Thursday, 28 May 2015

Ashtanga wrist issues and therapy: Gymnasts Wrist or Washer Woman's syndrome overcome with Trigger Therapy

http://www.hybridperspective.com/2013/10/24/wrist-pain-in-gymnastics-understanding-contributing-factors-and-tips-to-increase-mobility/


This post on wrist pain is broken up into 


1. Symptoms

Pain in the wrist originally assumed to be caused by 'weight bearing' - jumping back and/or floating up in my Ashtanga practice

2. Cause, Avoidance and therapy

Poor technique, hand placement/set up etc.
Articles by David Keil
also
Wild Yogi magazine

3. More therapy ( that cured the problem)

Massaging Trigger Points
inc. Susan Bysh's Trigger point protocol for avoiding pain in arm balanced etc.

4. Alternative cause

Washer woman syndrome doesn't sound as cool as Gymnasts wrist

NB: the videos in this post are just for illustration and can all be skipped

*

Symptoms
My fb status update earlier in the week

I seem to have 'gymnasts wrist', or something like it, first time for me... anyone know how long it lasts and what worked for them for a speedy recovery. Probably came from switching back suddenly to full Primary in the shala after a year of half taken more slowly ie. twice as many jump backs. Not too big a deal I think and no problem adapting them out for a while but a little tiresome. - perhaps a blog post on this in the next few days

The Video below is probably a fair representation of how I practice Sun salutations in  the shala, there's some light on the hands to show my general practice/technique too. Further down in the post is the Krishnamacharya long stay approach I've been taking at home, one sury takes 12 minutes or so, less jumping but still a lot of weight bearing. This is the first time though that I've had this kind of wrist problem. 




Cause, Avoidance and therapy

First, an old Padmasana Jump through/jump back video.





My friends Illya and Mick sent some links to articles that look at possible causes and some therapy.

Thank you to Illya for this

Yoga therapy for the wrists
WILDYOGI.INFO
http://wildyogi.info/en/issue/yoga-therapy-wrists





Mick Lawton
Working With Wrist Pain in Yoga?
David Keil
YOGANATOMY.COM
http://www.yoganatomy.com/2014/03/wrist-pain-in-yoga/



In the article David looks closely at

Three Common Postures

Chaturanga

Upward Facing Dog

Downward Facing Dog

Particularly interesting to me is Chatauranga as in the Krishnamacharya approach I'm spending a minute in it.

David has a nice section in the article on hand placement and that has come up several times in the advice below. I notice that my hands are spread nicely so the weight is evenly spread and I tend to employ the pushing the ground away approach that Natasha mentions however  do seem to have this bad habit of having my middle two fingers together, bit like a three toed sloth (three toed sloths understand about slow practice).





Some good general advice from my friend Gilad 

Ilya's and David's info is very useful.

Sometimes we forget that

1. We are not getting any younger everyday .

2. The hands are intended mainly for micro and intricate movements, and not for weight-bearing jobs.MAINLY.

Just compare the hands and the feet, and note the weight-bearing sector, and also the idea that we are walking on feet, not hands.

Most likely, you are right - switched too abruptly into full Vinyasa after a long time of not doing that. And, the whole idea of Ashtanga practice being a"hand standing" practice is greatly exaggerated. PAIN IS ILLEGAL!

After all, it does produce suffering. 

Modify what causes pain, it's a good time for practicing Abhyasa and Vairagya .

Use a little soft squashy ball that fits in your palm, Palm open backwards on the table, and close your fist over the ball with moderated strength OBSERVING the palm.
Find out the right amount of repetitions.


And this from Stephan

I've recently been dealing with this as well, and I do believe it is linked in my case to "floating."

Like you, I employ long slow breaths, movements, and long holds.

I used a combination of Simon Borg-Olivier's mani bandha movements, some wrist warm up techniques, including something similar to what Paul Belizere describe (below), except I don't use newspaper, I just expand my hands and then make fists at a relatively quick but not too quick pace.

