Working with Injuries Workshop, Where We Will Develop Skills That Helps Us Investigate Pain and Injury in a Yoga Practice

Working With Injuries

Workshop: Reference Guide

Introduction Welcome to the Working With Injuries Workshop, where we will develop skills that helps us investigate pain and injury in a yoga practice. Of course, ideally, we would avoid all pain and injury when practicing asana! However, the reality is that practicing asana is a physical activity. Like other physical activities, when we are doing asana we are moving a body that has a whole past history of patterns. We most likely do not arrive on the yoga mat with an even, balanced body. We have muscular patterns in the body from activities we currently do. Those patterns can come from simply commuting to work and sitting at a computer for numerous hours a day, sports that we play, or accidents and injuries we’ve sustained in the past from sports or any other activity.

When we start moving our body in new ways doing yoga postures, all of these patterns that we’ve retained in the body influence how we are able to move and the sensations that we feel from those movements. Each one of us arrives on the yoga mat with a unique set of muscular/body patterns, genetic body structure, and attitude about working with new movements. Even when aches and pains arise during our practice, we have to understand that sometimes the effect of repatterning how we move brings these things up. After all, your body has probably spent a decent amount of time adapting to existing patterns. New patterns are not always welcomed even though they may be good for you in the long run.

The new patterns might ask muscles to be longer, shorter, stronger, or more flexible than they previously were. Of course, muscles are attached to the bones and by their nature, when muscles change in tension and length, that has an impact on the musculoskeletal system and how it functions. Context and approach is very important.

There is no one-size-fits-all method of avoiding pain and injury in any physical activity and asana practice is no different.

Working With Injuries

Workshop: Reference Guide

Pain does not necessarily equal weakness! I often get asked questions about pain in a way that assume pain or even injury, is the result of weakness. The question is often framed as: “What do I need to strengthen now that I have this pain/injury?” While gaining strength might reduce pain at times, strength is not necessarily the solution to all sensations of pain or injury. In the same way, stretching tissue although the answer at other times, is also not always the solution. The right balance of strength and flexibility for your body is probably closer to the truth.

What I hope to offer you in this course is a method of assessing what you or a student is experiencing during a yoga practice and a process for modifying the practice to continue evolving the postures without injury.

At the most basic level pain is the body’s warning signal. What do we do when we experience pain in asana practice? I hope to provide you with some useful tools to answer that question in a thoughtful way. My intention in this course is to walk you through a number of the most common injuries I come across while traveling and teaching. Along the way, I will share tools and a process to evaluate what is going on and make intelligent decisions about how to proceed. I want to help you develop a way of thinking, rather than a one size fits all answer, which rarely exists. With this in mind, it’s my hope that these tools will help you navigate each unique situation that comes up.

The key here is to help you investigate by asking the right questions from the beginning. As you get answers to the questions, you can formulate an educated guess about what is going on. From there, you can modify, test, and then investigate with more questions until you get as close as possible to a solution to reducing or eliminating pain during practice.

This reference guide will give you a place to review the thought-process for working with injuries and make some notes for yourself regarding situations that are most relevant to you. In this document, you will find an outline of the overall process for working with injuries. Where we explore specific areas of the body where pain and injury are common in yoga, we have also included a list of some of the many questions that might be relevant for working with injuries in that specific area of the body. Remember that these questions

Working With Injuries

Workshop: Reference Guide

are just examples of questions that you might ask as you begin working with someone who is experiencing pain or an injury. It is our intent to provide enough examples to help you understand how to work with the process. Every situation is unique however. Adapt the process as it is relevant to you and/or your students.

Definitions and Context Let’s start with some definitions so that, as we move forward in the course, we’re clear about what we mean by “injury” and “pain”.

Definition of injury The medical definition of injury according to Merriam-Webster (http://www.merriam-webster.com/dictionary/injury) is: “hurt, damage, or loss sustained”.

For example: A sprained ankle would cause hurt and damage to tendons around the ankle: this is an injury. Signs of inflammation (redness, heat, and swelling) that would likely accompany a sprained ankle are indications that an injury might have occurred. Symptoms like sensations of pain or discomfort are also indications that an injury might have occurred.

