Helping hands

Wrist issues are common among yogis, but there are ways to ease the pain

Don’t compare yourself to other people in the class. Build your own pose and talk to the instructor for guidance.

You know that pain or discomfort in the wrists that you or your fellow yogis might feel in downward dog?

“Wrist pain is one of the most common issues we see in yoga,” says Alyson Shade, a yoga instructor in Washington. “But it can be addressed with proper modifications and progressions.”

Wrist pain can also occur in exercise like the CrossFit regimen or just by using bad ergonomics at work, says Robert Gillanders, a physical therapist in the Washington area. “Good alignment applies to everything you do, from riding your bike to how you set up your keyboard,” Gillanders says.

When the wrist is hiked upward, or extended, it puts stress on all the soft tissue.

When it comes to typing with hiked wrists, as opposed to the correct position of neutral wrists, the stress is low but frequent; in exercise like yoga or CrossFit, the stress is high but infrequent, he says.

High stress can trigger pain and eventually injury, says Angelo Dacus, an associate professor of orthopedic surgery at the University of Virginia, who specializes in hand and other upper extremity disorders.

“People walk on their feet, not on their hands,” says Dacus. “So when we load the wrists, it’s important that we allow for a certain adjustment period.”

So if we are using our hands as feet in exercises such as arm balances, planks and downward dog, we need to give them a chance to get stronger gradually — not go from couch to 100 chaturanga (a triceps-focused yoga plank) pushups in one practice.

The problem is compounded if the core also lacks strength, as the yogi is likely bring the weight forward toward the shoulders and away from the weak core, creating even more extension in the wrists, Gillanders says.

“Now you’re asking your wrists to work in a very strained position,” he says.

Another reason for wrist pain is the position of the fingers, specifically the weight distribution on the fingers.

If you roll the weight out toward the pinky you are more likely to feel wrist pain than if you place more weight into the “L” shape of the hand — the thumb and index finger, Shade says.

“I’ll say during class, ‘Place your hands shoulder-width apart’ — unless someone has very muscular shoulders, then they might need to be a little wider — ‘and then spread your fingers out wide,’” she says.

But the issue can also be inflexibility. For example, if you’re doing a downward dog and your hamstrings are tight, you’re likely to lean forward into your shoulders and wrists and cause a similar type of strained position of the wrists.

Along with alignment, it’s important to progress and modify according to ability and fitness level, all three experts agree.

“Don’t compare yourself to other people in the class. Know your limitations,” Dacus says. “Build your own pose and talk to the instructor for guidance.”

For example, if someone complains about low-level wrist discomfort, Shade might suggest the following modifications:

Instead of downward dog, do dolphin (dolphin is a downward dog done on the forearms.)

Instead of doing a wheel pose, you can place blocks at an angle against a wall and place your hands on those blocks.

Instead of cobra or upward dog, the modification can be a baby cobra or sphinx (a cobra on the forearms).

Instead of doing a plank on your hands, do a plank on your forearms and come down to the knees if the core is too weak to hold up the hips.

If the pain is mild but persistent during yoga, try wrist wraps, Dacus suggests: “They provide compression and support but they also advise you that you have something to be extra mindful of.”

So what exactly are we being mindful of — carpal tunnel syndrome, tendon inflammation, joint impingement? It’s more likely to be inflammation or an impingement in the wrist joint, Dacus says. Carpal tunnel syndrome is less likely if the pain is felt on the back of the wrist, he says, as the condition usually expresses itself with pain in the palm side of the hand and wrist.

For light to moderate discomfort, Dacus suggests using these modifications and monitoring the pain. But if the pain lingers and worsens, it’s time for a doctor.

Gillanders often asks his patients what their level of pain is on a scale of 1 to 10:

1-3: Pain is tolerable; modification can be used but might not be necessary;

4-6: Pain is moderate; modifications are suggested;

7-10: Pain is intense; rest and treatment.

“And if you have any stiffness or swelling, then it’s time to get it checked out,” Gillanders says.

Shade suggests yogis alert their teachers about discomfort and injuries so the teacher can either suggest modifications or a different level or class, or even just rest.

“Mindfulness has to be part of any practice,” Shade says.

“Keep observing your body and don’t let anything go unnoticed. That’s when injuries happen.”