A Yoga Practice for Carpal Tunnel Syndrome
. . . and other sources of hand/wrist sensitivity
by Amber Burke
Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional. Yoga teachers should remain within their scope of practice: This means not attempting to diagnose, treat, or offer medical advice to students.
Is yoga a good idea for those with carpal tunnel syndrome or other wrist and hand problems? It depends: Yoga can be irritating or helpful, depending on the emphasis of the practice.
A practice that’s heavy on poses in which the hands bear weight—like tabletop and the poses of the vinyasa, or even mudras (hand gestures) like reverse namaste—may cause pain, tingling, or numbness during or after practice for those with wrist issues.
In poses like tabletop, the wrists are in extension. According to physical therapist Bill Reif, author of The Back Pain Secret: The Real Reason for Women’s Back Pain and How to Treat It, extension is one of the most aggravating positions for those with underlying hand or wrist problems: “Those who have carpal tunnel syndrome or other wrist or hand ailments are typically better off avoiding extension and other positions that challenge the wrist’s range of motion, and certainly should avoid weight-bearing while in these positions.” Instead, he says, those students can benefit from “keeping a neutral wrist.” A neutral wrist has no bend in it: The line from the forearm to the back of the hand is flat (as in warrior II).
To minimize the irritation to the wrists and hands, poses in which the hands bear weight can either be modified using the suggestions here or simply skipped, with the practitioner instead focusing on standing, seated, supine, and prone poses that do not require the wrists to be extended or bear weight.
The following practice does one better, offering poses and movements that may actually be helpful. Reif explains: “A therapeutic practice for the wrists and hands will include shoulder alignment, stretching and strengthening of the upper extremities, and neural glides—movements that mobilize the affected nerves.”
In keeping with this advice, the practice below emphasizes shoulder alignment, because the three main nerves of the arms (median, ulnar, radial), which are often implicated in wrist pain, originate in the neck and shoulders. The practice includes shoulder and arm stretching and strengthening movements designed to keep the shoulders in the healthy alignment that may help to decompress nerve channels, as well as neural glides to assist the nerves in sliding freely along these channels.
Those with current wrist or hand irritation may wish to do this complete practice three or four times a week. Additionally, they may find it helpful to practice daily a few of the exercises they find most valuable, interspersing them throughout the day or whenever symptoms flare. Those whose wrist pain has abated may wish to do this practice weekly to stave off a recurrence.
While some of the movements below may be challenging, Reif emphasizes that you should not experience pain, tingling, or numbness during any exercise. And if wrist or hand pain worsens, do seek medical advice. “Increase in frequency, duration, and/or intensity of symptoms is a sign to stop what you’re doing and return to your physician,” Reif emphasizes.
You will need a wall (or door) to stand against for number 1, and a tennis ball (or other “squeezable” ball) for number 2. For number 2, it may also be helpful to have a clock with a second hand or a stopwatch. A strap will be necessary for many of these exercises. For number 9 (savasana), you will want two (or four) blankets.
1. Mountain Pose at the Wall
Since the nerves that run through the wrists into the hands originate in the neck and shoulder area, refining shoulder and neck alignment may help alleviate neck compression.
Stand with your back against a wall and your feet a few inches away from it, with your feet hip-distance apart and roughly parallel. (The back of your head, the back of your shoulders and rib cage, and the back of your pelvis should all be against the wall; the back of your neck and your lower back ideally curve gently away from the wall.)
While breathing deep, comfortable breaths with your arms at your sides, do several shoulder rolls: Roll your shoulders up, toward the wall, then down your back and toward each other.
Attention to Neck and Shoulders
With your shoulder blades and the backs of your shoulders pressing into the wall, bring your arms alongside you as in a traditional mountain pose, pressing the backs of your arms and hands against the wall, palms facing forward.
