Do Your Hands Swell Up When You Run?

author : AMSSM

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I've noticed when running that my hands start to swell. I started running with a fuel belt and started sipping water about 15 minutes into my run. It seemed to help for a few runs, but not all.

Member Question from cafenervosa

"I've noticed that about 20-30 minutes into my run my hands start to swell. I was initially told it was from the beginnings of dehydration, that my body is trying to hold onto fluid at all costs. I started running with a fuel belt and started sipping water about 15 minutes into my run. It seemed to help for a few runs.

It's been crazy hot down here so I thought maybe an electrolyte supplement might help. I started adding Nuun to my water after about the 30 minute mark, but I still seem to occasionally notice the swelling. It doesn't happen all the time, even though all of my runs are pretty much at the same time of day (around noon-ish) at the same location (outside in a park).

What is causing this? If it's dehydration, why doesn't it happen all the time?"

Answer from Jason M Matuszak, MD
Member AMSSM

There are a few possible reasons you develop swelling in your hands: normal heat dissipation, muscle inactivity, and less likely dehydration.  Although this problem is common in runners and not usually a worrisome health problem, if you have concerns that this may be a serious medical problem, please discuss them with your personal physician.

Your blood contains both fluid and cellular components. The fluid doesn’t necessarily always stay inside blood vessels (intravascular space) but can move into the soft tissue, such as in your hands. There are certain forces that dictate how much fluid comes through the walls of the blood vessels into the surrounding tissue (extravascular space).  The higher the volume of blood and the weaker the walls of the blood vessel, the more fluid moves from inside the blood vessels to outside the blood vessels. The blood vessels with the thinnest walls are the peripheral capillaries, and are especially in the hands and feet.

During exercise, the body tries to maintain a steady core temperature.  In order to dissipate heat, the body preferentially shunts blood to our skin from our core.  Blood is returned to the heart via the veins from the rhythmic contraction of muscles.  When we are running, we are not using our hands much, so extra blood pools in our hands.  Both body temperature regulation and the inaction of hand muscles increase the blood volume in the thin walled peripheral capillaries, and lead to more fluid moving out of the vessels and into the surrounding tissue.

To understand the effect of dehydration, you need to know that fluids shift in response to the relative concentration of electrolytes and proteins in the fluid and in the surrounding tissue, seeking to equalize the concentrations in a process called Osmosis. When your protein or electrolyte levels are low in your blood stream compared with the surrounding tissue, fluid moves from the blood vessels into extravascular space to try and increase the relative concentrations of the electrolytes and proteins in the bloodstream.  When electrolyte levels are high in the blood stream, the movement of fluid is from the surrounding tissue into the blood vessels to dilute the level in the bloodstream to that of the surrounding tissue, lessening swelling.

Try not to think about this swelling of the hands as being a problem, but as reflecting one of the body’s natural responses to exercise, especially in hot humid environments. This is particularly true if you are somebody who routinely takes in water without a sufficient amount of electrolytes, or if you are not a big protein person. Hot, humid environments usually will result in the most extremity swelling and cool, dry conditions will usually give the least.

Tips:

• Stay hydrated, especially with electrolyte containing fluids and, or under the direction of your physician, consider salt tablets.

• Make sure your diet has enough calories and protein in it for the level of activity you are doing.

• Consider changing the environment that you run in, either by changing the time to a cooler part of the day, or by changing the location of your workout.

• Think about other ways to cool yourself during your workout.

• Open and close your hands while running so the muscles assist venous return.

Jason M Matuszak, MD
Chief of Sports Medicine
Excelsior Orthopaedics
Associate Team Physician
Buffalo Bisons
Clinical Assistant Professor
University at Buffalo, School of Medicine

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date: November 5, 2010