Wrist pain when overhead pressing: the bar in your hand, the bent-back wrist, grip and swaps

What an overhead press asks of the wrist, and what no study has countedEmerging evidence

In an overhead press the bar's weight comes down through the hands and forearms, first from the shoulders and then from arm's length overhead. With the bar low in the palm over the forearm bones and the wrist stacked over the elbow, the wrist holds a small bend; with the bar back in the fingers, behind the forearm, the wrist folds back and has to stop it bending further on every rep. The site's overhead press guide teaches the first and lists wrists bent back and elbows flared as a common mistake.

No study has measured the wrist in an overhead press: the only press study that included the wrist measured bench presses and cable exercises at 15% and 30% of body weight in 20 adults. In push-ups on a bent-back wrist, force travelled towards the back and the little-finger side of the wrist in 14 volunteers, and in 8 donated wrists a push-up position with the wrist bent back raised the pressure on the scaphoid's joint surface. That a bar sitting back in the fingers loads the wrist the same way, and is the usual cause of overhead press wrist pain, is our reading of these push-up and cadaver studies, not something measured. No study counts wrist pain from overhead pressing.

Sources 1, 2, 3

Grip width, dumbbells and machinesEmerging evidence

In 11 trained men doing seated barbell presses with narrow, medium and wide grips, narrower grips lifted more weight with more shoulder and elbow movement; wider grips pushed the bar outward more, and narrower grips inward. That study measured the bar, the shoulder and the elbow, not the wrist, so that a slightly narrower grip helps a wrist that folds back is our reading.

In 15 men, standing dumbbell presses lifted about 7% less than a standing barbell and about 10% less than seated dumbbells, with the most shoulder muscle activity. In 8 competitive bodybuilders, a shoulder press machine with a palms-in grip worked the shoulder muscles less than a barbell press, so a machine is a stepping stone rather than a full replacement. None of these studies measured the wrist.

Sources 4, 5, 6

Where it hurts, and what it often isEmerging evidence

A hand surgery review of pain in the middle of the back of the wrist in athletes describes the joint lining being pinched, with pain worse at full wrist extension and when loading the wrist bent back; hidden ganglia, to be considered in any athlete whose back-of-wrist pain gets worse bending back under load; and injuries of the scapholunate ligament, where a painful click or grinding when the wrist is loaded is a helpful clue, which athletes may notice in push-ups or the military press.

On the little-finger side, the ECU (extensor carpi ulnaris) tendon is a common source of pain with repeated loading, and the TFCC is the other common cause. On the thumb side, de Quervain's gives pain made worse by lifting the thumb, and UK hand surgeons say sport can aggravate it. Tingling in the thumb, index and middle fingers, often at night, is carpal tunnel syndrome, which the NHS links with frequently bending the wrist or gripping hard. A bar forcing the wrist back can break the scaphoid: two case reports describe it from a bench press, one found on a computed tomography (CT) scan 2 months later.

Sources 7, 8, 9, 10, 11, 12, 13, 14

Who gets it, and what is rareEmerging evidence

Weight-training sports have low injury rates compared with team sports, and the wrist and hand are among the common injury sites; in weightlifting, the hands and fingers made up about 15% of injuries. In 270 CrossFit athletes, 20.4% had had a hand or wrist injury, about three-quarters of them at the wrist, and 72.8% were back to unmodified training within a month. CrossFit participants were more likely to be injured than traditional weightlifters in a 411-person survey, corrected in 2020 in ways that don't change its conclusions, and switching between prescribed and scaled loads went with injury. A review of CrossFit says injuries to the shoulder, elbow and wrist are more common than in traditional weight training. Of 321 adults who practise handstands, 56.7% reported long-lasting wrist pain.

In our reading, the people it usually bothers are people new to overhead pressing or adding load quickly, people who let the bar sit back in the fingers, flare the elbows or press with their thumbs off the bar, lifters who also load the wrist bent back in push-ups, front squats, cleans and handstands, and athletes doing high-rep presses and push presses. Serious causes are uncommon: a broken scaphoid after a missed lift or a fall, a stress injury of a wrist bone in a young high-level athlete, which early X-rays can miss, a joint infection or gout, an inflammatory arthritis, and, rarely, a lump that grows or is hard.

Sources 15, 16, 17, 18, 19, 20, 21, 22, 23, 24

When a scan or test mattersEmerging evidence

Not at first for a gradual ache without warning signs: the NHS starts with home care and a GP if it isn't better after 2 weeks. After a missed lift or a fall with pain at the base of the thumb, an X-ray comes first, but a scaphoid fracture doesn't always show up on an X-ray right away, and the AAOS (American Academy of Orthopaedic Surgeons) describes a splint and a follow-up X-ray after 2 to 3 weeks, or an MRI (magnetic resonance imaging) scan. Back-of-wrist pain that keeps coming back when the wrist is loaded may need an ultrasound or MRI for a hidden ganglion or a ligament injury, while plain X-rays are typically normal in impingement; bone stress injuries of the wrist may not show on early X-rays either. Tingling that lasts needs a GP.

Sources 25, 12, 26, 7, 24

How it usually goesEmerging evidence

No study follows wrist pain from overhead pressing. The NHS expects wrist pain to improve with home care within 2 weeks, or to be checked, and a mild tendon injury to feel better within 2 to 3 weeks. A hand surgery review says most pinched joint lining settles within 2 to 3 months of rest, a splint and anti-inflammatory painkillers. A TFCC tear without an unstable forearm joint is slower: of 72 wrists treated without surgery, 30% had fully recovered at 6 months and 50% at a year. A broken wrist usually takes 6 to 12 weeks. Most powerlifters with an injury keep training with changes: only 16% of those injured stopped completely. No one can promise a date.

