Wrist Pain in Yoga Poses

We ask our wrists for strength and fexibility in yoga. Here are some pointers for keeping these complex joints safe and for rehabbing them if they've been strained.
By Julie Gudmestad

Almost every yoga class includes one or two people who complain of wrist problems. Perhaps their difficulties began with long hours at a computer keyboard, or with a hard fall on an outstretched hand, or even with doing asanas. Whatever the cause, the problem may be exacerbated by bearing weight on the hands in yoga.

Yet such weight bearing is a very important part of asana practice. If you've ever had a wrist problem, you know how much it can interfere with your yoga. Wrist injuries can be especially demoralizing if you prefer a vinyasa-based style, in which you place weight on the hands over and over again as you flow through the classic Sun Salutation series—which includes Plank Pose, Chaturanga Dandasana (Four-Limbed Staff Pose), Urdhva Mukha Svanasana (Upward-Facing Dog Pose), and Adho Mukha Svanasana (Downward-Facing Dog Pose). If your wrists are strained, such asanas can cause you pain and further injury. Fortunately, a careful and gradual approach to increasing wrist flexibility and strength can help most students avoid problems—or rehabilitate the wrist if necessary.
A Vulnerable Marvel
Weight bearing on the arms seems to bring out the wrist's vulnerability. After all, the wrist is a relatively small joint, and a lot of rather delicate tissues are packed into this small area. These tissues include ligaments that knit the wrist bones together, as well as tendons that connect the forearm muscles to the fingers and help give the fingers their remarkable dexterity. Strain or irritation in these tendons can be a major factor in wrist pain.
To understand what causes this kind of pain, it's useful to consider the structure and function of a normal wrist. The wrist helps with control of the fine motor activities of the fingers and thumb by positioning and stabilizing the hand, which allows us to accomplish uniquely human endeavors like writing, drawing, and sewing. Most of the wrist's movement occurs at the juncture of the radius (one of the two forearm bones) and several of the carpal bones, which sit deep in the heel of the hand. Some movement also occurs at the junctures between the individual carpal bones.
The movements of the wrist include abduction (bending the thumb side of the hand toward the thumb side of the forearm), adduction (bending the little-finger side of the hand toward the little-finger side of the forearm), flexion, and extension. In yoga, by far the most important of these—and probably the one most likely to bring you grief—is extension. To feel this wrist movement, sit in a chair with armrests and position one of your forearms on an armrest, palm facing the floor. Cock your hand up, pointing your fingers toward the ceiling. Your wrist is now in extension. If you let your hand drape over the end of the armrest and your fingers point toward the floor, your wrist will be in flexion.
Most likely, you spend a lot of time every day with your wrist in mild extension. The hand has its most powerful grip in this alignment, and this position is the one we use most often in daily activities. So your wrist probably spends very little time in full flexion or full extension. Since the wrist, like any joint, will lose any part of its range of motion that isn't used regularly, most people gradually lose the ability to move easily and safely into full wrist extension (a 90-degree angle between the hand and forearm).
But as soon as you take a yoga pose in which you bear most or all of your weight on your hands, you demand extension from your wrists. Several of the postures in Sun Salutation—Plank, Chaturanga Dandasana, Urdhva Mukha Svanasana—require full extension, so performing the series over and over can put a cumulatively heavy load on the wrists. Arm balances like Bakasana (Crane Pose) and Adho Mukha Vrksasana (Handstand) add insult to injury by pressing all of your body weight into your wrists while they are fully extended. Combining extreme range of motion with a heavy load and multiple repetitions can easily add up to strain.
Under such conditions, it shouldn't be too surprising if the wrists send up a red flag: pain. I believe that a substantial part of yoga practitioners' wrist pain is caused by soft-tissue strain that occurs when the ligaments and tendons are forced into extension beyond their customary range.
Wrist Rx
If your wrists have become sore from practicing poses in which you bear weight on your hands, you may need to eliminate these poses for a while to allow the inflamed tissues to heal. It will probably take several weeks for the pain and soreness to subside; then you can begin a program of gently stretching the wrists and gradually reintroducing weight bearing.
Before resuming the poses that require 90 degrees of extension—or before embarking on them, if you're a beginning yoga practitioner—it's a good idea to check the range of extension of your wrists. You can do this by coming to your hands and knees with the heels of your hands directly under your shoulders. Your wrists are now at 90 degrees of extension. Are they completely comfortable in this position? If not, you should work to gently and gradually increase your wrist extension.
An easy way to do this is to put your hands together in Namaste (Prayer Position) in front of your chest. Keeping the heels of your hands together and your fingers pointing up, gently press your hands down toward your waist. Don't let the heels of your hands come apart; if you do, you'll lose the wrist stretch. If you regularly hold this stretch for a minute or two as part of your daily routine, you'll gradually be able to move the wrists into deeper extension.
