Yoga Journal - Wear and Care

7/28/2019 Yoga Journal - Wear and Care

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Wear and Care

Shoulder injuries are common among yogis, but they don't have to be. Here's how to

care for your shoulders, not tear them down.

By Catherine Guthrie

Trish J ones knew trouble was brewing when her rightshoulder began to throb during her favorite yoga class.The 29-year-old was no stranger to such pain. She hadsuffered from unstable shoulder joints for years. Herdoctors call it "multidirectional instability," but J ones refersto it as "having loose nuts and bolts." So loose that in1995 she had surgery to stabilize her left shoulder. Last

summer, when pain began to gnaw at her other shoulder,she couldn't shake the feeling that it was in trouble, too.

Still, J ones kept practicing Ashtanga three times a week at a studio near her home inAlexandria, Virginia, in hopes that the pain would work itself out. That is, until her rightshoulder dislocated in Vasisthasana (Side Plank Pose). "Luckily, I knew exactly whathappened, so I went out into the hall and popped it back in," she says. Still, theincident served as a wake-up call. She knew the way to dodge a second surgery wasto figure out how yoga could build up her shoulder strength without aggravating theinstability.

After her injury, J ones switched to a restorative yoga practice and sought advice fromyoga teachers, physical therapists, and doctors. Two weeks later, she was back at thestudio. Under the close supervision of her teacher, she modified every pose in theAshtanga primary and second series to spare her shoulder. They jettisoned all weight-bearing asanas, like Adho Mukha Svanasana (Downward-Facing Dog Pose) andChaturanga Dandasana (Four-Limbed Staff Pose), and took an easy-does-it approachto shoulder openers, like Marichyasana I (Marichi's Twist I.) "It was a much differentpractice than the typical first series," J ones says, "but it wasn't in my best interest tostop practicing altogether."

Although J ones was eager to build strength in the damaged joint, she knew the onlyway to thwart another dislocation was to perfect her alignment. So she analyzed hershoulder position in every pose. To prevent rounding forward in the front of theshoulders, she started each asana by widening her collarbones. To protect the back ofthe joints, she made sure her upper back was engaged, with the bottom tips of theshoulder blades drawing together and down. Soon, these shoulder adjustmentsbecame a meditation in themselves.

As J ones found out, yoga can be a boon to the shoulders, but it can also be a bust.While an intense yoga class can leave your shoulder muscles a little sore the next day,you shouldn't steamroll past any sharp or throbbing pain in the joint during or afterpractice. If your shoulders start to gripe whenever you roll out your mat, it's time to tune

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in and figure out what's going on before you do more harm than good. If yourshoulders are free of trouble, don't be overconfident: Now is the time to protect themfrom future injury. Either way, your shoulders will thank you, and your yoga practice willbe stronger.

How it Works

Shoulder problems shouldn't be shrugged off. In 2003 (the latest year for whichnumbers are available), nearly 14 million Americans visited a doctor complaining of abum shoulder. J oint instability, like J ones's, is one of the most common ailments.Others include impingements, rotator cuff tears, and arthritis.

Athletes often suffer disproportionately from shoulder injuries because the variousrepetitive movements stress the joints, says J effrey Abrams, an orthopedic surgeon inPrinceton, New J ersey, and a spokesperson for the American Academy of OrthopaedicSurgeons. "In other countries people play soccer, but here we like to ski and play golfand tennis, all of which are hard on the shoulders." J ones is a typical examplewhenshe was younger she played basketball and tennis and loved rock climbing. Now she

puts her shoulders through their paces in Ashtanga.

But there's another factor at playthe natural structure of the joint. "Shoulders aredesigned for mobility, not stability," says Roger Cole, Ph.D., an Iyengar-certifiedteacher in Del Mar, California, who teaches workshops on shoulder safety. The mobilityallows for an astonishing range of motion compared to that in the hipsif you havehealthy shoulders you can move your arms forward, back, across the body, and in360-degree circles. But the relatively loose joint relies on a delicate web of soft tissue tohold it together, which makes it more vulnerable to injury. (The soft tissue includesligaments, which connect bone to bone; tendons, which attach muscle to bone; andmuscles, which move and stabilize the bones.)

The main ball-and-socket joint is also quite shallow, adding to the flexibility but puttingthe joint at risk. Abrams likens it to a basketball sitting on top of a plunger. (Thebasketball is the head of the humerus, or upper arm bone, and the plunger is where itmeets the scapula.) The rotation of a big ball on a little base makes the shouldermobile.

When the soft tissue around the joint is strong and toned, the system works flawlessly.But factor in years of repetitive roundabout movements, like throwing a baseball,swimming, or even stretching the arms overhead in yoga, and shoulder ligaments canoverstretch and lose elasticity, like worn rubber bands. Plus, as muscles age, they lose

tone, making it even more likely that the ball will slip off the plunger at some point. Thebest way to stay out of a sling? Be diligent in your quest for proper alignment and buildbalanced strength around the joint to create stability.