Now that you have set up your shoulders, check on your neck. If your chin is lifting, and the back of your neck creasing, tuck your chin slightly to lengthen the back of your neck. “Imagine a string pulling you up by the crown of your head,” Reif suggests. If the back of your head is not against the wall, move it in that direction now, bringing it as close to the wall as you can without losing the length in your neck.
2. Tennis or Therapy Ball Squeeze
To strengthen the finger and wrist flexors, you’ll need a ball of a graspable size, like a tennis ball. Reif says to “Start with a soft or squishy ball; graduate to a harder ball over time, as the discomfort in your wrists abates.” While he stresses avoiding continually clenching your hands throughout the day, he recommends “occasional strengthening tennis-ball squeezes once daily in order to protect against future nerve compression and damage.”
Tip: You may want to keep your eye on a stopwatch or clock to sync the one-squeeze-per-second rhythm of this exercise.
Standing in mountain pose against the wall, or in a comfortable sitting position, squeeze the ball once per second, 60 times, in your right hand. (Or perform the number of repetitions you can do without fatiguing, aiming to eventually work up to 60.) After a break of a breath or two, switch hands and squeeze it 60 times (or the same number of times you did on the right side). Then put the ball aside, relax your arms, and wiggle your fingers.
3. Strap Hold
“I like this one to practice neutral wrist alignment and to strengthen the elbow and shoulder flexors, because it’s isometric—which means the muscle length remains constant,” Reif says.
Grab a strap and hold your arms straight out in front of you, as if you were holding a platter. Lay the strap across both hands over the bases of the fingers and under the thumbs; press your thumbs against the sides of your index fingers to hold the strap in place. Try pressing the bases of all your fingers up into the strap evenly while keeping neutral wrists. Hold here for several breaths.
Experiment: How low can you bring the strap without letting the wrists deviate from neutral and while still pressing into it with the bases of all your fingers? Take several breaths to lower your arms. Then see how high you can lift the strap while keeping a neutral wrist and still pressing into it with the bases of all your fingers. Take several breaths to lift your arms. When you’re finished, lower the strap and gently shake out your arms and shoulders.
4. Strap Pull 1: Bent Elbows
This isometric movement strengthens the shoulders' external rotators.
With your arms alongside you, take the strap in both hands and bend your elbows to 90 degrees. Your upper arms should be pressed against your torso, and your hands shoulder-distance apart with palms facing up. Make gentle fists around the strap while keeping your wrists in their neutral position. Pull on the strap as if trying to lengthen it. Keep pulling for one full breath cycle.
Relax your effort (while keeping your hands and arms in position), and then repeat another four or five times.
5. Strap Pull 2: The X
To further strengthen the shoulders' external rotators, try these movements.
Holding the strap lightly with your palms facing forward, change your hand position so that your right knuckles point up and your left knuckles point down; bring your right arm overhead and to the right and your left arm down alongside you and to the left, making one long diagonal from one arm to the other (half of an X shape). Keep the strap close to your torso and allow it to slide through your hands to accommodate the distance. Adjust your hand placement as needed so that when your arms are straight the strap is taut. Then, tighten your grip to pull the strap apart for one breath. Bring your arms back to their starting position. Then switch sides, making the other half of the X. Pull on the strap for a full breath cycle. Continue switching sides until you’ve made each half of the X about five times.
6. Shoulder Flossing
This exercise stretches many of the muscles girding the shoulders. Reif tells us: “When you are holding the strap up in front of you, you’ll be stretching the posterior deltoids and rhomboids, and when you lower the strap behind you, you’ll be stretching the anterior deltoids and pectorals.”
Stand tall. With straight arms, hold the strap in front of you, at waist height. Have your hands about three feet apart on the strap, palms down, with your wrists in a neutral position.
Over the course of two or three breaths, lift the strap overhead and then behind you. Do not allow your head to tilt forward, your wrists to extend, or your elbows to bend. Then, taking another two or three breaths, bring the strap forward, back to your starting position. If you could not keep your arms straight while moving the strap behind you—or if you felt tingling or numbness when you did so—move your hands farther apart on the strap. (On the other hand, if that was easy for you, bring your hands closer together.)