Definition of pain a : usually localized physical suffering associated with bodily disorder (as a disease or an injury); also : a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort (as pricking, throbbing, or aching), and typically leading to evasive action b : acute mental or emotional distress or suffering : grief (Merriam-Webster, https://www.merriam-webster.com/dictionary/pain)

For example:

Working With Injuries

Workshop: Reference Guide

Sharp, throbbing sensations that would likely accompany a sprained ankle are examples of sensations of “pain”.

What factors lead to injury while practicing yoga? Our ideal is to avoid injury at all. While this may not be possible all of the time, being mindful of the factors that can contribute to injury can help us reduce our chances of injury.

● Our history, which I refer to as “converging histories”: body patterns that predispose injury that may come from: ○ daily repetitive tasks that set patterns in our body (sitting at a computer, driving a car, picking up children, or possibly the kind of work-related activities that we do) ○ activities that we participate in frequently like sports ○ accidents we have been in ○ genetic body structure (bone shape, ligament/tendon length, tendency to acquire either flexibility or strength more slowly or more quickly than average) We are often unaware of what our converging histories are.

● Competition (with ourselves or with others) The way we approach our practice

● Wrong ideas about what yoga is for (we’re trying to get somewhere or “get the pose right”)

● Using videos to teach oneself and trying to make it look like the video

● Not being ok with who you are and how your body works ○ Trying to look like or be like someone else can lead to injuries ○ Even using alignment that works for one body may not work in yours

Working With Injuries

Workshop: Reference Guide

● Fatigue (just a generally tired day OR too much practice too soon) ○ Not honoring how you feel in the moment ○ Not adjusting your practice to energy level and circumstances

● Common Western postural patterns including tight hips and contracted front of chest

● Distraction: paying attention to anything other than what you’re feeling in a pose can leave potential for injury

How can we avoid these factors and reduce chances of injury? ● Stay present

● Stop being so competitive—be OK with where you’re at. That includes competition with yourself. Just because it was working for you yesterday doesn’t mean it’s going to happen today—every day is different.

● Aim for a balance of effort and ease

● Learn your body—get interested in your own postural patterns and what things feel like generally, so you are more able to tell when something feels “off” to you

● Be consistent with practice—better to do a little bit most days, than a weekend warrior style 2-hour practice once a week

● Listen to your body! It’s cliché, but true. When something feels “off” or “not quite right” in some way, Stop! and reassess the posture.

● Assess how a posture feels.

Working With Injuries

Workshop: Reference Guide

○ Is there a sense of groundedness? ○ Is there a sense of lengthening? ○ Avoid trying to make yourself fit arbitrary alignment cues (e.g. lining up the heels in revolved triangle pose often results in students feeling ungrounded in the pose because their hips are not open enough yet for that alignment cue to be appropriate or beneficial.)

What are the sensations that we feel in the body? If you or your students are newer to practicing yoga or even to movement in general, then all the sensations that come up in the body during practice may be unfamiliar as well. What are those sensations and when should you be concerned?

The sensations that we feel during and after yoga might include: ● Sore muscles from new movements

● Trigger points/ holding patterns in the body

● Pre-injury: your body is warning you that something is “off”, but nothing has been damaged/hurt yet. This might be a warning that you need to adjust or modify the pose in some way. It might also be a warning that the muscles in which you’re feeling sensation are fatigued and you need to stop practice there for the day.

● It could also be the pattern of the posture bumping up against your personal body pattern. In that sense, it’s showing you where you need to investigate further.

...and yes, it might be Injury

What kind of pain is it? Even the sensations of pain are not all the same. What might the different sensations of pain indicate?

Working With Injuries

Workshop: Reference Guide

Caution-yellow flag: Dull Achiness A general rule if it’s a dull achy kind of pain, is that it could be just general muscle soreness from using a muscle in a new way or it could be trigger points.

Characteristics of this kind of pain might include: ● Broad/generalized pain ○ Less likely to be a specific injury ○ Could be muscle soreness ● Moves around - More likely muscular ○ Possibly trigger points. ● Gets better or goes away while practicing ○ Usually muscular ● Only happens when doing a particular movement/posture ○ Can you modify the posture in a way that retains the intention of the pose, but does not cause pain?

Stop!-red flag: Sharp This kind of pain might include something being compressed or pinched, something pulling at an attachment, or injury.