Check your Ali gnment

Sounds easy enough, but here's the hitch: Perfect shoulder placement in yoga can beelusive. For starters, unless you practice yoga in a mirror-lined room or have eyes inthe back of your head, it's tough to know what your shoulders are up to. To makematters worse, poor posture is habitual. If your shoulders slouch, slump, or cave all


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day long, you can't help but bring a few bad habits into the yoga studio. "I see a lot ofstudents with shoulders that slope, turn in, and jut forward," says Mitchel Bleier, asenior certified Anusara Yoga teacher in Rochester, New York. "If those misalignmentsare maintained during yoga practice, especially during weight-bearing asanas, the riskof a shoulder injury goes up dramatically."

Therefore, weight-bearing poses, such as inversions, require extra vigilance. Inversionsare safe for the shoulders, Cole explains, but they are best performed with precise

alignment.

The first step in understanding correct shoulder alignment is to start simply, byexploring Tadasana (Mountain Pose) and Urdhva Hastasana (Upward Salute). Here areBleier's alignment instructions for his students in Tadasana: First, lift your shouldersslightly so they line up with the base of your neck. Simultaneously, draw the heads ofthe arm bones back, toward the wall behind you. Keeping a slight curve in the back ofyour neck, draw your shoulder blades down toward your waist. Your shoulder bladesshould lie flat on your back, instead of winging out. Feel your chest rise, but resist thetemptation to pinch your shoulder blades togetherdoing this will only compress yourspine. Instead, keep the bottom tips of your shoulder blades pressing into your back

and spreading. If you want to feel deliciously supported while doing this, try the StrapJ acket.

Reaching your arms overhead is a little more complex, but once you learn to do itcorrectly, you can apply the same principles in poses such as Downward-Facing Dog,Plank, or Adho Mukha Vrksasana (Handstand). Before you sweep your arms up intoUrdhva Hastasana, it's important to rotate your arm bones externally and move themdown so the head of the arm bone is in the socket. This will strengthen the muscles onthe back of the rotator cuff (the infraspinatus and teres minor), which are typicallyweaker than the front, and it will spare the supraspinatus, which can get pinchedbetween the edge of the scapula and the head of the arm bone when the arms lift. If

the tendon is pinched repeatedly, it wears and frays like a rope. Eventually, whatbegins as a mild irritation can progress to a severe injury, such as a tear.

Once your arms are straight overhead, you don't have to pull your shoulders downquite so firmly, because that will inhibit your ability to reach up. To get the maximumreach safely, start in Urdhva Hastasana and spread your shoulder blades away fromeach other. As your shoulder blades wrap around toward the front of your rib cage, youshould have more space to really lengthen up. The tops of your shoulders will liftslightly, which is OK. J ust don't let them bunch up by your ears. Now keep yourshoulders in place and press your palms up toward the ceiling. Feel familiar? This issimilar to the placement for Handstand.

Counteract Misalignment

Once you've mastered the ins and outs of proper alignment, you should be ready tobuild the strength to maintain it. And therein lies the rub. Done correctly, yoga posesstrengthen the shoulders, but in order to do them correctly and maintain properalignment, your shoulders have to be strong. Of any yoga pose, ChaturangaDandasana (Four-Limbed Staff Pose; exemplifies thisif you're not strong enough tokeep your shoulders in their proper place, you leave yourself wide open to injury.


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The most common misalignment is to collapse the chest and allow the heads of armbones to drop forward toward the floor. You'll know this is happening if your shoulderblades poke out instead of lying flat on your back, or if the fronts of your shoulders aresore the next day. This can strain the front of the rotator cuff and can also buildstrength unevenly, making the front of the rotator cuff stronger than the back. Overtime this imbalance will pull the arm bone forward, contributing to a vicious cycle ofmisalignment.

To counteract this, start in Plank Pose, and as you move into Chaturanga Dandasana,see that the heads of the arm bones stay level with the elbows. Try not to let them dipdown. (Practice at home in front of a mirror.) If they drop, you need to build morestrength around the whole rotator cuff. To do that, practice Chaturanga with your kneeson the floor and the Supine Sleepwalker Pose.

You can also practice what Cole calls the anti-Chaturanga, or Purvottanasana (UpwardPlank Pose). "Purvottanasana stretches most of the muscles that Chaturangastrengthens and also strengthens opposing muscles," Cole says. It's one of the posesTrish J ones credits for helping her escape another shoulder surgery. "My rotator cuffsare stronger since I've adopted Purvottanasana into my practice," she says. Finally,

stretch the front of the chest by doing Setu Bandha Sarvangasana) (Bridge Pose),Sarvangasana (Shoulderstand), and Matsyasana (Fish Pose).

Strengthen and Stabili ze

To stabilize the joint and reinforce the rotator cuff, you'll also need to focus on yoursupraspinatus, the muscle that helps you lift your arms out to the side. Morespecifically, the supraspinatus engages during the first 30 degrees of lifting the arms.Once your arms are shoulder level, your deltoids hold them up, which won't strengthenthe rotator cuffs. To strengthen the supraspinatus, practice standing poses where you

reach the arms out, such as Trikonasana (Triangle Pose) and Virabhadrasana II(Warrior II). Hold the poses for five breaths and bring your arms down and back upbetween each pose.

