Regular Ashtanga or Vinyasa yoga practice can cause elbow pain at one or both sides of elbows or clicking sounds as the elbow is straightened, or locking of the joint. Some pain is caused by damage to ligaments or joints but elbow pain can be caused by unbalanced muscle function of the shoulder at the Glenohumeral* and the Scapulothoracic** joints and sometimes improves with corrective exercise that balances the muscles at these joints.
Yoga doesn’t have pulling movements so it’s difficult to balance the relative strengths of the shoulder-girdle muscles of the upper back and the chest. The chest often becomes the stronger of the two, causing internal rotation of the arms and protraction of the scapulae – they draw up and outwards on the upper back. Protraction of the shoulder blades also occurs from poor body-posture, especially if the pelvis tilts forward: the upper back is round.
This is because Chaturanga strengthens Pectoral and Latissimus Dorsi muscles, which are responsible for internal rotation of the upper arm. As the arm is straightened while pushing up with the hands, a twisting force is applied to the elbow, stressing the joint and causing unnatural tension in the forearm muscles which balance rotary forces.
Elbow joint structures can become damaged and inflamed over time if elbow pain isn’t treated. Wrist pain and rotator cuff problems, as well as neck tension and pain are common side effects of an imbalance between internal and external rotation at the shoulder and incorrect positioning of the Scapulae. Elbow pain is felt whether the elbow is turned inwards or outwards and often doesn’t improve with forearm stretching exercises prescribed for inflammation at the elbow.
These kinds of imbalances tend to occur in flow or vinyasa classes if
- the focus is on Chaturanga – held for long periods – and arm-balances without Sirsasana, Pincha Mayurasana, Tolasana, Lolasana and jumping the legs back or through in Vinyasa to strengthen the shoulders in different ways
- arm binds and Purvottanasana are not practised regularly to open the chest.
- abdominal crunching exercise causes rounding of the upper back and incorrect scapular positions.
With Ashtanga yoga sequences the large number of Vinyasa performed can make the chest stronger than the shoulders, especially if
- Chaturanga is held longer than other asanas in the vinyasa (some teachers use this method)
- practising vinyasa when fatigued can cause weakness in the Serratus anterior and Rhomboid muscles. The scapulae will lift off the chest wall when holding plank positions, looking like wings. The scapula moves up towards the head and can cause pain under the collar-bone and clicking at the Sternoclavicular*** joint. Abnormal scapular positioning also alters the function of the Glenohumeral joint and is a cause of rotator cuff pain and impingement
Elbow pain often improves if the external rotator cuff muscles of the arm are strengthened but it is wiser to consult a physical therapist who can prescribe a range of rehabilitation exercises to rebalance the arm, chest and shoulder girdle muscles. Sometimes pelvic tilt and body posture also need assessment and correction.
Although yoga students are constantly instructed to draw the shoulder blades back and down, this doesn’t counter-balance the active strengthening of the chest by Chaturanga and arm balances, or the shortening of the Biceps and Pectoralis Minor caused by bent elbow positions especially when yogis practising vinyasa are not strong enough to jump back and through and bear their weight on their hands with bent elbows all the time. Tight Biceps muscles cause clicking at the elbows when the arm is straightened. If the shoulders and elbows are not painful, then stretching the Biceps is will stop the joint from clicking or locking up.
Muscle imbalance at the Scapulothoracic joint and Deltoid muscle weakness can also create tension in the Biceps. Deltoids are often weaker than they should be if handstands are not practiced regularly. Makrasana must be practised by people who aren’t strong enough to do inversions but are practicing vinyasa. Vasistasana is an important asana for balancing chest and shoulder muscles and should be practiced regularly.
Painful, inflamed elbows need rest, but arm and shoulder rehabilitation is necessary to avoid damaging the elbow joint and this is a good time to stop and consider whether vinyasa yoga is good for your body in the long term. A vinyasa teacher who creates their own sequences needs to teach a variety of asanas using the upper body in many planes in every class to avoid causing shoulder and elbow pain in students
* the Glenohumeral joint is where the Humerus (upper arm) attaches to the Scapula (shoulder-blade)
** the Scapulothoracic joint is the joint that attaches the scapula to the chest wall. It is not a true bony joint because the shoulder-blade is attached to the chest wall by muscles only and imbalances between the Serratus Anterior, Rhomboid and Trapezius muscles are common
*** the Sternoclavicular joint is at the front of the chest where the Clavicle (collar bone) attaches to the Sternum (breastbone)
Kendall, McCreary, Provance, 1993, Muscles, Testing and Function
Ellenbecker, De Carlo, DeRosa, 2009, Effective Functional Progressions in Sport Rehabilitation
Brunnstrom’s Clinical Kinesiology 5th Edition 1996