Friday Practical Pointers: Who Should Avoid Certain Wrist Movements?

by Baxter

Leslie Greinstein, Age 62

We now arrive at one of our most delicate joints of the body, the wrist. I remind my students at least once a week that the human body has evolved to walk upright, freeing the wrists and hands from clomping around on all fours like our very distant ancestors. And yet, in modern yoga, we are down on hands and knees quite often, with poses such as Cat/Cow pose, Hunting Dog pose, and much more challenging poses for wrist integrity, strength, and flexibility such as Plank pose, Downward-Facing Dog (Adho Mukha Svanasana) and Upward-Facing Dog (Urdva Mukha Svanasana) poses, and even Handstand! We are often asking a lot of our wrists, and for some it may be too much.

Movements of the Wrist

Start by taking your arms  out in front of you with your palms turned up towards the sky—or imagine it.

Flexion: From the starting position, bending the palm of your hand toward your chest. We rarely use this movement in yoga asana, except in the version of Arms Overhead (Urdhva Hastasana) where you interlace your fingers, pulling the wrists away from one another, and take your arms overhead, with the backs of your hand facing the ceiling. 

Extension: From the starting position, dropping your hand forward and down so the palm faces away from you. We often use this movement in yoga asana, from the slight flexion of Downward-Facing Dog to the 90-degree flexion of Upward-Facing Dog, Plank pose, Side Plank pose (Vasithasana), and so on. Sometimes we bear our full weight with our wrists in this position, as in Handstand, and sometimes we bear just a light amount of weight on it, for example, in Extended Side Angle pose (Utthita Parsvakonasana) when the bottom hand is flat on the floor or block. 

Abduction: From the starting position, moving the pinky sides of the hand away from the midline of your body. We use this movement when our hand is on the floor or a support to adjust the angle of our hand and wrist, such as in Downward-Facing Dog pose when we turn our hands toward each other or in Upward Plank pose (Purvottanasana) when we turn our hands out a bit. 

Adduction: From the starting position, moving the pinky sides of the hands towards each other, toward the midline of your body. We use this movement when our hand is on the floor or a support to adjust the angle of our hand and wrist, such as in Downward-Facing Dog pose, when we turn our hands away from each other or in Upward Plank pose (Purvottanasana) when we turn our hands toward each other. 

Note on Rotation: Although it feels like the wrist joints can rotate, this action actually comes from the forearm bones rolling over one another, not from wrist joint itself rotating. 

Cautions for the Wrist Joint 

Now let’s look at who should avoid or minimize certain wrist movements. Keep in mind, however, that we want to maintain as much of our full range of movement of the wrist joint as possible. So, in many instances, my caution will not mean “don’t” or “never,” but rather approach cautiously and stop if the movement worsens pain. 

In general, most people can safely do all of the wrist movements if they are not bearing weight on the hands and wrists. In fact, a famous study published in JAMA in 1999 Yoga-Based Intervention for Carpal Tunnel Syndrome looked at using yoga to address one of the most common maladies of the wrist, carpal tunnel Syndrome, and all of the poses used where non-weight bearing poses. So even if you have wrist issues, you can still do a modified practice using lots of our poses! 

Generally avoid a particular wrist movement if:

1. The movement increases pain or numbness due to a painful wrist condition that is chronic, such as long standing repetitive strain injuries of the wrist, general arthritis or thumb joint arthritis, or more acute, such as acute sprains and strains of the wrist, carpal tunnel syndrome or new ganglion cysts.
2. If you have significant swelling in the joint—whether from an acute injury or the flare of a chronic condition—and the swelling inhibits a particular movement or elicits significant pain during the movement.

Now for the specific movements. Who should avoid or minimize the following movements?

Flexion

1. Those with carpal tunnel syndrome, which can worsen with flexion, even when non-weight bearing. 
2. Those with arthritis of the wrist that becomes more painful with flexion, especially when weight bearing. 
3. Those with a ganglion cyst (which usually appears on the back of the wrist). 

Extension

1. Those with hyper-flexible wrist joints may want to avoid full extension in weight-bearing poses to avoid wear and tear on the internal wrist structures and overstretching ligaments. 
2. Anyone who experiences significant numbness and tingling in the fingers and hands in extension while bearing weight in the wrist joints. 

