HandLab Clinical Pearls

January 2022 No. 71

Namaste…Returning to Yoga Weightbearing after Hand Surgery

Karol S. Young OTD, OTR/L, CHT

 

Yoga is known to facilitate flexibility, strength, and peace of mind so patients often desire to return to yoga as soon as possible after surgery or injury. (1)

J.B., a 56- year-old occupational therapist and yoga enthusiast was seen following left thumb CMC joint arthroplasty and left ring finger PIP joint fusion. As expected, J.B. was not able to place her hand flat on a surface because of limited thumb abduction/extension as well as ring finger PIP joint immobility. See Figure 1. Her left wrist extension was also limited.

Figure 1: Limited left thumb abduction/ extension following CMC arthroplasty and limited ring finger extension following PIP joint fusion.

J.B. was aware of the importance of avoiding positions that placed stress on the newly reconstructed CMC joint and the healing PIP joint fusion, but she wanted to return to yoga. She began by eliminating weightbearing through the wrist and hand by only performing positions that allowed forearm weightbearing. One example was use of the dolphin pose instead of the downward dog pose. (2) She also wore her post operative protective thumb orthosis during yoga.

Wrist extension improved at about 8 weeks post-surgery, but thumb motion remained limited. The ring finger PIP joint fusion would always restrict ring finger extension.

J.B.’s physician approved a progressive return to weightbearing activities, allowing blocks and pads to be used to eliminate excessive pressure on the left thumb and ring finger PIP joint, so J.B. began a weightbearing progression:

  1. Partial bearing weight while standing: leaning over the narrow side of a block. This allowed the thumb and ring finger to fall beyond the block while the partial body weight was distributed across the palm. See Figure 2.
Figure 2. Using a narrow block while standing to bear partial weight without stress on the thumb or ring finger.
Figure 3. Increased weight bearing through the wrist and hand while standing
  1. Increased weight bearing while standing: leaning over the wide side of a block. This prepared J.B. for full weight bearing when prone. See Figure 3.
  1. Distributing more weight through the wrist and hand while prone on a wide block. This final position remains J.B.’s adapted position for all yoga weight bearing. See Figure 4.
Figure 4. Full weight bearing on the corner of the block while prone.

Before J.B. could progress to the next position, she had to demonstrate each pose could be accomplished without pain.

Patients returning to yoga must employ sensible ergonomics and work closely with their therapist to ensure repaired/reconstructed structures are protected and positions are achieved without pain. Weightbearing through the wrist and hand can cause re-injury, therefore patients may benefit from a personal session with a trained yoga instructor to ensure the safe and correct performance of yoga postures (3) while using modified support props.

Furthermore, the Push® MetaGrip® may offer ideal long-term protection for CMC joint arthroplasty patients who want to continue with yoga while protecting a thumb CMC joint arthroplasty.

 

1. Goyal N, Tsai AG, Li J, Wysocki W. Return to yoga rates are high after volar plating of distal radius fractures. Hand (N Y). 2021;16(1):110-114. doi: 10.1177/1558944719850639.

2. Strouse S. Yoga: Tune in to your wrist alignment. ASHT Times.2020;27(2):36-39.

3. https://www.yogaalliance.org/

 

Download Clinical Pearl No. 71, Namaste…Returning to Yoga Weightbearing after Hand Surgery, January 2022

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Disclaimer: BraceLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

 
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