Characteristics of this kind of pain include: ● Shooting ○ Nerve related ○ Could also be trigger points ● Localized ○ Specific pain should always be a bit more of a red flag, especially when accompanied with sharp and or shooting type pain ○ Could be pain from injury ○ Could be a pre-injury warning from the body ○ Could be trigger points

Working With Injuries

Workshop: Reference Guide

○ Could be a nerve being compressed. ● Stays consistent ○ Needs a closer look ○ Could be pain from an injury ● Gets worse while practicing ○ Could be injury

Is all pain an injury? Sometimes it’s general muscle soreness. In this case, this may be a healthy body’s response to doing a new activity. However, this is also information about your body’s strength, flexibility, and endurance for these new activities. By providing this yellow caution flag in the form of muscle soreness, your body is giving you a head’s up! This is a good time to assess where you are with yoga asana practice. If you’re fairly new to practice, then maybe this is your cue to continue practicing consistently at this level before you add more to your practice.

Sometimes it’s trigger points.

Sometimes it’s the body’s warning before an injury. Pain is not necessarily an injury yet. Sensations of soreness or pain in the body before anything has actually been damaged is your body’s warning that you need to stop and change something.

For example, when students are practicing with tight hips, it’s common for students to experience pressure or even pain on the inside of the knee when they begin to bring the leg into a half lotus or lotus position. The first initial sensations of pressure or pain are likely compression of meniscus or even irritation to ligamentous structures at the knee. This is your body’s warning that the hips are not open enough to allow the leg to go all the way into that position yet. When the hips are tight, they often are tight in a particular pattern that puts pressure into the inner knee. If you heed your body’s warning at the first sensations of pain, you have time to modify the posture in a way that continues to stretch

Working With Injuries

Workshop: Reference Guide

the tissues around the hips without causing knee pain. This process allows you to continue practicing without causing injury. If you continue to deepen the posture, despite sensations of pain, you are more likely to actually cause injury, potentially tearing the meniscus or damaging other structures around the knee.

Sometimes it is an injury. So if it is an injury, how do we work with it?

Let’s walk through a basic format for how to work with injury in yoga asana practice. If you’re a yoga teacher, then you’ll be going through this process with your students. If you’re a student who is practicing on your own, you can use this same process to investigate your own practice if you notice that you are experiencing pain in a posture. You can even take a video recording of your practice so you can observe your movements.

METHODS OF INVESTIGATION: Observe,

Investigate, Test, and Modify

Observe As a teacher, this process might start with a student coming to you to tell you that they’re experiencing pain in a posture or it might start with you observing something in a student’s practice which suggests that something is not right with a posture.

The following are a list of some examples of questions you might ask to gather information about where to focus your investigation. Remember these are examples of questions to help you understand the process of observation. You should come up with your own questions that are relevant to your own situation.

Your intention is to gather information about: 1. Where is their pain?

Working With Injuries

Workshop: Reference Guide

2. Where might there be tension or restricted movement? 3. What muscles might be involved with those actions?

As you observe your students, in your mind, ask yourself these general questions:

● How does your student generally move? ● Are they inherently tight/stiff or loose/flexible? ● Where do they move from or where don’t they move from? ○ For example, maybe their body easily does forward bending but has difficulty doing backbending type postures. ● What is the movement that is causing the pain? ○ If you know what movement it is, then you might create a list of muscles that allow or restrict that movement as a starting place. ● Does the affected area of their body move easily or is it generally tight? ○ In other words, is there something specifically tight or restricted in this area that may be separate from the rest of their general flexibility or tightness. ● Are they pushing through pain and not telling you? ● Are they making facial expressions? ● Are they holding their breath? ● Are students avoiding postures, or parts of a posture? ○ This can often inform you about what areas of the body are part of the issue. ○ This may also help you narrow down what body areas are the most important to focus on first as you try to work with them and figure out what’s going on. ● What kind of personality do they generally have? ○ Are they competitive, motivated to “get it”, and do they push hard? ○ Are they relaxed about their practice? ○ Are they more interested in the physical or more subtle aspects of practice?

If you are the student or practitioner, observe yourself:

● What postures cause pain or strong sensations?

Working With Injuries

Workshop: Reference Guide

● What stage of the posture causes pain: entering, staying in the posture, exiting, or more than one of those? ● Does the quality of sensation/pain or where it comes from change in particular movements? ● What type of pain is it: dull, sharp, etc.? ● Do you feel it in practice only? ○ In other words, does it go away when your body warms up? ● Do you feel it out of practice only? ● Pay attention to what activity you are doing when it hurts outside of practice. ● Do you feel it both in and out of practice? ○ In this case, it doesn’t matter what temperature your body is or specifically which activities change it.