Abduction 

1. Those with arthritis at the base of the thumb (the most common site for arthritis in the hand and wrist) or tendonitis of the thumb tendons, known as DeQuervain’s tendonitis, because abduction narrows the thumb side of the wrist joint which can compress the arthritic thumb joint or the inflamed tendon. 

Adduction 

1. Those with arthritis the pinky finger side area of wrist because this action can narrow and compress this side of the wrist joint. 

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Friday Q&A: Wrist Problems

Q: I have students who continue to be challenged in their wrists. I use props to alleviate the strain (blocks under palms, push up bars, forearms, etc.). What else can help?

A: As I was prepping to answer this inquiry from one of our readers who teaches yoga, I went back and reread the posts on the wrists that we have done over the last three years, and there are quite a few! So, I want to link some of those here so that anyone interested in learning more about this potentially vulnerable area of the body can look over those as well.

Wristful Wrists: How to Keep Your Wrists Happy and Healthy

Friday Q&A: Wrist Flossing

Featured Sequence: Wrist Flossing for Wrist Care

Friday Q&A: Ganglion Cysts

Featured Pose: Wrist Circles

As we look at the issue of yoga practitioners who are “challenged in their wrists.” it’s important to acknowledge that there are a variety of issues that could cause someone to be challenged, from new onset pain, chronic wrist pain, specific diagnoses such as carpel tunnel syndrome or ganglion cysts, repetitive strain (like the kind I got today from working with a hammer and staple gun for two hours on Sunday night!), to arthritis in the wrist or even at the base of the thumb. So, if you have unexplained wrist pain, my first recommendation is always to always get your wrist evaluated, or, if you are the teacher, to encourage your student to do so. Knowing the underlying cause of the pain can be helpful in guiding you in healing it or in modifying your yoga practices so as to minimize aggravating the condition and hopefully promoting healing as well.

Another recommendation is to play with all the modifications you can employ in the key position of on all fours or “Hands and Knees.”

This is the starting position for several common poses, including Cat-Cow pose (Marjaryasana), Hunting Dog pose, Plank pose variations, in which your wrists are in extension and bearing weight. 

In the typical position of the hands flat on the floor, make sure you are distributing the weight evenly between the heel of your hand and the ball of your hand (where the first knuckles are located). It is so common for practitioners to be dropping all the weight of the upper body down into the heel of their hands and not utilizing the entire palm for support. My colleague Richard Rosen encourages his students to create a suction cup effect in the center of the palm as well as the channel between the base of the thumb and the pinky finger, as he feels it takes pressure of the carpal tunnel (through which tendons and one large nerve flow).

Also, practicing hands and knees on your finger tips will take much of the pressure off the wrist joints and can be used for easier poses like Cat-Cow and Hunting Dog, but would likely not be so effective in Plank. But in other poses where one or both hands is touching the floor or a block, such as in Lunge or Triangle pose (Trikonasana), the fingertip method can be very helpful. Keep in mind that your fingers may not be used to this kind of extra work, so you want to start with short periods of time in the poses and gradually work up to longer holds as your fingers and hands get stronger. 

Another simple modification is to make a fist with your hands and place the flat proximal phalanges (the closest finger bone to the hand) on the floor, with your two hands oriented so the inner wrists face one another. This specific orientation keeps the weight on the wrist joints very even between the thumb and pinky sides of your wrists. It can work nicely for hands and knees, but should not be used for Downward-Facing Dog pose (Adho Mukha Svanasana), as it will jam and compress the pinky side of your wrist joints. So, when transitioning from one position to another, take a moment to reposition your hands and wrists to avoid the risk of aggravating your challenged wrist. And with the fist variation, it is helpful to keep your fingernails trimmed so you can tuck your fingers into your palms to make a stronger, more stable fist.

For some practitioners, a little lift under the wrists and heel of the hands can complete relieve pain and pressure in the hands. One inexpensive way to accomplish this it to simply tightly roll the front narrow edge of your yoga mat under a turn or two. Because it will tend to want to loosen or unroll, hold it in place with one hand as you get the other hand into position. Ideally the heel of your hands should press into the center of the rolled mat and the ball of the hands and your fingers will be on the bare floor in front of your mat. You will still want to press the heels and balls of your hand down evenly as recommended above. This can work well for Hands and Knees position as well as Plank and Downward-Facing Dog pose and might even provide enough support for one handed poses where one hand has to support the weight of the body, such as Side Plank pose (Vasithasana).

