Pay Attention to Wrist Pain in Yoga
If you want to learn a process for working with injuries you should definitely check out the online injury workshop. It teaches you a process of how to assess, modify, and work with injuries.
The first things to investigate are the student’s personal circumstances surrounding the wrist pain or problems. Although I’m not going to talk specifically about carpal tunnel syndrome in this article, it should always be considered a potential cause. I will address it in its own article in the future or you can read about it on page 234 (1st ed.) of my book, Functional Anatomy of Yoga. Please consult with the appropriate medical practitioner if you are having consistent wrist pain in yoga.
Factors you’ll want to consider are things such as:
- What is the student doing with their hands on a daily basis outside of yoga?
- Do they work with their hands?
- Do they sit at a keyboard all day?
- What does their general posture look like?
- Are their shoulders significantly misaligned?
- Are they also complaining of neck issues?
- How often do they practice?
- Are they conforming to alignment “rules” that don’t actually work for them?
- Where is the pain showing itself?
- Is there anything that makes it feel better or worse?
Asking questions will help you take in the larger picture. Compiling all the relevant facts is very important for understanding whether you’re dealing with generalized sensations in the wrist that will pass over time or alignment issues that need to be dealt with. It’s even possible that the person should stop practicing for a period of time all together. All of these are possibilities when evaluating wrist pain in yoga postures.
Anatomy of the Wrist
The hand and the foot are comparable, but there are some very different considerations when we start bearing weight on our hands. Of course, it‘s when we’re bearing weight on our hands that wrist problems and pain are going to show up in our yoga practice.
When you look at an image of the hand and wrist you’ll notice that the radius is the bone that makes the most contact with the carpal bones. From anatomical position, this bone is the one on the outside (lateral) of the forearm. However when we place the palm of our hand on the floor (as in chaturanga, upward dog, and downward dog), this bone rotates around the ulna to be on the inside. The radius is always associated with the thumb side of the hand regardless of the hand position.
Although there are similarities between the foot and the hand from an anatomical point of view, the largest departure or difference between the two is when they are weight bearing. The heel sits behind the place where weight passes into the foot. This is not the case in the hand and wrist.
In the hand and wrist the radius and ulna sit behind the bones of the hand when it’s placed on the floor; the bone to bone transference of weight is significantly less than what we find in the foot. For this reason, the soft tissues that surround the wrist become that much more important. At the same time, they are also more prone to injury.
This is also the reason that emphasizing a balanced pressure into both sides of the hand, or even an added emphasis on grounding through the thumb side of the hand, is so important. These are verbal cues often given as advice for protecting the wrists during practice. These actions help keep the pressure off of the tissues on the outside of the wrist when the palm is on the floor. The more pressure you have going into that area, the more pressure there is on the soft tissues.
The postures that put the most amount of pressure on the wrist are of course postures where you are bearing weight on your hands.
Three Common Postures
Let’s take a look at three common yoga postures that are associated with wrist pain and consider some key places we should look at.
Oh yeah, it’s the one that gets blamed for everything, including wrist pain in yoga. Like most postures, chaturanga requires a balance of strength and flexibility. OK, wait a minute, flexibility? Where in chaturanga do you need flexibility?
Actually, there is only one place where you really need flexibility, THE WRIST! Most people should be flexible enough in their wrist for this pose, but if you’re someone who uses your hands a lot, say, typing, grasping, pulling, you may have short, tight hand and wrist flexors.
Having tight hand and wrist flexors could make it difficult to extend (technically hyperextend) your wrist as needed in a pose like chaturanga. This lack of flexibility is a potential cause of generalized wrist and/or hand pain in yoga.
Another issue to evaluate is the most common alignment cue given at the wrist. This is that the elbow should be aligned over the wrist creating two ninety degree angles. The image here popped up pretty quickly on a google search. It shows the “right” and “wrong” way to do chaturanga. Even if this is true, (and I’m not convinced of it personally), if you’re dealing with wrist pain, do something more like the wrong one (the one pictured with the “x” in the box below). Although the wrong one showed in this image is WAY too far back, the extreme shows how moving the elbow behind the wrist reduces the wrist angle and creates less compression. Sometimes breaking the rules is a good idea.
