Unit 6: The Upper Limbs - media.yogaanatomy.netmedia.yogaanatomy.net/fundamentals-new/unit-6-transcript-v2n8sik3.pdf · Unit 6: The Upper Limbs Module # Topic Timestamp Page #

Unit 6: The Upper Limbs

Module # Topic Timestamp Page #

6.1 Somatization: Pathways of Weight 00:00:54 1

6.2 Geek Out: Hands & Wrists 00:11:55 2

6.3 Geek Out: The Forearm 00:22:00 4

6.4 Geek Out: The Elbow 00:26:51 5

6.5 Proportions: Hands vs. Feet 00:33:07 6

6.6 Geek Out: The Shoulder 00:39:48 7

6.7 Pathways of Weight in the Upper Limb 00:53:53 10

6.8 Comparing Structures: Shoulder Girdle vs. Pelvic Girdle

00:58:36 11

6.9 Shoulders: What Might Your Students Say? 01:10:13 13

6.10 Putting it into Practice—Using the Hand as a Foot 01:29:26 20

Review Unit 6: In Review 01:57:28 28


[Timestamp 00:00:00]

Narrator: Welcome back to YogaAnatomy.net Fundamentals. This is Unit 6, The Upper Limbs. In the previous unit we looked at the structure and function of the lower limbs, starting at the feet, moving up to the knee, and ending with the pelvis. In this unit we’ll look at the corresponding structures in the upper limbs, hands and wrists, the forearm, the elbow, and the shoulder. We will again examine how the structures evolve and how they are put together so we can see how best to use them in yoga and in life. We will close with a discussion about the kinds of questions that you are likely to hear from your students about health and their upper limbs, and then we will put it into practice. But first we’ll join Amy for a somatization.

Module 6.1 Somatization: Pathways of Weight


Amy: Find a comfortable standing position with your legs underneath you. Your feet can be as wide or as narrow as you like. See, as you stand now, if you can orient yourself towards the weight falling into your heel foot. We're going to settle our attention inwards, starting with the weight in your feet. So if you need to adjust your feet, you can. Feel the heel foot and the ankle foot, the spiral through your foot. Feel the pull of gravity traveling through the bones of your lower legs and through the bones of your upper legs. Can you feel or imagine or visualize the weight of your sacrum traveling through your pelvis all the way down to your feet? What would it be like to be able to sense the weight in your bones as much as, if not more than, you sense your muscles?

Can you feel, or can you imagine you can feel, where the front of your sacrum is receiving the weight of your spine? From the front of your sacrum at the top, travel up through the bodies of the vertebra and the discs, through the curves of your spine, to where the weight of your head, your skull, and your brain pours into the top of your spine, down into your sacrum. From your sacrum, through your pelvic halves into your legs and down into your feet. The chances are good that one leg wants to take a little more weight, so let yourself pour a little more weight into that leg. Find your heel on that side and then pour forward into your little toe across to your big toe on that side and then into the other foot. Heel, little toe, big toe. See if you can feel or imagine, or visualize, that you are pouring the weight of your spine into your sacrum into this figure eight pattern in your feet. Can the shifting of your weight come from, though your muscles are facilitating it, can the shifting of your weight come from a sense of your spine pouring itself into the different bones of your foot?

The movement might be so tiny that you can't see it from the outside or it might actually move your body through space. Then let the movement, whether it's moving you through space or not, get smaller and smaller so that gradually there's no movement on the outside, though you may feel that figure eight continuing on the inside. Then release the weight of your head forward and you are going to roll down into your spine. As you do, keep noticing what happens to the weight in your legs. So can you keep pouring the weight of your sacrum into your legs, even as you start to pour more and more of your spine towards your head? As you come forward, if you want to bend your knees you certainly can. Straight legs are not necessary for feeling the weight traveling into the floor. When you've gotten down there, bend your knees as much as you need to bring your palms to the floor. It might be a little bit out in front of you. Pour some weight into your hands, then. Now see what you imagine might be the pathway for the weight

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to get from your spine to your hands. If you are weight bearing in your hands, what do you notice or imagine? Then walk your feet back and bring your knees down to the floor so that you come to your hands and knees, and your spine is parallel to the floor, then. So rather than being in that forward bend, can you find your spine now parallel to the floor with its curves? And how here do you distribute, pour, the weight of your spine into your legs? Can you feel the pathway of weight from your sacrum through your pelvic halves into your femurs and your knees? Then, how in this relationship to gravity do you find the front of your spine? Because the weight is traveling, the pull of gravity is traveling through you from back to front. But can you counter that, or can you balance out, that pull of gravity that might pull you into an extension in your spine? Can you find a sense of the continuity of your spine, head to tail? Maybe through the front of your spine, through the bodies of the vertebra, through the ligaments that run the length of your spine, through the relationship of the bones from your head to your tail. Can you feel the wholeness of your spine? And then how does that weight of your spine get to your hands? What is the pathway of weight from your spine to your hands? Now knowing that the pathway of weight is not based on your joints being in one position, that your arms do not have to be straight for you to find this, you could play with bending your elbows, which will change the organization in your wrist. See what happens in different positions of your arms if you ask about the pathway of weight from your spine into your hands. Where do you feel like there's a clear pathway of weight without all of the movement being asked of one joint? Without leaving any of the joints out of the question?

[Timestamp: 00:10:00]

If you want to, try this little figure eight in your hands and bring more weight into the outer edge of the hand and little finger side of the hand, across from your little finger to your thumb and then, from that thumb to the other outer edge of your hand to little finger, and across through the thumb to the other outer edge of your hand. See if this can also be an exploration of pouring the weight of your spine into your hands, though a different exploration or a different experience than what you might have found in your feet. Let that movement become smaller and smaller, until you feel balanced between the two arms. Then pour your weight back into your legs and come back into child's pose. Then pause the tape and take a few moments to write down your experiences around the pathway of weight in your arms and how you might feel any difference between looking for the pathway of weight in your arms, and in your legs.

Module 6.2 Geek Out: Hands & Wrists


Amy: Looking at the anatomy of the hand, then, we see a lot of similarities to the foot, but also some significant differences. The bones of the hand can be organized into the radial hand in blue here and the ulnar hand in orange. What we're looking at in these pictures is actually a right hand from the back and from the palm. So the radial hand is the thumb and the index finger and the middle finger, and the carpal bones and metacarpals that go with it. The ulnar hand is the fourth and fifth fingers and the metacarpals and carpal bones that go with it. They are named, in this case, for their relationship to the bones of the forearm, which we'll talk about in a little while, which are the radius and the ulna. When we look at the bones of the hand, then, we have, like in the foot, phalanges that are the bones of the fingers, in this case. The long bones of the metacarpals. Then, at the proximal part of the hand, which is the part of the hand closest to the rest of the arm, we have what are called the carpal bones. The carpal bones each have their



own names. But they interact with each other in a different way than the tarsal bones in the foot do. Where, in the foot, we had a spiral through the bones of the tarsals to create that twisted plate, the spiral in the upper limbs does not happen in the hand. Instead, what we have in the carpal bones, which are all of these eight little bones here, is an arch that goes across this way. The arch in the carpals is called a keystone arch, or can be compared to an architectural arch called a catenary arch, or a keystone arch. It works in a really interesting way. We have a model of this arch here. In a keystone arch, the pieces of the arch are cut and stacked in such a way that when the keystone is put into the relationship, the relationship between the parts of the arch is such that any force coming into the top is distributed through the parts, through the bones, into the supporting surface. This is a different kind of arch than other arches that might need buttresses or support from the side. So the nature of a keystone arch is that there is no glue needed. There's no mortar needed. There's no nails or anything like that needed, and the pieces will support each other. In our hand we do have connecting things like ligaments and muscles, but underneath the muscles, the ligaments, we have this relationship between the bones of a keystone arch. When we look at what the keystone of that arch is, then, in the hand we can look at this bone at the base of the middle finger, which is called the capitate bone. Which, in the drawing, is this bone right here. So the capitate bone is oriented at the base of the middle finger and fairly in the middle of the carpal bones that relate to the thumb and index finger and to the fourth and fifth fingers. The actual wrist joint, then, is here at this relationship between the carpal bones and the bones of the forearm. Now, you might hear different descriptions of where the wrist joint is. You might also hear described that the wrist joint involves all of the carpal bones. So we can have different definitions of this. They might play out in different ways.

But when we look at supporting the pathway of weight from the forearm into the hand, what we actually call the wrist joint is not as important as making sure that in this place where we have a lot of movement, we distribute that movement into the little bones of the carpals and that we find a way through those places with a lot of movement in flexion, in extension, in deviation to either side so that we can distribute the activity, the pressure, all the way out to our fingertips.