Sources 25, 27, 7, 9, 26, 28

The bar over the forearm: our reading of push-up and cadaver studiesEmerging evidence

No study has tested where the bar sits in the hand against wrist pain. A bent-back wrist under body weight sent force to the back and little-finger side of the wrist, and raised scaphoid joint pressure in donated wrists, so holding the bar low in the palm with the wrist stacked over the elbow is a sensible change by analogy, as the site's overhead press guide teaches.

Sources 2, 3

Grip width: more weight with a narrower grip, and no wrist dataEmerging evidence

A narrower grip lifted more weight in the seated barbell press in 11 trained men, and a wider grip pushed the bar outward more. The study measured the bar, the shoulder and the elbow, not the wrist, so a slightly narrower grip for a wrist that folds back is our reading.

Source 4

Dumbbells, a landmine and machines keep the shoulders trainingEmerging evidence

Standing dumbbells cost about 7% of the weight with more shoulder muscle activity in 15 men, and the site's overhead press guide gives palms-in dumbbells as its swap for wrist pain. A machine press with a palms-in grip worked the shoulders less than a barbell in 8 bodybuilders, so it is a short-term step. No study has measured the wrist in any of these.

Sources 5, 6

Wrist wraps: steadier, not strongerEmerging evidence

In a randomised crossover trial of 18 trained adults, flexible and stiff wrist wraps didn't change the most they could bench press once, their power or their bar speed; the wrist felt more stable in the wraps but less comfortable. In 54 CrossFit athletes, a wrap didn't change grip strength (35.7 against 35.6 kg). In the CrossFit survey, 34.5% of those with a wrist injury had worn wraps beforehand, which says nothing either way about protection. No study has tested wraps for wrist pain.

Sources 29, 30, 18

Rebuilding the wrist: NHS hand therapy, borrowedEmerging evidence

No trial has tested a programme for wrist pain from pressing, so the plan borrows NHS hand therapy advice written after wrist injuries. Cambridge's active wrist exercises use each movement 5 to 10 times, 4 to 5 times a day, with 5-second holds, and say a tightness or pulling is normal but a sharp pain means reducing the exercises or stopping for a couple of days. The site's wrist guides add still holds, weighted wrist curls both ways and weight back through the hand on a table, a wall and the floor, from NHS hand therapy booklets. The NHS says keep your hands and wrists moving with gentle exercises, and don't lift heavy objects or grip anything too tightly while it's sore.

Sources 31, 25

Splints, injections and specialist careEmerging evidence

The NHS suggests a night splint for carpal tunnel syndrome, for up to 6 weeks. UK hand surgeons suggest a splint that holds the thumb and wrist for de Quervain's, and say a steroid injection relieves the pain in about 70% of cases. For a pinched joint lining, rest, a splint and anti-inflammatory painkillers come first, and an injection often gives about 70% pain relief for several weeks. A TFCC tear with a stable joint gets at least 6 months of care without surgery first, and a torn scapholunate ligament is best repaired early, within about 6 weeks.

Sources 11, 10, 7, 9

Your overhead press for now (written steps)

Our 3D figure can't show where the bar sits in your hand or your grip width. No trial has tested these changes for wrist pain; each step names its source or says it is our reading or suggestion.

• 1. Hold the bar low in your palm, on the heel of the hand over the forearm bones, with your wrists stacked over your elbows and your thumbs round the bar, as our overhead press guide teaches. That a bar back in the fingers loads the bent-back wrist is our reading of push-up and cadaver studies.
• 2. Grip just outside your shoulders so your forearms are vertical from the front and the side (our overhead press guide); if your wrists still fold back, bring your hands in a little (our reading: a narrower grip lifted more weight in a lab study that didn't measure the wrist).
• 3. Elbows a little in front of the bar, not flared, so the bar doesn't sit behind your forearms (our overhead press guide).
• 4. Lighter, 2 or 3 reps short of failure, no heavy singles while it's sore (editorial).
• 5. Palms-in dumbbells, a landmine press or a machine with palms-in handles while it settles (our overhead press guide; editorial).
• 6. Wraps on heavy sets only, if they make the wrist feel steadier; they didn't change strength in trials and haven't been tested for pain.
• 7. Pressing in a rack, set the safety arms just below shoulder height (our overhead press guide), and decide in advance how you will lower or drop a failed rep, as the move page says; a bar drifting back drives the wrist back, as in one lifter's broken scaphoid.
• 8. Daily life: the NHS says keep your hands and wrists moving with gentle exercises, don't lift heavy objects or grip anything too tightly while it's sore, and don't use heat for the first 2 to 3 days after an injury.

Sources 2, 3, 4, 29, 30, 13, 25

Back to your usual training (written steps)

No study has tested how overhead pressing comes back after wrist pain, so these steps are our suggestion unless a source is named.

• 1. One change at a time: forward-grip dumbbells, then the barbell at about half your old weight, then push presses and jerks.
• 2. The gym: push-ups, planks and burpees on handles, fists or a bench, as our push-up and plank wrist guides say; front squats with crossed arms or straps, as our front squat wrist guide says; the bench press as our bench press wrist guide says.
• 3. CrossFit, weightlifting and kettlebell sport: strict presses before push presses and jerks, with the kettlebell resting on the forearm, not the wrist bent back.
• 4. Typing and carrying shopping: split loads between both hands, carry bags with straight wrists, and take breaks from typing.
• 5. Handstands come back last, as our wrist bending-back guide says.
• 6. Keep forearm work twice a week for a few months.

Source 25