Working with Carrying Angles in the Elbows

by Baxter

Woman Carrying a Child Downstairs by Rembrandt

In addition to the tendonitis I wrote about last week Elbow Pain and Yoga, another fairly common situation that I have observed in my students over the years are elbows that appear to look like knock knees do at the knee joint. What I mean by that is that the elbow joint seems to bow inward instead of making a straight line from the upper arm bone to the forearm bones. In anatomical terms this is referred to as a “carrying angle,” and sometimes as hyperextension. This could be considered just a variation on normal anatomy of the arms at the elbow joint, but ever since I started studying yoga in the mid-90s, it has been implied by many of my teachers that a carrying angle in weight bearing yoga poses could present some problems for those practitioners. I’ll get to that in a few moments. 

Interestingly, if you or I stretch our arm out in front of us, fully extending or straightening at the elbow, with our palm turned up toward the ceiling (known as supination of the forearms), and we look at the angle between the humerus and the forearm bones, it is usually not a straight line. The forearm bones angle slightly out to the side, away from the midline. But, wait! If you turn your hand down toward the floor (known as pronation of the forearms bones), you will likely notice that the upper and lower bones of the arm now appear more aligned! This is true for many yoga practitioners, but not all. And when the arms are not bearing weight, such is in many of the standing yoga poses (Warrior 2, as an example), it is really a non-issue for someone with a carrying angle. However, when we look at the elbows in one of the most common modern yoga poses, Downward-Facing Dog pose (Adho Mukha Svanasana), practitioners with a carrying angle will demonstrate this bowed-inward appearance while doing the pose. It will also show up in other straight arm yoga poses where you are bearing weight on your hands, such as Upward-Facing Dog pose (Urdhva Mukha Svanasana, Side Plank pose (Vasithasana), Plank pose, and Handstand to name some of the more obvious poses. 

I should mention that hyperextension of the elbow joint, where, instead of 180 angle between upper and lower arms in full extension of elbow, the angle is greater than that, is often present in those with a carrying angle. In hyperextension, it is often loose or lax ligaments around the joint that allow for the greater angle, but it is also influenced by the joint capsule and the shape of the bones. In both the situation of the carrying angle and hyperextension of the elbow joints, there is potentially less stability and even contact between the ends of the bones at the joint. This could increase the chances for wear and tear between the bone surfaces, as well as strain on the ligaments and tendons, and the development of pain around the elbow joint. 

A HUGE however: Because there is great variety in our skeletal structure, influenced by muscles and connective tissue, allowing the elbow joint to “lock out” into full extension where the carrying angle or the hyperextension become evident may not mean that the yoga practitioner is destined to develop arthritis or tendonitis of the elbow joint. So, it may be that only yogis who have elbow pain in the setting of a pronounced carrying angle should modify their poses to try to eliminate pain around the elbow. 

If you are interested in reading a great discussion on this topic (and to avoid re-inventing the wheel), I’d recommend you check out this post from YinYoga.com’s Bernie Clark: 

Now let’s assume that you or your yoga student is experiencing elbow pain in the weight-bearing poses mentioned above. What modifications can you try to attempt to eliminate the pain and quiet down the underlying problem that might be behind it? Here are a few ideas: 

1. Take a break from those poses for a few weeks and notice if the pain subsides or goes away completely. 
2. Do modified versions of the weight-bearing poses, like Half Downward-Facing Dog pose at the Wall, or Side Plank pose (Vasithasana) at the Wall and notice if less pressure through the elbow joint results in a decrease or absence of pain. Stick with those variations for a while before re-introducing the full arm balances. 
3. In Downward-Facing Dog pose, try to slightly bend your elbows until your arm bones will line up evenly. You might need someone to tell you where that alignment is if you can’t see it yourself. Keep in mind that you will now be relying more on your muscles, so it is going to feel like a lot more work and you may not be able to maintain the pose for as long as you did when the elbow was fully extended. Build strength gradually! 
4. For poses where the arms are parallel, like Downward- and Upward-Facing Dog pose and Handstand, try placing a looped strap just below your elbow joint towards your wrists, on the thick parts of your forearms. Make the loop just big enough that when you press your forearms outward against the loop your arm bones line up at that 180 degree angle. The strap will take on some of the muscular work you had to do in #3, and you will probably be able to stay longer in the poses. This could allow you to better sense the even alignment of the bones and find it on your own without the strap over time. Notice if the pain is gone when using the strap.
5. Also in poses where the arms are parallel, try turning your elbow creases to face each other (they are probably turning away from each other). Once your elbow creases are facing each other, try rolling your upper arm bones slightly out (external rotation) at the same time you roll your lower arm bones slightly in (internal rotation). See if these actions bring your arms into a straighter alignment.
6. Working with your shoulder joints and hand placement can also re-align your elbow joints, so it would be worth exploring what more external rotation or internal rotation of the humerus bones does to your elbow joints. Turning your hands slightly in or out (abduction or adduction at the wrist joint) could also bring the bones at the elbow into a more even alignment. But you have to make sure you don’t trade pain in one joint for that in another! 

There may be other suggestions that some of our readers have tried for elbow pain attributed to carrying angles or hyperextension of the elbow. What have you found beneficial? And have any of you lived with this variation of anatomy without developing any problems? Let us know you experiences and thoughts on angles at the elbow!

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