Podcast: Episode 96: Relieving Wrist Pain

Wrists are a fascinating area of the body. They express a lot of pain that isn’t theirs, and in many scenarios, particularly in yoga, the wrists are taking a load they don’t need to take.

Whether you look at this from the perspective of yoga, or if you have Carpal Tunnel Syndrome or experience any other wrist strain, the principles I’m teaching you this week will apply.

Tune in this week as I discuss the anatomy and mechanics of the wrist, the connection between the wrists and the shoulder girdle as well as some ways to observe how you feel with your wrists. I’m sharing some key principles to consider when it comes to exploring what’s going on with your wrists and showing you how to tune into your mechanics and improve your situation.

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What You'll Learn from this Episode:

  • The connection between your wrists, shoulder girdle, and your breath.
  • How to make significant changes in your system.
  • What I mean by keeping your spine in mind.
  • How I work with people to relieve their wrist pain.
  • Some movements you can try to relieve pain.
  • Why having wrist pain doesn’t mean you can't do certain yoga movements.

Featured on the Show:

  • If this episode has resonated with you and you want to dig in more, we have the Therapeutic Yoga Intensive and our IOIT certification program coming up. Email us at [email protected] for more information.

Full Episode Transcript:

Male Announcer: You’re listening to From Pain to Possibility with Susi Hately. You will hear Susi’s best ideas on how to reduce or even eradicate your pain and learn how to listen to your body when it whispers so you don’t have to hear it scream. And now here’s your host, Susi Hately.

Welcome back. I'm so glad that you're here because we're talking about wrist pain, and wrist pain in yoga today and how we can relieve it. Now, while I'm utilizing yoga as the framework, the concepts I'll be teaching will also apply if you've got carpal tunnel syndrome that's arising out of scenarios like being in front of a computer, or wrist pain that comes from cycling, or from weightlifting. The principles I'll be sharing today will apply for you as well.

Now, I've divided the episode into a few sections. The first we'll get into some of the anatomy and mechanics briefly about the wrists and the connection of the wrists up through to the neck and the shoulder girdle. Then I'll get into ways that I work with people to relieve it and go through some of those principles that you can apply for yourself. And then I'm going to wrap it up talking about downward dog, plank and Chaturanga Dandasana.

Now, I did do an episode recently on plank, so we’ll have that in the show notes that you can take a look at. We'll also post some links to YouTube videos on the wrists where you can go and view more. Keep in mind that with all of this, I can't see you, I have no idea what has created your wrist issues.

All of this is based off of principle. And while I will introduce some movements, just recognize that I'm not suggesting that they are what you need to do to relieve your wrist issues, more so that they’re things for you to explore.

Now, if you find that what you're hearing is like, yeah, this makes so much sense. And you want yoga therapy professional training, we've got a therapeutic yoga intensive and certification program coming up that you might love. And if you're thinking what Susi is saying makes so much sense, then send an email to Kia and she will have a 30 minute conversation with you so you can see if this is a fit for you, if you are a fit for us. And then we can take those steps forward if there's a resonance.

So with that then, let's work with our wrists. Now the wrists are a really fascinating area of our body because I like to say they're the ones that express a lot of the pain that's not theirs. So yes, there is carpal tunnel syndrome and the pain that is there is real. But for a lot of scenarios, particularly in yoga, and if we were to talk about it from a desk jockey perspective in front of a computer, those wrists are taking a load that they don't need to take.

When I have looked at people's ribcage, thoracic spines, shoulder blades, cervical spines, that whole area of the neck to the ribcage to the blades to the arm, there's so much that is often limited that when we can clean that up and clear that up and really help those mechanical patterns, so much change can occur down the chain through to the wrist.

Now, typically in yoga that's not how it's addressed. Oftentimes it's someone's in a practice and they just want to keep doing the positions like downward dog, plank, Chaturanga Dandasana, they're suggested to go into a fist with their hands. Or to place props underneath their hands so that they can lessen the amount of extension through the wrist. And that can be helpful. They might even stretch out their wrists into flexion and extension, and that can be helpful.

