Today's Daily Tip
Gwyneth found the job emotionally toxic. Her boss had the reputation of being a tyrant. "I was terrified," she says. Making matters worse, Gwyneth found very little emotional support among her co-workers. "In most jobs I've been in, I've been able to make good connections with people," she says. At this job, she remembers sitting at her desk and not speaking to anyone all day. The wrist problem required her to make some changes in her yoga practice. Poses like Downward-Facing Dog, in which a substantial portion of the body weight lands on the wrist, were painful, so she skipped them. But she kept up her practice as well as her running, because she felt they were keeping her sane in a time of great stress.
Wrist problems like Gwyneth's are often caused by carpal tunnel syndrome (CTS). To understand how to heal them, it helps to know a bit about the area's anatomy. The carpal tunnel is a narrow passageway in the wrist formed by ligaments and the eight small carpal bones. These bones are arranged in two rows of four, and lie on either side of the crease between hand and forearm. CTS is caused when the median nerve to the hand gets compressed in this tunnel. It's become near-epidemic among computer users in recent years.
The problem, however, is not always caused by repetitive motion. Anything that decreases the space in the wrist joint and compresses the median nerve can lead to CTS. Fluid retention due to pregnancy or thyroid disease, for example, can narrow the carpal tunnel, as can cysts, old fractures, or arthritic changes in the bones.
The symptoms of CTS include intermittent numbness and tingling in the hands, which often wake people at night. The sensations typically occur in the area of the palm served by the median nerve, though some people get arm or shoulder pain. Left unchecked, compression in the wrist can progress to permanent nerve damage and muscle weakness in the hands.
How Yoga Fits In
During my medical training, the entire conversation about carpal tunnel syndrome focused on about one inch of anatomy, the canal in the wrist through which tendons and the median nerve pass . There is some validity to this perspective. Tom Alden, a Boston-area chiropractor and yoga teacher, explains that compression of the carpal tunnel often happens when people engage in activities like typing which require that they rotate the forearms so that the palm faces down. This can cause flattening of the normal arch made by the carpal bones. Cocking the wrists up, as many people do at the keyboard, can intensify this flattening of the carpal tunnel arch, putting further pressure on the tendons and the median nerve.
But from a yogic point of view, the failure to consider other factors beyond compression in the carpal tunnel is simply shortsighted. It is precisely this myopic approach that results in surgeries to open up that space before other options have been thoroughly explored.
While the medical profession tends to view carpal tunnel syndrome primarily as a problem involving the wrists, the yogic approach is to look at the whole body. Senior Iyengar Yoga teacher Mary Dunn explains, "Posture has a huge impact. It's not just the position of the wrists. It's the position of the head on the shoulders, whether the chest is sunken," etc. Medical textbooks mention that posture can play a role in CTS, but in my experience, physicians rarely address the issue. Like Dunn, many yogis believe that the disruption of nerve impulses to the median nerve in the wrist can begin upstream in the neck, shoulders, and chest. If you adopt the common postural habit of rounding your back into a C-shaped slump, nerves and blood vessels can be compressed on their way to the arm. If this bad posture is habitual, muscles, ligaments, and tendons in the chest and neck can shorten, making matters worse. Yoga also teaches that if your alignment is bad in one area it can cause ripple effects.
Yogis find that breathing is also an issue in CTS.Tom says that most people today don't know how to breathe effectively. He finds that those who have arm or wrist problems almost always have constricted breathing too. Typically, they sit slumped forward, so that the back ribs—essential for deep breathing—can't move much, and the chest doesn't expand or contract enough when they breathe. Tom has also observed that those with CTS have separated the movement of their wrists from movement of the arms and the shoulder blades. When one area is underutilized, another area has to compensate by working too hard and "the area that is overused becomes problematic." While CTS often gets lumped into the category of repetitive stress, Tom views it as being, more typically, "a holding injury." He differentiates repetitive from sustained stress. "The over-holder keeps one position for a long time. The repetitive stress person is doing something over and over again." Bringing yogic awareness to your daily habits can reduce the likelihood of wrist problems. When typing, for example, many people strike the keys with more force than necessary and slouch at the keyboard.
