Tuesday, November 6, 2012

(Ashtanga Vinyasa) Yoga with Wrist Injuries; a guest post by La Gitane

So much of our regular Ashtanga yoga practice relies on being able to bear weight with our hands: Chaturanga, vinyasas, jump-backs and jump-throughs, you name it. Because of this, injury to the wrists can often be a very debilitating and demoralizing blow to our practices. It's easy to become discouraged when a particular body part that has served us so well and whose reliability in carrying us from point A to point B on the mat we have virtually taken for granted suddenly breaks down and becomes the source of great pain rather than pride. 

But if you are suffering from wrist pain or injury, fear no longer! In response to my recent call for guest posts about healing from injuries in the practice (I'm still accepting guest posts, by the way, just so you know...), La Gitane from Yoga Gypsy has written a very illuminating post in which she describes in great detail her journey of healing from a recent wrist injury. She includes some very useful suggestions on how to modify your practice to work with this great bane to Ashtanga practice; now we will have no excuse not to practice if and when, God forbid, we injure our wrists. Sigh...

Before I shut up and let you read her article, I feel that I should also say a couple more things about La Gitane. In my mind, she is most famous in the Ashtanga blogosphere for writing that infamous open letter to Ashtanga back in June, in which she admits that she's, ahem, seeing other yoga. Ha! Talk about Brahmacharya violations... (Bad Lady!) I don't know if she's now back with Ashtanga, or if she's still persisting with her Ashtanga infidelity; in either case, what other people do (or don't do) behind Ashtanga's back is none of my business, so I'll leave it at that :-)

In "real" life, La Gitane works in international development as a communications professional, and is based in East Timor. She also teaches yoga.

Alright... now that I have gotten my daily ramble out of my system, I shall leave you in peace to enjoy La Gitane's post. More later.

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 (Ashtanga Vinyasa) Yoga with wrist injuries


by La Gitane
When I saw Nobel was asking for guest posts about practicing with and healing injuries, it felt pretty serendipitous, because about 6 weeks ago I injured my right wrist. I think it happened while I was practicing an arm balance: I lost my balance and started to tip forward, but caught myself. I didn’t notice it at the time, but I must have over-strained my wrist in that moment. 

Anyway, one day my wrist just hurt like crazy. The pain was most pronounced in the wrist joint itself, but radiated all the way up to the elbow. I couldn't put ANY weight on it. However, I was able to modify my practice and now it is healing quite happily. Since I know that the audience of this blog is an Ashtanga audience, I’ll write from the perspective of having a wrist injury but wanting to still do an Ashtanga or vinyasa-based practice. I shouldn’t have to say it, but of course, if you are practicing with an injury you are always best to seek a doctor’s opinion – especially if you have pain that lasts for more than a week without any improvement.

For me, there are two key components to dealing with an injury in yoga. The first is quite obvious: protect the injured area and allow it sufficient time and space to heal. The second is to identify the root cause of the injury and work to prevent it from happening again.

It's important to remember that in yoga therapy, the mantra is "function over form". You have to let go of attachments to a particular pose, and find others that move or stretch your body in the same way. From a physical perspective, for every pose that you aren’t able to do, look at the pose and identify what the main muscles are that are stretched and strengthened, and then find other ways of achieving that. From a mental perspective, think about these modifications as an opportunity to deepen your sadhana, your study of the practice, and as an investment into an injury-free future: not as a sacrifice.

Dealing with a wrist injury in vinyasa yoga involves some pretty obvious modifications, but in fact, it didn’t affect my overall practice too much. I was still able to practice a dynamic flow with a combination of standing and seated poses. I also wore a wrist brace to support the wrist and reduce movement, and massaged the affected area daily with anti-inflammatory gel.  I wore the brace to teach as well, and used the opportunity to talk about wrist safety and alignment! 

Part I: Dealing with the Injury – practice modifications

Week 1
  • Practiced (wearing the brace) without putting any weight on the wrists
  • Instead of sun salutations A, I warmed up my back and hamstrings by simply moving through tadasana - urdvha hastasana with a backbend - utanasana - looking forward - utanasana - urdvha hastasana with a backbend – tadasana.
  • I practiced the standing poses as normal, except without placing any weight on my injured wrist in poses like trikonasana, parvritta trikonasana, parsvakonasana etc., and I avoided any odd angles for the wrist like bringing the hands into reverse prayer in parsvottanasana, or grasping the foot in ardha baddha padmottanasana.
  • For all poses that required putting weight on the wrists, I substituted others that targeted similar areas of the body. So for example, I substituted cobra or shalabasana for upward dog, dolphin pose for downward dog, dolphin plank for plank pose, fish for purvottanasana, bridge for urdvha dhanurasana, and so on.
  • Instead of taking the traditional vinyasa between seated poses, I practiced the following standing vinyasa that was taught to me by one of my Ashtanga teachers. It doesn’t place any strain on the wrists but still emphasizes core strength and stretches out the back between poses. (You might want to add halasana between navasana and standing up to help get some momentum!)