But for a good deal of people, it's not helpful at all, and they're not interested in fisting their hands, or utilizing props, or continuing to stretch with their forearms, particularly because the results are not lasting. So that's the point of this episode, is to provide a little bit more to the conversation about the relationship between that spine, shoulder girdle, neck, arm to the wrist.

So to begin with let's take a look, just a little bit, we're not going to go into like full detail of the connection. But we're just going to look at some of the connections between the wrist and then further up the chain to the shoulder girdle, and the neck, and the shoulder blade.

What becomes really interesting is how the spine, the shoulder blade, and the arm are connected, and how the neck, and the wrist, and that T spine have such a strong relationship. And when we improve those areas, so much can shift for the wrist.

So specifically, when we take a look at the shoulder girdle, it attaches to the top of the sternum at the sternoclavicular joint, and that's the only bony attachment along the center line of the body. The muscles up in this area are the primary stabilizers between the arm the blade, the ribcage the blade, the spine the blade.

So it becomes really important, and dare I say the word profound, to work in those areas to free those areas up, to help bring more suppleness to that tissue surrounding the shoulder girdle for a lot more freedom to occur in the wrist. Because if you look at it, the wrist and the shoulder blade are at either ends of the upper limb.

The movement of one impacts the other and because of the size and the number of muscles surrounding that shoulder blade and its proximity to the nerves exiting the spine and the central lymphatic flow, if the shoulder blade is not stable or not moving well, the wrist will often bear the brunt. So we want to spend time there.

When you look at the neck, many neck muscles attach onto the ribs, onto the thoracic vertebrae, and onto the shoulder blades. For example, the fibers of the longus colli attach to T-3. The fibers of the scalenes attach to the first and second rib. The sternocleidomastoid attaches to the manubrium of the sternum. The splenius muscles attach to the upper three thoracic vertebrae. The trapezius attaches to the scapula, and also further up the neck, and the levator scapulae attaches to the scapula as well.

So if the scapula shoulder blade is stuck, or really if anywhere on the shoulder girdle is stuck, that stuckness is going to impact the attachment points of these muscles on both sides. Which will then impact the movement between the blade, the neck, the thoracic spine, the arm, and in turn what goes on down through to the wrist.

So then the key here is that if we want to improve that wrist functioning, we're really going to have to pay attention to what's in that central area. I like to call the muscles that surround the shoulder blades the primary stabilizing structure.

Because when it comes to the work we do in yoga with dog pose, with Chaturanga Dandasana, and plank, those muscular structures provides such an important structure of support, absorbing so much of the load so we can be light through the wrists. And if that's not happening, as I've said a couple of times now, those wrists will bear the load.

And if I could relate this back to working in front of the computer, it's not dissimilar there as well. That's a different position and we are oriented to gravity, we're not bearing load the way we would with dog, or plank, or Chaturanga Dandasana.

However, what I find many times with people with carpal tunnel syndrome or other wrist issues is that there tends to be so much congestion, tightness, rigidness, limitation up in that T spine, cervical spine, and around the blades. So it's not dissimilar, we're having to do many of a similar things up in that area to free it up.

So then when we're looking at freeing things up, I like to begin with the principles of movement that I talk about in my book, Anatomy and Asana. And the first place is just this notion of relaxation. Now, when I'm working with my clients I don't start with breath work.

Sometimes what I find is just in our initial conversation I can see the person down regulate in front of me, right? I can see them starting to relax as they're telling me their story, as they're letting me know what's going on through their body and through their system, what's worked, what hasn't worked.

It's the presence that I have with them that almost or perhaps does entrain them, and then they start to quiet down and become more aware of their body. So in those cases, because they've already settled in, I don't need to do a bunch more of work to grow that sense of awareness, that sense of calm because it's already present. And we can start to get into movement.

Now, in other cases when that's not the scenario, then I might bring in the breath or other techniques to nurture or nourish relaxation to help grow awareness. Because as I mentioned before, it's what we're not aware of that is often where the issue lies. So many people come to see me where they have worked with the symptoms, worked with the sensations, they get some kind of relief, but not a lot. They might get occasional relief, but not a lot and they're frustrated.

