Carpal tunnel syndrome is a phrase that gets thrown around a lot in conjunction with wrist pain, including in yoga. It’s common for practitioners to jump to their own diagnosis when they have wrist pain. But there are a number of other causes for wrist pain. And they can get confused with carpal tunnel syndrome. So how do we know the difference between carpal tunnel syndrome and other types of wrist pain in yoga? And what should we do if we’re experiencing wrist pain in yoga? Read on for some answers to these questions.
What is carpal tunnel syndrome?
Carpal tunnel syndrome refers specifically to the symptoms caused by pressure on the median nerve at the “carpal tunnel” in the wrist. The carpal tunnel is the space or “tunnel” created by several carpal bones (found at the base of the palm) and a connective tissue band that goes across the base of the palm close to the wrist. The median nerve, as well as several tendons, run through the “tunnel” created by those bones and connective tissue, into our hand.
The median nerve starts as part of the brachial plexus. The brachial plexus is a bundle of nerves that starts in the neck and ultimately innervates our arm, forearm, and hand. The median nerve heads from our armpit area down the upper arm and into the forearm. It ends when it passes through the carpal tunnel to innervate our thumb and first two fingers. If the median nerve is compressed as it passes through this anatomical tunnel, and causes tingling, numbness, and/or pain in the thumb side of the hand, you may end up with a diagnosis of carpal tunnel syndrome.
Symptoms and causes of carpal tunnel syndrome
Tingling, numbness, or other “nervy” sensations on the thumb and forefinger side of your hand are the most common symptoms of carpal tunnel syndrome. These sensations sometimes travel up the forearm and even into the shoulder. You might also experience weakness when holding or gripping things.
Causes for carpal tunnel syndrome include repetitive motions from activities like typing. Other diseases and conditions in the body can make carpal tunnel syndrome more likely. These include things like: obesity, diabetes, and arthritis. You might also be more likely to experience carpal tunnel syndrome if you have a family history of others with this condition, or if you’ve experienced an accident or trauma to the wrist. You should see a doctor for an official diagnosis if you think you have carpal tunnel syndrome.
By far, overuse is the most common cause. People who do a lot of typing are one example. Those who have to grasp things with their hands repeatedly are also more vulnerable to getting carpal tunnel syndrome. Overusing the muscles with tendons that pass through the carpal tunnel is often what starts the process. When we overuse the muscles, their tendons become inflamed. Along with that inflammation, you get swelling. When the tendons swell inside the carpal tunnel, compression of the median nerve begins.
Causes of similar symptoms
This is where it gets tricky. Our bodies are a complex network of muscles, tendons, bones, nerves, veins, and other structures. There is also variability from person to person as far as how all these structures come together. And it’s often the case that where we experience pain or tension in our body, is not actually the source of that pain.
It’s not just the structures at the carpal tunnel that can put pressure on the median nerve. Any of the muscles or other structures that pass near or over the median nerve along its path can put pressure on it. Additionally, pressure from muscles or other structures on other nerves that originate from the brachial plexus and run down the neck and into the arm and hand can cause similar symptoms to carpal tunnel syndrome. So, it’s important not to be too hasty in assuming all “nervy” sensations in the arm, hand, or wrist mean that you have carpal tunnel syndrome.
In order to help you differentiate carpal tunnel syndrome from just wrist pain, in yoga or generally, here are a few things to keep in mind.
- If you have pain on the pinky side of the hand, it’s unlikely that it is coming from carpal tunnel syndrome.
- Pain on the top crease of the wrist is unlikely to be coming from carpal tunnel syndrome.
- If you also have pain in your forearm or higher, this is unlikely to be carpal tunnel syndrome.
That list is not intended to minimize any pain that you have near your wrist, however. It just means that you want to think about that pain in a larger context. Don’t get fixated on giving it a label too quickly.
How is carpal tunnel syndrome managed?
The severity of symptoms often define which treatments are recommended. They vary from simply changing activities that are causing the tension and pain, to surgery in the worst cases. Intermediate treatments include things like physical therapy exercises and anti-inflammatory medications. Splinting the area to reduce pressure on the carpal tunnel during movement can also help.
What about carpal tunnel syndrome and yoga?
When there is actually pressure on the median nerve at the carpal tunnel (true carpal tunnel syndrome) the pain is pretty severe. So, that person is not likely to show up to a yoga class until they’ve met with a doctor and started treatment of one kind or another. But, that person might be interested in yoga after surgery or other treatments.
The good news is that yoga may help prevent the onset of carpal tunnel syndrome. I say this theoretically. The reason is that in yoga practice we don’t just use the forearm muscles in a contraction way. We also stretch them through various postures. These include poses like reverse namaste, chaturanga, plank, etc. Yoga helps us create a healthy balance between strength and flexibility in these tissues.
Yoga practitioners who are managing carpal tunnel syndrome, or recovering from treatments like surgery, may need to make some changes to their practice. They’ll likely need to reduce or eliminate weight-bearing on the hands for some period of time. When they are able to do weight-bearing poses without pain, they may still need to modify postures to avoid small wrist angles.
Modifications for carpal tunnel syndrome in yoga
If you have a mild case or a newly developing case of carpal tunnel syndrome, it’s extremely important not to exacerbate the problem in yoga practice. What to do is more complicated than just saying always do this or never do that. In part, it depends on where and how the practitioner experiences their condition. I have met some practitioners who appreciate stretching the flexor muscles in hand positions such as namaste or reverse namaste. However, putting pressure on the base of the palm may be problematic. For others it has been the wrist angle that is most likely stretching already inflamed tendons that irritates the median nerve.
This means we have to experiment based on what the student presents in front of us. This applies to those who are also post surgery and have the clearance of their doctor to use their hands and put weight on them. Here are a few ideas of things you can do:
- Use yoga gloves that have cushioning on the palm of the hand. Sometimes cycling gloves work if they have enough padding.
- Reduce the wrist angle. Use a yoga prop that looks like a wedge or fold over the front of your yoga mat. You can use the mat to act as both a cushion and a prop that lifts the heel of your hand and reduces the wrist angle.
- Finally, if weight-bearing itself is the issue, just let students drop down to their knees in poses that they can. In these cases, I’ll say the obvious, highly modify any type of arm balancing postures. Just don’t lose sight that stretching the flexors, albeit it lightly, may actually help in the long run.
What about other causes of wrist pain symptoms in yoga?
Particularly in vinyasa styles of yoga, we do a lot of weight-bearing poses and transitions on our hands and arms. Wrist pain can show up when there is tension or dysfunction at the wrist. It can also show up when there is tension or dysfunction somewhere else in the kinetic chain that makes up our upper extremity. That chain includes the shoulder girdle, upper arm, elbow joint, forearm, and the wrist and hand.
So it’s important to really keep an open mind about where your wrist pain might be coming from. Remember, the source is often not the wrist. Be willing to experiment and change how you’re doing the postures to see the effect it has on the wrist. You may also need to consider simply doing less weight-bearing on the arms and hands while you build strength. For more specifics about dealing with wrist pain in yoga, check out my previous article on that topic: Working With Wrist Pain In Yoga.