Looking for the arch of the carpals, then, is also a piece of that, so that when I bring my hand to a supporting surface, if I can look for the capitate, the base of the index finger [should be middle finger], to not drop into the floor, I actually can help to keep a hollow underneath the hand here, which would be this hollow of the carpal arch. The carpal arch becomes a carpal tunnel when we take a ligament and connect from this bone to this bone. As we've heard with ligaments, when they don't have support, when they get stretched more than they can accommodate, they can either give way and stop being supportive. They can, worst case, be torn. But they can also be inflamed or aggravated or painful in some way.

In the carpal arch, if the carpal ligament, then, is not supported by the keystone arch, but the capitate being supported... If that ligament gets stretched out and flattened, then the things that travel through the carpal tunnel will be pressed on when there's weight on our hands, and there are nerves and blood vessels and muscle tendons that travel through that carpal tunnel. So finding a balance between the places where we have lots of movement and not so much movement, and finding a clear pathway from the bones of our forearm into our hand can keep us from dropping too much into that carpal tunnel, can keep us from over-stretching the carpal ligament, and damaging what happens in the carpal tunnel. One of the ways to look at that distribution of action, then, is to see where in our hands we have lots of movement and where we have less or might perceive that we have less.

One of the instructions that gets told a lot, put out there a lot,




is to spread your fingers as much as you can. So in my body, when I spread my fingers as much as they can, my fingers are actually spread further than they can stay in relationship with the metacarpals. So, in the drawing, that would be moving a lot right at these joints to do something like that. It does certainly give us a broader base of support. But it diminishes the clarity of the pathway from the forearm into the hand. It makes it maybe less easy to feel the carpals relating through into the fingers. So instead of looking for the widest hand, we could also look for a clear pathway from the forearm into the hand and support through the carpal arch in such a way that—we can look for a balance of actions in the wrist, the fingers to be in relationship to the bones of the hand and support through the carpal arch in such a way that when we bring our hands to the floor or the platform, the weight to my arm can get to my fingers with a little bit traveling through each small bone. Because we don't have any giant bones in our hand that are meant to take the kind of weight that lands in our calcaneus all at once. A little bit of movement in a lot of places can let our hands take the kind of weight that we ask of our feet.

Module 6.3 Geek Out: The Forearm


Amy: When we travel up from the hand through the wrist joint into the forearm, we have some movements available in the bones of our forearm that are very different than the movements we have available in the bones of our foreleg. When we look at the forearm, separated out from the rest of the model, there are two bones. The radius bone is smaller at the top and larger at the bottom, at the distal end. The distal end of the radius bone is going to be on the thumb side of the hand, which is why the thumb and the first two fingers in the carpals are called the radial hand. The ulna, which is the other bone of the forearm, is smaller at the distal end and larger at the proximal end. If we look at it from the back, we can see this large part where it articulates with the elbow. If you feel it on your own elbow, if you start at your little finger and walk your fingers down to the bump of your elbow, that's actually the top of your ulna. So when you extend your elbow and flex it, the bone that's moving is your ulna, is one of your forearm bones.

So we have available in the bones of our forearm a movement called pronation and supination. The movement of pronation is one where the bones of the forearms cross. In supination, the bones of the forearm uncross from each other. In our hand, pronation looks like this and supination looks like this. They are sometimes defined as turning the palm down and turning the palm up. But that doesn't always convey what's happening the forearm, because I can turn my palm down without crossing the bones of my forearm. And when I turn my palm back up, the bones of the forearm stay uncrossed, because I articulated at my shoulder joint instead of in my forearm. So what that would look like in this model would be that, instead of crossing the bones of the forearm and uncrossing them, it would be as if I just turned the whole thing over and then unturned it. As compared to crossing the bones of the forearm and uncrossing the bones of the forearm. Supination and pronation.

This is a movement that may or may not be familiar to people in terms of what happens in our wrist. If I am not able to pronate very far, if for some reason there's a restriction in that movement, which might come from a habitual holding in here, it might come from the connective tissue between the bones. There might be all kinds of reasons that it can be challenging to pronate. One of the things that can happen is that in trying to get my hand down, if the bones of our forearms don't cross easily or far enough, then I



might ask too much of my wrist to do it. So something might show up as discomfort in the wrist that is actually about mobilizing the bones of the forearm. The bones of the foreleg don't have the same possibility. In the foot, as we talked about, there's a spiral through the bones of the foot. In the forearm the spiral happens in the bones of the forearm. So pronation and supination in the lower limbs happens in the foot. Pronation and supination in the upper limbs happens in the forearm. The forearm, then, is part of the spiral of the transfer of weight into the hand when we are weight bearing, and is part of the distribution of choices about how we articulate in engaging with our environment.

Module 6.4 Geek Out: The Elbow


Amy: When we move up from the forearm, the next joint in the upper limb is the elbow joint, which is made up, actually, of three bones interacting with each other. The proximal end of the radius articulates both with the ulna at the superior radial ulnar joint and the proximal end of the radius also articulates with the bottom of the humerus. The top of the ulna articulates with the radius at the proximal radial ulnar joint, which is part of the forearm articulation. The top of the ulna also articulates with the humerus. So movement at the elbow joint is flexion and extension. Pronation and supination is a movement of the two bones of the forearm, but the joint where that pronation and supination happens is included in the overall capsule of the elbow joint. So the two movements, the movements of the forearm and the movement at the elbow joint, they can get really connected to each other. One of the things that we hear about happening in the elbow joint is a carrying angle, or a carry angle. That has to do with the alignment of the long shaft of the humerus and the long bones of the forearm, and whether they are at an angle to each other in this way or more straight or more directly aligned. To some degree, a carry angle has to do with the shape of the bones and the amount of curvature in this articulating surface on the humerus. To some degree, it has to do with how we use the muscles around the elbow and how much pull there is on this part of the ulna, which is called the olecranon process. So if the ulna gets pulled to the side, it’ll tip the forearm and increase the carry angle. It won't necessarily be because of the shape of the bones. So this model is very loosely strung together. So we have a lot of range here. But it’s not— the organization of the joint is partly a product of the shape of the bones and partly has to do with what we're doing with the muscles around the joint, or the idea we have about how the weight is supposed to travel through the bones.

So when we look at how the elbow might align, one of the questions we often hear is about where the elbow is supposed to point, either the back of the elbow or the hollow of the elbow.


Interestingly, because the movement of the elbow joint itself is flexion and extension, when we're organizing, when we're talking about where the elbow should be, it's actually not about the movement that happens in the elbow so much as that the elbow is kind of a landmark that expresses what we're doing in the forearm and what we're doing in the shoulder joint. So if I rotate my arm here, if I rotate the elbow in such a way that the point of the elbow faces to the side or the eye of the elbow faces here or faces here or faces here or faces here, that is not rotation in the elbow joint, but is instead some expression of what's happening in the pronation and supination of the forearm or movement at the shoulder joint, which we will be talking about next. If we look at that on this model, then this doesn't have a hand on it. But I think



that you can see that when I turn the elbow joint, what's happening is movement between the two bones of the forearm. Some rotation here of the head of the radius in relationship to the humerus. But it's not about the joint action of the elbow, which is flexion and extension, and to some degree this little bit of deviation to either side.

So when we look for organizing a clear pathway of weight through the elbow, the question of hyper-extending in the elbow, which, like the knees, is an instruction that's often given. We hear lots of things get said about what to do for the elbow joint. Rather than specifying where the eye of the elbow points as the only kind of criteria for the joint, it's also interesting to look at how the weight of the humerus gets into the two bones of the forearm, both the radius and ulna. From there, then translates into the outer hand and inner hand so that we can have a clear pathway of weight as a criteria for the position as much as the absolute kind of spatial location of the elbow point.

Because of the different shapes of the bones, it is possible to have a clear pathway of weight even if there is a carry angle. Even if the elbow is bent. Even if the elbow is extended. The pathway of weight can travel through. Because that's what joints allow for, for movement to travel through from bone to bone. We have a lot of choices about where a clear pathway of weight can be in the elbow. Because we have a variety of choices about the position of the elbow, we don't have to have it in only one place for it to be well-organized or supportive of our weight or of our movement through space.

Module 6.5 Proportions: Hands vs. Feet


Leslie: So we started our exploration of the articular anatomy with the feet and worked our way up. We're about to start talking about the upper extremity. So this would be a good time to actually do some comparative anatomy. The similarities between the hands and feet are immediately apparent. In fact, when we look at the bony structure, we will see that just about every bone in the foot has a corresponding bone in the hand and the wrist. It's the differences that I want to talk about. The main difference that I want to talk about is the proportional relationship of the different sections of bones in the foot compared to those same sections of bones in the hand. This is going to turn out, not surprisingly, to be a sthira / sukha discussion. You will find it everywhere you look in the body. You can't look anywhere in the body and not find a sthira / sukha discussion because you are looking at a living organism that has to balance these qualities in order to be successful.