Finally, I practice the last ulpluthi on my fists.

I also massage extensor carpi radials trigger point (see below). 

Finally, I am one who takes seriously the gymnastics aspects of the practice and have begun more traditional gymnastics conditioning work to strengthen the wrists and avoid placing my shoulders too far forward over the wrist.

Additionally, I've also taken lots of time to integrate Simon Borg-Olivier's approach to using weight via leaning of the hips and armpits (as described in his 17 part video which you posted) to facilitate a more effortless press, pick up, and float.

In all it took about one month until I could press up again without pain, but some days it is still tender (so I take it easy on those days).


More Hints tips on Techniques and general practice came in...


from Chiara 

...try not to put all your weight on the wrist but to distribute it over the all hand. Sometimes if you look at how you press the hans on the floor you see that the base of the thumb and first (?) fingers are not used very much as support.


from Stuart 

Use more serrates anterior when jumping/floating and keep it out the wrist


and my teacher Kristina Karitinou 

Please keep the fingers open and apart.the thump must be away from the fingers and push the point between finger and thump strongly on the floor!


and also Natasa 
...always push the ground away (power comes from scapula) and change regulary the placment of the hand - use the fingers. Kristina tip is also very fine...Hope you feel fine soon.


Peg recommended David's ultimate cure outlined in  full in the article above

Ice bucket. hold in for 1-2 minutes at a time. more if you can stand but I'm a big baby and never make it !!


How I generally approach Suryanamaskara at home

Krishnamacharya may not have actually taught Suryanamaskara (except perhaps a version with mantras). He did outline longer stays in each of the asana that make up the sun salutation. The stays he suggested tend to be ten minutes or so, I usually practice ten breaths in each, around a minute at each stage.

The video below is of the Krishnamacharya type approach to Sun Salutations I tend to take at home with the longer stays - Yeah, it's actual speed, 12 minutes for one Suryanamaskara, akin to watching paint dry. i got all floaty for the video but don't tend to bother especially for just the one. In the shala this week I was having so much fun practicing the sury's again that I through in some general floatyness.





More Therapy and a bit of magic

I'd been looking forward to trying out David's ice bucked techniques but my dear friend Susan had me cured in ten minutes with trigger point therapy...


Trigger Point therapy


from Susan Bysh

Try massaging extensor carpi radialis trigger point, in the meaty part of the top of the forearm, near the elbow....
If that is tender then bingo.

And it worked, just like that! A few minutes messaging the trigger point and the pain was gone, I'd come back to it every now and again and especially in the morning before practice and all was pretty much well again. i didn't want to over do it so settled for just a couple of light sury's and and the first half of Ashtanga 2nd ( less jump back anyway), just stepping back and forth, had a nice practice.

https://www.realbodywork.com/learn/hand/wristE.htm


I asked Susan about the book I remembered her recommending a while back

The Trigger Point Therapy Workbook: Your Self -Treatment Guide for Pain Relief: Your Self-Treatment for Pain Relief Paperback – 2 Aug 2004
by Clair Davies
http://www.amazon.co.uk/Trigger-Point.../dp/1572243759

Check out Maya's review at Mayaland



And here's some more from Susan about what's going on with trigger points.

I think the wrist ones are some of the more obvious and convincing ones…. it seems like magic at first, but then you become very aware of the connections between the two areas and it all begins to seem obvious…. yes this muscle moves that part of the hand, and if it seizes up in a moment of stress or becomes traumatised, I will feel the effect in the hand, of course'….
And then we have learned something about the body at a deep intuitive level. The beauty of it also is that one can test the other side - hmmm no hand pain and no tender spot in the muscle on that side, pretty convincing. Or, if the muscle is a little tender on the other side too, then we can take preventative action!!

