How to Avoid Shoulder Problems
We don’t really appreciate how much work we ask our shoulders to do until we injure one and then the simplest tasks become almost impossible. Yoga students certainly aren’t immune to shoulder problems, but as yoga teachers we can often help them recover from the most common ones—or prevent them from happening in the first place.
BONUS: Click here for a pose to help treat Rotator Cuff injuries!
First, an abbreviated anatomy review
The shoulder is a shallow ball-and-socket joint designed for maximum movement of the arm—forward and back, up and down side to side. The scapula (shoulder blade) and clavicle (collar bone) together with ligaments, muscles, and tendons form the shoulder girdle, which work to hug the scapula to the rib cage for stability, while the humerus (upper arm bone) moves within the joint. Muscles that surround the shoulder such as the deltoids, pectorals, latissimus dorsi and teres major for example are prime movers of the humerus. In addition, there is a deeper set of muscles called the rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis) that are also involved in arm movement. However, their main job is to hold the upper arm tightly in the ball-and-socket joint. Problems arise when the shoulder isn’t stable enough to support the wide range of arm movement. We yoga teachers always encourage our students to place their shoulders back and down to promote stability of the shoulder girdle. We also encourage dynamic tension for smooth and controlled arm movement.
The shoulder structure also includes nerves and bursa. The nerves in the shoulder—the radial, ulnar, and medial nerves—serve as messengers from the brain (for muscle control and movement) and back to the brain (with sensory information about touch, temperature or pain). The bursa is a small watertight sac found between two moving surfaces in the body to reduce friction.
Common injuries include bursitis (inflamed bursa caused by improper joint movement or muscle imbalances); tendonitis (tendons of the shoulder become irritated and inflamed from overuse); Shoulder impingement syndrome (inflamed and irritated rotator cuff tendons); rotator cuff injuries and tears (resulting from a trauma to the shoulder, wear and tear, or moving something far heavier than the joint is prepared for).
Second, a caveat
Shoulder injuries occur for a variety of reasons. Every injury is unique, so encourage your student to have a medical professional provide a specific diagnosis before she returns to practice. It is fair to say, however, that most shoulder problems stem from overuse and can happen as a result of any repetitive activity, including yoga. It’s never advisable to move through pain; always encourage your students to allow time for rest.
Poses that may aggravate the shoulder
Plank pose, Crocodile, and Upward-Facing Dog (and moving from Crocodile to Upward-Dog)
When reintroducing these poses, it is important to establish proper alignment of shoulders (back and down) and work within a pain-free range of motion.
Yoga Do’s and Don’ts
With careful attention to posture and movement, you can help your students recover from and, hopefully prevent shoulder injuries.
What to Do
Always warm up. A proper warm up is important for proper joint lubrication and to prevent wear and tear of cartilage and bone. Mountain 1 Warm up: Starting with a small range of motion and gradually increasing as body temperature does, properly prepares the shoulder joint for more intense activity. For example; small to larger circular arm movement will increase synovial fluid (joint lubrication) and flowing Child’s Pose to kneeling Plank, (with the option of Down Dog to full Plank) will prepare the shoulders for weight-bearing. This prep can also assist with setting up for stability in the shoulder girdle, placing the shoulders back and down.
Access a full range of motion gradually. Once properly warmed up, careful pose selection in Mountain 2 (work phase) will help strengthen the body’s inhibited or weaker areas. Certain poses will also offset repetitive movements. For example a swimmer who does the front crawl will likely get tight in the front of the shoulder. Offer Chest Expansion (option with a fold), Cobra, Upward Dog, and Dancer, all poses to help release the shoulders and open the chest. To access more shoulder mobility, mix up arm positions in Warrior poses. For example, Cow-faced arms in Reverse Warrior, Eagle arms in Warrior 2, and Reverse Prayer in Warrior 1 and Warrior 3.
Move on to deeper stretches cautiously. A proper progression in Mountain 3 (deep stretches) will bring more success when it comes to deeply stretching and opening tighter areas. Locust, Bow pose, Camel, Incline Plank and Fish are deeper, more intense poses to improve range of motion in the chest and shoulders. Start conservatively, modify whenever necessary and encourage your students to stop whenever they feel pain.
Practice regularly. Invite your students to commit to a well-balanced yoga practice, so they might increase strength and mobility over time. Working within their limits and yet finding their edge will help the body to adapt to the load/demand placed upon it. It is a fine balance between easy and hard that does not include pain but does include a challenge.
Practice Mindfully. Injuries often happen when we take things too far. The YogaFit Essence of Breathing, Feeling and Listening to the body reinforces the mind-body connection so students can respond safely when they experience pain. Remind your students that sometimes less is more. Urge self-control, awareness and non-violence (ahimsa) on their mats—and in their daily lives. Sometimes our bodies need more prep or a different option for optimal alignment and movement patterns. Always encourage props such as blocks, mats, straps for more ease in a pose.
What NOT to do
A painful practice. Pain is an important signal that lets us know something is wrong. Also, pain signals activate the body’s stress response, which increases the breathing rate and muscle tension and makes it hard to relax and benefit from the pose. Encourage your students to steer away from pain.
Crocodile Pose without modifying. Never dive with the shoulders down and elbows up in crocodile as it creates pressure in the top of the shoulder leading to injury. Instead, keep the shoulders and the elbows equal distance from the floor. If there is pain, lower the knees to kneeling crocodile and definitely avoid pushing through with load from Crocodile to Upward Dog. Instead, from Crocodile, lower to the floor and then extend the spine to Cobra. Choose the kneeling options (Child’s Pose to kneeling Crocodile, Cobra and back to Child’s) until strength improves and pain diminishes.
Internally rotate the shoulder joint: Turning the shoulders toward the middle of the chest puts them out of the optimal position to withstand load (as in plank, incline plank or Table Top) without injury. Place the shoulders back and down to create space across the chest and collar bone and encourage the scapula to hug the rib cage.