Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

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Top 5 Challenging Wrist Poses in Yoga : Why Do my Wrists Hurt Part 2

On Monday, I posted a bit about why your wrists might not easily explore full ranges of extension, especially if you spend your whole musical and technological life in flexion.  I additionally had two students in my yoga classes yesterday that complained of wrist pain, and it reminded me that we teachers can do better in teaching progression and strength. First though, what are some of the postures in yoga (and pilates and other movement disciplines) that might create full wrist extension?

This is sometimes seen as "table top," or the beginning of cat cow, or quadruped. It may come at the beginning of class, but it can be hard on the wrists if the range isn't there.

This is sometimes seen as "table top," or the beginning of cat cow, or quadruped. It may come at the beginning of class, but it can be hard on the wrists if the range isn't there.

1.  Table Top/ Cat- Cow/ Plank

Whether at the top of a pushup or the beginning of a spine warm-up, this set up requires full wrist extension.  One way of modifying it is to make a fist and use the knuckles as the contact point with the ground.  Another option is to roll up the edge of your mat and decrease the angle of wrist extension needed.   Planks on top of physio balls are equally demanding, as well as side planks, so keep in mind that pilates and traditional gym classes may also be taxing.

2.  Downward Facing Dog

I mentioned this last time, but DFD requires wrist extension, but not to 90 degrees.  It's usually less taxing than the plank to pushup situation, but as with other weight bearing poses, it’s about progression, building strength over time, and not suddenly doing 50 Downward dogs out of the blue.

3. Chaturanga to Upward Facing Dog

This posture,  upward facing dog , requires the body weight to be lifted on the wrists, whereas cobra keeps contact between hips and the mat. That's a little tough on the wrists sometimes.

This posture, upward facing dog, requires the body weight to be lifted on the wrists, whereas cobra keeps contact between hips and the mat. That's a little tough on the wrists sometimes.

This sequence, often called the vinyasa, requires full range of wrist extension.  The easiest thing to do is to skip it when you're tired, or just lower to your belly and do a baby cobra.  Upward facing dog itself is super taxing because of the extension, transition through the pushup, and weight combination. This sequence of events is often glossed over in yoga, but it’s a stylized pushup, and pushups are great if your body is prepared, adapted, and ready to be loaded with your body weight, but if not, you may need to work up to the strength required to perform the activity. (Yoga teachers and pilates can also do a better job of training students to get to this point rather than just asking people to do them!)

4.  Any arm balance.  

This pose is commonly called  crow  or crane, depending on the variation. For obvious reasons, it can be a bit tough on the paws.

This pose is commonly called crow or crane, depending on the variation. For obvious reasons, it can be a bit tough on the paws.

Whether it's crow, side crow, twisted scissors, handstand, or galavasana, your entire body weight is balanced over your hands.  If you have weak wrists, limited range of motion, or have no idea if you should be doing arm balances, you probably shouldn't.

5.  Full wheel (AKA. Urdhva Dhanurasana)

For years, this was my wrist nemesis.  It requires shoulder mobility and wrist mobility, and I always wanted to do it because everyone else could.  Even now, I can't hold it for a long time, and I have to be really mindful about warming up my body before I attempt it.  Stick with bridge if you're sensitive, or put the hands on blocks against the wall to decrease the range (or grab a hold of the teacher's ankles).  

Now that we've looked at some of the wrist extension culprits, we'll address some ways to modify postures to make them more wrist friendly, and how to work on building your range and strength over time.  


Why Do My Wrists Hurt During my Workouts? Part 1

One of the questions I'm most frequently asked is why yoga makes our wrists hurt so much in yoga, pilates, planks, and other movements.   First thing, let's look at the small bones of the wrist and what's going on in there.

Can you tell I'm excited about my new model skeleton?

Can you tell I'm excited about my new model skeleton?

Our wrist is a somewhat delicate joint, at least in comparison to the foot, which has a very similar structure.  The eight carpal bones are very small and fit between the radius/ulna and the metacarpals.  (The phalanges are what we think of as the finger bones, but clearly, fingers start from the wrist, not the knuckles!)

We flex the wrist to type and text, we extend the wrist to do plank and down dog.

We flex the wrist to type and text, we extend the wrist to do plank and down dog.

It also means that we may not have the same range in the opposite direction that some people do.

It also means that we may not have the same range in the opposite direction that some people do.