So extensor carpi radialis for pain on the top of the thumb side of the wrist… and the other common pain area is the underside of the pinky side, and for that we massage flexor carpi ulnaris, both up by the elbow and also down nearer the hand where it gets kind of ropey/tendinous. With this protocol I have had no wrist trouble in a couple of years despite all the arm balances and handstands, I just massage FCU on both sides a little each day. 

Susan Bysh is an Authorised Level 2 Ashtanga teacher and an old friend, some may remember her excellent and much missed blog.
She teaches in London at Yoga place 
http://www.yogaplace.co.uk/early-morning-mysore-teachers/

Picture hasn't been changed on the website yet so how about this 'wristy' one.

Susan Bysh - Mysore : Photo by Alessandro Sigismondi of Digital Drishti

*

More tips/suggestions came in that I would have liked to have tred but by then the problem was under control.... and Paul, what's a newspaper ( can I get the same effect from opening and closing my macbook)?


from Paul 
...take a large sheet of a newspaper in your hand by a corner and make a tight ball of it using just your fingers and the movement of your wrist, do that everyday with one or two sheets. It will strengthen all your digits' tendons, the muscle which activate the fingers in the forearm, thoroughly warm up and energise your hands and rid you of any pain (even carpal syndrome).


from Samantha 
I had a similar problem for years, after trying everything physiotherapists etc and nothing working I was advised by a friend and clever person to up my magnesium. I did and as well as calcium and vitamin d (plus a bit of natto for k2) after two months not a trace of a problem. The lump on my wrist has gone and even when I do things that would previously have caused pain for days nothing. Now it may just be coincidence and correlation is not causation but I'm fairly sure that's what helped my joint heal itself.


*

However, it turns out it may not have been jumping back and forth, floating up at all. Which would make sense as I've never had a problem before and can assume my technique and general practice improved over the years with all the videos I've looked at and shared here.

Alternative cause


Washer woman syndrome doesn't sound as cool as Gymnasts wrist


fb update: I was checking my hand placement, general technique this morning and it all seemed pretty sound but then I realised the problem may just have likely have come from wringing out (tightly) my freshly rinsed yoga towel. It's only now I'm visiting a hotter shala again each day that I've needed to rinse them out right away. . the plot thickens.


I remember my grandmother having one of these.... now I know why.

Feel free to 'jump in' with a comment below  if you have anything to add. Even though the problem seems to be sorted out there's lots of good advice and suggestions here that somebody else might find useful. Feel free to look at any of the videos below and tear into my general technique and practice...

Afterthoughts 

In general, my own practice tends to be stripped back more and more as time goes on. Gone are most of the fancy flourishes I used to go in for, my jump through tends to be a little Sharath like hop and I'll often skip them altogether and slip into Vinyasa krama mode in certain sections of my Ashtanga practice. Practicing with longer slower breathing plus kumbhaka I tend to settle for the first half of Primary or the first half of Intermediate. Can't remember the last time I bothered with arm balances.

That said, all the fun, the flourishes, the general floatyness and party tricks helped me to build my discipline, helped at those times when the enthusiasm was flagging. They certainly have their place apart from selling workshops and promoting webpages. According to the Yoga for the Three Stages of life theory, in the first and second stages it's perfectly acceptable to focus more on our asana practice, our strength, health and fitness, to work on building discipline, exploring tapas, building resolve in yama and niyama and introducing pranayama and meditative practices. However, it's in the third stage of life that those later limbs will come more to the fore when we are  free from the burdens of the householder and can retreat to the metaphorical if not actual forest.


And besides, although I've posted this video from Jessica Walden several times before it still fills me with awe, the breath here...., the composure, it's almost enough to tempt me back to arm balances....





UPDATE

Nice reminder in comments of how in Martial arts the wrists and other joints are often warmed up by being rotated this way and that. I remember this from my old Ashtanga days, it's also a warm up practice in Shadow yoga.

Sharath has argued stated that no warm up is necessary, that the suryanamaskara are enough but then he weighs about as much as a stick insect and has been practicing since he was a boy. Coming to practice later in life and carrying some extra weight, warming up the joints and cutting back on the vinyasas in the beginning may well be advisable.

