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Bernie's article on hyperextension of the elbow

 
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JessGlenny



Joined: 19 Jun 2011
Posts: 4

PostPosted: Mon Jul 01, 2013 7:59 pm    Post subject: Bernie's article on hyperextension of the elbow Reply with quote

Broadly, I would agree with this if we are talking about yin yoga, which I assume we are, in which the intention is to stress ligaments and fascia in a very particular way. Speaking as someone with Ehlers Danlos / Hypermobiity Syndrome (ED / HMS) who specialises in teaching hypermobile people, I feel that the situation is a lot more complex when we start talking about yang style postures. Not everyone with hyper-extending elbows will fall into the category of ED / HMS, but many will. At present, there is very little awareness of this syndrome among yoga teachers, and yet it is very common, particularly so among yoga students. The ramifications are complex and too far-reaching to go into more than superficially in a forum post. However, some of the reasons it it is generally unhelpful for people with ED / HMS to work in hyper-extension in weight-bearing, yang style postures include: a heightened risk of osteo-arthritis (for which they are already at higher risk than the general poplation) as bone ends are compressed in active postures. Stabilising by compressing (locking) the joint increases the tendency of stabilising muscles not to fire and perpetuates a cycle in which these muscles become increasingly weaker and more 'switched off'. The hypermobile student who stabilises themselves by compressing the joints will often end up in the most extreme and bizarre physical positions as one hyper-extension is stacked upon another, and these may be very painful; however, due to the proprioceptive deficit that is integral to ED / HMS, hypermobile people are often unable to identify and activate the muscles that might stabilise their body more effectively. Another issue is the triggering of the sympathetic nervous system that occurs for people with ED / HMS when we work without substantial grounding in muscular integrity but literally out on a limb. This is a huge subject. For a little more about it, see the article on my blog here: http://movingprayer.wordpress.com/2013/06/05/teaching-yoga-to-people-with-hypermobility/
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Bernie



Joined: 23 Sep 2006
Posts: 1107
Location: Vancouver

PostPosted: Mon Jul 01, 2013 11:45 pm    Post subject: Is hyperextension safe? Reply with quote

Thanks for kicking off the discussion of the relative safety of hyperextension in response to my article. Hopefully others will be inspired to join the conversation.

You mention Ehlers Danois [ED] syndrome. Another post also asked the question whether Yin Yoga could help with this disease of the connective tissue. Your experience and input is valuable.

My point in writing the article was to take issue with the claim that no one should ever hyperextend the elbow. Never is never right. This does not mean that I claim that everyone should always go into hyperextension. Always is always wrong. Rather my point is that for some people, hyperextension is okay and sometimes even necessary; but for other people, hyperextension is definitely not okay. You are pointing out that people with ED should not engage in yang stresses that take them into hyperextension. That is a good point, however, we also know that no stress can be just as harmful to a joint as too much stress.

You mention arthritis: this can certainly arise if a joint is overstressed. Unfortunately, with no stress osteoporosis can develop. These two extremes are waiting for us if we do too much or too little. For students who have pre-existing conditions, the distance between too much and too little is very short. I discussed this in the article Yin Yoga or Restorative Yoga - and this image here was used to explain the need to pay close attention to what is happening when there is disease or some other pathology.



Based on this, my question to you would be - are you saying someone with ED should never allow their elbows to hyperextend? If so, are you risking eventual osteoporosis? It is obvious that a student with ED could easily go too far and make their condition worse, but to default to saying never do it may also create problems. It is not easy to determine, but maybe the challenge for them is to find their Goldilocks' position where there is some stress but not too much stress.

Cheers
Bernie
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JessGlenny



Joined: 19 Jun 2011
Posts: 4

PostPosted: Mon Jul 01, 2013 11:57 pm    Post subject: Reply with quote

I'm not saying anybody 'should' do anything. Do whatever you want, people. However, my experience in my own body and in working with many students with ED / HMS, some of them also themselves teachers, is that in general hypermobile people will have a physically, somatically and energetically less painful and more beneficial experience of yang asana work if they release hyper-extension from their elbow. Protection from osteoporosis can come from a yin practice.
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mikeluque



Joined: 07 Jul 2013
Posts: 1

PostPosted: Sun Jul 07, 2013 2:13 am    Post subject: Reply with quote

There are a couple of points in this article that I'd like to put some light onto.