And part of the reason they're not getting the gains they want is because they're dealing with the symptoms. And what is really the problem is under that level of awareness. So when we can start to just begin in an awareness practice with somebody, to tune them into how their body is moving, to tune them into the relationships of their parts, it really becomes quite significant and powerful in the process of recovery.

So often when people go to many healthcare professionals, they're looking for the external fix, which I mean, makes sense, right? However, if we don't take our attention inward and draw inward and take that information gained that was applied to us externally, and we don't gain that awareness, we're not going to make significant changes within our system.

So that's why I like to begin with awareness. And again, it could simply be that that happens through a conversation at the beginning. Or we start with some awareness based work, which could be a breathing thing, it could be a movement thing. Anything really that is going to support that client.

Then we start to look at how the arm bone is moving in the shoulder socket. And the reason why I look at that first and not say the shoulder blades, is because we can see the arm bone really, really well. It's the largest joint, or it's a largest joint between the hips and the shoulders.

A lot of times when we can clear up some of the movement issues in that shoulder joint, that glenohumeral joint, lots of awareness and lots of freedom can be had. So it can really open the gates to being, “Oh yeah, see what's possible? Do you see how the evidence here is showing that as you improve this, then other changes happen?”

The other piece to this is because so much congestion and limitation can happen around that glenohumeral joint, we will start to see other compensatory patterns in and around the ribcage, or the pelvis, or breath holding, or with the shoulder blades that can tune us into some of the contributing factors to why the situation with the wrist is showing itself.

So it could simply be lying on your back, holding onto a strap about shoulder width apart and taking the arms over the head. And doing that in a way where you're only going as far as there's no clicking or clunking. And this is really important because the clicking and clunking is letting you know that there's something that's not quite moving as well as it could.

And we could, if you just move in the range that doesn't have a clicking and clunking, you can free up a lot of that tissue and just a few more repetitions later, you'll go through that range without the clicking and clunking. I find that people can be really kind of quick to normalize clicking and clunking.

And not that it's necessarily bad, but because they're normalizing it, they don't think to become curious about it. Whereas if you can just go in that range, yes, I know it's smaller. But if you can go in that range that is click free or clunk free, it becomes really interesting to see what else is contributing.

People have discovered that they're jaw grinders, or teeth grinders, or they hold their jaw really tight, or their neck is holding way more tension than they ever imagined when they do something really quite simple. And then that opens the door to like, oh, maybe this is contributing to why my wrist is what it is.

So when we are actually moving in a range that really does serve us, it's amazing the information that you start to learn about how your body is functioning. This kind of blends in with one of my key principles of moving your joints in an optimal range of motion. And so you're really finding that range that works on the day, a range that's not a compensatory strategy.

And while you're doing, you're able to keep in mind and be aware of what's going on elsewhere in the body. So you're tuning into the optimal range really everywhere as you're working with a movement as simple as moving the arms overhead.

You're doing that with easy breath, you're staying tuned to if you're bracing or if you're gripping, really if there's any extra rigidity that's not needed or has been added to the mix. If you can keep all of that settled out, you'll start to really recognize and see some of this relationship to what's going on through to the rest.

The other is lying over something like a pool noodle, or I've got a prop called the spinal strip. Like a firm-ish prop, you could even use a rolled up towel or a rolled up blanket. So it's not quite firm but it provides a little bit of contrast, if I could use that word.

And you place it vertically along your spine, putting the bottom and the vibe at the base of your breastbone but on your back. So as a woman if you wear a bra, it goes right to where that bra strap is. Or if you've ever worn a polar heart rate monitor, that's that same place.

So if you point to the bottom of your breastbone and then put your finger on the backside of that, that's where it is. So in your thoracic spine, it's about thoracic vertebrae seven or eight, that's where you placed the bottom edge and then you place the top edge at your head.

Now, I recommend using something thin-ish like a pool noodle or like the spinal strip I referred to. Or a rolled up towel, you could even use a rolled up mat, but I wouldn't go so far as like a pranayama pillow, or a typical thick bolster, or even like a roller that's often used with massage. Those rollers are a bit too big, they've got very little give, and they can be a little bit brutal, so I wouldn't recommend using those. And then the bolsters are often just too wide and or too cushy plus wide.