There are many different styles of yoga, but the many flow styles these days emphasize vinyasas or the sequence of plank, chaturanga, to upward facing dog.  Even if those terms don't mean anything to you, think plank to pushup, repeated over and over, which occurs in many fitness formats.  So why does this sequence hurt so many folks?  Well, most musicians (and normal people) keep their wrists in partial flexion, whether they are desk bound, using their phone, keyboardists, string players, woodwind players, teachers, etc.  That partial flexion adds up over the years, especially if we never use the opposite range of motion- wrist extension.  The tissues of the palm, hand, and forearm, stay partially contracted, and then limit our range of extension.  One day, you decide to try yoga, which demands a lot of wrist extension plus you decide to LOAD your whole body weight on top of it, and then you wonder why things hurt.     Staying in one position for a long time (like 15-20 years, many hours a day) keeps the muscles and connective tissue in that position- making it difficult to adapt to the opposite shape of extension.

So there’s two remedies:

1) build the range of motion in extension, and 2) progressively load those tissues to build up strength. If we never use our wrists in extension, we need to gently progress with range of motion and weight, rather than putting 130-230 pounds on our hands out of the blue. That means you can’t go from zero to full plank/push up hour without some gradual change to optimize adaptation.

My wrists are sometimes tight- you can see that it's hard for my thumb to fully rest on the floor without a small bend..

My wrists are sometimes tight- you can see that it's hard for my thumb to fully rest on the floor without a small bend..

Let's get more specific- planks require full wrist extension (meaning that the distance between the back of the hand and forearm is 90 degrees) whereas down dog is more of a 60 degree angle, depending on many factors.  

Notice that the angle between the forearm and wrist is acute, whereas the other is a right angle?

Notice that the angle between the forearm and wrist is acute, whereas the other is a right angle?

Imagefrom the Melt Method, which has a terrific hand and foot massage kit!

Imagefrom the Melt Method, which has a terrific hand and foot massage kit!

So then, imagine repeating full extension over and over again when you don't actually have that full range, or you only have it on one side. In addition, it’s been days, weeks or months since you’ve done yoga, so your body hasn’t been loaded this way. 

First, let's test the range you have in your wrists right now, shall we?  Bring your forearms together in front of your chest, then allow your wrists to extend comfortably.  Don't force it.  Do your wrists naturally open to a 180 degree angle?  Or is one side more acute (hello left hand for me!)?  That explains why full extension might aggravate things!  I'll talk a bit more about poses that are wrist intensive next time, and how to help your wrists out, and possibly gain more range in the long run.

How do I find a good massage therapist?

Most stock images of massage feature tropical flowers, perfectly white towels, and beautiful young women with flawless makeup.  This in fact has never been my experience and I'm 100% ok with that. I'd love for massage establishments to STOP using gendered stereotypical images like this.

Most stock images of massage feature tropical flowers, perfectly white towels, and beautiful young women with flawless makeup.  This in fact has never been my experience and I'm 100% ok with that. I'd love for massage establishments to STOP using gendered stereotypical images like this.

Reader Question_.jpg

My friends and colleagues often ask me questions, (or just email one), and one of the most common is "how do I find a good massage therapist in my city/area?"  It's a great question, and not a simple answer.  

First of all, what makes a "good" massage for you, i.e. what conditions must be present for you to feel relaxed and supported?  What type of pressure do you like? (Soft tissue, energetic work, craniosacral, deep tissue, structural integration, etc.)  A "good" massage depends on your body, your issues, your likes and dislikes, and a host of other factors, so there is no one bodyworker that is perfect for everyone!  Just because you loved one particular practitioner or session does not mean that your friend will, and that's ok.

What's going on in your body that is spurring you to seek a massage?  Are you overly stressed, in pain, working with a chronic pain or muscle issue, recuperating from a surgery, pregnant, dealing with chemotherapy, etc?  Are you just looking for a maintenance session to keep your body functioning well?

This is a way more accurate image of my massage experiences- charts, props in the room, clothing on, etc.  I've never had a massage where tropical flowers seemed  an appropriate hair accessory.

This is a way more accurate image of my massage experiences- charts, props in the room, clothing on, etc.  I've never had a massage where tropical flowers seemed  an appropriate hair accessory.

What do you want to accomplish in your session- is this a one time session or are you hoping for multiple sessions?  This can help your bodyworker best serve you, but also help you choose a practitioner as well.  

One of the big questions I struggle with as a movement teacher is are you treating the symptom of a movement based problem, or are you treating the problem itself? So let's say that you have shoulder pain- you can get a massage that focuses on the shoulder and chest.  This can be beneficial, but what caused the pain to begin with?  Was it something else like your daily use of your neck or spine or hips? Was it just a one time weird way of sleeping? Do you want a session that will help clarify what the problem is, i.e. should you see someone who is a physical therapist, or a bodyworker who does muscle testing or movement assessment?  Many bodyworkers who are not physical therapists also teach movement, whether as personal trainers, pilates teachers, etc., and finding someone who does both can help you identify where you have deficiencies and how you can address them through movement.

