Christine Carr Protecting the Elbow

Smart Asana: Protecting the Elbow

Protecting the Elbow Complex During Yoga

Hand balances are a common part of many yoga classes.  We often place weight on our hands as we progress through our poses.  We may move from a bird dog variation, to downward facing dog, to upward facing dog several times in one class.  Whatever dog you do (or teach), the joints of the hand, elbow and shoulder may be at risk.  Injuries (from yoga) are on the rise (1).  The causes of joint injury may include: stiffness, hypermobility, muscle weakness, or performing hand balances improperly.   We should not underestimate the importance our elbow joint complex has in the safety of our practice.  Our elbow is situated between two mobile joints and is susceptible to strain.

The Parts

Like the knee, the elbow is considered a complex hinge joint.  Like the hinge to a door, this type of joint allows primarily one plane of motion.  In the elbow, there are 4 joints (3 bones) that enable not only bending and straightening (flexion and extension), but also rotating the hand up (supination) and down (pronation).  These joints are respectively: the humeroulnar joint, the radiohumeral joint, the proximal radioulnar joint and the distal radioulnar joint.  The last two joints are considered pivot, multi-axial joints hence the ‘complex’ part.

The elbow joint is designed to be stable.  In addition to a network of ligaments, there are 16 muscles that control movement in the elbow, wrist and hand.  Seven muscles that cross the elbow control the elbow specifically, and the other nine control the wrist and hand.   When we lack stability in the elbow joint itself through injury or genetic predisposition, we rely more heavily on muscle groups to provide the stability we lack.

If we maintain optimal joint alignment during hand balances, it will give our muscles the advantage they need to function most effectively.   As we move from plank pose to chaturanga (low plank) to upward facing dog, we place tremendous strain through our joints if they are not lined up properly.   Weight bearing poses are essentially a closed chain exercise.  With your hands firm on the ground, you are immobilizing your wrists.  The pressure of your hands against the ground provides joint stability as your muscles attempt to flex against a solid surface.  However, this action may be more difficult to achieve if our wrists, which are designed to be mobile, are stiff and tight. If we are not able to achieve a solid grip or hand placement on the floor, instead of feeling stable through our wrists and elbows, we will feel strain on our joints.

For Example

In chaturanga specifically, we need adequate flexibility to get the hand back far enough by our ribcage so that our elbows are at  an optimal 90 degrees and not more.  This position also requires shoulder flexibility to keep the elbows close to the body and scapula firm on the rib cage so the shoulders don’t roll forward.  For those who work all day at a desk, ‘forward shoulder posture’ is common.  This posture is not conducive to ideal alignment in chaturanga and various other poses that require scapular retraction (shoulder blades towards spine) and shoulder flexibility.  Therefore, many of your students may need to modify, even if they are physically strong, to avoid unnecessary strain to the joints.

Strength Requirements

Strength is another factor influencing the elbows and our ability to perform safe hand balance.  We strain our elbow, wrist and shoulder joints if our muscles are weak, at least too weak to hold our body weight.   Building adequate strength to support our weight takes work and practice.  Modifying poses like plank and chaturanga by putting the knees down for example, is a great way to build strength over time.   The elbow should not bend past 90 degrees of flexion or 180 degrees of extension while weight bearing.  Individuals that are very flexible may be physically able to extend their elbows past 180 degrees (over extending), but it doesn’t mean they should.  In fact, these folks should spend even more time building strength before attempting hand balances, even the notorious downward facing dog.

Teaching and Practice Tips

When teaching downward facing dog, instruct your students to micro bend elbows and make an effort to let the crease of the elbow face forward rather than inward.  The arm will naturally turn inward due to forearm pronation as required to keep the heels of the hands firm on the ground.  We enhance joint stability by activating opposing muscles (co-contraction) across the both the elbow and shoulder.  We may achieve this stability in downward facing dog by making an effort to move the crease of the elbow forward.  The slight external rotation bias (armpits rotating forward) not only aids in shoulder stability but also prepares the elbows for the transition to chaturanga, plank pose or cobra.  When we externally rotate the arms with our arms over our head and our hands fixed on the ground, it creates shoulder blade protraction.  This action will help to widen the back and create better stability through the shoulders so your students don’t collapse onto their joints.

If you teach twisting or binding poses, remind students to release and modify if they experience discomfort in any joint.  They may need to work on shoulder or spinal mobility first before attempting a bind to avoid torsion to the elbow.   Following these safety steps for your students will allow them to show their elbows some “love” and keep them coming back for more fun and exploration on the mat.

Practicing SMART SAFE yoga will keep us all healthy and so we can continue doing yoga into our golden years!

1. http://www.sheknows.com/health-and-wellness/articles/818809/Yoga-injuries-on-the-rise-in-women

2 Comments

  1. Jennifer Hildreth on July 24, 2015 at 4:32 am

    Dr.Carr, I am so glad you have embraced yoga! This is an excellent article. As a physical therapist who has also embraced yoga I am aware of the importance of paying attention to the details of a yoga pose Often this detailed instruction is missed by my colleagues and even community yoga instructors. I can’t wait to share this with my colleagues. I’m looking forward to your next article.

    • Christine Carr on August 9, 2015 at 9:23 am

      Jennifer,
      Thank you for your kind words! I too think that alignment cues are very important in the safety of asana practice. I think as PTs we are unique in our ability to help both students and teachers in this area. Please do share! I value feedback.

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