So if we came over here to our skeleton and I just grabbed a couple of extremities, like so. Okay. Just straighten that out. There. So this articulation here of the hand at the end of these two bones, of the radius and the ulna, is the equivalent of the articulation at the ankle joint here of the foot at the meeting place of the tibia and the fibula. So we see five toes. We see five fingers. But we see a vastly different proportional relationship between these tarsal bones in the foot and these carpal bones in the hand. I can cover the entire carpal region here with one of my fingers. It takes pretty much my whole hand from my pinky to my index finger to cover the tarsal bones of the foot. The metatarsals and the metacarpals, actually, if you look at them, are pretty much the same. See, I'm lining up the base of the metatarsals and the base of the metacarpals with each other, and if you look at that length, they are actually pretty identical. Right? But then, when we get to the phalangeal joints here in the foot, okay, I can cover these phalangeal joints with



a couple of my fingers. I cannot cover them with a couple of fingers of my hand. I need to bring in pretty much, again, my whole hand to cover the phalangeal section of the hand.

So if we were to map this out with numbers, looking at these proportions, this is what we get. If we divide the foot and the hand into 10 units of length, we can see that one third or 30%, actually, of that length is occupied by the metacarpals and the metatarsals of the foot. That would be here and here. Okay? When we deal with the relationship of the phalangeal structures with the tarsal and carpal structures, that's completely reversed. 50% of the length of the foot is taken up with these dense, heavy, irregularly shaped weight-bearing bones of the tarsals, whereas only 20% of the length of the hand is occupied by those corresponding bones. 50% of the overall length of the hand is taken up with the fingers, the phalangeal structures, whereas, in the foot, you've only got 20% of its length occupied by the corresponding structures. This is what I would call a reversal of the sthira / sukha relationships of these bones. The foot is clearly a structure intended to absorb, transmit and retransmit the downward and upward forces of weight bearing and support in locomotion. The hand, however, is not engineered for that. It is not engineered for weight-bearing. It is engineered for reaching and grasping and manipulating and taking all of our environment back into ourselves. You can think of the lower limbs in general as the part of our body that moves us out into the environment and the upper limbs as the part of us that brings the environment back into ourselves. This is also a prana / apana kind of an idea, as well as a sthira / sukha idea, of how we gather in and then move out.

So the basic message here is that when you decide to use these structures as weight-bearing, we need to be aware that we’re working against their engineering principles and we have to be very conscious of how we find pathways of weight through these bones. Remember, the foot is a twisted plane, where the back part is perpendicular and the front part is parallel to the surface that it's resting on. That is not true in the hand. The back part of the hand is not a heel. It is actually parallel to the surface, as well as the front. But the lessons we can learn about weight-bearing and support from the foot we can transmit to our attempts at using these structures for weight-bearing. We'll be talking much more about that as we progress in this unit.

Module 6.6 Geek Out: The Shoulder


Amy: When we move up, then, to the next joint in the upper arm, from the elbow joints, the next place that we have two bones articulating with each other is the shoulder joint. If we’re very specific about what the shoulder joint is, it is the glenohumeral joint, which is where the top of the humerus articulates with the scapula. On this scapula, which I have drawn some coloring in on, this shaded-in blue part is where the glenoid fossa is. It is where the head of the humerus articulates with the scapula. So that is the shoulder joint itself. Now, as you can see, I think, the hollow here on the scapula is much shallower than the acetabulum, which is the similar structure on the pelvic half where the head of the femur sits. The glenoid fossa does have a labrum around it. It does have a ring of cartilage that makes it a deeper socket. But it is still shallower than the acetabulum, which means that the shoulder joint has a lot of movement choices. Even more than the hip joint in terms of the range of movement available.

When we look at the head of the humerus in relationship to the scapula, then, at this glenohumeral joint, like the hip joint, the curved surface of the humerus means we have an incredible assortment of



movements possible in every possible combination of dimensions. So they are described as being flexion and extension and abduction and adduction and rotation. But we can do everything in between. Oops. Besides that. This structure on the scapula that comes out over the top is called the acromion process. It is protective. It creates part of the containment of the joint around the head of the humerus. In this space between the acromion process and the top edge of the glenoid fossa, we have some muscle tendons that extend out into the arm. So this space can get compressed by the head of the humerus sliding up. That is not something that we want to do. But we have an incredible assortment of choices without ever sliding the head of the humerus up. We can create some situations where the scapula isn't able to stay in relationship to the humerus very easily, which has to do with the range of motion in the glenohumeral joint. When we find ourselves in those situations, then we can set things up where we can cause some difficulty in this joint because of what we do with the rest of the scapula.

So if we look at the articulation of the scapula itself, then, on the ribcage it has the ability to slide up and down and wrap around and back, and to rotate in all of these different directions. Because there is not a bony joint between the scapula and the ribs in the back. There is not a bony joint between the scapula and the spine. The significance of that, the reason I make a big deal about there not being a bony joint is that, in a bony joint where bone to bone are talking to each other is where weight transfer happens. In these places, the scapula is in relationship to the ribs. The scapula is in relationship to the spine. But between these two bones and between the scapula and these ribs, there's muscle. So it's not a weight transfer place because weight doesn't travel through muscle. Weight squishes muscle. That's not functional. So the scapula does not have a bony articulation with the ribs in the back or the spine in the back. If we take as workable the idea that the bones are where weight transfer happens and that the muscles play the role of moving the bones so that bones can transfer weight, then we have to look for the place where the scapula articulates with another bone to follow the pathway of weight in. The place where the scapula articulates with another bone is here, where the front, the piece of the scapula that comes forward here, which is called the acromion process, meets the clavicle, the collar bone. This acromioclavicular joint is where the scapula articulates with the next bone in as it's transferring weight towards the body in this pathway of weight. This is a synovial joint. This is the joint that gets separated. When someone says that they have a separated shoulder, it happens in this acromioclavicular, or AC, joint. If we travel in from the clavicle, then, the next articulation, the next bony articulation, is at the sternoclavicular joint between the clavicle and the sternum. There's actually a little disc in here that makes it more mobile and gives us more movement choices. So the sternoclavicular joint, then, is where the shoulder girdle, which is the clavicle and scapula together, the shoulder girdle connects to the torso, or to the axial structures. If we consider the ribcage an axial structure, which we could also consider it an appendage, but for right now, if we call it an axial structure, the place where the upper limb articulates with the axis is at the sternoclavicular joint. Not between the scapula and the ribs or the spine in the back.

From the sternum, then, we can find our way into the spine through the ribs, which is a really interesting choice as a place for transfer of weight to happen. Because the ribs are always moving in response to the breath or always could be moving in response to the breath. So that something that is moving is also a key element in a pathway of weight and force, I think, illuminates something about how our body works. For something to be apart of a support structure, it does not have to be unmoving. If we make the assumption that stability goes with being rigid or unmoving, we're going to miss out on some of the ways we can get both support and movement in our body. So the ribcage is an example of that, and the entire shoulder girdle, because when we look then at the movement possibilities we have in the shoulder girdle and the upper limb, the arm bones, relative to the ribs and the spine, we have an incredible assortment of choices because the scapula does not have to be in one particular place on the ribcage for there to be a clear



pathway of weight, or for there to be a safe, supported arrangement of the head of the humerus and the glenoid fossa.

If we come back to the glenohumeral joint for a moment, then, and that squishing that I was talking about when the head of the humerus slides up and presses on whatever is coming through in the space under the acromion process, when I bring the humerus bone out to the side here there's a certain amount of sliding that happens between the head of the humerus and the glenoid fossa. Like in all of our other joints, it is both rolling and sliding. But at a certain point as I roll and slide up, these two bones right here will start to run into each other. At that point, or I would have to dislocate it downwards. So at that point, to keep balanced joint space in the glenohumeral joint, I either need to stop moving or I need to let the scapula follow and be part of the movement of the upper limb. Or, when I bring the arm forward, at a certain point I either need to stop moving or let the scapula follow. Similarly coming back, I don't have the same bony restriction in the back, but it's a similar question about keeping the head of the humerus in relationship to the glenoid fossa that, as I come back, at a certain point I either stop or I let the movement travel into the next bone, which, in this case, is the scapula.

What that means of our movement choices, then, is that what's often described as movement of the shoulder might include both movement at the shoulder joint and movement of the scapula on the ribcage. This movement of the scapula on the ribcage is sometimes described as being movement in the scapulothoracic joints, and taking our broadest definition of joints being where there are two surfaces in relationship to each other,


we could call this a joint. They slide and relate and communicate. It is not, however, a bony joint. So the relatedness of bone to muscle here is essential to the organization of the pathway of weight through our upper arms. But it is not where the weight transfer happens. When force from the humerus comes into the scapula, the pathway it takes is through the scapula, not to the spine. The pathway it takes is through the scapula, to the acromion process and then to the clavicle and the sternum, which is what I have drawn on the scapula here. That the weight, the force, would come in through the glenoid fossa and it swoops through the blade of the scapula and comes out to the acromion process here, where it's heading forward and will meet the collar bone in the front. If you ever have an opportunity to visit a real scapula, to see or hold a real scapula, which is what this is, it's very interesting, I think, it’s amazing, anyhow, to hold a real bone, a gift, and amazing to see how different bone structure is or to feel how different bone structure is from plastic models. But we can see, particularly if you hold it up to the light and see where it gets translucent, how this part of the bone is very developed to receive weight and this edge of the bone is very developed to receive weight. But the center part of the bone is not so much, doesn’t have so much density to it, so much hardness to it.