Next suggestion is to look beyond chain massage facilities-there are some great therapists at chains, but many times, recent program graduates with less experience are working at such places.  When reading someone's biography, look at how many years of experience they have to begin with.  What sort of the training do they have?  Most states have a comprehensive 750-1000 hour massage certification, but beyond that, many people will seek extensive continuing education, other certifications, or specializations. What sort of populations does this person serve or aim to serve? (older clients, those with special issues, etc.)  Do they have anything in their biography that indicates a focus on your specific issues, pains, etc.? If they don't say "focus on performing artists or focus on athletes" in their biography, it doesn't mean that they can't be of help, but it's something to also consider.  Some of my favorite massages (and personal training sessions) have been from people who used to play the violin, viola, or cello, and who very much can visualize what my issues are just from playing the instrument.  

With all this begin said, I personally like deep tissue work sometimes, as someone who is not petite and with a lot of muscle mass.  This is not good for everyone, and not good for me all the time.  I also appreciate bodyworkers who understand human movement more in depth, and who maybe have training in movement assessment strategies, such as the work of Grey Cook and the SFMA/FMS.  I also have had some really interesting success with NKT and P-DTR practitioners.  If you're working with a chronic pain issue that is undiagnosed (and you're not being treated for), I'd highly recommend seeing a medical professional, and working with a good physical therapist who does both manual therapy, movement screening, and correctives.  At the end of the day, finding a good bodyworker involves a certain amount of trial and error, to see if they're a good fit for you.

Help-I bruised my tailbone!

It's embarrassing sometimes to admit, but I have bruised my tailbone...twice.  Neither time was particularly graceful, and both times involved falling on my tailbone, and that's all I'll say about that.  Clumsiness aside, bruising your tailbone, technically called your coccyx, is incredibly painful, especially if you have to sit for a living.  In the last 3 weeks, 3 different colleagues have talked to me about past or present tailbone pain, and the difficulties and discomfort of bruising what seems like your butt, but is really the culmination of your spine.

So how does one bruise a tailbone?  Good question.  A bruised tailbone can be an injury to the tailbone itself or the tissues surrounding it.  It will likely hurt the most when sitting.

1.  Sudden impact- this can mean falling in any capacity, whether in a contact sport, or in day to day life.  If someone pulls a chair out from underneath you, you would fall, most likely on your tailbone.  Sports such as soccer and football can also lead to similar falls.

2.  Repetitive strain- horseback riding, biking, rowing, anything that puts the torso forward of the pelvis could strain the ligaments surrounding the sacrum and coccyx.  In horseback riding and mountain biking, the bouncing and jostling can also catalyze discomfort or damage.  

3.  Childbirth and pregnancy can also lead to strain for the muscles, ligaments, and tendons surrounding the tailbone.

What will help with the pain and discomfort?

1. Wear flat shoes.  Any elevation in the shoe heel will change the angle of the pelvis and change the load on tissues surrounding the tailbone including the pelvic floor. 

One of these  cut-out cushions  could help relieve some of the pain of sitting.

One of these cut-out cushions could help relieve some of the pain of sitting.

2.  Consider sitting on an elevated cushion to help keep the pelvis in neutral while seated.  While different cushions will work for different people, even a rolled up towel on the back part of your car seat or orchestra cushion can help.

3. Heat therapy can help any back spasms or hip discomfort triggered by the bruising. Icing could aggravate the issues, as pointed out in this article.

4. Acupuncture around the back and hips can also be helpful- I've personally found it to be great for addressing my back issues in general.

5.  Initially, you won't want to or need to massage the tissues surrounding the tailbone or low back.  Once the acute pain has diminished, having a skilled bodyworker address your low back and hips can be really helpful.  You can also start to self-massage with a soft implement (no lacrosse balls!), like a tennis ball or YTU ball at the wall. 

6.  Walking can be a great movement option for your back and pelvis when other forms of exercise are too painful. (Assuming you're wearing flat shoes while walking!)

7.  See a medical professional- although my doctor prescribed painkillers and told me it would get better eventually, your doctor might have a few better options for your recovery, including PT, insurance covered acupuncture, or insurance covered medical massage.

8.  Strengthen the other muscles of your back.  For me, this was really important once the acute pain diminished.  I found that low back strengtheners like locust pose, baby cobra, and sphinx helped with my pain but also improved my proprioception of my back as a whole, and paved the way for a stronger back post recovery.

9. Sit better, making sure that you're sitting on your ischial tuberosities and not your tailbone!  Perhaps you can sit less too?

Although tailbone pain can be embarrassing, it's not uncommon!  Be patient with yourself as you recover and know that the pain will dissipate with time.



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