Yoga's focus goes beyond posture, breathing, and usage recommendations to the broader question of what's going on in your life. Tom says you need to examine "the state of mind that you're in when you're typing, the way you're holding your tension, how often you take breaks, and how much you care about your own well-being." If your job is stressful, if you lack autonomy, if your boss is a jerk, if you are asked to do more than you reasonably can—a good description of Gwyneth's job—you are more likely to develop pain.
Yoga would predict that marital problems or anything else that added stress or took joy out of life might have an impact. Factors like depression or anxiety can make just about anything worse, and CTS is no exception. Tom says, "Many of the people who have carpal tunnel put their emotional tension into their forearms." Many of his CTS patients are people who have been forced for financial reasons to do a clerical job they hate.
Although yoga teachers have been using yoga to successfully treat carpal tunnel syndrome for years, the first scientific evidence of its effectiveness came in a 1998 article in the Journal of the American Medical Association. In a randomized trial of 42 patients conducted at the Medical College of Pennsylvania, half of the patients took part in an eight-week program of Iyengar Yoga while the control group received wrist splints. Marian Garfinkel, the study's lead author and a senior teacher of the Iyengar method of yoga, taught the subjects in the yoga group 11 yoga postures designed to strengthen and stretch each joint in the upper body, along with Savasana. After the intervention, the people who had done yoga had less pain and a significant improvement in grip strength compared with the controls. While the group studied was small, and a longer-range study might be more revealing, the results were encouraging.
Gwyneth went to see Tom Alden soon after she developed her wrist symptoms . The exercises that he gave her were designed to increase her bodily awareness, adjust her alignment, and help her let go of tension. In keeping with his emphasis on self-care, he also taught her bodywork techniques that enabled her to self-administer the kind of first aid work he did on her when she came in with the problem.
Gwyneth says that she experienced almost immediate relief from the exercises that Tom recommended, and has continued to do them. Before starting her asana practice, she meditates, then does the whole sequence of wrist stretches and openers. Gwyneth also works the breathing meditation into the cracks of her day, even if it's just for a few seconds or a minute. "I do it all the time."
When Gwyneth was able to change how she bends her wrist to allow the movement to come between the two rows of carpal bones, she also noticed a difference in Down Dog. "There's more of a feeling of lift, and it allows you to extend the weight through your hands more." When she does it her old way, she can feel the row of carpal bones at the bottom of her wrist (between the creases) pressing uncomfortably into the floor.
Changing for Good
The increasing awareness that came to Gwyneth with her yoga practice had other effects as well. The contrast between the calm and serenity she found in meditation and yoga and the feelings she had at work made her realize that, although technical writing was lucrative, it was not what she wanted to do. Years ago, Gwyneth had begun training in shiatsu, a Japanese bodywork technique also known as acupressure, but stopped for a variety of reasons. As part of her life change, she decided to finish that program. In yogic terms, you could say that Gwyneth's experience s helped her find her dharma, her life's work, or a sense of purpose and direction. She has now finished her shiatsu training and has begun to see patients.
The exercises that Tom taught her have allowed Gwyneth to keep up her growing shiatsu practice with almost no wrist problems. She found the idea of the neutral alignment of the arm to be particularly helpful for her massage work. Though she has occasionally forgotten and wound up with a mild recurrence of CTS symptoms, her heightened awareness proved useful. As soon as she began to feel even the slightest symptoms, she reminded herself to correct her alignment, and it worked.
Gwyneth has even been able to teach her wrist exercises to some of her clients, including a woodworker who was worried about whether he could keep doing his job. "I found he had the exact same thing I did, the extreme muscle gripping in the flexors, and I did for him what I do on myself, and it was almost immediately effective for him." To see that she can take what she's learned and use it to help others, Gwyneth says, "feels really good."
This article is excerpted with permission from Timothy McCall's book, Yoga as Medicine: The Yogic Prescription for Health and Healing. Timothy McCall, Yoga Journal's medical editor, has traveled in India and throughout the U.S. studying with leading yoga teachers and therapists