The bones of the scapula and the collar bone come embryologically from the same place that the arm bones come from in a similar way that the pelvic halves arise in the embryo from the same tissue as the rest of the bones of the leg. Which is different than where the bones of the spine arise and the ribs. The spine and the ribs actually arises from the same part of the mesoderm layer, and the ribs eventually articulate from the spine to become separate bones with synovial joints with the spine. But the scapula, the collar bones, the humerus, radius, ulna and all the small bones of the hand arise from a different part of the mesoderm layer and then come back in and connect to the torso at the sternoclavicular joint. So the scapula, in its development, arises as part of the arm more than as part of the ribcage. Functionally, in the movement of our arms, it is necessary for the scapula to be able to follow the arm in order to get the



incredible range of motion we have to bring our arms all the way around us. If we don't let the scapula be part of the arm, then we limit the range of motion in our arms to about 90 degrees.

Module 6.7 Pathways of Weight in the Upper Limb


Amy: If we look then at the pathway of weight through the whole upper limb, we could start either at the spine and find our way out to the hands, or we could look at the hands and find our way into the spine. The nature of a pathway is that you can go either way along that pathway. We're going to start from the hands in this moment. So in the hands, the weight travels, if we start at the fingertips, from the fingertips through the bones of the hand, the short bones, the long bones, into the bones of the wrist and the bones of the forearm. In the bones of the forearm, we have not so clearly just one bone that the weight travels though, where, in the lower leg, the tibia is clearly larger and clearly more a weight-bearing bone. In the bones of the forearm, we have a bone that's larger at the bottom and then another bone that's larger at the top. When they are crossed like this they share the weight more efficiently than when they are uncrossed. But when they are uncrossed and supinated, they can also bear the weight. It's not necessarily better to pronate or supinate the forearm in this pathway of weight, though each person may find their own way into what works best for them. There may be a little more stability in the forearm when the bones are pronated or crossed.

So, from the little finger to the thumb, we can find an ulnar hand to radial hand kind of pathway, like the heel foot to ankle foot in the foot. Find, through the bones in the carpals, the support of all the little carpals in their arch, feeding through into the bones of the forearm, meeting the humerus, humerus bone at the elbow joint, and through the shaft of the humerus, then we come up to the glenohumeral joints, travel around the scapula, out the spine of the scapula to the collar bone and into the sternum. From there we travel through the ribs into the spine, and at the spine we can either travel up to the head or down to the tail.

If I trace this on a real person, then, it might look like this. Lovely assistant, would you come? So Leslie is going to put one hand on the stool. Thank you. This is a great thing to do for yourself as much as you can, but even better to get someone to do it to you, if you can. So we're going to start from the hand and find our way up the arm to the top of the arm and then find the outer edge of the scapula and then the inner edge of the scapula. Walk your way out the spine of the scapula to the acromion process. I'm gonna switch hands so I don't turn my back to you. From the acromion process area, you're going to find the way in through the collar bones to the sternum. Feeling there that that is where the arm bones connect to the torso. From the sternum, you might imagine your ribs radiating out around and feeding into the front of the spine, and from there you can find your way down to your tail or up to your head. If we were to go the other way, then, just to retrace the pathway, we would come, reach all the way around here. Hi, Leslie.

Leslie: Hello, Amy.

Amy: Out to the collar bone to the spine of the scapula, around the scapula to the arm bone, down the arms to the hands. Thank you.

Leslie: Thank you.



Amy: You're welcome.

Leslie: I'll go do the other side.

Amy: Do the other side. I know. I'd hate to leave you unbalanced.

Module 6.8 Comparing Structures: Shoulder Girdle vs. Pelvic Girdle


Leslie: Now that we've explored some of the pathways of weight that we can find between the hand and the spine, it will be interesting to take a step out, a step back and look at the bigger issues of the similarities and differences that we can find when we look at the pelvic girdle in comparison with the shoulder girdle, and what we find are some very interesting similarities, but more important are the differences.

Okay so when we look at the structure of the pelvic girdle, what we see are very long levers connected to a pretty stable girdle of bone that connects pretty much directly with the spine, with the sacrum, so there's only really four major joints in between the foot and the spine,


in the lower part of the body. That would be the ankle joint, knee joint, the hip joint, and the sacroiliac joint. So it takes four joints to get from your foot to your spine in the lower body. The reason why finding a pathway of support from the hand to the spine is more complicated is a function of the fact that there are far more joints than that in between any supporting surface the hand encounters than the spine.

You got the hand, you got the wrist, you got the elbow, which is actually kind of a double joint. There's 2 aspects, there's the hinging and then there's the rotating aspect of the elbow, so that's already more complicated than the knee in many ways. You've got the glenohumeral joint, and then you got to find your way from the scapula to the clavicle, from the clavicle to the sternum, from the sternum to the ribs, and from the ribs to the spine.

This is many many many joints, not just four. If we take a step back, and look at the girdles themselves, in their similarities and differences, we can see that they have evolved for very different purposes. If we look at the shoulder girdle from the top and the pelvic girdle from the top, we do see that there is a very noticeable similarity in the way they are formed. You have these broad, flat bones, both of the scapula and the pelvic bones, and you have these struts that come around on the other side. In the case of the pelvis, it's the pubic rami, which come here and join at the joint of the pubic synthesis.

In the case of the shoulder girdle, you have the clavicle, which comes in and joins at the sternum, and you also have spinal structures that are somehow part of all of this, but in the pelvic girdle, the spinal structure is part of the girdle. Whereas in the shoulder girdle, it actually isn't a direct part of the girdle. Now it's tempting to think of how to make your scapula become part of your spine from the back just as the pelvic bones are part of the spine from the back of the pelvic girdle at the sacroiliac joint.



That in fact may be what a lot of this pulling of the scapula together and down may be about is trying to get a closer relationship between your shoulder blades and your spinal structures. In other words, trying to get this to function the way this functions, is tempting. But it violates the rule of weight transfer through the bones.

It has to go from bone to bone to bone, through ligamentous connections. This is not a ligamentous connection. This is a muscular connection. The only ligamentous connection, bone to bone between your shoulder girdle and the rest of your body is in the front. It's here between your clavicle and your sternum at the sternoclavicular joint. So, an interesting way to frame this question is, what joint in the upper body is the equivalent of the sacroiliac joint in the lower body, right?

To phrase it a little differently, the pelvic bone connects with your spine at the sacrum in the pelvic girdle very directly. Where can we find the bone to bone connection between your shoulder blade and the rest of your body? In other words, what joint serves the same function in the upper body that the SI joint serves in the lower body?

If you look at this view, it's tempting to look here, for where that relationship would be, just as it is here in the pelvic girdle. But that's not where it is. The sternoclavicular joint is the upper body equivalent of the sacroiliac joint, and it's in the front, not in the back. Because that's the only place you can find the bone to bone pathway of weight, from your shoulder girdle, going in the direction of your spine.

Now because this is such a more mobile structure than the pelvic girdle is, there's a lot more muscle that gets involved in positioning your bones for weight transfer in your upper body. You see, in the hip joint, you have a pretty deep socket. This is a pretty deep socket that the head of your femur fits into. It's even deeper than it looks here on the skeleton because you actually have a little ring of cartilage that extends beyond the lip of this socket, it’s called the labrum, which actually holds it in place a bit more. So this is a very deep, stable ball-and-socket arrangement.

When we look at the corresponding joint here, in the shoulder girdle, we find not a very deep ball-and-socket at all. We find the rounded head of the humerus, somewhat similar in shape to the rounded head of the femur, but we don't find a particularly deep socket for it to relate to. The glenoid fossa is actually quite shallow. It is made a little bit deeper by a ring of cartilage as well, which is also a labrum, we have labrum here and here. But it moves around quite a bit, compared to this. There’s a lot of muscle that gets involved in creating and maintaining this relationship at this joint.

Here, the structures that bind the head of the humerus to the socket aren't muscular, they're ligamentous. You have your iliofemoral ligaments here. You have your rotator cup here, that's muscle. And unlike these bones here which are pretty tightly bound through ligaments to the sacrum, here, the relationship between these bones and the rest of your body is all through muscle except this one place at the sternoclavicular joint.

What guides the action of the muscles in all of this choice that we have about where our arm is in relation to the scapula and where our scapula is in relation to the rib cage? There's many more choices that we have up here than we have down here because of the difference. And that's why this idea that we're developing of sensing the pathways of weight through your bones is so so critical. Because unless we're using that awareness of the pathways of weight through our bones as a way of organizing what our muscles are doing to position our bones so that that pathway of weight is effective, then we have no real guiding principle in terms of where all of these mobile structures should be placed other than the standard alignment cues of “always pull your shoulder blades down and together,” which may work for certain



things for certain people, but certainly can't work for everyone under all conditions in a wide range of asanas.