One is the picture taken from the "Anatomy of Yoga" DVD. The picture showing the man to only be able to extend his elbow to 158 degrees doesn't conclusively say anything about his bone structure. The picture is in isolation doesn't support or refute your points about hyper-extension. Without more assessment, there is no way to know if the limit of his range of motion is pathological or a consequence of tight ligaments and joint capsule. The only way to tell is to either feel the end range: is it "thick and spongy" or "hard bone on bone" or through medical testing (x-ray). From the picture alone there is no way to know. Therefore the picture itself could lead people who see themselves unable to currently extend to 180 to believe they never will be able to reach that structural angle.

The comparison to Olympic style power lifters "locking out" doesn't work in the context of yoga. The locking out at the end range of motion is the same, and in fact in power lifting, there could be even greater force into the elbow joint and bones. However, when getting out of that position, power lifters simply step back from the weight and allow it to drop freely to the floor. No attempt is made to actively guide the weight back down. This is in complete opposition to what occurs in yoga, when we're weight bearing as in side plank. The yoga practitioner needs to be able to get back out of that position actively and purposefully. They can't just "drop out" of it. That requires all the musculature around the joint to remain active. As JessGlenny says above, in a locked out, hyper-extended joint like the elbow, the stabilizing muscles one one side of the joint are in slack while those on the other side are at full length. This is an uneven length/tension relationship and can make it difficult to smoothly transition out of the position. Keeping a "micro-bend" (which is relative to the maximal ROM of the practitioner's joints) keeps all the stabilizing muscles active.

Finally, it's a mistaken idea that bones strengthen based on the forces placed on them from other bones. It's true that bones develop based on the forces placed on them (Wolf's Law), however, it's the forces from the muscles, transmitted into the bones through the tendons that increase bone density. The idea that it is hard joint compression is also seen when people, especially women, do exercises like box jump ups at the gym. They'll land as hard as possible, believing the impact is what strengthens the bones. However, it's the forces transmitted into the bones from the contraction of the muscles that is increasing bone density. Your body doesn't want to fall, so a large number of muscles are firing to allow you to land purposefully instead of just falling on your buttocks. In yoga, it's the isometric force of the combined efforts of all the muscles in the arms and shoulders (in downward dog for example) and that force being transmitted into the bones that is good for bone health. Direct bone on bone force is actually rarely good.
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JessGlenny



Joined: 19 Jun 2011
Posts: 4

PostPosted: Sun Jul 07, 2013 2:24 am    Post subject: Reply with quote

Interesting. I am not a scientist - I work in ways I find experientially to be effective - but these comments on the role of muscle in bone strengthening feel intuitively right to me. I'm interested in other comments.
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Bernie



Joined: 23 Sep 2006
Posts: 1107
Location: Vancouver

PostPosted: Mon Jul 08, 2013 3:19 am    Post subject: Strengthening bones Reply with quote

Hi Mike thanks for taking the time to contribute to the discussion. Let me address your questions in order:

1) You are quite right: the picture of the man whose arm is bent at less than 158 is not an indication of what is going on in the bones or in his joints. To know what is going on there, we would have to ask him what he is feeling. Paul Grilley explains this in detail in his DVD. In the interest of brevity (my article was already quite long) I did not include this guys full background. Paul did ask him and knows that he is not feeling any tensile resistance in his muscles, there is no pathology. This guy had reached the limit imposed on him by his bone structure, as indicated by the feeling of compression in his joint. He is not going to be able to go further, short of some sort of surgical intervention. I can sympathize with this guy because my own right arm similarly cannot open to 180. I too reach compression before my right arm can openly completely. I can easily feel that I am reaching a bone on bone compression in my elbow, it is not a pathology or a tightness in my joint capsule. (Interestingly, my left arm can open 180.)

2) You say that comparing a power lifter to a yogi is not a valid comparison because of what happens after the weight dropped. However, before the lifter drops the weight, there is stress in her joints just as there is stress in a yogi doing, say, side plank. This is a valid comparison because both are stressing their joint in a place that is beyond 180. Both are spending some time there, even though the yogi will tend to stay there longer than the weight lifter. The fact that a yogi will smoothly come out of her pose does not negate the stress that she felt while in the pose.