Here's the Shadow Yoga Warmup with Emma Balnaves
Shadow yoga was developed by Shandor Remete who studied Yoga with Krishnamacharya as well as having a background in Martial art and Dance.


6 comments:

  1. Hey Grimmly, I just had a very quick look at the video and one thing that might help is to squeeze the elbows into the side of the trunk/ribs when in chatarunga...Niall.

    ReplyDelete
    Replies
    1. Thanks Niall, bad habit, I remember for a while and then they drift back out again. The longer , one minute, stay in Chtauranga is usually a good reminder

      Delete
  2. I have tiny, stick wrists. When I first started practice I had a lot of wrist pain. David Williams suggested skipping vinyasa on alternate sides and keeping the legs on the floor in up dog (cobra?), all of which I still do, to lessen the amount of time/pressure spent on wrists.

    I also iced both wrists right after practice and heated them in the evening (with an inferno wrap, god I love that thing, I use it now on my hamstring before practice) for that whole first year. I also did trigger point work--I actually blogged about that very book, Clair Davies is THE MAN. I HIGHLY recommend that book and his work. A pinky ball is the perfect trigger point applicator (against wall or floor). He has a book for shoulders, too, excellent.

    My wrists don't bother me now, haven't for a while. I think they got stronger. But they feel like a weak link that I need to be aware of, to keep that good status. They're about 7 inches around, really thin, and I broke one of them twenty years ago, which still has a bone lump. No way to get around babying them, prob for the rest of my life.

    I hope your pain goes away! No more wringing out towels for you!

    ReplyDelete
    Replies
    1. Hi Maya. I wonder if it's just that they've got stronger or that your technique has improved, that little Sharath hop rather than the Kino half handstand made a lot of difference. Will hunt out your trigger point review and link to it.

      Delete
  3. In the internal martial arts one always starts the practice by rolling each of joints. We do the neck, shoulders, elbows, wrists, waist, pelvis, knees and ankles. We do this to gently open the joint, and disperse any stasis accumulated through out the day or night. This practice is also used in Shadow Yoga, which is called Dasha Chalana, or the ten churnings. In both Maramastana and TCM, the joints are seen as critical junctions for the movement of energy, which also easily get blocked because of how humans use them extensively through out the day. I believe you also posted on Simon Borg's discussion of the multiple bandhas throughout the body. It is often noted that both overuse and underuse lead to blockages. So, one can even roll the joints after a long period in seated meditation or pranayama. Here's a video of Emma Balnaves doing the Shadow Yoga Dasha Chalana. https://vimeo.com/28173594 feel better.

    ReplyDelete
    Replies
    1. Thank you for this Anon, yes, remember the joint warm ups from my Aikido days. have added Emma's Shadow Yoga warm up video to the end of the post.

      Delete

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A Reminder

from Kalama sutra, translation from the Pali by Bhikkhu Bodhi This blog included.

"So, as I said, Kalamas: 'Don't go by reports, by legends, by traditions, by scripture, by logical conjecture, by inference, by analogies, by agreement through pondering views, by probability, or by the thought, "This contemplative is our teacher." When you know for yourselves that, "These qualities are unskillful; these qualities are blameworthy; these qualities are criticized by the wise; these qualities, when adopted & carried out, lead to harm & to suffering" — then you should abandon them.' Thus was it said. And in reference to this was it said.

"Now, Kalamas, don't go by reports, by legends, by traditions, by scripture, by logical conjecture, by inference, by analogies, by agreement through pondering views, by probability, or by the thought, 'This contemplative is our teacher.' When you know for yourselves that, 'These qualities are skillful; these qualities are blameless; these qualities are praised by the wise; these qualities, when adopted & carried out, lead to welfare & to happiness' — then you should enter & remain in them. Buddha - Kalama Sutta
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