So that's a little bit about the similarities and differences between the shoulder girdle and the pelvic girdle between the hip joint and the shoulder joint, and it's important to keep this big picture of the sthira relationships of these joints to the spine in these sukha, or mobile relationships of these joints to the spine.

These are much more sthira joints, these are much more sukha joints. So in order to maintain our stability here in our weight-bearing, supportive, locomiting—is locomoting a word? Locomotive structures and to maintain the breadth and the freedom and the range of motion that is available here, we just have to understand what these different structures are engineered to do and what they are engineered not to do.

This evolved to be weight-bearing. This evolved in a different direction. This evolved to be reaching and holding and grasping. One way to think of it, our lower body structures move us out into the environment, our upper body structures can take the environment and move it in towards us. That's another expression of not just of sthira and sukkha,


but of prana, apana. So just some things to think about based on anatomy, and we'll be exploring them in greater detail in other sections of the course.

Module 6.9 Shoulders: What Might Your Students Say?


Amy: So we're going to talk now about some of the things that come up in terms of shoulder injuries, or that people come to us and they hear about having shoulder injuries. The first things I want to talk about are some of the things that show up when we get into a pattern of pulling down on the shoulders too much.

Leslie: Yeah.

Amy: Yeah. So when the scapula get pulled down consistently and we try to bring the arm bone up, it creates, one of the things it creates is this compression between the acromion process and the head of the humerus, which is called an acromion impingement. I mentioned before that that can happen. What it pinches on is the biceps tendon, and it can cause pain not in the biceps, but that radiates down the arm. The other thing that ends up happening, which we didn't mention, is that the nerves from, the nerves to the arms come from the neck and they travel out—oh, beautiful.

Leslie: I anticipated this.

Amy: Picture of the brachial plexus. They come out underneath the collar bone, underneath the coracoid process there. Behind that muscle is the pec minor. If we pull down on the scapula, those nerves can get squished or compressed between the scapula and the ribcage right in there. That can lead to pain and numbness.



Leslie: And it's not just the nerves. It's also the blood vessels that follow the same pathway that feed the nerves and everything else.

Amy: Yeah. 'Cause nerves and blood vessels, they travel the same routes.

Leslie: Yeah.

Amy: So this pulling down the scapula, maybe the idea that it's the right place for the scapula to be, ends up having these repercussions in terms of the acromion process and the brachial plexus that don't really help the health of the nerves or the tendons in there. It also ends up, this pulling down pattern, can end up restricting the range of motion in the neck. I end up seeing people who can't turn their head side to side, or they feel like they can't lie on their side, partly because they have this pattern of pulling down so strongly that there's nothing left for their head to go to the side. If they release their shoulders, their head can go further to the side. Now, there's nothing better about getting your head further than not getting your head further, except for that we have often some choices available to us that we experience as tightness and we think are muscles we need to stretch, right? It's not a muscle tightness thing. This is actually a really long position when my shoulder is down, and if I let my shoulder come up I can actually articulate through the joints of my neck a little more and find more choices about where to place my head.

Leslie: Also, I would just add that there's a difference between allowing the weight of your shoulder girdle to settle onto your ribcage and yanking the shoulders down onto the ribcage. I think that instruction often is given to people because they are observed to have this kind of response when they are raising their arms or doing other things. It's, like, "Oh, that's no good. Your neck disappeared. Make your neck show up.” But then you're yanking in the opposite direction. You haven't done anything about that fundamental reason why your shoulders want to go up in the first place. It's just a cosmetic fix to make it look better. But it's actually making everything less functional in the long run.

Amy: Exactly. Yeah. It's slapping a solution on top of a symptom, but it's not treating—

Leslie: I call them alignment bandaids.

Amy: Alignment bandaids?

Leslie: Yes.

Amy: Yeah. Then the underlying reasons why people have their shoulders up, then, is really interesting. I mean, I think there's all the stuff we get told about posturally, like pulling our shoulders back to get our spine up. Then there are all kinds of other stuff that shows up right in the ribs and the breathing patterns.

Leslie: We will see this in the asana section when we get into—ask people to do some simple movements. You will see a lot of people will have a tendency to try to create mobility in their axial body by initiating it here. There's not necessarily anything wrong with that, but if that's what you're stuck in and you can't feel the opposite, which is to simply maybe move your ribcage and spine and let your shoulder girdle relax enough to ride on that movement, we want to have the flexibility to be able to do both and not be stuck in any one thing or the other.

Amy: Yeah. If moving the shoulders is the only way we can move the spine, then the shoulders, the scapula, can't be free to be part of the arms.



Leslie: Right. You're trying to make the scapula part of the axial anatomy, which it isn't, as you have explained. Yeah. You mentioned the acromioclavicular joint. Separations of the AC joint are quite common. By the way, the clavicle, just as a point of reference, is the most frequently fractured bone in the body. By contrast, this joint here, the sternoclavicular joint, is very, very stable. Dislocations are virtually impossible there.

Amy: We break our clavicle before we dislocate the sternoclavicular joint, which is interesting because it's a very mobile joint too.

Leslie: Mobile and stable.

Amy: So it's very stable and it's very mobile. There are a ton of movement choices available there, and it's very hard to dislocate.

Leslie: Yes.

Amy: So I feel like one of the things that happens... Because people talk about having well, one thing they do is say that thing where they are, like, "I have a rotator cuff.” We all have a rotator cuff. The rotator cuff is a designation of a group of muscles that are right around the head of the humerus, which are these, on this posterior view, this deeper set of muscles. Then, on the anterior view there, that one from the front. But you can see what they do. They are the muscles that attach scapula to the head of the humerus. Just the head of the humerus to the scapula. So they are not about where the scapula is on the ribcage.

So everybody has a rotator cuff. To say, "I have rotator cuff," is just naming some body part.

Leslie: I have carpal tunnel.

Amy: I have carpal tunnel. I have SI joint. I have TMJ.

Leslie: I have TMJ.

Amy: Yes. We all do.

Leslie: I have two TMJs.

Amy: You do. You're so special.

Leslie: Yeah. Stereo jaw joints.

Amy: So the rotator cuff injury that could happen, though, could be some kind of tear in the rotator cuff. But I think that's a really interesting area that gets diagnosed as a thing. I feel like this happens with lots of things, but with the SI joint too, someone will get told what something is. Then they will stop inquiring, or they will get the diagnosis and stop. They will be, like, "I know what it is. This is the only thing."

Leslie: But that's not a diagnosis. That's just naming the symptom with a body part.

Amy: Exactly. It's just saying, "Oh, this is where we can see that this movement pattern is causing something in the tissue.” But we think, by getting a name of it, like rotator cuff injury, like we know what it's all about. But rotator cuff injury is just naming this stuff as injured. I think that those tissues,



something like the rotator cuff weakness or mis-function or malfunction or dysfunction or injury, it's an expression of some idea we have that's affecting all of the muscles and that, particularly in the arm, if we use a lot of positioning—so it's going to loop back to that postural thing. If we do a lot of this positioning of the scapula by itself because we think the scapula is supposed to be in a certain place on the ribs, like posturally or location-wise, have them up, have them down, have them forward, pull them, back—all this positioning of the scapula.

Leslie: Well, there are so many choices.

Amy: There are so many choices, but there's also looking for the right place. Are my scapula in the right place? But when we build up our awareness in those muscles, we might lose a sense of the relationship between the head of the humerus and the scapula, because that gets made less important than where the scapula is on the body. Then we also end up getting the idea that the top joint of the arm is the shoulder joint, is the glenohumeral joint, and I feel like I run into that all of the time. Like, "This is where the end of my arm is."

Leslie: This is where your leg ends, too.

Amy: And this is where my leg ends, right, exactly. We hurt ourselves. I will speak for myself. I have hurt myself by asking too much of my shoulder joint. I think we end up calling it a rotator cuff injury. It shows up lots of ways. I ask too much of my shoulder joint and I think my scapula has to be back when I bring my arm forward, or I think my scapula has to be down when I bring my arm up. We don't want to be here. I get that we don't want to be here. But the assumption that having the scapula slide up with the arm necessarily leads to neck tension, it's a mistaken assumption that those two things go together, I think.

Leslie: As we just mentioned, a little anatomical information can be a dangerous thing. There are certain syndromes that show up all over the body, but we're talking about the upper body now, that have become part of the popular imagination. A lot of things that go on in a body region tend to get named by those syndrome. For example, for awhile everyone that had wrist pain presented as having carpal tunnel syndrome.


Or people that have tension up in here have brachial plexus syndrome.

Amy: Right, or thoracic inlet-outlet syndrome.

