Wrist flexor tendinopathy: understanding your wrist pain and getting back to activity

What is wrist flexor tendinopathy?

Wrist flexor tendon anatomy

The wrist flexor muscles sit on the inner side of the forearm and their tendons attach to the palm side of the hand. They flex the wrist and contribute to grip strength. This tendinopathy causes pain on the inner side of the wrist or forearm, the mirror image of golfer’s elbow but located lower down, at the wrist.

Why do these tendons become painful?

Pain appears when the wrist flexors are repeatedly loaded beyond their capacity, typically during wrist flexion movements and forced gripping (golf, throwing, weight training). Too rapid an increase in training volume or unsuitable technique are common contributing factors.

Symptoms and diagnosis of wrist flexor tendinopathy

Typical pain and its triggers

The pain sits on the inner side of the wrist or lower forearm, triggered by wrist flexion against resistance and by forced gripping (squeezing, pulling, carrying). It can also appear on direct palpation of the tendons, just below the wrist crease.

Differential diagnosis

Several wrist or forearm conditions can resemble this tendinopathy:

• Golfer’s elbow, which affects the same flexor muscles but at their attachment at the elbow, higher up the forearm[1]
• Wrist extensor tendinopathy, the mirror image but located on the outer side of the wrist
• Carpal tunnel syndrome, which tends to cause tingling or numbness in the fingers rather than pure pain on movement

Causes and risk factors

This tendinopathy develops when the wrist flexor tendons are repeatedly loaded beyond their capacity to adapt at that point in time.

Biomechanical and personal factors

• Too rapid an increase in training volume or intensity
• Unsuitable gripping or swing technique
• A strength or endurance deficit in the wrist and forearm flexors
• Returning too quickly after a period of rest

Which sports contribute to wrist flexor tendinopathy?

Any sport with repeated wrist flexion and forced gripping exposes these tendons:

• Golf (swing and club grip)
• Climbing (prolonged forceful gripping)
• Racquet sports such as tennis and padel
• Crossfit and Hyrox (pulling movements and heavy loading)
• Throwing sports (baseball, javelin)
• Repetitive manual activities

Treating wrist flexor tendinopathy in rehab with a sports physio

The goal of treatment is to progressively strengthen the wrist flexors to restore their capacity to absorb load, particularly through eccentric work.

1. 1Reducing pain and managing load
2. 2Wrist and finger mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Full forearm work
7. 7Correcting sporting technique
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“It’s not that the tendon is fragile, it’s that the load needs to be better dosed and distributed.”

Eccentric strengthening, the cornerstone of treatment

Strengthening the wrist flexors, particularly through eccentric work, restores their capacity to absorb the load specific to your sport.[2] This is complemented by comprehensive forearm and grip work.

In brief

• Eccentric strengthening of the wrist flexors
• Progressive, comprehensive forearm work
• Correcting technique if needed
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary. It’s better to temporarily adapt the movements that clearly reproduce the pain, while starting eccentric strengthening as soon as possible.

When should you see a specialist for this tendinopathy?

If the pain persists for more than four to six weeks despite adapting your activities and following a well-run strengthening programme, a medical opinion is recommended.

Expected recovery timeline for wrist flexor tendinopathy

Gradual improvement is generally seen over several weeks to a few months with a well-run eccentric strengthening programme, with recovery speed depending mainly on how long the symptoms have been present when treatment begins.

Preventing recurrence

Once the pain has settled, several measures can help stop it coming back:

• Keep up regular maintenance of eccentric strengthening for the wrist flexors
• Progress your training volume in stages, especially after a period of rest
• Work on your gripping or swing technique with a coach if it’s a contributing factor
• Warm up the forearm and wrist specifically before golf, throwing or climbing

The HOPP care programmes to treat your flexor tendinopathy and get back to sport

This tendinopathy requires rigorous, progressive eccentric strengthening. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your wrist is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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