Week 3
  • Once my wrist was generally pain-free and stable, I began to gradually and mindfully re-introduce weight bearing poses, while continuing to wear the brace.
  • Before practice, I warmed up my wrists with some gentle wrist stretches. (See this old blog post for details: http://yogagypsy.blogspot.com/2012/04/simple-excercises-for-wrist-pain.html)
  • In addition, I used extra padding under my wrists at all times I was putting weight on them. An extra yoga mat is perfect for this. Place it under the palm of the hand with the fingertips hanging off the support. This reduces the angle between the wrists and the floor and helps line up the arm bones. For a vinyasa practice, two extra mats is ideal, because you can place one either side of your feet and it won’t interrupt your flow.


Practice modifications:
  • No jump backs / forward / throughs
  • Plank and chaturanga with knees on the ground
  • Fewer breaths in downward-facing dog, or dolphin pose instead
  • Replace upward facing dog with cobra / shalabasana
  • No arm balances
  • For all vinyasas between seated poses, I continued with the standing vinyasas shown previously
Week 6
Practice modifications:
  • Continuing to warm up the wrists before practice and stopping periodically to stretch them out
  • Continuing to use padding, but practicing without the brace
  • Jumping back to plank before lowering to chaturanga - this places considerably less strain on the wrists than jumping straight to chaturanga.
  • Alternating between standing vinyasa and jump-backs, slowly building back the number of vinyasas
  • Re-introducing arm balances with sufficient padding under the hands
  • Closely observing how my wrist feels for the rest of the day, to know when I have gone too far.
Part II: Identifying the root causes
This, of course, is much trickier. For wrist injuries, there are a few possible causes that come to mind. Maybe you readers can add more:    

      1. Practicing with poor alignment of the wrists
      2. Practicing with hyperextension of the arms, locking the elbow joint and putting too much weight/strain on the wrist
      3. Long holds in downward dog when the hamstrings & shoulders are very tight, leading to too much weight on the arms and wrists
      4. Practicing plank/chaturanga/jump-throughs/backs/arm balances without having enough ‘lightness’ from the core and from the back body, thereby putting too much strain on the wrists       
      5. One-off injury caused by putting too much weight/strain on the wrist, probably while attempting a new arm balance

I think in my case, 4. are issues I need to work on in my regular practice, although the injury itself was caused by 5. So I am working on building core and back body strength, and making sure that I do my jump-throughs and -backs slowly and mindfully, with control.

Thanks for reading! Have you ever practiced with a wrist injury? What did you do?

57 comments:

  1. Oh! This reminds me of when I broke my arm! DUH! I totally could have written a guest post about healing an injury! I forget my victories sometimes!!!

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    Replies
  2. Sweet! I have never been called infamous before. And for the record, yes, I am still, ahem, seeing other yoga. And enjoying it - although I do still flirt with Ashtanga from time to time. Does that make me a tease? ;)

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    1. Hmm... I'm beginning to think that cheating on Ashtanga may be the only brahmacharya violation out there that is morally okay :-)

      Or maybe you are in an "open relationship" with Ashtanga, where both you and Ashtanga have mutually agreed that it is okay to "see other people/yoga". If this is the case, then maybe you are not committing any brahmacharya violation at all. I see an interesting topic for a new post here... :-)

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  3. Great post! Over the years, I managed to maintain a practice through carpel tunnel syndrome, two surgeries and a serious accident that left me with multiple fractures. Trust me, it didn't look like my 'regular' practice, but so what. The modifications,extra breaths and reduction in asanas did not detract from the results - calmness and well-being. I'd like to think it helped me heal faster both mentally and physically. I've only had one injury from the practice and that's when my ego was showing off. But injuries can and do happen to just about everybody - even the most careful. It's comforting to know it's not 'all over' when stuff 'happens.

    Aloha

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    Replies
    1. Thanks for sharing, Leslie. I have not had all the experiences with working with injuries and surgeries that you have had, but like you, my own experience has also led me to feel that my practice has helped me to heal faster both physically and mentally from injuries. And no, it's definitely not over when stuff happens. I think I wrote in a post on this blog sometime ago that in many ways, working with injury is a new beginning and opens up new doors of insight and understanding in the practice for one.

      You're from Hawaii? :-)

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    2. Yes- I'm in Hawaii. In fact I'm going to an 'Intensive' in Hilo this weekend with Chuck Miller. We're fortunate to have a number of senior teachers and authorized teachers here in the islands and they know how to make modifications when warranted. As for practicing through the painful times, that can really be an eye-opener for self study. I learned a lot about myself - good and not so good - that I might not have known otherwise. Also, if you can practice and heal through a difficult time - be it physical or mental- and reach the 'other side' intact, you are reassured that no matter what happens you're ok. I should add that I also incorporate acupuncture, massage therapy and chiropractic as needed. It's all helpful. ;-)
      Aloha,

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    3. A few years ago (summer 2007), I went to Maui to attend an asana intensive with Eddie Modestini and Nicki Doane. I think they have a similar approach to the practice as Chuck and Maty; basically, do postures with an Iyengar-like attention to alignment, but within the context of an Ashtanga practice. Very interesting approach; I learned so much from them.