Leslie: Thoracic outlet syndrome, which is a variation of that. It's almost like every pain down the leg has to be sciatica.

Amy: Sciatica.

Leslie: Or every problem in this region, "Oh, my QL. My quadratus lumborum.” That's a fancy sounding word to blame something on.

Amy: Yeah.

Leslie: So we tend to identify regions of the body by specific structures that live there, and then it becomes a syndrome with the structure's name as part of it.



Amy: Then we think we can control it because we’ve named it. It's an illusion.

Leslie: It's an understandable illusion.

Amy: Yes.

Leslie: It's an understandable desire to name something and thus have some control over the situation. Yeah. So what's really going on with carpal tunnel syndrome?

Amy: I think we don't know. I think carpal tunnel syndrome is describing sensation in an area of the body. That question, what's really going on? Without a person in front of me, because carpal—

Leslie: Well, it's a specific thing that people get surgery for.

Amy: Yeah, but it happens because of a whole bunch of different things. So it's a specific surgery that people get, but it's not a specific thing they get surgery for. Do you know what I mean? I'm splitting hairs a little bit, but carpal tunnel issues can arise because the ligament gets overstretched, because the tendons and nerves that travel through there get inflamed. It can arise because of some kind of pressure in the back. A whole bunch of different things can cause a whole assortment of syndromes. You can have the pressure without the inflammation. You can have the inflammation without the pressure. You can have numbness in your fingers and have it not be about the carpal tunnel, but have it be about something up in the brachial plexus. Right? So I think even the symptoms that get said, "Oh, this is a carpal tunnel thing," it's a little bit like what you were saying about back things. Right? People have pain in their hands. They have numbness or they have tightness or they can't extend their fingers and they say, "Oh, it's a carpal tunnel thing.” You go in and you see the carpal tunnel ligaments got lengthened in some way and say, "Oh, it's your carpal tunnel. Let's cut it open, release the inflammation, blah, blah, blah.” Blah, blah, blah. But that might not be the cause of those symptoms. It might be something in the brachial plexus and it might not be something in the structure. It might be some way we're sleeping. It might be some habit we have of moving.

Leslie: Or breathing.

Amy: Or breathing.

Leslie: That's a big part of it, I found.

Amy: Exactly. All this upper limb stuff has so much to do with breathing, and if we don't change those underlying moving and breathing patterns...

Leslie: Yeah. So I suppose you get this question a lot too. My body is making a noise when I do this. What's that about?

Amy: Yeah.

Leslie: So it can be the grinding when you move your scapula around on your ribcage. I think that's about the scapula trying to become part of the ribcage and the body, it's just complying with what you're asking it to do. It says, "Okay, we'll just send some calcium in there. If you want these to be a bone to bone connection, we need more bone.” You get that grinding that builds up in the tendons and muscles from chronic inflammation. That's usually what the grinding is about, but that happens also inside the shoulder joint. The body will deposit calcium around some of those tendinous attachments within the capsule, and



then the capsule itself, if it gets adhesed, when you start trying to move it again you get the sound of some of the adhesions breaking, hopefully, when you're trying to mobilize it again. There's also just generalized joint sound as well. Sometimes you get that.

Amy: Yeah.

Leslie: Non-specific decompression of a capsule, like cracking your knuckles. But what else? There’s tendons sliding over other tendons and bones, which you can do repetitively. You can do it—bonk, bonk, bonk, bonk, like that. These capsular sounds you can do once, and then you have to wait.

Amy: I think there's also a set of sounds that show up, and they show up in a lot of different places. But one of the places, for me, they show up is, because I have a lot of mobility, when I go past valid joint space. Where I don't feel overstretched, but I kind of clicked it out of joint and popped out.

Leslie: So it's a clicking sound?

Amy: Well, click, pop, thunk.

Leslie: Yeah.

Amy: It's not quite grinding. It's not painful.

Leslie: But it's just a (sound).

Amy: Yeah. It might be going out and it might be going back in. The going out is often part of looking for a stretch for me and letting it go to a place where it goes, tink. It's, like, “Ahh." Somehow it was satisfying in its excessiveness. But I have begun to learn that in the range of things, when I do things and I do something and I go, "Well, I can make it click right there," to just not go there. Sometimes that making it click in that spot is an imbalance in the whole spectrum of movement. I can make it click because I go too far right there and I go too far right there. It's, like, well, how about if I explore the rest of the range instead of seeking that excessiveness right there? But I think the other thing that happens, and this is a little more kind of tricky for me to negotiate when people ask me about it, is the click where it feels better after they have clicked.

Leslie: They often ask about that. Yeah.

Amy: And I think that that, at least what I tell people, and what it feels like in my body when that happens is that I've very slowly gotten out of alignment. I think that this is pretty much a thing that happens in the joints where there's a lot of movements. Where when a hyper mobile person or in a person who isn't overall hyper mobile, but has asked one space to do, or one joint to do a lot of movement, and it might gradually slip out of alignment. So we don't notice it going out.

Leslie: You just notice it going back.

Amy: But then there's this accumulated tightness in the connective tissue and the muscles.

Then the sensation has ramped up enough that we finally notice it. It's, like, pop it back and it feels better. So it's tricky because it feels better when you pop it back.

Leslie: But what about the next day?



Amy: But the next day—well, and it might not. I have clicks in my back that, day to day, don't hurt when I pop them back. But over time, now, the things that I clicked all the time when I was 20, 16 years later are, like, cranky at me. So it might not even be within a day.

Leslie: You're 36?

Amy: Ah, 26 years later. 26 years later, thanks. [laughter] The things I did when I was 20... Now 26 years later, I feel.

Leslie: We're going to do a math course next time.

Amy: Yeah, whatever. I'm ageless. I'm all ages. All and nothing.

Leslie: Bottom line is, bodies make noise.

Amy: Bottom line is, bodies make noise. I think a random noise once in awhile, not a bad thing. But a repeated noise is an indicator...

Leslie: Yeah. It should be looked at.

Amy: ...Of either too little movement and we're asking too much of it, or we're asking too much movement and we might contain it. But the satisfaction of the click is something that we need to look at long term. Because that click, any sound that happens like that, I think, is an indicator of an abrupt enough change that it's hard on the tissues. Even the joint. I know the random joint noises might not matter, but making those noises, I think they are an indicator that it's not all sliding and gliding, that something else is happening.

Leslie: Sure, and there's a certain amount of it you get just when you get out of bed in the morning. Just from having been horizontal and relatively immobile for eight hours or so. We can feel how quickly our soft tissues congeal from lack of movement. It's what our friend Gil calls the fuzz.

Amy: The fuzz.

Leslie: Yes.

Amy: Exactly. So when these questions come up about issues in the shoulders and the wrists, for me, at least, I don't usually start with right where the issue is. But try to look for, like you said, the underlying cause, because it’s often not right where the pain is. I find there are strategies, or people come in having learned how to stop the issue right there. How to fix the pain right there. But getting at the underlying question of the movement pattern is really interesting, then, and whether it's finding where the support is so they stop holding there or adjusting the breathing or all of that, I think, is a better way in.

Leslie: Or you can never go wrong just starting at the feet.

Amy: You never go wrong just starting at the feet.

Leslie: If you ask, "Oh, why is this hurting?" You ask yourself, "Well, what's holding that up? Well, what's holding that up? What's holding that up?” You keep going and you're going to end up at the feet.

Amy: You end up at the feet. Right.



Leslie: You can never go wrong getting people to get their feet doing their job better, no matter what body part is in trouble.

Amy: And you could never go wrong helping them have more breathing choices.

Leslie: Wow. You just said my thing and I said your thing.

Amy: Exactly.

Leslie: Oh, that's so cool.

Amy: Isn't that nice? Okay. I think we're done.

Module 6.10 Putting it into Practice—Using the Hand as a Foot [Timestamp 01:29:26]

Amy: So let's look at putting these upper limbs pathways of weight into practice and how it affects some of the things we commonly do. Come to the front of your mats on your hands and knees. So bring your hands to the front of your mats. Take a moment—we began the unit with this question about the pathway of weight in your limbs, and now that we have specified what that pathway of weight is, can you find your way from a sense of the front of your spine


through your ribs to your sternum, out through your collar bones, around to the spine of your scapula, around your scapula to your arm bones and down into your hands? How do you experience your breath here? Then slide back. We're going to take the transition back to child's pose and just see what you notice in your scapula as you do that, and really what you notice in your scapula in relationship to your arms and in relationship to your rib cage. Then come back forward to your hands and knees. Now the instruction is often given to draw your scapula towards each other on your back. So take that action now, drawing your scapula towards each other. Maybe drawing the bottom tips of your scapula towards each other. Then slide back towards child's pose and see what you notice there.