Upward Facing Dog
I have covered chaturanga along with shoulders in upward facing dog in previous articles. The hands and the wrist are part of the foundation of these two postures. How we set them up has an effect on what’s above it. I have watched thousands of upward dogs at this point and I have to say that it is probably more likely to cause wrist pain in yoga for beginners than even chaturanga.
Why? It is very common for beginners to have their shoulders too far out in front of their wrists. Awkward body control, lack of strength in the core, shoulder girdle, and bad technique in moving from chaturanga into upward facing dog can easily lead to the shoulders being too far forward. What happens then? Simple, wrist compression occurs.
The image here of upward facing dog was easily found on a website that sells a product for helping wrist pain. Interestingly, their model has her shoulders so far out in front of her wrists well… I’m not surprised she’s wearing the product. Sorry guys, nothing personal, just my observation.
If you have wrist pain, don’t use the alignment above. Something closer to what you see below makes more sense, where the shoulder is just barely in front of the wrist.
Downward Facing Dog
Downward dog does not have wrist compression written all over it like the other two postures we just looked at. None the less, it is a pose where students complain about wrist pain in yoga. Deciphering downward dog wrist pain is a little different.
This is a good place for me to bring up the alignment of the wrist. In reality, we should have been paying attention to this in the previous two postures as well. I mention it here because it’s more easily seen. I have a couple of images from a different article I wrote on your shoulders in downward facing dog that highlight a few things to look for.
As it turns out, your shoulders are connected to your hands and wrists. Shocking news I’m sure. The position of the shoulders has an effect on your hands and wrist position as well as the other way around. Check out the previous article on this topic. When we are talking about alignment of the hands through all three of these postures, we want the line, or crease of the wrist, to be facing forward! That is, parallel to the front edge of your mat. For a beginner, I would give precedence to this over anything else.
In downward dog, you will either want to have your middle finger pointed straight forward or you’ll want your index finger pointed straight forward. How will you decide which one works for you? Which one puts the crease of your wrist parallel to the front edge of the mat? That’s the one you should probably adopt.
A final reason that someone might be experiencing wrist pain in downward dog is that forearm muscles are tight. Even with the relatively minimal wrist angle of down dog, the weight of the body may be borne on the hands. This will quite naturally activate these muscles. If they are already dysfunctional for other reasons, this posture can add to that dysfunction.
If you’re having wrist pain in any of these yoga postures, I would suggest you don’t even consider doing any type of arm balances. If you’re in pain, I doubt you would. Most people are already familiar with the typical modifications for practicing postures where the hands are bearing weight when you are experiencing wrist pain: make your hands into fists instead of placing the palm on the ground, go onto your forearms or come down to your knees. Propping up the heel of the hand, or giving it cushioning may be the trick for you. I’m always for doing what works, so play with all of these if you’re having wrist pain.
If I meet someone and the source of their problem seems to be tight hand and wrist flexors, I suggest my million dollar secret solution. I am going to give you my million dollar secret for the low, low cost of simply reading to the end of my article. It’s simple. Fill your sink with ice water. Submerge your entire forearm just above the elbow into the icy water. Do not remove it for 7 – 9 minutes. Do this once or twice a day for 5 – 7 days. Each time after removing your forearm from the water, don’t move it in a hurry, let the blood come in slowly.
I can’t begin to tell you how many people this extremely simple and inexpensive treatment helped. If you’re really into it, you could do what’s called a contrast bath; this article spells it out quite simply.
If you’d like to read more about the anatomy of the wrist and how that comes into play when doing yoga asana, check out chapter 8 ‘Hand, Wrist, and Elbow’ in my book Functional Anatomy of Yoga.
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David explains why he doesn’t look for specific alignment in the elbow crease in upward dog. Instead, he looks for a healthy position of the shoulders and wrists.
David explains why serratus anterior is often the key muscle that you need to strengthen in order to maintain a handstand.