Hyperextension of the Elbow
Good, Bad or Just Plain Ugly?
Beware of dogma - the insistence that there is only one right way to do something, and thus all other ways are wrong. Never is never right and always is always wrong (and that applies this sentence too!) But is it dogma when a yoga teacher commands her student to straighten her arm when it goes past 180°, past straight, into hyperextension? Or is it just plain common sense that an elbow should never be allowed to go past straight?
Hyperextension of our limbs just looks wrong! Basing our judgments of hyperextension on visual aesthetics tells us to never do it. But, never is never right - and so the command to never allow hyperextension of the elbow in yoga is also not right. Let's find out why.
Hyperextension is a slippery term. It generally is used to describe the situation where a limb is extended past the perfectly straight 180° line: this often occurs in the elbows, the knees and the shoulders. All three areas can be of concern in yoga classes, but we will look at only the occurrence of hyperextension of the elbow. That will be controversial enough for now. The term hyperextension is also used medically to describe a situation where a joint has been taken past its normal range of motion, resulting in damage to the tissues around the joints: its ligaments, tendons and the joint capsule itself. These are two very different uses of the term hyperextension. Clearly the woman in the picture above is not injuring herself: she is simply opening her arm to the normal, natural range of motion that her unique anatomy allows. This is not clinical hyperextension but it is hyperextension by the yogic definition.
The Standard Yoga Teacher Response
"One of the most common positional faults of the elbow joint can become apparent when students take up the practice of yoga asana. It is called hyperextension of the elbow Normally this angle is approximately 180°. Hyperextension occurs when the elbow is extended past this angle." Thus wrote Judith Lasater in her book Yogabody. Clearly Lasater is using the yogic definition for hyperextension of the elbow and clearly she doesn't like it. She is not alone. Here are a few comments found in the web site for the popular magazine Yoga Journal who posted this picture as an example of the asana called Side-Plank (aka Vasisthasana):
It would be easy, but pointless, to cite similar reactions: most yoga teachers would agree that the hyperextension of the bottom arm shown by this yogini needs to be corrected, but is that really correct for her? I don't do this. I can't do this. Chances are you can't do this either. We don't have the same bones that this lady has, but that does not mean that she shouldn't do this. Ignorance of natural skeletal variations is a big problem in yoga because it means that teachers treat everybody the same regardless of how different each body is.
- "This lady should be very very careful with all weight-bearing asanas on her arms. ... She must strengthen the muscles around the elbow joint .... But I would prefer [Yoga Journal use] a model with non hyperextended elbows!"
- "Yes ... I'm glad to see someone else noticed this as well."
- "The hyperextension in her right elbow makes me cringe."
Locking the Elbow
Another term for what this yogini is doing is called "locking out." She has locked her elbow joint so that her muscles are no longer supporting her; she is relying upon the architecture of her bones to provide the stability needed to stay in the pose. This is controversial, not just in yoga, but in other fitness realms as well, such as weight lifting. However, not everyone agrees that locking out is bad and should be avoided. According to Greg Everett, author of several books on weightlifting including Olympic Weightlifting: A Complete Guide for Athletes & Coaches:
"Press a weight overhead and stop just short of elbow lock; when you begin to fail, lock the elbows completely and you'll find you can suddenly continue holding the weight. This is why individuals without the ability to completely lock the elbows are at a huge disadvantage in the sport ... The elbows must be locked out; [emphasis added] in other words, they will be extended to the end of their range [of motion], which will normally be slight hyperextension. This creates the bone lock described previously and allows the muscles of the arm to support much more weight than they could directly."
Here is a picture of what he means: notice the right arm here - it is the same as the yogini in the earlier picture: it is locked out and hyperextended. This picture is from Sarah Robles' blog. Robles is a USA weight lifting Olympian and has been called "the strongest woman in America." She encourages her students to "Lift big and lock out."
Locking out is not necessarily hyperextension: it can happen even when your normal range of motion is exactly 180°. Locking out simply means that you are using your bones to support the stress of the position rather than employing only the muscles. This is an important distinction, as we will see, because most people who cannot hyperextend will still tend to lock the elbows when in a posture that puts a lot of strain on the arms.
What is Your Intention?
If we do not like our students to "lock out" then we should not be telling only the hyperextending students to bend their elbows, we should be telling everyone to do the same. And there may be good reasons for doing just that, depending upon your intentions. Try this little exercise in empathy: come into Down Dog to the point where you can lock your elbows. Don't worry if you have to hyperextend the elbows or not, just lock. Notice how much effort you need to stay there. Now, come into Turbo-Dog: bend your elbows just a couple of inches towards the floor. Stay! Staaay! Good dog. Doesn't that feel special?