Do five to ten more repetitions. (Once you have ensured that your hands are a workable distance apart on the strap, you can go a little faster: taking your arms back on the inhale, bringing them forward on the exhale.)
7. Shoulder Extension
This exercise stretches the pectorals.
Hold the strap behind you, with arms straight, hands a bit wider than your hips, and palms facing forward. On an inhale, lift the strap away from you while keeping the tops of your shoulders back and the crown of your head reaching up. Lower the strap on your exhale. Lift and lower the strap five to ten more times.
When you are lifting the strap away from you for the final repetition, pause for two or three full breaths. If you can, externally rotate your shoulders farther: “Think of turning your thumbs outward, which in turn encourages the shoulder to rotate outward,” Reif says.
8. Neural Glide
According to Reif, this neural glide “stretches” the three main nerves of the arm. “The first hand position stretches the median nerve. As you rotate the hand the stretch moves to the ulnar nerve, then, when the hand is pointing down, to the radial nerve.”
1. Standing with the right side of your body almost an arm’s length away from a wall, place your right hand on the wall, at shoulder height, with your fingers pointing up and your right elbow bent. Tip your head to the right, and hold here for a few breaths. In this position (which shortens the median nerve), you probably won’t feel a stretch.
2. To lengthen the median nerve, slowly press your hand against the wall and tip your head to the left until you feel a sustainable stretch. Hold here for a couple of breaths. Repeat this movement several times, moving with your breath. On an inhale, move your head to the left and straighten your elbow; on an exhale, move your head to the right, bending your elbow.
3. After several repetitions, when your head is tilting to the right, your right elbow is bent, and your hand is still on the wall, slowly turn your right hand clockwise until your fingers point behind you.
4. Slowly straighten your right arm, and tilt your head to the left. (Repeat this movement several more times.)
5. With your head tilting to the right and your right elbow bent, turn your hand until the fingers point downward. Don’t force this: Stop before you feel a pins-and-needles sensation, allowing the heel of your hand to come away from the wall.
6. Slowly straighten your right arm and move your head to the left. Repeat this movement several more times, and then switch sides.
9. Savasana with Supported Hands and Arms
If you have hand or wrist issues, you may not be able to relax your hands and wrists in savasana; your wrists may instead remain extended, with a large gap between the back of the wrists and the floor. Supporting the hands, wrists, and arms may encourage the hands and wrists to relax and help chronically rounded shoulders to drop toward the floor. You will need two or four blankets for this support.
Fold two blankets into long rectangles. Place them at diagonals alongside your mat where they will be able to support your arms. (Don’t support your shoulders with the blankets, unless your shoulders are rounding away from the mat.) Tuck the far edges of the blankets under, providing support for your hands and wrists by lifting them higher than your forearms.
Alternatively, you can drape additional blankets (rectangularly folded) over the far edges to provide even more support for the underside of your wrist.
Lie down, with your arms, wrists, and hands supported by the blankets in such a way that there is no gap between the back of your wrists and the blankets. Rest here for several minutes.
10. Seated Namaste Variation
Hands in anjali mudra (offering seal) at the heart places the wrists in full extension. Instead, press your palms to your heart, with one hand on top of the other, or lift prayer hands higher, as shown below.
From savasana, roll to one side and use your hands to press you up to a comfortable seated position like sukhasana (easy seat), with shins crossed and spine long. (Sit on blankets if it is hard for you to lengthen your spine.)
To seal your practice, bring your palms together at your forehead, with thumbs resting against your hairline and forearms either touching or moving toward each other.
In this position, which connects your mind to your hands, take a moment to notice the vitality and ease that may be coursing through the hands, wrists, arms, and shoulders, readying you to seize the day—with a gentle grasp.
Photography: Andrea Killam