Baxter Bell's reply:
This question highlights an interesting phenomena that I, too, have encountered as I research the use of hatha yoga for specific health conditions—seemingly diametrically opposed recommendations for the same condition abound. I was recently preparing a workshop on the sacroiliac joint, an area that commonly causes pain in yoga practitioners, and I found that the poses contraindicated by two prominent Iyengar teachers essentially canceled out the recommended asanas! What’s a poor yogi to do?!
It’s probably helpful to remember that the application of hatha yoga to “Western” health practice is a relatively new evolution and, as such, is in a constant state of flux and development. This could mean that you’ll need to try different recommendations and critically assess how they feel in your body.
The wrist is a complicated joint with lots of movement available to it, but it is also vulnerable to repetitive stress injury. I often see this in my patients who spend lots of time at their computer keyboards. The median nerve runs from the arm to the hand through a small tunnel created by the wrist bones and bands of ligaments. If pressure builds up in this tunnel, the nerve can get pinched and stressed, resulting in symptoms of pain reaching into the fingers and arms, often at night as well as during the day. Other symptoms include weakness of the hand, difficulty with grasping and typing, numbness, and tingling.
There has been one famous study on hatha yoga and CTS that appeared in the Journal of the American Medical Association (JAMA) in 1999—perhaps the first time the word “yoga,” let alone a medical study on yoga, ever appeared in a prominent Western medical journal. The study was certainly not perfect, but it showed the possibility that asana could improve certain aspects of CTS. The sequence of poses that the study participants performed were based on an Iyengar sequence. There was a strong emphasis on standing in Tadasana (Mountain Pose) and doing arm variations, focusing on lengthening of the flexor (palm side) side of the wrists by doing Namaste (Prayer) position, both in front and in back of the chest. Other poses included:
- Urdhva Hastasana (Upward Salute)
- Ardha Adho Mukha Svanasana (Half Downward-Facing Dog Pose) at the wall
- Arm variations of Virabhadrasana I (Warrior Pose I), which open the elbow joint, shoulder, and neck areas.
- Urdhva Mukha Svanasana (Upward-Facing Dog Pose) with hands on the edge of a chair to open the front of the wrist. Placing the hands on the chair places less pressure on the joint than the full version of the pose.
- Seated spinal twist variations, which focus on the spine and neck as areas that can directly or indirectly influence the wrists and hands downstream.
Different traditions in the yoga world have different approaches to this problem that is becoming so common. I recommend that you find an experienced instructor to do some individual sessions.
Also consider other healing modalities in your pursuit of improved wrist health. Lynde Howe, physical therapist and massage therapist at Feathered Pipe Ranch in Montana, has had great success with CTS clients by regularly massaging the arms, shoulders, neck, and wrists. She claims that the great majority of these folks have been able to avoid surgery altogether. Acupuncture may also complement your efforts to heal your wrists.
Another query regarding wrist pain gives additional recommendations for modifying your asana related to the wrist. And hopefully the future will provide more clarity on how we all address this particular dilemma.
Baxter Bell, M.D., teaches public, corporate, and specialty back-care yoga classes in Northern California, and lectures to health care professionals around the country. A graduate of Piedmont Yoga Studio's Advanced Studies Program, he integrates the therapeutic applications of yoga with Western medicine.