Investigate When investigating potential sources of pain or injury we ask questions informed by our initial observations. This is the stage in the process where we gather additional information and continue observing.

● What type of anatomical structures are there? ○ For example, which bones, muscles, tendons, ligaments, cartilage etc. make up the area? ● What muscles make the movement happen and which ones resist that movement? ● Have you/they had previous injuries that might contribute? ○ If so, go back in your mind and see if you have a sense of what muscles or structures were involved in the original injury. ● Do you/they do other activities on a regular basis outside of yoga that might be contributing?

Working With Injuries

Workshop: Reference Guide

Test

Short-term Try a modification of the pose, and/or re-pattern the way they go into it and come out of it. You might even try asking them to avoid using any alignment cues they have been given. In other words, go back to their neutral or natural body position, if possible.

Check in immediately with the student after you’ve suggested a change, by asking a neutral question: “Does that modification feel the same, better or worse?” Keep an open mind and be available to hear “no change” or “worse” as the answer.

You can also: Try a brief treatment and see if a temporary change makes a difference. Palpate possible muscles involved in pain (if that is in your skill set). Test for trigger points (if that is in your skill set)

Mid-term Once you find a modification that seems to eliminate pain, have the student adopt the change and do the pose or transition themselves with the new pattern.

Check in after the student has been practicing with the new pattern for a few days again by asking a neutral question: “Does that modification feel the same, better or worse?”

Keep an open mind and be available to hear “no change” or “worse” as the answer.

If the modification still seems to be producing the intention of the pose without pain, then check in again after several weeks.

Working With Injuries

Workshop: Reference Guide

Long-term Check in with the student again over the long-term. Depending on the how consistent the student is with practice, patterns can certainly change over weeks or months of practice. You may find that after some amount of time, the modification is no longer necessary. It’s possible that tight tissues that were causing pain in some area of the body will have opened. It’s also possible that tension, flexibility, and strength will have shifted where sensations are being felt in the body, and now you may find that a different modification is needed.

If after some weeks or months of working with modifications, the pain/injury does not seem to be changing or seems to be recurring, refer the student to a licensed professional who can offer a more in-depth assessment.

Modify What we’re really asking is: How can you keep the intention of a pose, but make a change in order to practice without pain?

● Don’t go as deeply in the pose ● Figure out what part of the posture is eliciting the problem ○ This can be related to the depth of the posture ○ Testing a modification in this way can inform the observation aspect ● Modify some aspect of the pose, but keep the main intention(s) ● Substitute a different pose with the same/similar intention ● Re-pattern the entrance into the pose or the exit out of the pose ○ Sometimes the way that we or our students enter into the posture may need to be changed to create a different outcome once we are in a posture or once we are deeper in the posture. ● Leave the pose out ○ It may be that at this moment, the pose is simply not appropriate at all

Working With Injuries

Workshop: Reference Guide

KNEE PAIN / INJURIES

Below, we include some examples of questions that you might ask to help gather that information.

Initial questions: ● What postures do they feel pain in? ○ Are they experiencing pain in half-lotus pose, full lotus, warrior poses, and/or other poses with a deep knee bend (virasana, utkatasana, pasasana, etc.) ● Where in the knee are they feeling pain? ● Have they had previous injuries to their knee joint? ● Has this student been a runner or a cyclist?

Observe: Based on the initial questions, observe the student do the postures where pain is experienced.

● Do they generally have tight hips? ● Do their hips more easily do internal or external rotation? ● How are they bringing their lower leg into lotus? ● Do they internally rotate the lower leg?

Working With Injuries

Workshop: Reference Guide

● Do they externally rotate the lower leg? ● How fast/slow are they moving the leg in? Is there time for the tissues to open as they bring it in? ● Does their foot/ankle get into the “right” spot? ● Does their knee point forward when doing postures such as standing forward bends or downward facing dog? ● Do they feel pain often when the knee is bent ninety degrees in standing such as warrior postures? ● Do their patella track straight forward and back? ● Do their knees point straight forward in standing postures? ● Are they new to practice and have weaker quadriceps? ● Is it possible that the quadriceps are particularly tight? ● If we had them do virasana, would they be able to sit on their heels?...Do they need a block? ● Can they do chair pose for an extended period and how low can they go? ● What muscles/structures/tissues are involved in creating this action and its opposite action?