Don't do anything that's too distressing, but do see how it feels to try that idea out. Then come back forward to your hands and knees. Rather than drawing your scapula together towards each other on your back, see what happens if you pull your shoulders down your back towards your hips, and how it feels to do that and slide back towards your heels. What effect it has on your arms, on your spine. Then come back forward to your hands and knees and let's take that once more now, the movement, but see how it is to think about your scapula staying in relationship to your arm bones and that your scapula might be closer friends to your hands than they are to your ribs. Try that idea out and see what happens and what effect that might have on your spine. Then come up to sitting from there and just come up to sit. Just to sit. For a moment, see how you feel sitting about the placement of your shoulder blades. Certainly, sitting up is another place where we’ve been told all kinds of things about what to do with our shoulders. Okay. I'm going to ask Stefania to come up. We talked earlier that she has been given this instruction because of shoulder injuries to pull her shoulder blades down her back. So will you, on your hands and knees, why don't you start out a little bit longer?



Stefania: Okay.

Amy: So not in your right angle, so you have a little more range so that you don't have to bring your hands out but you also do get to go your range. I'm just going to adjust your hair there. So why don't you do what you have been told to do. I can see you have a lot of movement choices in your shoulder.

Stefania: Now I’m trying to understand.

Amy: Yeah.

Stefania: I try to find the position.

Amy: Yeah. Trying to find the position. Where's the right place for them? So what you did when you hurt them, and I don't want you to hurt them too much. But what you did when you hurt them was that you tried to open up through here.

Stefania: When I hurt it, because I was in too many inversions.

Amy: Too many inversions?

Stefania: Yeah.

Amy: Okay. So what you were told to do was to pull your shoulder blades together here. Okay.

Stefania: Yeah.

Amy: So can you come back from there doing that action that you have been told to do to pull the shoulder blades together?

Stefania: Like this?

Amy: Yeah. Yeah. Great.

Stefania: Do you want me to change anything?

Amy: Yeah. Go ahead.

Stefania: Okay.

Amy: So what's interesting in doing that is that she has a lot of mobility in her spine as well, and so has the ability to keep the shoulder blades in their place and let the spine accommodate that movement. I'm going to ask you to come forward again. Actually, go ahead and leave your hands out here. So you’ll start in a longer position instead of adjusting later.

Stefania: All right.

Amy: Yeah, and then as you come forward, can you think about keeping your scapula...

Stefania: Yeah.

Amy: ...in relationship with your upper arm, so that instead of doing something with your scapula, it's going to stay friends with your upper arm, if that idea makes sense? Let's see, as you come back, what



happens. Stay there for a moment. What I see, and I don't know if the camera can see this, but the clarity of the pathway into her shoulders through her shoulder joint right here, seems like it has got a clearer line, to me, than what you were doing before. How does that feel? You can come up.

Stefania: This one, is kind of like, I’m not extending.

Amy: Yeah. Right.

Stefania: But it feels more organic to me. So now, after two years of being injured, I'm going back to normal.

Amy: So come back forward to your hands and knees. I'm going to say another thing and make it a long position, because you have that range.


Amy: I'm going to suggest now, it's so interesting in people who have this many choices about where to move in their joints, that this question of where to be and how sometimes we have to go really far to get sensation. Like, to get a sensation you stretch, you have to go so far, that organizing things becomes a really different question. So with the idea of this pathway of weight, can you feel, and as much as you can, look for the sensation of relationship in your bones from your hands to the bones of your forearms and the bones of your forearms to the bones of your upper arms, and then to your scapula and around the scapula. Can you find a sense of the bones of your collar bones and that this whole connection doesn't stop here where you're doing all this organization, but that it comes all the way to here.

Stefania: Mmmm. Do you want me to talk?

Amy: I want you to mmmm. Does that make enough sense that you could try it going back?

Stefania: Yeah.

Amy: Keep it going back. Yeah.

Stefania: Yeah. I'm actually doing much less work.

Amy: You're actually doing much less work.

Stefania: Yeah. I'm not doing much, and it feels good.

Amy: And it feels good. Less work and it feels good. That seems like a useful thing. It doesn't feel like it's too much movement in your shoulders?

Stefania: No.

Amy: Okay. Can you come forward and do the same idea, but transition back to downward dog so it's a little more weight-bearing?

Stefania: All right. Same thing you asked me to…?

Amy: Same pathway of weight.




Amy: So same connection to your collar bones. The idea being that you find your way to your collar bones and you don't go any further than you can keep that connection. Mmmhmm. Then all kinds of other choices happen in the spine. Mmmhmm.

Stefania: It actually feels good.

Amy: It actually feels good. And you have a lot of range in your scapula here. So I might ask you further questions about your collar bones into your ribs into your spine, but in terms of the pathway through the scapula to the collar bones, that's a clear pathway and she has a lot of range right here. Then come back forward and come back to sit over your heels. Good. Will you do one more thing, which might feed into something you want to say about, but I know you said you could go far, not weight bearing, and dislocate. So can you keep that same idea now of keeping the connection all the way to your collar bones and take your arm just up overhead.

Stefania: What, same idea?

Amy: The same idea of the connection all the way through to your collar bones so that pathway that I traced...

Stefania: That you just told me to do.

Amy: ...That I just told you to do.

Stefania: Okay. Right.

Amy: Same pathway. Different movement. Bringing your arm up overhead.

Stefania: One? One arm?

Amy: One or both. Doesn't matter, and that you keep the attention on the connection through there. Yeah. So that you don't have to pull your shoulders down. But you don't have to lift them up.


They are just an expression of what's going on all the way through there. Yeah. Great. Then lower your arms down. Do you want to say anything else?

Stefania: Can I ask questions?

Amy: You can ask a question.

Stefania: Yeah. When you asked me to keep the range a little bigger, my arms and knees, when you were talking about a clear pathway, it was a little odd for me because I am used to this relationship. What I try to do now every time I do my practice, I really need to understand what's going on inside my shoulder and then find kind of a middle path. So when I was doing it, you asked me to do it from here, it was a little more difficult just because it's new.

Amy: Yeah.



Stefania: That's why. That was the question I wanted to ask. And then about the collar bone, something, I think, you asked me to connect them. I always think to do the opposite. This is something that I do. I don't know.

Amy: Well, yeah. So we get that instruction. We haven't talked about the collar bones very much, but we do get this instruction to widen the collar bones.

Stefania: Yes.

Amy: Which we can certainly do if they are coming in too much. But for as much as there are people in the world that need to widen their collar bones, there are probably some people in the world that need to connect them in. If we understand that the top of the arm connects, that the upper limb connects to the body at this joint right here, then someone with so many movement choices might be helped by connecting the collar bones in as much as they might be helped by spreading them out. So widening the collar bones is not necessarily something that everybody needs to do to find their way into balance. If I'm already like this, I may not need to widen my collar bones anymore. Or even if I'm already like this, or if I have this kind of question about mobility in my shoulder joint, maybe I want to find it in. I think that what I'm suggesting is that rather than connecting in in the back, that you find the connection here. Because this is where the end of the upper limb is. Not in the back. Does that make sense?

I think the other thing that I would say is that, in relationship to the question of putting your hands in a different place, when we look for a pathway part of the idea of that is that we can find the pathway or the relationships in any position, that it becomes not about a position or a location, but a relatedness that might be easier to find in some positions, but is eventually available to us in any position. So can I find it here? Can I find it here? Can I find it here? Can I find it here? All the way through. Can I find it here? Then more choices become supportable. Does that make sense?

Stefania: Yes.

Amy: But not necessarily every choice is immediately doable because of what's familiar or strong or organized. Yeah? Thanks.

Leslie: Cool.

Amy: Thanks.

Leslie: Okay. So I'm curious, cause as I was looking around watching all of you do those little explorations, I was seeing what I was seeing. But I'm curious what any of you may have been feeling in terms of a sense of restriction or struggle, or any kind of difficulty in executing any of those particular instructions that Amy was giving you. So think back. Yes? Let me come over so we can hear you on the mic. Yes.

Lisa: What was really striking was how much more effort, and unnecessary effort, it felt to try to do all those things with my shoulder blades that Amy was telling me to do, as opposed to thinking of the shoulder blade as connected to the arm, which felt like, “Oh, of course. This is where I want to be.” But others were bordering on really uncomfortable, actually, for me.

Leslie: Sure. Physically uncomfortable.

Lisa: Yes.



Leslie: But also, it's a lot of mental effort to have to micromanage that joint that has so many movement possibilities.

Lisa: That too. Yeah.

Leslie: You don't automatically know, necessarily, where it's supposed to be like you do when you're standing on your leg and the relationship of your pelvic half to your sacrum. That kind of knows where it needs to be. This is a whole different relationship. Yeah. Maybe I could borrow you for a sec?

Lisa: Yeah, sure.

Leslie: Okay. So the exploration that we were doing on the hands and knees involves what we call a closed kinetic chain. You are weight bearing on this upper extremity. The whole lesson was about pathways of weight. One of the interesting things I found to explore is to play with these relationships in these, what we call open kinetic chain movements, right? The interplay between how we can experience what's going on in an open chain and a closed chain can be quite interesting. So let me have you stand up. The exercise is quite simple. Let me turn you sort of obliquely to the camera. There we go.

