing to my ankle problems. Being otherwise strong and building your muscles in the right way to support better form is what you should be going for, which it seems like you are, so great!

I don't know if wearing your orthotics during yoga is appropriate. But a podiatrist or good physical therapist should. I'm currently doing pilates to help with my balance and gait issues and I do it barefoot. But I also had a course of physical therapy first to both sort out the issues that had developed and to build up some baseline strength so that I could move in the correct way, and the classes are run by my physio. I've also found that the balance exercises on my Wii Fit have been helping, both in general and with allowing me to do the harder balance exercises in pilates, but again only after getting professional advice and treatment first. Jumping straight onto a balance board or into wrist exercises could make things much worse rather than better, you really need good advice first to figure out which it's likely to be.

I have RSI issues with my wrists and arms as well as a totally messed up gait and resulting issues. I've never found a GP much use. If you can go straight to the physio, maybe by getting a recommendation from your podiatrist (that's how I found my excellent therapist), and work out a treatment plan with them then you may be able to get things moving along faster.
posted by shelleycat at 2:15 AM on February 6

If it interests you, nothing will strengthen your ankles like ballet. Intro ballet classes are all about learning where certain muscles are and gaining strength gradually so that you can do the steps properly. Many gyms offer adult ballet classes, as do most large ballet/dance schools.
posted by deeparch at 5:17 AM on February 6

It's been amazingly helpful and really enlightening to hear stories from folks who have had the same problems and what steps they've taken in order to alleviate them (namely: PT, PT, PT!).

I have a lot of trouble with grasping 'adult' stuff like when/how to seek out medical attention, as I am imbued with the sentiment that my problems must only be fixed by bucking up and trying harder. Knowing that you shouldn't wait until you are completely debilitated or in unyielding agony before seeing a physical therapist is news to me, for starters!

Action items:
- call insurance to see who writes the almighty Treatment Plan
- make an appointment with those folks
- see physical therapist/podiatrist/orthopedist as recommended
- balance boards, flexbars, rice bag-lifting, alternate push-ups, maybe some ballet! (Really fantastic answers on this end, btw, I had no idea that some of this equipment existed, or about the wrist/forearm strength connection.)

Without y'all, I would've just continued to scan YouTube for more no-wrist and seated yoga routines. If there are more answers or experiences to share for the weak-jointed sufferers of the future, do keep 'em coming, but I'll be sticking with the plan outlined above for now.

Thank you, MeFi.
posted by divined by radio at 7:53 AM on February 6

Hey there,

Drummer here, got a GREAT exercise for your wrists. Learned it from JoJo Mayer!

Put your hands together, like in a prayer position, with both your arms touching. Try to get your elbows to get as close as possible to each other, without straining. Be relaxed! This will feel most comfortable if you move your arms slightly to the left or right of your body. Now, with your wrists still touching, clap your hands 8 times. It will almost be like butterfly wings. That's one rep. Do 100 reps of 8. Go as fast as you can (while staying relaxed) at a steady tempo until you complete all 100 reps. At first, your forearms are going to BURN. Don't stop the reps, but slow down if you need to. Finish all 100. This really should only take 5 mins. Do it in the shower, while watching TV, on a walk, or anything you can do that doesn't require hands at all times. If you do this once a day for a month, your forearms will be 1000% stronger. BUT STAY RELAXED. Straining to finish the reps will only hurt you - push yourself without increasing chances of hurting your body.

Hope this helps!
posted by packfan88c at 8:31 AM on February 6 [1 favorite]