Elbow Pain and Yoga

by Baxter

As I was preparing for an upcoming workshop on Yoga for Elbows and Wrists, I decided to look back at our blog posts and see what we had shared with you over the last three years about elbows. To my surprise, there was not one dedicated post on the elbows (my sincere apologies to all the elbows out there!). It’s a bit surprising on both a professional and person level. Professionally, it is not uncommon for my students to complain about one of their elbows being sore or painful. And, personally, I have had intermittent bouts of elbow soreness over the years, most often associated with sudden increases in my violin playing. If I am at a music jam and playing for several hours (without enough regular practice time), I will often have right elbow soreness the next day that can persist for up to a week. Why the right one? It is my bowing arm and therefore the side that is repetitively flexing and extending at the elbow joint over and over as I play. On those occasions, I find myself modifying my yoga practice to address the soreness and limitations, both to keep the yoga from worsening my symptoms and to choose poses I think could speed my recovery.

The elbow joint is often referred to as a “hinge joint,” much like a door hinge that allows two movements, swinging open and closed, or, in the case of the elbow, flexing and extending. However, this is a bit simplistic, as just beyond the place where the upper arm bone, the humerus, and the lower arm bones, the ulna and the radius, meet to form the elbow joint is another important joint that adds a few more movements into the mix. This is the connection between the two forearm bones themselves. The top part of the radius and ulna abut one another in such a way that the forearm bones can roll over one another, which ultimately allow the palm of the hand to spin up and down, as in the action of giving and receiving some “skin.” To the untrained eye, this seems like “rotation” of the wrist joint, but in actuality, it starts at the elbow joint and has the fancy names of supination and pronation. And, like the knee joint, the elbow joint also has ligaments on the inner and outer aspect of the joint to keep the upper and lower arm bones from bowing in and out. Cartilage coats the bony ends of the elbow joint bones to keep them flowing smoothly over one another as we move the arm around.

Like many of the other joints of the body, the elbow is subject to wear-and-tear arthritis, problems that arise from injury, repetitive stress on the ligaments and tendons near the joint, and unusual skeletal variations. The most common source of elbow soreness and pain in my students by far is of the repetitive stress variety, so I’d like to focus on those for the rest of this blog. And, of the many possible causes of such repetitive stress, working at the computer is way at the top of the list. As a family doc, when my patients came in with elbow soreness and pain at the outer edge of the elbow, I’d diagnose them with “tennis elbow” and if the pain was on the inner elbow, it would be tagged as “golfer’s elbow,” even if they did not play tennis or golf! The underlying problem was really the repetitive action, whatever its source, leading to a chronic inflammation of the tendons in those areas that is called “tendonitis.” And this is probably what I was kicking up in my own elbows when playing my fiddle. The areas involved are often tender to touch and also painful when you flex or extend your elbow, or even when you flex and extend your wrist (which could be confusing, eh?).

Addressing Elbow Pain with Yoga

An initial approach to addressing this kind of elbow pain would be to avoid the repetitive movement that precipitates it, even if certain yoga poses might normally require such a movement. This means you have to be willing to improvise and change the appearance of poses as needed to keep the joint relatively quiet. 

Non-weight bearing poses for the arms are a good idea initially, so as to reduce the additional pressure and demands on the elbow joint that poses such as Downward-Facing Dog pose (Adho Mukha Svanasana) and Upward-Facing Down Dog (Urdva Mukha Svanasana) bring into the elbow. Choosing to focus on poses where your elbows are fully straight and extended, such as Warrior 1 and 2 (Virbradrasana 1 and 2), Triangle pose (Trikonasana) and Extended Side Angle pose (Uttitha Parsvokanasa), is a great starting place, and also has the added benefit of moving your shoulder joints through a pretty full range of motion, which could have positive effects on your elbows. 

Eventually exploring poses that bring your elbow joints into play with weight bearing on the joints should be done mindfully. You want to try and maintain the full movement of the elbow joint without worsening the pain. Start with Eagle pose arms (Garudasana), and if that feels OK, advance to Cow-Faced pose (Gomukasana) arms, which adds more deep bend to the joint. See Standing Shoulder Stretches. 

Eagle Pose Arms

Cow-Face Pose Arms

I also find that Wrist Flossing  can be beneficial for the elbows as well as the wrists, so take that for a test spin, too!

When your joints are beginning to improve, gradually add in more challenge for your elbow joints by taking a bit of weight onto them, such as in Half Downward-Facing Dog pose at the wall. 

If Half Downward-Facing Dog pose feels good, advance to full Downward-Facing Dog. When you start working on all fours, such as in Cat/Cow pose or Hunting Dog pose, play with the even press of your hands into the floor, evenly between the heels and balls of your hands and evenly between the pinky and thumb sides of your hands. This can often give you important feedback on how the placement of your hands relates to the even work of the elbow joints.

Use caution with the poses that super load the below joint, such as Pushup pose (Chaturanga Dandasana), and arm balances, such as Heron and Crow poses or Handstand. You might want to wait until your elbows are pain free for a while before learning these or adding them back into your practice. 

Finally, as I mentioned before, there are many other elbow issues that can cause pain and soreness. Some will benefit from the above recommendations as well, whereas others may need different approaches. I hope to share more about the elbows in the coming weeks, and if you have specific curiosities about elbows, please send me a comment!

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