Turbo-Dog is pure strength building, and it is great if your intention is to build muscular strength. If that is the reason you are asking your hyperextending or locked out students to bend their elbows, great! They will build strength. But why save this juicy pose just for students who hyperextend? Why not put all your students into Turbo-Dog? The reason is - it is hard! Few people can stay in Turbo-Dog for very long. But if you are going to pick on just one student in your whole class to do a Turbo-Dog, be fair and give everyone else the option too. The problem is - you can put a hyperextended student into a version of Turbo-Dog so she looks "normal" but, as you just discovered, she will suffer - just as you did when you weren't allowed to lock out.
If your intention is to build mobility, rather than stability - if your goal for this pose is length not strength - then don't request your students to bend their elbows. Let them hang out at the limit that their unique anatomy allows them. Let them explore the edges of their natural range of motion. Let them lock out.
Anatomy of the Elbow Joint
This is controversial - hang out in hyperextension!? Is that safe? To answer that, we need to delve into the anatomy of the elbow. Here we see the lower portion of the upper arm bone, the humerus. Below it we see the upper end of the main lower arm bone, the ulna. Notice how they are supposed to fit together.
At the bottom of the back of humerus is a notch, called the olecranon fossa. It is a space just inviting something of a similar shape to slip into it. At the top, front of the ulna, shown here from the side view, is a protrusion of bone called the olecranon, which just happens to fit into the fossa of the humerus. A perfect match - most of the time. Shown together in the side view with the elbow in extension you can see that the hook of the ulna nestles snugly into the opening of the humerus.
What stops the elbow from going further than shown here? Judith Lasater believes, "Hyperextension is created in large part by ligament laxity, and it is unlikely to change." Most yoga teachers would agree. They would say that to go to the point of locking the elbow you reach a place where you are relying upon your ligaments to support you. But this is not really the case. In Gray's Anatomy, a resource that Lasater refers her reader to, we are told "full extension is limited by tension in the (elbow's joint) capsule and muscles anterior to the joint ... and the entry of the tip of the olecranon into the olecranon fossa." Another text explains more succinctly, "Elbow extension ROM is limited by contact of the olecranon process of the ulna with the olecranon fossa of the humerus."
When we reach the limit to which we can extend or open our elbow we reach a place of both compression and tension: compression - where the two bones are pressed into each other; tension - where the muscles and the joint capsules are under stress as well.
Compression is Healthy!
All tissues need stress to be healthy, even our bones, our ligaments, our muscles and our joint capsules. One of the main benefits of yoga asana practice is that we stress our tissues, all of our tissues. This stress comes in two flavors: tension (the stretching of the tissues) and compression (the forcing of the tissues into each other.) When we lock out the elbows what we are doing is allowing our bones to compress - and this is good! Bones need stress to stay strong and healthy. But! You can do too much. How to know? Pain! Pay attention - if you experience pain, you are going too far. Compression is not bad per se: we need to compress our tissues. Painful compression is not good, but painful anything is not good. Pain is a signal the body sends us to tell us that we are on the verge of damaging our tissues.
Here is the reason most teachers will advise students not to hyperextend the elbow: "You could hurt yourself!" Yes - that is true: some students could go too far or hold a pose too long and damage the elbow joint. But this is true for students who do not hyperextend as well. It is also true that crossing a road is dangerous, but should we never cross streets? Or should we take care when crossing streets and still cross them? Just because something could create a problem does not mean it will create a problem: it simply means we need to take care and pay attention. That is good advice at anytime while doing yoga. Pay attention.
There is a danger also inherent in the teacher's well-meaning instruction to back out of hyperextension - there is a danger that we will never stress the joint! If our goal, if our intention, is to keep our joints healthy, then the advice to never stress the joint is not very helpful. No stress at all leads to atrophy: too much stress leads to degeneration. We need to find our Goldilocks' position in whatever posture we are doing: to be where it is not too much nor too little either.
Architectural Stability versus Muscular Stability
Beyond pure aesthetics, being able to stack the bones right on top of each other has other benefits. Architecturally, when the bones are completely aligned, the stresses of the weight being borne in the posture are taken by the full column of the bones, not by the joints nor by the muscles. In this case the muscles are used simply to keep the bones aligned, not to support the weight of the body. Bones are great at supporting weight. When we are not architecturally aligned, however, the bones are not doing this job, and more of the stress of the body's weight falls onto the muscles and/or the joint and its ligaments: we could call this "muscular stability" versus "architectural stability." Muscular stability is harder to maintain: it is work, but as we have seen that may be quite desirable. Turbo-Dog is hard work. Using the muscles rather than the bones to maintain a posture can help build strength. Likewise, as we have seen, relying on our connective tissues of ligaments and joint capsules to maintain stability can also help strengthen these tissues. The big difference will be time: when we are architecturally aligned we can stay much longer in a pose than if we have to rely on muscles or ligaments.