The exercise is quite simple. It's to allow the breathing action in the ribcage, sternum, upper spine, to take you here and then take you here. The goal is to let your shoulder girdle just go for a ride, really, on what your upper ribcage and upper spine are doing. Okay? So let's just see you do that in a simple way. Good. That's it. Good. There you go. Think about where the top of your sternum is going, both upward and then down and in. Right. Very nice. And one more time. Now what you all may have noticed watching, and what you probably noticed if you were feeling it, is that the natural movements of your arms and shoulder girdle when you do that are things kind of fall in towards the midline as you go down and they open out here. Notice I didn't actually tell you how to breathe. But you sort of figured out how to exhale when you did this and inhale when you do that. There are other ways to do that. That's not etched in stone. We often have people explore the opposite breathing, but for now we're just going to look at this.

So this idea that your arms are kind of falling in toward the midline in this position and being naturally moved away in this position—see, this is kind of a broadening across the collarbones, which isn't necessarily created by pulling your shoulder blades together and yanking the space open here. It's more about the upper ribs doing something that causes a response here. What if that were the real genesis of an arm lift? And then, on your way down, you fall back into that released place at the end of that movement. So see if you can do exactly what you were doing before, but allow it to sort of jumpstart the lifting of the arms. Good. So the idea of this particular exercise is to get the movement initiated with the breath, spine, sort of core movements, and then let the arms follow from that. So the arms and scapula are being moved by the breath, by the spine. Then you are going to naturally just let your scapula follow what the arm is doing in space, right? Now if I gave you the additional idea that it would be a good thing to have your shoulder blades being drawn down your back as your arms are going up, let's just see how that works for you in the context of this movement.


That put a kind of sour look on your face there.

Lisa: It feels so, not what the body wants to do. It's like what you talked about with gait, where your foot is pulling back. It feels like the equivalent in the shoulders. They want to go up, but you're pulling them down. Why would you do that? Or why would I do that?



Leslie: Well, if someone asked you to and told you that was the right way to put them. But the raising of the arm, if it is part of the movement, if the scapula is part of what the arm is doing, it’s actually—it wants to raise up. That doesn't necessarily mean that you are doing this. See, because I think when people do this they get that instruction. It's, like, "Don't do that. Do that instead.” But maybe the reason the shoulders are coming up in the first place is because it's getting all involved in the breathing and what the spine is doing in the first place, right?

So why don't you all give that a try? So this is sort of the standing open chain equivalent of what Amy was asking you to do on your hands and knees, right? So see if you can start with just that simple breath movement in the upper ribcage, in the upper spine. Notice how you can just permit your shoulder girdle to ride on that movement. Your arms, your shoulder girdle, are being moved by the core structures of the spine, the breath, the lungs, the ribs. You don't have to really make the arms do anything if you just permit them to be moved by the core structures. Then, once you feel you have gotten that a little bit, see if you can use that movement as the genesis of this arm lift. Not necessarily thinking about anything other than how that movement gets initiated and supported as it continues up in space.

Nice. At a certain point, maybe you want to experiment with that idea of directing your shoulder blades downward as your arms come upward and see what your experience is at that point when you interpose that alignment cue in this process. Right? Not fun, Susanna? No? Did anyone else notice something happening? Yeah? How about you? Yeah. Because you have learned to manage your scapula to protect your shoulder, right? Sometimes, though, the best protection is to start un-managing these things. Right? That's often harder to do, to unwind some of these strategies that we have acquired for positioning our bodies. So what did anyone notice about that in their body?

Student: Complete loss of fluidity.

Leslie: A loss of fluidity? Yeah.

Student: Yeah. It's just stuck. There's a detachment of the main part of my body to just my arm bones.

Leslie: Right. Did your attention zoom into your shoulder joint?

Student: Yeah.

Leslie:: That happens quite frequently when you do that, and Amy can explain the kinesiology of that, the contradictory kinesiology of that, if you'd like. Actually, they don't go that well together when you're trying to raise the arm, while at the same time using muscles that want to pull it in the opposite direction. You do a beautiful job of that.

Amy: We did. We did talk about that in the little unit on the anatomy of the shoulder joint, that when the shoulder blade gets pulled down and the glenohumeral joint—when the shoulder blade gets pulled down and the glenoid fossa pulls down but we try to bring the arm up, we're treating the upper limb like it stops at the shoulder joint. I mean, that's just not where the top of the upper limb is. I think the point you bring up about involving the scapula in the breathing or the postural support, really doesn’t—it’s not needed for postural support. Letting it be apart of the upper limb actually increases our range of motion. Because if you put your hand on top of your shoulder and then move your arm bone, your humerus bone, there's not really very far to go.

Leslie: Yeah. You get to 90--



Amy: Until you let the shoulder move. Maybe a little more than 90, but above that, then the shoulder blade has to join in. So to get this tremendous range we have, we have to let our scapula and our collar bones be a part of the movement.

Leslie: Plus, also one of the muscles you may be employing to draw your shoulder blades down could be your latissimus dorsi, which happens to attach to your arm bone up here.

Amy: Yeah. Exactly.

Leslie: So you are actually yanking down on your arm with one muscle at the same time you're using other muscles to raise it in the opposite direction.

Amy: Yeah.

Leslie: That doesn't work so well.

Amy: Or it creates a lot of effort.

Leslie: A lot of effort and resistance, yeah.

Amy: Yeah, which might make us feel like we're successfully working hard if we're deeply attached to making things harder for ourselves.

Leslie: It could.

Amy: But I don't really think that's what it needs to be about, the unbridled pursuit of effort. Yeah.

Leslie: Great.

Amy: Great.

Leslie: Okay. You had a question?

Student: It was more of an observation. I'm feeling sacrilegious in saying, except I was reassured by what Amy just said, which was—there’s something reassuring for me about—because I have had so much instability in my shoulders.

Leslie: The resistance that you are generating, yeah.

Student: Yeah. There's something that makes me feel more stable. And I can see how—I’m less free, but I'm also more stable. Or I have the illusion of stability.

Amy: Yeah. I think it's an interesting question.

Leslie: That's a good point. That's a really good point. Yeah.

Amy: If we think that stability comes from muscle strength and a sensation of resistance, then we end up sticking with this pattern of, "Oh, I'm working hard," because we're getting sensation in our muscles. But if we understand that stability has to do with all of the moving parts moving in relationship to each other, it may feel destabilizing, but then I invite you to this different understanding of what stability is. Because when we pull the shoulder blades down and try to lift the arms up, we inhibit the movement of the ribcage altogether and then we can't breath. But we get a lot of feedback.



Leslie: Yeah.

Amy: So we might feel like we're breathing because we're meeting resistance. We get sensation. But we don't actually get more functional organization in a balance of stability and mobility.

Student: It's seductive, to keep getting that.

Leslie: It is seductive to keep generating that feedback.

Student: It's really cool and…

Leslie: Yeah. It is. Thank you for saying that.

Amy: And we have to look for different kinds of feedback than that.

Leslie: Yeah. It's not the only thing that can generate that feedback.

Amy: Exactly.

Leslie: Yeah.

Amy: Yeah. Great.

Leslie: Thanks, guys. That's it for that section.

Amy: Thanks, everybody.

Leslie: All right. Cool.

Unit 6 In Review


Amy: We began this unit with a movement experience, reviewing the pathway of weight in the lower limb and exploring what the pathway of weight in the upper limb might be to get from the spine to the hands and from the hands to the spine. We looked in some detail at the anatomy of the hands and the wrists, including the carpal tunnel, at the forearm and the movements of the forearm and the elbow, and the movements at the elbow, and the anatomy of a carry angle.

Leslie: Then I looked at the anatomical proportions of the hands and feet in comparison to each other from the perspectives of sthira / sukha and locomotion, weight support and reaching, grasping, holding, articulating.

Amy: We looked at the anatomy of the shoulder joint and the shoulder girdle, and the movement choices available there. Then, at the pathway of weight from the spine to the hands and the hands to the spine when we travel bone to bone through those articulations.



Leslie: Returning to the model of sthira / sukha, we then looked at the pelvic and shoulder girdles in comparison. Their similarities and their differences. Amy and I then had a conversation about some of the things that can go wrong with the shoulder, upper extremity.

Amy: Brachial plexus, carpal tunnel, all the things that get said and what might actually be happening... Some of the questions that arise around that. Then we looked at putting it into practice in the transition from hands and knees to child's pose, and how the scapula can stay in relationship to the hand in doing that movement in someone who had a lot of movement. Then Leslie also did it in an open chain way.

Leslie: Yeah. We explored a little bit, from a standing position, how we can experience the difference between letting the shoulder girdle be mobilized by the axial structures as opposed to trying to reposition our axial anatomy using our articular shoulder girdle structures.


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