You can use a yoga prop called a yoga wedge similarly to the mat roll, but you have to make sure to catch the heels of your hand on the top edge of the wedge and let your palms and fingers steam forward and down the slope of the wedge. Your wrists need to feel slightly lifted so they do not sag down behind the top edge of the wedge, which could undo all the good you are trying to do! I will sometimes place the wedge under the front edge of the yoga mat to increase the stickiness of my hands on the slope of the wedge, so play around with that, too.

I have also had quite a bit of personal experience with the Gripitz prop, which many studios have available for students to use, and think that with proper use and understanding, they can be helpful. That said, I almost always see students who have not been given any specific guidance on proper use using them in a potentially detrimental way. Perhaps at another time I can do a post with photos to clarify my take on using those correctly.

Another consideration is playing around with Downward-Facing Dog pose variations that can be less impactful on your wrists (see Featured Pose: Downward-Facing Dog Variations). One of my favorites is the chair version; but again, you have to make sure the heels of your hands catch the front edge of the seat correctly and your wrists stay lifted and don’t drop down at all in front of the edge. And in fact, Nina did an entire post on protecting your wrists in this pose (see Protecting Your Wrists in Downward-Facing Dog Pose), so take a look at that as well.

And although this is not an exhaustive list of options, I will end with encouraging you to design a practice for yourself or your students that does not involve any weight-bearing poses for the wrists in the sequence. This will give you or your students with wrist challenges a wonderful yoga practice that will still have many benefits while completely resting the wrists. Also, if weakness in the wrists could be contributing to the wrist challenges, consider something as simple as playing with a squeeze ball periodically throughout the day to strengthen your forearm, hand and finger muscles. Improving strength can sometimes resolve many wrist issues. That should give you all some ways of working with those challenged wrists! 

Bay Area readers can learn about wrists in person with Baxter at his upcoming Workshop on Wrists and Elbows, Sept. 20th, 2-5pm at Mountain Yoga, in Oakland, California. See here for further information.

—Baxter

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Friday Q&A: Wrist Flossing

Q: I teach a chair yoga class. Last week I led my students in the "wrist flossing" exercise described on this web site (see Featured Sequence: Wrist Flossing for Wrist Care) and also in Timothy McCall’s "Yoga As Medicine."

A new student came up after that class to challenge me in using this sequence. She had had carpal tunnel surgery 6 months ago. She said that her surgeon said that people should never, never, never, put pressure on their hands while bending the wrists back, and that the wrist flossing we did was very dangerous. Her surgeon apparently says that bending the wrists back on their own is OK, but applying any pressure is very wrong. My student claims that poses like down dog, plank, even being on hands and knees, would make her surgeon shriek in horror.

If someone has no wrist problems, is there any danger in such positions?

I told my student that she is free to avoid doing such movements but that I will continue to have the class do the wrist flossing exercise occasionally. But I wonder...when should this NOT be done?

A: These are great questions! I want start by saying that for students with healthy wrists, wrist flossing, done appropriately and not excessively, poses no danger to the wrist joint, nor for that matter should positions such as Downward-Facing Dog pose, Plank pose, Cat/Cow pose or other positions when the wrist is in the position known as "extension." Having said that, keep in mind that too much of any position could be a problem if someone has sensitive wrists that are prone to episodes of soreness or pain.

Wrist Flossing

Secondly, I would point out that the yoga teacher who developed wrist flossing is also a chiropractor who sees many, many patients who present with wrist pain and overuse issues related to the wrists from computer work and other repetitive activities. You can read more about Tom Alden in Timothy’s book, but he claims to have good results in improving function and decreasing pain teaching this technique. I have had a few students with wrist pain from excessive keyboarding or activities like rock climbing, which is intense for the hands and wrists, and have taught them wrist flossing without problems, and with improvement in their symptoms.