      I wonder what it is about the islands that cause them to "harbor" so many authorized and certified teachers and of course, David Williams himself? Maybe it's simply the geographical proximity to Asia? Or are the Hawaiians right that the islands are in fact the center of the Earth, and hold a certain special energy? :-)

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    4. Well, we are sitting on a 'hotspot' - a direct conduit to the earth's mantle. But who knows.... The cost of living is high - very high and not just financially. We are isolated and and a great distance from anything. Which sort of makes this a world of it's own. We have year-round great weather, beautiful scenery, great fresh food and a laid back (polynesian?) attitude that values family, friends and community more than things- even our homeless would rather camp on the beaches than live in shelters. Oahu is getting a little crazy, but we're relocating to the Big Island next year.
      Although I went to school on the mainland, other than that I grew up here and have always lived here. We travel a lot but at the end of each trip, it's always good to be home. besides most of us shrivel below 65 degrees and wilt past 90. I don't know if we're "spoiled" or pansies!

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  4. I cannot begin to enumerate the ways in which this is going to help me. Thank you, thank you.

    ReplyDelete
    Replies
    1. My pleasure... well, actually, we should thank La Gitane :-)

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    2. I am so, so glad! Feel free to share your experience or ask anything else you want. I had to make it up as I go, so I wanted to post this in case it could be helfpul. The padding really does make an amazing difference.

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  5. Great post. Because Im a masage therapist too I tend to have sore wrists so a practice all upper body weightbearing stuff with folded up mats under the heels of my hands. Makes such a difference :)

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    Replies
    1. It really does make an incredible difference. The next challenge is to find the balance between how much to persist with wrists to build strength, and when to ease off. It varies day by day - but I'm not giving up my padding! One of the perks of being a yoga teacher is that I have lots of brightly coloured spare mats lying around. :D

      Delete
  6. I would love to read a post similar but about knee injury! I have trouble modifying for this because it seems like everything uses the knee. It's challenging!

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  7. Some one may realize that while we are attempting for the yoga asana the mere difficulty comes in the responsiveness of the wrist to these difficult steps. The performing of these events lead to the breakage of the wrist ligaments if not actually done without a trainer. Love to read all the posts, these are really good and informative too.

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  8. I actually am in the middle of practicing with a wrist injury. I didn't injure my wrist during my Ashtanga practice, but slipping on a wet floor and putting my wrist out to catch my swift fall. I didn't even notice that it was injured until the day after when I woke up and then of course, when I went to practice realized I couldn't dorsal flex it (place hand flat on the ground) let alone place ANY weight on it at all. This friday will be five weeks and I just did my first full chaturanga yesterday and am just starting to be able to put my wrist flat in trikonasana and parsva etc. . I still can't jump through or do any arm balances. : ( But I too modified using dolphin plank and forearm downward facing dog, and have done similar things like navasana series instead of the full vinyasas - I also though chose to practice primary once per week like that and then practice a modified 2nd series as there aren't as many jump throughs to seated with all of the back work in the beginning. But I REALLY like the advice to use this as a way to learn how to use other asanas to target the same area of the body - I hadn't done that and will look at that tomorrow and this week prior to practicing. It's definitely a journey, lots of patience, and love to the wrist. I am also using acupuncture, massage, and have recently started to have the wrist and forearm adjusted as I know it too has affected my alignment of my elbow / forearm and shoulder too.

    ReplyDelete
  9. Thank you for this post. This certainly is a frustrating challenge. I have a couple of questions and would really appreciate any feedback you or any readers can offer...

    First, I've been practicing vinyasas on your knuckles and knees. Would you recommend against the knuckles?

    Also, I've concluded that my upper body isn't as strong as I thought. I think I may be developing some compensation-related strain in my arms and shoulders. If anyone else has experienced that, can you recommend a way to heal your wrists without loosing too much upper body strength? I'm considering weights at this point.

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  10. Oh, I forgot to ask! I tried a modified vinyasa by doing chaturanga on my knuckles/knees, then a very low cobra, then downward facing dog on my forearms... but how the heck do you transition into Virabhadra I pose from there?

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  11. Brilliant, thank you for sharing.

    ReplyDelete
  12. Thanks for sharing this! It’s already proven that practicing yoga can be very beneficial not only physically, but psychologically as well. And when doing this, just make sure that you’re free of any negative thoughts that might affect your concentration.

    Yevette @USHealthWorks.com

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  16. Thank you so much! I've been having mild wrist pain on and off and have such a better understanding of what's probably going on.

    ReplyDelete
  17. Hi. Can you please elaborate a bit on cause of wrist injury due to alignment.

    ReplyDelete
  18. I need to work on in my regular practice

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  19. Continuing to use padding, but practicing without the brace.

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  21. I need to work on in my regular practice in yoga

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  22. Thank you so much for sharing this. I sprained my hand a couple days ago, during yoga. I understand what I did wrong, but do not want to take too long a break from my practice.

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