Variations in Range of Motion of the Elbow
But, what about someone who cannot even get their elbows to extend open to 180°? Here are two people who have very different bones. The lady on the top we have seen before: she can hyperextend her elbow to 195° but the guy below is limited to only 158°. This guy can never get to the architecturally stable point; he can't lock out. His arms will always want to collapse inward, like a jackknife. For him to stay in Down Dog or Side Plank will be very challenging because his muscles will have to be active all the time. This guy has no choice in his yoga asanas: he will never be able to reach the lock out position. His practice will be all about building strength, and dealing with frustration. The lady has a choice: she can choose to straighten her elbow to 180° and build strength, or she can go to her full length, lock out, and enjoy enhancing her full range of motion and stressing her joints. Neither person is doing his or her yoga wrong: they are just dealing with the reality of their bodies.
Paul Grilley does a masterful job of explaining the concepts of tension, compression and skeletal variations in his DVD called Anatomy of Yoga, from which the above graphic is taken. This DVD belongs in the library of every yoga teacher and serious student. In it, you will discover that there is a vast difference in our bodies; and that what works and is easy for one person may be death and destruction for someone else. We are all unique. You will see how your uniqueness manifests in your yoga postures. Curiously, medical textbooks that describe the variations in ranges of motions of our joints almost always claim the elbow joint can move between 30° to 40° (almost full flexion) to a maximum of 180° (full extension.) And, yet, in most yoga classes, teachers will often see students who easily go beyond the 180° position assumed to be the limit by medical texts. Going beyond 180° is assumed to be a pathology, a problem. But, since there is no pain associated with this degree of extension and students can easily go there, clearly this is not some pathology needing correction.
Most students hyperextend their elbows because they have to, if they want to stay in the pose. The position is not harmful per se. If the student has a pathology, if they did indeed damage their elbow in an accident or through some sports trauma, then they should take great care when approaching this edge. They may be well advised to back off and use their muscles to support them. But in that case, warn them that they will not be able to stay in the pose as long as others who are able to stay in a locked out position.
It is a lot easier to add a "micro-bend" to hyperextended elbows in Down Dog than in Side Plank, because two arms are taking up the weight of the pose in Down Dog. In Side Plank there is only arm supporting the body's weight: it requires a tremendous amount of strength to keep the arm straight if it is not locked out in that position. Anyone who has to hyperextend his or her elbow to reach lock out will do so. We saw it in the weight lifters, we saw in the Yoga Journal yogini, and we can even see this in the venerable B.K.S. Iyengar. In his book, Light on Yoga, there are several examples of him hyperextending his elbows and locking out. One example is shown here in this picture of Iyengar in a variation of Side Plank. He is locked out - and seems to be quite content to stay there.
Hyperextending the elbow is not bad, necessarily. For some people, yes - don't do it. Ouch! Pay attention: if it hurts, if there is some pathology present, don't go there. For other people however, why not? They are different - let them go to where their body allows them to go, so that they can lock out and hang out just like everyone else, just like Mr. Iyengar does. This may be the only way they can stress that joint and make it stronger and healthier. Don't deprive them of that just because of aesthetics. Occasionally, to build strength, have them back off a little, but don't be dogmatic: don't insist that no one should ever hyperextend or lock out their elbows.
That is hyperextension of the elbow: what about hyperextending the knees or the shoulders? Is that safe? Should that never be tolerated? That is a whole other article, and if there is enough interest in taking a yin-side look at these areas, maybe a new article will manifest in a future Newsletter. If you would like to comment on this article, feel free to share your thoughts in the YinYoga.com Forum.
1 -- Yogabody: Anatomy, Kinesiology, Asana by Judith Lasater, page 174.
2 -- See Yoga Journal Side Plank Pose.
3 -- See an earlier article called The Two Biggest Challenges in Yoga Today for more on the dangers of the ignorance in yoga of skeletal variation.
4 -- From Greg Everett's web site.
5 -- See the Wikipedia article on Sarah Robles.
6 -- From Sarah Roble's Blog.
7 -- See Wikipedia's images for the humerus.
8 -- See Wikipedia's images for the ulna.
9 -- Yogabody: Anatomy, Kinesiology, Asana by Judith Lasater, page 175.
10 -- Gray's Anatomy: The Anatomical Basis of Clinical Practice, 39th Edition, 2205, page 861.
11 -- Joint Range of Motion and Muscle Length Testing by Reese and Bandy, page 79. See also The Physiology of the Joints, Vol. 1 Upper Limb, 5th Edition by Kapandji IA, Churchill Livingstone, 1980.
12 -- See The Two Biggest Challenges in Yoga Today to understand why stress is healthy and necessary.
13 -- See the article on The Goldilocks' Position to learn more about this useful concept.
14 -- Visit Pranamaya to learn more about the Anatomy of Yoga DVD.
15 -- See for example Joint Range of Motion and Muscle Length Testing by Reese and Bandy, page 472.
16 -- See plate #400 of Light on Yoga by B.K.S. Iyengar. But also check out plates #12, 37, 75, 359,3 77, 396 - 399 for other examples of his hyperextension.