I cannot comment directly on what your student’s surgeon said or implied (since I was not there!), although it sounds like the student felt the warnings were quite serious. I will comment on the wrist movements she referred to: “bending the wrists back on their own is OK, but applying any pressure is very wrong.” Bending the wrists back on their own into “extension” in situations when your wrists are not bearing weight, for example, with your right hand when you arm is in the air, and you do this with the muscles in right arm and hand area alone, is called “active range of motion.” If you then, at that point in your wrist’s range of movement, bring your left hand over and bend your wrist more deeply into extension by applying pressure with your hand onto your right hand, the wrist will likely go a bit further. This additional movement is called “passive range of motion,” and it could allow you to stretch your forearm muscles a bit more deeply, which could have a nice benefit. However, if I were significantly injured or just out of surgery for carpel tunnel syndrome, I’d want to be very cautious of this, as it could aggravate things. Even with the wrist flossing instructions that I learned, the emphasis is on using the passive range of motion on the wrist that is bending into flexion, not the one going into extension.

I hope this additional information will allow you all to feel more comfortable teaching and/or doing wrist flossing.

Finally, yoga teachers should always encourage students to let them know about injuries, surgeries and health issues at the start of every class. And yoga students should please let your teachers know ahead of time what is going on with you! It sounds like the student that the teacher wrote about didn't let her teacher know about her wrist problems until after class. This happens to me all the time and is a bit frustrating—so hard for me to offer modifications after the fact! 

—Baxter

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Protecting Your Wrists in Downward-Facing Dog

by Nina

There seem to be a lot of enthusiasm for my recent post on upper body strength (see Building Upper Body Strength the Easy Way), so I thought I would begin expanding on some of the poses and suggestions I made in that overview. Because so many people have concerns about their wrists in this pose, today I'm going to recommend some variations on Downward-Facing Dog that allow you to reduce or eliminate pressure on your wrists.

To lessen the pressure on your wrists, you can use various props to reduce the angle at which your wrists are bent (the more deeply your wrists are bent, the more pressure there is on your wrists). Depending on which props you have available and what feels best to you, you have three possibilities:

Slant board: Set up your slant board at the top of your mat so the higher side is closest to you. If your hands tend to slip on the slant board, you can wrap the front portion of your mat on top of it. Now, starting in a kneeling position, place your hands on the slant board so the palms of your hands are fully supported and your hands angle down the slant board. Then, come into Cat pose. From there move into Downward-Facing Dog pose and assess how the pressure feels on your wrists. If there is pain or discomfort, try another modification or use one of the options where your forearms are on the floor (below).

Blocks: Set up two same-size blocks on the medium height so their long sides are parallel to the side edges of your mat and their narrow sides line up with your shoulders. Now, starting in a kneeling position, place your hands on the blocks so your fingers spill over the front and sides of the block and your wrist is at much less than a 90-degree angle. Then, come into Cat pose. From there, move into Downward-Facing Dog pose and assess how the pressure feels on your wrists. If there is pain or discomfort, try another modification or use one of the options where your forearms are on the floor (below).

Chair: Place the chair with its back against a wall and its seat facing you. Standing on front of the chair seat, come into a forward bend and place your hands on the side edges of the chair seat, so your arms turn out slightly and you can hold onto the chair seat without bending your wrists. From there, walk your feet back into Downward-Facing Dog pose and assess how the pressure feels on your wrists. If there is pain or discomfort, try another modification or use one of the options where your forearms are on the floor (below).

To prevent pressure on your wrists entirely, you can do Downward-Facing Dog with your forearms on the floor (sometimes called Dolphin pose).

Dophin Pose Version 1: In the first version of this modification, you keep your forearms parallel to each other and shoulder-width apart. Starting in Child’s pose, place your forearms on the floor so your elbows are shoulder-width apart, your forearms parallel to each other, and your index fingers are parallel to the sides of the mat. If you wish, to keep your hands in line, you can use a block between your hands with the bottom corners in the web between your thumbs and index fingers. From there, keeping your head in line with your upper arms, lift your hips into Downward-Facing Dog position. This will be a more intense stretch on your shoulders but should remove all pressure from your wrists.

Dolphin Pose Version 2: In the second version of this modification, you place your hands and forearms in a headstand position, with your hands clasped while your elbows are shoulder-width apart. This hand position is less intense on your shoulders, but may have an effect on your wrists because you are putting weight on the sides of your wrist. So check it out and see how it feels! Starting in Child’s pose, place your forearms on the floor so your elbows are shoulder-width apart and clasp your hands completely, though not tightly,  together. From there, keeping your head in line with your upper arms, lift your hips into Downward-Facing Dog position. As always, assess how the pressure feels on your wrists. If there is pain or discomfort, go back to version 1.

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