I also recommend that beginning yoga students and anyone with wrist injuries or problems begin weight bearing on their arms slowly. Rather than suddenly launching into dozens of Sun Salutations, start by spending a little time almost every day on your hands and knees. In this position, there is relatively little weight on the hands, so the wrists can become accustomed to weight bearing.
On hands and knees, you can also vary the degree of extension of your wrists. If placing the heels of your hands directly below your shoulders feels too intense, you can move your hands out a little in front of your shoulders, reducing the amount of extension.
As your wrists stretch out over time, begin to work them back beneath your shoulders. Also, as your wrists gain range of motion and endurance, you can put more weight onto them by modifying the position, lifting your knees up briefly into Plank Pose. Gradually build endurance in Plank, then you can begin carefully exploring Sun Salutations.
Other positions can also introduce the wrists to weight bearing. Adho Mukha Svanasana puts some weight on the wrists but doesn't force them into 90 degrees of extension, so the joints feel more open and are less likely to be painful than in full-extension poses. Downward Dog provides an excellent way to build arm and shoulder strength, thus helping prepare you for Plank, Handstand, and other arm balances.
Props to the Rescue
If you are weak not just in your wrists but also in your arms and shoulders, you may find it helpful to begin with modified versions of Downward Dog and Plank using a chair. Pick an armless chair with a firm seat. Put a folded sticky mat over the seat to lightly pad the heels of your hands. Then place your hands on the seat with the fingers pointing out to the sides instead of forward and wrap the fingers around the sides of the seat. Walk your feet back until your body forms a straight line from heel to hip to shoulder to ear, and you will be in the modified Plank Pose.
To avoid wrist strain, make sure the heels of your hands are under or in front of your shoulders. Take a few breaths, then pull back with your thighbones into Downward Dog. As part of your daily routine, a few repetitions of this sequence will build strength in your wrists, arms, and shoulders, and will gently familiarize your wrists with weight bearing.
Other props can also help with weight bearing on the hands. You can take a lot of pressure off the wrists in Urdhva Dhanurasana (Upward-Facing Bow Pose) by elevating the heels of your hands on the wide face of two yoga blocks placed shoulder width apart against a wall; place one edge of each block on a sticky mat on the floor and lean the blocks at an angle against the wall. Using a rolled-up sticky mat or a foam or wood wedge under the heels of the hands similarly reduces the sharp angle of extension of the wrist in Plank Pose and arm balances.
You might also find relief from wrist pain in Plank and arm balances by grasping dumbbells placed on your mat, pointing toward the front edge; they allow the wrists to be in a neutral position. (It's best to use dumbbells with square weights, not round ones, so they can't roll around.) A foam-covered yoga prop called Gripitz, which is shaped like a dumbbell, was recently designed for just this purpose; you can buy it at www.gripitz.com. Be very cautious when you begin to explore arm balances using wedges or dumbbells—the props shift your center of gravity and your alignment, so the poses may seem a little unfamiliar or awkward for a while.
Working with the alignment of your shoulders, arms, and hands can also help take strain off your wrists. In Downward Dog, for example, many students take virtually all of their weight on the heels of their hands. Instead, press down with the knuckles where the fingers join the palms. Stretch the fingers forward and at the same time visualize that you are lifting the forearms up out of the wrists. Try to apply this action whenever you're bearing weight on the hands.
The wrist is a complicated structure and can develop many problems other than the soreness that comes from unaccustomed extension. If you have more serious wrist problems—like carpal tunnel syndrome, arthritis, or previous fracture or surgery sites that are still stiff and painful—please consult your health care provider before attempting weight-bearing poses.
Carpal tunnel syndrome is a fairly common, painful condition caused when the narrow tunnel formed by the carpal bones and adjacent ligaments puts pressure on the median nerve and finger flexor tendons that pass through the tunnel. If you think you may have carpal tunnel syndrome, it's important to get an accurate diagnosis from a health care professional. Conventional medicine usually treats the syndrome with medication, splints, or surgery, but you might also want to seek out the asana sequence created by Iyengar Yoga teacher Marian Garfinkel, director of the B.K.S. Iyengar Yoga Studio of Philadelphia. In a medical study published by the Journal of the American Medical Association (November 11, 1998), Garfinkel documented that the program she developed helped the carpal tunnel sufferers who tried it.
Whatever the status of your wrists—currently painful, in recovery, or blessedly problem-free—remember that yoga is meant to be a beneficial, healing practice. Make sure you aren't straining your wrists through yoga. If you have done so, integrate some of the gentler poses mentioned in this article into your routine and give your wrists a chance to build strength, flexibility, and endurance before you take on more advanced or strenuous weight-bearing poses.

A licensed physical therapist and certified Iyengar Yoga teacher, Julie Gudmestad runs a private physical therapy practice and yoga studio in Portland, Oregon. She regrets that she cannot respond to correspondence or calls requesting personal health advice.