All power to the elbows. Noticing what helps in a functional approach to yoga.

Image result for medial epicondyle
The elbow joint made up of the lower part of the humerus and the upper ends of the ulnar and radius, which make up the forearm. The joint allows us to 
                                            – bend the elbow (flexion)
                                            – straighten the elbow (extension)
                                            – turn the palm up (supination)
                                            – turn the palm down (pronation)
In these simple movements there is a functional interplay of the  shoulder, elbow and wrist which means that examination of all three joints may be necessary. In our “integrated approach” to yoga practice, we try to discover through small functional movements, areas that comply and those that do not comply .  We then try to balance the areas that do not comply so that compensation is reduced. 
Whenever handling persistent elbow pain treatment consider:

  • The shoulder and elbow both share the long bones of the arm and any deviation of shoulder function will affect the elbow.
  • The shoulder and elbow need to work smoothly together to prevent excessive strain and pain in the elbow.
  • Thus the focus needs to improve the function of the shoulder as it relates to the rest of the chest and back. If shoulder movement is restricted, the muscles in the arm will have to work harder in simple movements  – and on a daily basis.
  • We need to improve the way the scapulae move around the back and areas above, below and in between the scapulae and the spine that get “stuck”.

Common spots for injury are at the lower end of the humerus where the two bony prominences (epicondyles) on either side are attachment sites for ligaments, tendons and muscles. Tennis elbow (lateral epicondylitis) is characterized by pain on the outside of the elbow and Golfer’s Elbow (medial epicondylitis) features as pain on the inside of the elbow.  Only a small proportion of suffers actually play the sports.  Problems result from repetitive patterns of overuse. Consider common activities which may involve holding patterns in the shoulders, upper spine and ribs:

Typing; gripping a computer mouse; teaching, ballroom dancing with it’s emphasis upon holding posture; supermarket checkout operators; cooking; diy; childcare -grandparents lifting children for the first time in a number of years(!)??  Weight-bearing yoga poses that the body is not ready for.  You can probably think of many more.

There are many sites with exercises for the above conditions. Arhthritis UK has many fact sheets.  Great Western Hospital, Swindon, is useful for strengthening and conditioning the muscles of the forearm to help with tennis elbow.   

Exercises for  – golfer’s elbow from Leicester NHS Trust.

What we do in class.  When we are on all fours we mobilize the spine and shoulders.  Side bending and thoracic rotation is particularly helpful.  We strengthen the bones and as we place the hands and turn them around on the floor, we are working eccentrically – strengthening whilst lengthening the flexors in the forearm and fingers.  This counteracts the flexing and griping that we regularly do with a “mouse” /keyboard usage.  This should help with golfer’s elbow pain.  For tennis elbow we may benefit from turning hand around so that the back of the hand is on the floor and gently drawing the flexed hand along the mat and “flicking water off the fingers” at the end of the movement.  We regularly practise functional movements of the shoulder, arm, elbow and wrist whilst lying on our side.  In this way, we notice areas that comply with the movement and area that we need to “whisper” to.

This approach develops proprioception in the joints in smaller ranges of motion and is very beneficial to people with hypermobility. Yoga is an attractive pursuit for those with hypermobility.  Therapy for hypermobile people should be focused on strength building, with a balanced approach to stretching. This translates into doing smaller movements, with more repetition, as opposed to going to an extreme range of motion and holding. That is why we use dog pose to stabilize and to free up the shoulders.  We take the pelvis back to the heels and spend sometime noticing whether the pelvis can be lifted up through the action of the feet and legs. In this way, we do not “achieve” the shape of dog pose by compensating with muscles around the shoulders and ribs.  What we do is lengthen the spine and roll it through an undisturbed shoulder girdle.  We reduce compensation.

Compensation – the recruitment of muscles that could be quiet will generally affect our breathing.  Thus when we use the opening minutes of a session to examine our breathing, we can notice whether tightness in the diaphragm means that we use muscles in the neck and shoulders to help lift and widen the ribs.  If we don’t notice, we will never change.  In yoga classes, teachers will always encourage you to “go back and notice”; repeat in different positions; be curious about how your ribs move in other patterns practised in the session and be patient with yourself.

When we “brace” or strive to “complete” a pose (to make a shape), we should notice and back off – but we don’t.  Some of us stop but it is also a good idea to go to the first stage and to notice at which point the discomfort/bracing kicked in.  Be “brave enough” to go back and explore.  Our yoga practice is not about the end pose.  That is why we tread slowly and carefully along our journey.
Looking forward to seeing some of you during the next half-term.

 

 

 

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