So doing something like with a pool noodle, or a rolled up towel, or a rolled up mat, or the spinal strip, and placing that at the T-7, T-8 marker and then lying back on it provides a bit of contrast. Meaning you're up a bit off of the floor, you're in a little bit of a back bend, and your arms are needing to extend a little bit toward the floor.

And what that can do is start to connect with the tissue that attaches from the ribs on the front side, so the pec minor, pec major towards the arm bone. What's really neat is that there’s an area of your body, and I think I'll do an episode on this in the coming weeks, called the coracoid process. It's the part of the shoulder blade that sticks forward, and three muscles attach to it, the coracoid brachialis and the biceps go from it to the arm, and then there's the pec minor.

And these have impact on the shoulder blade. And that area can get really, really congested and stuck. And in part when that can be freed up and then connected to better movement of the blade overall, better movement of the T spine and the C spine, the cervical and the thoracic spine, and all the way down through the arm, like it can free so much up through the wrist because there is just a greater ability to transfer and dissipate load.

So if you can lie on that, and it doesn't have to be big. And the one thing to watch for is if as you lie on whatever it is, pool noodle or a rolled up towel, if you find you start to get a little bit of lower back issue, just make the rolled up towel a little bit less, make your rolled up mat a little bit less. If you're on the pool noodle, maybe stick a little blanket underneath your bum, or get a little bit lower to the floor with just a rolled up towel. And that can just start the process.

Sometimes it's surprising when you look at a pool noodle, you want to use a smooth one too, not one of those ribbed ones, that might be kind of weird feeling. But the pool noodle can sometimes come across as being very innocuous, but where it's placed tends to be an area where a lot of people hold tension. So it's surprising for some people to kind of go whoa, there's a lot of stuff in here, I had no idea.

And it's a great example of showing yourself where there's some limitation, which can contribute to the overall function of your shoulder girdle, which can then have an impact on your wrist. It’s really, really interesting. So from there, I've given you that idea of the arms coming overhead, as well as lying on the spinal strip, or the pool noodle, or the rolled up towel.

The other thing you can play with as well are your shoulder blades and the movement. Because the shoulder blades have six ranges. They can go into retraction, so towards the spine, away from retraction, so that's protraction. So towards the spine, away from the spine, that's retraction, protraction, elevation is up to the ear, depression is down towards your hips, and then upward and downward rotation.

And when those are stuck, that can have a big impact on the way the arm bone moves. Think about if you're going to reach your arm forward and hold on to the steering wheel in some cases, or even a bit further like reaching out for a cup or a mug, you need to be able to protract that blade and then as you bring the arm back. then there's probably a bit of retraction.

Think about when you're bringing your arm up to grab something from a shelf above, we want to have upward rotation. If we are taking our arm behind ourselves and going into a parallel parking, then that blade is going to want to do a little bit of retraction as the arm moves into some extension. So if there's a limitation in those ranges, it can really impact are activities of daily living, which then will require us to compensate.

Which is a great thing, it's great our bodies can compensate. But when we compensate and compensate, and compensate, compensating is borrowing from another area to make the desired movement happen. If we continue to borrow, and then borrow, and then borrow again, well we're borrowing from an area that's not designed to do the work.

So something's going to start to break down and then we're going to have to find another place to borrow from. And then the whole system starts to become more depleted and perhaps degrade. So we want to be conscious of that.

And as you free that up, it's really fascinating how flow and energy really starts to move down towards the hand and it's almost like your limb, your whole arm as a limb, feels more connected to your torso. And I would say of the people that I've worked with who've had wrist issues, that's a really common experience. Because often with wrist issues, there's some level of numbness that's happening too. And it feels like the arm is just heavy and it's just not connected to the center of you.

So as you start to free up that blade movement and the arm movement and really tune into the awareness of what's connected and not, where you're compensating, where you're not, what's working, and what's not working, it's really interesting how you get more plugged in. And the flow of things just works better, your arm feels less dangly, if I could call it that.