Your point is more appropriate when talking about the stresses that occur while in the pose and the use of muscles when coming out. You say that in a hyperextended and locked out joint that the stabilizing muscles on one side of the joint are slack while those on the other side are at full length. If that were so, it would be true even in a non-hyperextended but locked out joint. When I lock my left elbow at 180 in side plank, my biceps are stretched to the maximum that they can possibly stretch. (They cant go further because I am locked out there is no more ROM for them.) But I dont agree that my triceps are slack. Try it yourself: go to where you lock out and see if your agonist muscles are lax. They are contracting to help me stay in the pose and the antagonist muscles, the biceps, are stretched. But, my point is this is the same whether you are hyperextended or normally extended: the biceps will be stretched to their max and the triceps will be engaged. This is not an uneven relationship it is the natural relationship of that body.

Yes, we could microbend the elbow and make it more muscularly active: but why reserve that command only for the hyperextending student? Even normal 180 students, (like my left arm) will lock in side plank. If your intention is to activate the muscles the whole time you are in the pose, then why not tell everyone to microbend their elbows? Why because it is hard. Try it yourself: how long can you hold side plank with a microbend in your elbow compared to being locked out? (Maybe only as long? That is the point of Turbo Dog it is great for building strength, but you cant stay as long.)


3) I would disagree with your statement that bone density is only increased by the stress placed on the bones by the muscles. NASA has been wrestling with the problem of bone density loss for astronauts who remain in orbit for months. They have experimented with all sort of muscular exercises to create a suitable stress on the bones to keep them strong, but so far have found no way to maintain bone density in a microgravity environment. [They are coming closer, as this study shows, but to recreate what gravity does for us every day they have to get really creative and the amount of muscular exercise is extreme.] We need gravity to stress the bones; and that comes from the bodys weight creating stress on the bones. A NASA study of isometric exercise has shown that such exercise can maintain muscle strength but at the cost of muscle cells! (The astronauts doing only isometric exercises in orbit lose myofibrils.)

The examples you use of women jumping to help strengthen their bones and failing are dynamic stresses of the bones: jumping creates a transient stress on the bone and the joints. That is a yang form of exercise and i agree that this is not the way to strengthen yin tissues. Yin tissues require yin stress: long held stresses. A 300-pound basketball player dunking a basketball places tremendous transient stress on the arches of his feet when he lands, but he doesnt suffer fallen arches. He may break his feet, but he wont change their shape. A 90-pound waitress, standing on her feet all day long, may suffer fallen arches over time: that is a yin stress.

You said, Direct bone on bone force is actually rarely good. While we use the term bone on bone, to be precise, in our articulating joints we never have direct bone connecting with bone: we have bone connecting with cartilage connecting with synovial fluid connecting with cartilage connecting with bone. To maintain health we need this whole system to undergo stress: stress is what stimulates the chondrocytes in the cartilage to create more cartilage and synovial fluid. Stress in the bone stimulates the osteoblasts to build more bone. If we ever get to bone contacting bone in a synovial joint, we have reached the pathology of osteoarthritis and that is not good, I would agree. But, to say no one should ever try to stress their bones or their joints is unhealthy and unhelpful, because no stress is just as damaging to our body as too much stress. Too little stress leads to osteoporosis. Life requires a balance between the too little and the too much.

My main point is if you prevent people who can hyperextend from going to where they can, you risk too little stress to their joint and it may atrophy over time. Yes, they could go too far and the joint could be damaged but the opposite extreme is not better.

Thanks again for your thoughts.
Cheers,
Bernie
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jessofwight



Joined: 16 Jul 2013
Posts: 12

PostPosted: Tue Jul 16, 2013 11:29 pm    Post subject: Reply with quote

I read this article with interest, and the follow up here.

I can't help but feel that more emphasis on encouraging student body awareness is linked to this. For some students locking out or hyper extension will feel instinctively right; for others it won't, but I'm not always sure the balance between "do as I say" and "listen to your body" is correctly reached in classes.

Of course, I recognise that some natural patterned movements are unhelpful for the body, and sometimes systematic correction is needed, but in general attunement by the student to their own body provides a good initial feedback mechanism?

My t'penneth from the mat rather than the front of class.

