Case Study: Resolving End-Range Wrist and Forearm Pain After Overseas Travel
Sometimes “wrist strain from luggage” isn’t the whole story.
(Fascial Counterstrain Treatment – 3 Sessions)
Disclaimer: This case study is based on a real treatment series. Identifying details have been changed to protect patient confidentiality. Individual results will vary.
Background
A patient attended the clinic with a frustrating problem: right forearm/wrist pain that only appeared at the very end of movement.
They had recently travelled overseas and, like many people, handled luggage frequently. What made this case unusual was the timeline: they didn’t recall a single moment of injury, and the pain didn’t show up immediately. Instead, it became noticeable about a month after returning home.
Even more interesting:
- It only hurt at end-range pronation or supination (turning the palm down or up as far as it can go).
- It didn’t hurt during everyday tasks like brushing teeth, using cutlery, or light gripping.
This pattern often suggests the body is protecting something—sometimes locally at the wrist, and sometimes further “up the chain.”
The First Clinical Question: Is This a Wrist Cartilage Problem?
With a more conventional musculoskeletal lens, one structure that can’t be ignored is the TFCC (Triangular Fibrocartilage Complex)—a cartilage complex that supports the small bones and mechanics of the wrist.
So we did what good assessment requires: we tested it.
I performed appropriate wrist screening and compression/provocation testing to see whether the symptoms behaved like a TFCC-type irritation. While the wrist deserved respect as a possible source, the testing didn’t convincingly explain the entire picture—especially because the pain reliably appeared with active end-range rotation.
That was the turning point: if the local structure doesn’t fully account for the symptoms, we widen the search.
Looking Wider: What Else Was Contributing?
Using my Fascial Counterstrain assessment framework, the body showed multiple areas contributing to the restriction and irritation.
Three themes stood out:
Upper thoracic stiffness (T1–T2 region)
Their upper thoracic spine was rigid and under-moving. In many people, reduced mobility here can change how the neck/shoulder/arm system loads and coordinates—especially during end-range rotation.Autonomic and soft-tissue tension around the upper chest and rib cage
Further assessment suggested protective tension through the rib cage and upper chest tissues—areas that can influence shoulder girdle mechanics and neural sensitivity.Local wrist and forearm tissue irritation
I also found tenderness and restriction around the wrist region itself, including the periosteal (bone-covering) tissues around the carpal bones, plus a specific chain of muscles along the right upper limb that were over-recruiting as a protective response.
Treatment Session 1: Reducing the System’s “Protective Hold”
Treatment focused on:
improving mobility and reducing protective tension at the cervicothoracic / upper thoracic region
addressing relevant autonomic and soft-tissue restrictions through the upper chest/rib cage
treating local wrist periosteal points and related forearm/upper limb muscle chains using Fascial Counterstrain principles
By the end of the session, they re-tested rotation and reported:
full pronation/supination was still there, but pain had dropped by about 50%.
Not perfect yet—but a meaningful change in one visit, and a strong sign we were on the right track.
Session 2 (5 Days Later): The Improvement Held
Five days later, the patient reported the result had lasted. They hadn’t “flared it up” again, and day-to-day function remained comfortable.
Now the pattern had narrowed:
supination was pain-free
only full pronation still triggered mild–moderate pain
That’s often what happens when the system is settling: the problem becomes more specific and easier to target.
This session followed the reassessment findings and focused more heavily on:
remaining autonomic nervous system drivers
further periosteal and fascial restrictions around the wrist/forearm region
Session 3 (2 Weeks Later): A Small Twist, Then the Real “Map” Appeared
Two weeks later, they had a minor aggravation: while holding a rail on public transport, a sudden stop caused a small twist through the right wrist. The increase in pain was mild—but it was enough to remind us the system still had some sensitivity.
We reassessed again. This time, the body revealed a broader pattern that needed clearing.
To summarise, I treated three key spinal regions that were contributing to the chain:
cervicothoracic junction (lower neck / upper thorax)
mid-thoracic spine (between the shoulder blades)
coccyx / tailbone region
Across these areas, treatment addressed a combination of:
fascial restrictions associated with neural and vascular pathways (in the Counterstrain model)
periosteal restrictions
protective muscle patterns that were maintaining the end-range irritation
After treatment, the patient re-tested:
full pronation and supination without pain
end-range no longer felt “blocked” or sharp
What This Case Suggests
In hindsight, this didn’t behave like a simple “I strained my wrist” story.
It looked more like this:
the body had accumulated older restrictions, overload, or unresolved protective patterns
travel and luggage handling may have been the last straw, not the true root cause
the wrist became the messenger, not necessarily the only problem area
There’s a saying often shared in manual therapy circles: the painful area may be the “victim,” not the cause.
In this case, the lasting change came when we stopped treating it as “just a wrist” and instead treated the whole chain influencing end-range rotation.
A Practical Takeaway
If you have wrist or forearm pain that:
appears only at end range,
doesn’t match a clear injury, and
lingers despite rest,
…it may be worth assessing beyond the wrist itself. A thorough evaluation can help decide whether this is a local tissue irritation, a movement-chain problem, or a combination of both.
If you’d like help working out what’s driving your symptoms, you can book an appointment at Fascial Release Clinic.
Frequently Asked Questions
1) Could this have been a TFCC injury even though testing wasn’t clear?
Possibly—but TFCC irritation usually has a more consistent pattern with specific loading, gripping, or ulnar-side wrist provocation. In this case, the symptoms didn’t behave strongly like a classic TFCC presentation, and the best improvements occurred when we treated the broader movement chain.
2) Why would the upper back or rib cage affect wrist rotation?
Arm movement is a whole-system action. Shoulder blade control, thoracic mobility, and neural sensitivity can all influence how the forearm and wrist load at end range. When the upper trunk is stiff or protective, the arm may compensate — and end-range rotation can become a tipping point.
3) What does “autonomic” mean in this context?
It refers to the nervous system pathways that regulate protective tone, sensitivity, circulation, and tissue reactivity. In some people, calming these drivers can help reduce “over-protection” and allow smoother movement.
4) How many sessions does this usually take?
It varies. Some people improve quickly; others need more time depending on how long the problem has been present, the number of contributing regions, and day-to-day aggravators.
5) Should I get imaging first?
Not always. Many wrist and forearm issues can be screened clinically, and imaging is most useful when there are red flags, significant trauma, suspected fracture, or persistent symptoms that don’t respond as expected. If needed, I’ll liaise with your GP regarding appropriate next steps.