Working With Injuries

Workshop: Reference Guide

Anatomy

HAMSTRINGS / SIT BONE PAIN

Observe and Investigate Remember to start with some questions to gather information: 1. Where is their pain? 2. Where might there be tension or restricted movement?

Working With Injuries

Workshop: Reference Guide

3. What muscles might be involved with those actions?

Below, we include some examples of questions that you might ask to help gather that information.

Initial questions: ● In what poses are they experiencing pain? ● Did the original injury start with a popping sound at one of the attachments? ● How long ago did it happen? ● If there was an “event” more than a week earlier, has the student been bending their knees since initial onset of pain? ● What have they been doing already to alleviate the pain? ● Is the pain felt throughout the muscle, or primarily at one or both attachments? ● Ask if the pain comes and goes. ○ If so, when does it come or go? ● Does prolonged sitting add to the pain? ● Does it radiate down the leg at all? ● Does it change as they practice?

Observe: Based on the initial questions, observe the student do the postures where pain is experienced. ● Do they bend their knees while moving in and out of postures? ● Do they move in with straight legs? ● Do they have hyperextended knees? ● How do they align their feet in tadasana/samastitihi? ○ Are they aligning the outer edge of their feet, the inner edge of feet, or aligning the feet in some other way? ● Which direction are their knees pointing in forward bends or down dog? ● What muscles/structures/tissues are involved in creating this action and its opposite action?

Working With Injuries

Workshop: Reference Guide

Anatomy

Working With Injuries

Workshop: Reference Guide

Working With Injuries

Workshop: Reference Guide

Working With Injuries

Workshop: Reference Guide

LOW BACK PAIN Remember when working with back pain: There are many possibilities for where pain in the lower back comes from. You should be very careful and err on the side of caution when working with people with lower back issues. This is especially true if they come and already have received a good diagnosis of disc issues or other detectable spinal issues.

Working With Injuries

Workshop: Reference Guide

Although it is possible to have a number of issues that are recognizable from images, such as an MRI, that are not the cause of lower back pain, assume that it is at least a component.

For instance, I have met many people who have had images taken that show herniation of discs. The assumption is that it is the cause of the pain they are experiencing in the back. Some of them have even had surgery where they shave the disc material away from the nerve. After surgery and recovery, the same pain remains. It asks the question, then: was the pain ever the result of the herniated disc at all?

When someone has already been to the doctor and there is nothing particularly obvious, there is a better chance that the problem is coming from the soft-tissues, such as muscles. But this is not a guarantee. Again, proceed slowly, and make small changes and see what the outcome is before doing additional things.

Low back pain could come from sources such as: ● Tight surrounding tissues ○ Contributors could include: hamstrings, gluteals, abdominals, iliopsoas, quadriceps and quadratus lumborum ● Over-doing forward bending when you are bendy ○ Allowing an excessive lumbar curve when folding forwarding can put pressure into the low back ● Disc problems such as bulging, herniated, or ruptured discs ● Other spinal problems including stenosis (narrowing of spinal canal), spondylolisthesis (where a vertebrae has shifted forward), or scoliosis

If you or a student have a specific diagnosed medical condition that is causing back pain, you should consult the medical professionals from whom you are receiving treatment regarding what movements are appropriate for you.

Working With Injuries

Workshop: Reference Guide

Observe and Investigate Remember to start with some questions to gather information: 1. Where is their pain? 2. Where might there be tension or restricted movement? 3. What muscles might be involved with those actions. Below, we include some examples of questions that you might ask to help gather that information.

Initial questions: Again, take some time to observe the students patterns and gather information about when and where they are feeling pain. ● In what poses is the student feeling pain? ● Where in the low back is pain felt? ○ Ask the student to point to it. ● Is there more generalized pain throughout the low back or is it more localized to a spot, like the sacroiliac joint, for example? ● Is the pain on one side or both sides of the back? ● Is it a commonly felt crunching, pinching sensation in the lower back? ● Is this a problem that the student has had before? ○ In other words, does it come and go? ● What other activities does the person do frequently that might be contributing to postural patterns? ● Do they do a lot of sitting at a desk or in a car? ● Do they run, cycle, or do other physical activities on a regular basis? ● Are they going through a stressful period of time in their personal life?

