Yoga and wrist pain: Listen to your body!

I wanted to open a discussion regarding association of wrist pain and exercise that requires increased weight bearing on upper extremities. In my practice, I see patients from mixed demographics with complaints of wrist pain. In fact, wrist pain happens to be one of the most searchable conditions on the Internet.

A large number of patients associate wrist pain with increase or change in exercise activity—sometimes, a newly developed love for yoga or Pilates.

With multiple benefits comes the unfortunate side effect: pain in the least expected locations such as wrist, elbow and shoulder joints. While this phenomenon is more common in women, we are beginning to see an increasing occurrence in men. How can physical activity that has been praised for thousands of years for bringing emotional and physical well being cause its followers pain and injury?

As most of you are aware, there is a multitude of different yoga practices that offer variable benefits of meditation, relaxation, and increase in flexibility, physical and emotional strength.
If you are a yogi that enjoys more physical aspects of practice you probably tried "power", vinyasa, ashtanga, Bikram yoga etc.

The beauty of most yoga group practices is that you can meet a 20-year yoga veteran and a newbie in the same class. Yoga practice is just that, practice. It is not a sprint or a competition.

The key to success is proper execution. Especially in practices that require significant physical exertion and inversions. Some of the practices focus on body balance in unusual positions in order to strengthen the mind and body connection. Sometimes this means balancing most of the body weight on hands and wrists.

Transitions from pose to pose in a flow of chuduranga can strain the shoulder joint and rotator cuff, cause elbow tendinitis, wrist ligament injury, exacerbation of arthritis, carpal tunnel if performed improperly.

I've been seeing patients who developed painful cysts in the wrist joints that could be related to the practice of yoga and Pilates. Hand stands and plank poses in particular.

The next question arises, are humans made to weight bear on their hands?

While the answer is somewhat intuitive, this doesn't mean that it can't be done for specific poses in well-prepared individuals. The answer is ‘no’ if the pose causes you pain. Pain is one of the ways our body alerts us of an ongoing problem. Like a check engine light, many of us ignore the signal only to find that our own ‘vehicles’ are leaking engine fluid months or years later.

My advice to beginner yogis and veterans alike would be to listen to yourself before, during and after practice. Many teachers will tell you there is a difference between good pain and bad pain. 

My suggestion would be to look for modifications so your body does not feel pain until you can do more. Perform every pose as carefully and accurately as you can. Never over-exert yourself or push your body where it doesn't go today. Ask for your teacher’s feedback.

If you do experience hand, wrist, elbow or shoulder pain that is related to a pre-existing condition, such as an old tendinitis or a wrist fracture, ask your teacher for modifications.

The industry is inundated with commercial devices (props) like silicone filled pads that soften the pressure on the upper extremity in balancing poses and inversions.

Another thing that every beginner yogi should pay attention to is the teacher's resume—in particular, that cryptic E-RYT designation. E-RYT 200 means your teacher has at least two years and 1000 hours of teaching experience under their belt. You definitely want this.

Some yoga forms may have to be excluded for patients with certain preexisting conditions—so it’s a good thing there are plenty to choose from.

Our bodies are miraculous and are made to handle and tolerate the extremes. Unfortunately, once things go wrong, repair can be very difficult and not always feasible. Take care of your most important asset—yourself.

Namaste.

Julia Mayberry, M.D., specializes in hand and upper extremity surgery, as well as microvascular surgery at Main Line Hand Surgery P.C., Lankenau Medical Center and Riddle Memorial Hospital.


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