So those are some key principles to consider. I didn't cover every single one of my movement principles, but I dealt with some of the key ones that you can consider as you're exploring what's going on with your wrist. And as I mentioned, if you want more help with this, then do send us an email because I'd be glad to support you in your recovery process from wrist issues.

Okay, so now, where we want to explore is this downward dog, plank, Chaturanga Dandasana conversation. And the key here is building off of what I've already mentioned above, but to make it really related to the dog, the plank, and the Chaturanga Dandasana.

The first one is really, really, really and truly breathe easy. Like try not to make your breath something. Really keep this easy and notice if as you're going into any of these positions, if you're starting to hold your breath. And can you only move in the range that you're actually breathing, and not like from a tense breathing? Because sometimes as we go into more loaded positions, we want to hold our breath because either the movement is hard and we need to create more stability or something similar to that.

So the key is to really focus easy, easy on your breath. Also, keep aware of where your spine is. I like to call it keeping your spine in mind because here what's vital is that you're not flaring out your ribs, or tucking in the ribs, or tucking through your tailbone. I know there's people out there who teach that, it's just not my style. So if that's something that you have been doing and it's not working for you, then you might just want to try keeping your spine as it is.

And then from there, notice when your spine starts to shift position, because when you look at downward dog, it's primarily a movement through your shoulders and your hips and your knees. Your spine basically stays the same throughout unless you're limited through those two major joints or your knees. And then your pelvis starts to do something. and your ribs start to do something, or your head juts forward.

The same thing can happen in plank and Chaturanga Dandasana. And then oftentimes there's a breath holding, tension building exercise of doing whole body action. And then that's actually not really supporting, it's just adding more tension into the mix.

Consider too what's going on with your legs. And I know I haven't mentioned the legs in this episode. But if you play around with either putting blocks between your legs really close up toward your pubic bone and the meat of the adductors or placing a strap, or maybe even both around your legs, and doing the strap and pressing out. And like I said, you could always do both, both strap and block.

And see if that support helps you relieve some of the pressure away from the wrists. And just connecting with your legs in that way might be the thing that's the thing. Then as you're playing around with Chaturanga, notice as you're lowering, do you take more load through the wrists because you've lost connection with your shoulder girdle?

And I pause there on purpose because it's so easy when we're loading with gravity, so we're going down with gravity, our body has to control that descent downward. And so we can lose it as we're lowering down and break through the ribs or do something through our pelvis or our spine. And then we're back into the wrists again.

So it's something to consider of like notice, if you're in tabletop or whether you're in plank, just notice where you're at and can you be there? And then take the movement, maybe just from tabletop, lifting the knees ever so slightly. And then when you lift the knees, can you just take the load through your abdomen as opposed to your wrists?

And if you can't, there's a likelihood that it might be a movement that's just too big at the time. And then to work more with your ribcage, your shoulder blades, and your arms first, get that cleared up and then come back to tabletop. Then come back to tabletop with knees lifting. Then come back to plank. Then come back to lowering down, maybe dropping the knees first to lower down.

Because each of those movements are segues into a more complex movement. And a more complex movement means there's more load or force to absorb or dissipate. Which means if you don't have the mechanics, if you don't have the connection to do that, the chances of you landing in your wrists are pretty good, okay?

So I want to emphasize that your having wrist pain does not mean that you're never, ever, ever going to do those movements again. Even if you're someone who's older and you've been told that, it's not true. I've worked with too many people over the age of 60 who have come back to doing tabletop, Chaturanga Dandasana, and plank pose and their wrists are fine.

So it really becomes a message of tuning into your tissue, tuning into the function, tuning into your mechanics and improving that there. All right? Have a great, great time exploring the connection between your wrists and your shoulder girdle, your movement, your mechanics, and your breath.

If this episode has really resonated with you and you want to dig in more, you want some professional training, we've got the therapeutic yoga intensive and our IAYT certification program coming up. You are going to want to talk to Kiya, and she is at [email protected] And she'd be delighted to tell you about the program.

You can get a feel if it's a fit for you, we can get a feel if you're a fit for us. And we would love to help you build your client practice of consistently supporting people and getting out of pain and reducing all sorts of other symptoms. Give us a shout, [email protected]. See you there.

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