Yoga and Arthritis of the Hands

by Baxter

Every time I get a call from a student or patient about arthritis of the hands, it brings to mind an image of my beloved Grandma Lopresto, at her towering height of 4’11”, who lived to be 93 with the clearest mind you can imagine. She had arthritis in her hands. Yet I never recall her complaining about it. In fact, I never heard her complain about her body at all, even though she also suffered from post-herpetic neuralgia, a chronic painful condition that is an aftermath of getting shingles. 

But back to Grandma’s hands—when you looked at her hands, she had obvious swelling around the knuckles of almost every finger on both hands. And although I would see her working the fingers by rubbing and bending them, it did not seem to slow her down, as she lived on her own for 29 years after her husband died when she was 64. I can recall her even doing some simple sewing projects to replace a button and such.

Ah, if this were the case for others with arthritis of the hands! For many, there is chronic pain that is disruptive to daily activities, sometimes requiring pain medication, anti-inflammatories, injections and more invasive measures to deal with it. Grandma certainly had classic osteoarthritis of the fingers, which affects the last joint of the finger, the DIP joint, and involves small nodular swelling around the joint known as Heberden’s nodes, and the closer knuckle, the PIP joint, with Bouchard's nodes. The most common site affected by arthritis in the hands, however, is the thumb. It is usually a form of osteoarthritis, the common wear and tear arthritis that affects millions of Americans annually. It affects the joint between the carpal (wrist bones) bones and the metacarpal of the thumb (which resides in the palm of the hand). On its worst days, basal joint arthritis (its other name) can cause pain, swelling, stiffness, weakness or immobility. In addition to what I have mentioned already, treatment by your family doc or rheumatologist can also include self-care recommendations and splints. These splints can help decrease pain, re-align the bones, and permit the joint to rest. Obviously, if you have to wear a splint, you’ll need to modify your hand use in yoga.

One thing to keep in mind is that osteoarthritis often results from trauma or injury to the thumb at some point in the past, and that over time the protective coating of cartilage on the ends of the bones wears away, exposing sensitive bone to bone.  One way to address this via yoga or visualization is to lengthen the thumbs or fingers, depending on which joints are affected, from palm to fingertips, specifically focusing on the affected joint. The encouragement you get from your teacher to spread and lengthen the fingers in poses like Downward-Facing Dog pose is pretty good advice. Although, as you might imagine, you may need to avoid putting full body weight onto your hands if you are experiencing a full-blown joint flare.  In such situations, non-weight bearing asana would be more appropriate, of which there are many.  Ones in which the arms are overhead, such as Warrior 1 and Tree pose, can be particularly helpful to enlist the aid of gravity in pulling swelling away from the hands and back toward the heart. 

Often the pain and stiffness of osteoarthritis in the hands is most noticeable in the morning when you first get up. Warming your joints in the shower and gentle movements of your hands and fingers for 15 to 20 minutes can result in less stiffness and decrease in pain.  If you have not seen a physical therapist for specific range of motion exercises, consider asking to do so. In the meantime, you can use your yoga sessions to put your hands and thumbs through their paces, maximizing the range of motions in the most pain free way you can. 

Other patterns of finger arthritis include the less common condition of rheumatoid arthritis, which affects the hands at the wrist joint and at the joint between the palm bone and the finger bone, the metacarpal-phalageal joint.  Often, more than one joint is involved. Rheumatoid arthritis is an autoimmune illness, and it can cause much worse and more persistent symptoms than osteoarthritis so even gentler approach may be needed.

If you are at risk for developing arthritis in the hands, via age (over 40), sex (female), family history of osteoarthritis or rheumatoid arthritis, or history of trauma to your hands, a balanced yoga practice, with a careful, stepwise approach to yoga poses that involve bearing weight on the hands (such Cat/Cow pose, Downward-Facing Dog pose, Upward-Facing Dog pose, and all arm balances), may be helpful in maintaining a good range of motion in your hand joints over time. Adding a variety of hasta mudras, or hand seals, could exercise and strengthen your fingers in a non-weight bearing fashion.

And for those who have already developed arthritis, less weight-bearing asana is likely the way to go. There are also a number of props coming out that could assist in more pain-free exploration of the asana in which your hands are on the floor.  Specialized gloves with a rubber cushion for the heel of the hand, as well as wedges, rounded blocks, and weird circular cushions called Yoga Jellies are all possible aids to permit careful inclusion of weight-bearing asana in your practice.  And surely, as you must know by now if you are a frequent reader, enlist the help of an experienced teacher who has worked with others who have arthritis!

Friday Q&A: Ganglion Cysts

Q: I get a ganglian cyst at the top side of my wrist and sometimes the top of my hand from doing poses that put pressure in those areas. Plank positions, Upward-Facing Dog, etc. Any recommendations?

A: Dear Ganglion Cyst,

Thanks for writing in about this. I, too, have had a cyst in my wrist area many years ago that was of the ganglion cyst variety. These cysts are considered benign, and may grow up out of the tendons of the wrist and hand bones. Scientists still do not know what causes them, so prevention is not an issue.  But dealing with them once they arise is an issue, especially if they interfere with your regular activities.

First off, I'd recommend that you confirm your diagnosis of this common and benign form of a mass that can appear on and around the hands and wrists. A trip to your family MD should do the trick,  with the caveat that they may recommend an ultrasound or drawing a bit of fluid from the mass to confirm that it is indeed fluid filled.

Once you have a confirmed diagnosis, it is important to decide if modifying your practice is needed. The main reason to do so is if the cyst is causing you pain,  especially in the poses you mentioned. If it is,  you may be able to avoid those aggravating poses until the cyst gets smaller. Over half of all ganglion cysts will resolve on their own without specific treatment. So we are talking about any pose that bears weight on the hands and wrist joint and takes the wrist into full extension.  As noted, plus a few more, such as, Plank, Chaturanga, Upward-Facing Dog, Handstand, and most other arm balances done on the hands could all make things worse before they get better.

Avoid the old folk remedy of smashing the cyst with a bible or any other large book for that matter. This has not been shown to beneficial and the cyst can return and be harder to treat if treatment is ultimately necessary. If you want more information on the western medical approach to ganglion cysts, check out this website: emedicinehealth.com. And let us know how things unfold for you and your cyst.

Namaste,
Baxter

A: Since your pain symptoms could be worsened by excessive pressure on the wrists, you should modify the poses that cause pressure. The way to think about pose modification is to look at your wrist and if your wrist "folds" are visible, then there is pressure on the wrist itself.  I might use a chair for Dog pose or do Dog pose with the forearms on the floor (or chair) . The same modification can be used to do Plank pose. Shoulderstand would also have to be modified. Doing the chair version of Shoulderstand, which is less active, would keep the wrists from being vulnerable and keep them in a neutral position. Standing poses, forward bends and twists don't  need modifications. But as long as the cysts are present, I would avoid active Dhanurasana (Upward Facing Bow pose) and other backbends where you use your hands to support yourself and wait till they reabsorb. Passive backbends would still be possible. —Shari