Observe: Based on the initial questions, observe the student do the postures where pain is experienced.

Working With Injuries

Workshop: Reference Guide

● What muscles/structures/tissues are involved in creating this action and its opposite action? ○ If the pain is a compression like pain either in a full wheel backbend, or in something like up dog, notice where they are tight and restricted in these postures specifically. ○ Open, long hip flexors allow the pelvis to rotate around the heads of the femurs and leave space in the low back when back bending. Any tissues that prevent ease in the rotation of the pelvis could contribute to sensations of crunching, pinching, and pain in the low back. ○ Tissues that could cause restrictions in the movement of the pelvis if tight include: hamstrings, gluteals, abdominals, iliopsoas, quadriceps and quadratus lumborum

Working With Injuries

Workshop: Reference Guide

Anatomy

Working With Injuries

Workshop: Reference Guide

Working With Injuries

Workshop: Reference Guide

Working With Injuries

Workshop: Reference Guide

SHOULDER PAIN

Observe and Investigate

Remember to start with some questions to gather information: 1. Where is their pain? 2. Where might there be tension or restricted movement 3. What muscles might be involved with those actions?

Working With Injuries

Workshop: Reference Guide

Below, we include some examples of questions that you might ask to help gather that information.

Initial questions: ● Where specifically in the shoulders are they feeling pain? ○ Have them point to it. ○ Is it just one shoulder or both? ● When do they feel pain? ○ Is it holding chaturanga, transitioning from chaturanga into or out of updog or down dog? ● Does the sensation of pain change if they hold plank with straight arms vs chaturanga with bent elbows? ○ What if they just don’t lower as far into chaturanga? ● How long has this person been practicing? ● How consistent is their practice? ● What other activities do they do in their work and leisure time?

Observe: Based on the initial questions, observe the student do the postures where pain is experienced. ● What patterns of strength relative to flexibility are you seeing in this student’s practice? ● Do they look generally weak in their upper body when they move through these postures? ● What is the relationship of shoulder to elbows to wrists in chaturanga, updog, and down dog? ● Are they sinking through the low back in chaturanga or is their body held straight? ● Where are their shoulder blades held in chaturanga position? ● What are their proportions like between upper arm and forearm? ● In down dog how do they have their hands aligned?

Working With Injuries

Workshop: Reference Guide

○ Are their shoulders scrunched? ○ Are they rotated more internally? ● What muscles/structures/tissues are involved in creating this action and its opposite action? ○ Strong serratus and latissimus are key for supporting the shoulders in chaturanga. ○ Simple lack of strength as well as postural imbalances can compress, pinch, and cause pain in rotator cuff muscles.

Anatomy

Working With Injuries

Workshop: Reference Guide

WRIST PAIN

Below, we include some examples of questions that you might ask to help gather that information.

Initial questions: ● Where specifically in the wrists are they feeling pain? ○ Have them point to it. ○ Is it just one wrist or both? ● When do they feel pain? ○ Is it when holding chaturanga, transitioning from chaturanga into or out of updog or down dog? ● Do they feel wrist pain during the day outside of practice? ○ If so, when? ○ Is it all the time or during a particular activity? ● How long has this person been practicing? ● How consistent is their practice? ● What other activities do they do in their work and leisure time?

Observe: Based on the initial questions, observe the student do the postures where pain is experienced.

Working With Injuries

Workshop: Reference Guide

● What patterns of strength relative to flexibility are you seeing in this student’s practice? ● What is the relationship of shoulder to elbows to wrists in chaturanga, updog, and down dog? ● Are they sinking through the low back in chaturanga or is their body held straight? ● What muscles/structures/tissues are involved in creating this action and its opposite action? ○ Strong serratus and latissimus are key for supporting the body over the wrists in chaturanga, updog, and down dog. ○ Simple lack of strength as well as postural imbalances in forearm muscles, wrist extensors and flexors, and all the muscles around the shoulder girdle can compress, pinch, and cause pain felt in the wrists. ○ Even contracted neck muscles could be the source of pain felt in the wrists. ○ Scalenes compressing brachial nerves could cause pain felt down the arm and into the hand.

Working With Injuries

Workshop: Reference Guide

Anatomy