As its my first post, a quick "hello". Yoga student, working towards teacher training over the next few years probably with a strong yin component to a teaching practice, reflecting how my home practice has developed. Long term pilaties student, hence my body awareness thoughts, more a recent adherent to yoga.
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Bernie



Joined: 23 Sep 2006
Posts: 1107
Location: Vancouver

PostPosted: Wed Jul 17, 2013 12:25 am    Post subject: Developing inner awareness Reply with quote

Hi Jess - welcome to the Forum.

I would very much agree with you: one of the best skills we can help people develop is an inner awareness of their body (as well as their heart and mind.) To have the student know for herself/himself what is right, good and skillful rather than rely upon someone else telling her/him what should be right is precious. Since everyone is different, no one instruction is going to work for every body, thus the student has to take responsibility for finding out what really works, and what doesn't. Teachers are only guides.

Cheers
Bernie
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Cathy



Joined: 06 Jan 2014
Posts: 3

PostPosted: Mon Jan 06, 2014 3:37 pm    Post subject: The radius Reply with quote

Hi, the forearm has two bones, the radius and the ulna. It's not just the joint with the ulna that determines the range of motion in the elbow. The radius has a role to play as well. I recently fractured the Radial median head, this type of injury typically results in loss of ROM to elbow of 10-15 degrees (which coincidentally I lost in hyperextension).

Would be interested to understand the relationship between all the bones in the joint, do you know more about how all the bones play together to determine range of motion?

Thanks
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Bernie



Joined: 23 Sep 2006
Posts: 1107
Location: Vancouver

PostPosted: Fri Jan 10, 2014 2:47 am    Post subject: Bones and Yoga Reply with quote

Cathy - I would highly recommend you view Paul Grilley's DVDs and online courses on anatomy in Hatha Yoga. You will find a treasure trove of knowledge in this specific area.

Cheers
Bernie
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LCA



Joined: 29 Aug 2014
Posts: 1

PostPosted: Fri Aug 29, 2014 1:43 am    Post subject: Hyperextension Article Reply with quote

Thanks so much for this article!!! I have extremely hyperextended elbows. I just wanted to add my 2 cents from experience. A) The Yoga Journal model may not have in fact been locking out. If you have extreme hyperextension, even keeping a slight bend in the elbow will still appear "locked" as you put it. I was always corrected in my elbows the first few years of practicing yoga. Teachers would tell me to microbend my elbows, so I would- but because of just how overextended my elbows were, a microbend looked still overextended! So I'd have to bend quite a lot to look "straight". The model's elbows could have been locked- who knows! But I have to say that I've seen pictures of myself with microbent elbows where I'm shocked at how overextended they STILL look! B) I've been doing Turbo-Dog's unfairly this whole time??!! Sad Thank you for pointing this out, on behalf of all of us overextended folks. I have extremely muscular arms from yoga, and honestly, so many ppl have asked what ELSE I do to get arms like this. (The answer is "nothing!") It's because while everyone else was regular Downdogging, I was Turbo-dogging this whole time!!!! Good way to get crazy muscular arms, I have to say. Smile And lastly, keeping arms bent an entire yoga class, with no straightening, makes my elbow joints start to ache. This is what is expected of anyone with overextended arms. That you keep your elbows bent the ENTIRE time. It actually feels good to straighten them once in a while. I encourage anyone with "normal" arms to do an entire class and never straighten the arms. It feels bad. The arms wants to straighten. It's natural. What's unnatural is never ever straightening (and when I say straighten, I mean straighten for MY body, which looks overextended to anyone outside of my body). There is no pain whatsoever in straightening (overextending) the arms, and putting weight on them when in their full range of motion. It feels very natural. I was born this way and I have never had any injuries or pains in my arms or elbows due to my natural overextension. To me, it feels completely normal. I feel like teachers just assume that because it looks weird it must be wrong. But it's just different. Yes- tell your students to listen to their bodies, but also LISTEN when students tell you that it feels OKAY! It goes both ways. (I am a teacher too, btw!) Just thought I'd let you know my experience.
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Bernie



Joined: 23 Sep 2006
Posts: 1107
Location: Vancouver

PostPosted: Sat Sep 13, 2014 1:27 am    Post subject: Teachers: LISTEN when students tell you that it feels OKAY! Reply with quote

What a great personal testimonial. Thank you for sharing your experience. As you point out, always bending the elbows will put stress on the joint too. We need to relax once in a while, and that may mean not microbending and just hanging out in the joint for a while.

Cheers
Bernie
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