Once you feel readymeaning, the head of the arm bone isn't slipping around and thejoint is free of paintoss a few weight-bearing poses into the mix. One of the bestways to build strength around the rotator cuff is to move slowly from Downward-FacingDog out to Plank and back again. J ust be careful not to let the upper back hyperextendand sink toward the floor in Downward-Facing Dog, which, according to J ean-ClaudeWest, a kinesiologist and master manual therapist, can compress the joints."Maintaining width in the upper back keeps the shoulder girdle active and the shoulder

joints stable as you approach Plank," he says.

Many yoga poses build arm strength by requiring you to push away from thefloorposes like Downward-Facing Dog, Handstand, and UrdhvaDhanurasana(Upward-Facing Bow Pose)but few demand that your shoulder musclespull against resistance, which is part of the reason the back of the rotator cuff gets soweak. One way to build oomph in the back of the shoulders is to engage in activitiesthat require pulling, like swimming or even pull-ups, says Cole. On your yoga mat youcan practice poses that require pressing the back of the shoulder joint against the floor,such as J athara Parivartanasana (Revolved Abdomen Pose), or on a stable part of thebody, such as the front leg in Parivrtta Parsvakonasana (Revolved Side Angle Pose).


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Finally, create balanced flexibility by practicing poses that require an inward rotation ofthe shoulder, such as Gomukasana (Cow Face Pose), Marichyasana III (Marichi's TwistIII), and Parsvottanasana (Side Stretch Pose). "If you feel a pinching sensation whenyou rotate your shoulders inward, you are probably irritating a tendon or otherconnective tissue," Cole says, "in which case, let the scapula wing out a little bit."(Don't practice these poses if you have a history of dislocation or shoulder instability.)

Although these practice tips are meant to keep your shoulders free of injury, when it

comes to pain, it's important to remember that there are no guarantees in yoga or inlife. "Injuries can be a wonderful blessing; they offer us an opportunity to learn, togrow, and to be able to help others," Bleier says. "We all have asymmetries in ourbodies; there is no perfect way for the body to be, and if you have pain, it's just yourbody's way of asking you to examine what you're doing."

If anyone has learned that lesson, it's been Trish J ones. "My shoulder pain has taughtme to slow down and take my yoga practice back to basics," she says. "The journeyhas been a humbling one, but I know I'm better for it."

The Shoulder Strengtheneing Sequence.

Supine Sleep Walker

This movement not only trains the heads of the arm bones to stay in the sockets duringa wide range of movement but also builds well-rounded strength in the rotator cuff. Lieon your back with your knees bent and feet flat on the floor. Hold a yoga blockhorizontally between your hands and extend your arms up toward the ceiling. Draw thehead of the arm bone into the shoulder socket so both shoulders press into the floor.Keeping the arms long, slowly lower the block overhead. As the block moves towardthe floor, the backs of the shoulders may lift off the floor just slightly. But if the

shoulders begin to bunch up by the ears, stop the block's descent, realign theshoulders, and then continue to lower the block until it rests on the floor an arm'slength above your head. Now slowly lift the block back into the starting position whilekeeping your shoulders stable. Repeat up to 10 times.

Purvottanasana Upward Plank Pose

Purvottanasana counteracts the effects of Chaturanga by stretching the pectoralismajor, pectoralis minor, and anterior deltoids. Sit in Dandasana (Staff Pose) with yourhands several inches behind your hips and your fingers pointing forward. Bend yourknees until you can place your feet flat on the floor. Exhale, press your feet and hands

down into the floor, and lift your hips until you come into a tabletop position. Straightenyour legs one by one and lift your hips still higher without squeezing your buttocks.Press the soles of your feet toward the floor. Lift your chest as high as you comfortablycan. Keep the back of your neck long as you slowly drop your head back.

Jathara Parivartanasana Revolved Abdomen Pose

Lie on your back with your arms in a cactus position. Bring both feet off the floor andbend your knees until they are directly over your hips and your shins are parallel to thefloor. Keeping your arms and shoulders pressing into the floor, exhale and lower your


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knees to the right. Don't worry if your knees don't come all the way to the floor. Instead,focus on keeping your shoulders grounded. Inhale and bring the legs back to center.Exhale to the opposite side. Repeat five times on each side. Keeping the back of yourshoulders in firm contact with the floor strengthens the back of the rotator cuff, an areathat's commonly weak. This is generally safe to do if you're recovering from injurybecause your body is well supported by the floor.

Standing Rotator Cuff Strengthener

This pose is similar to J athara Parivartanasana but can be done from a standingposition. Stand with your back to a wall. Raise your arms into a cactus position. Pullthe heads of the arm bones back until you feel the upper back engage and press intothe wall. Keep the tailbone tucked to avoid overarching the lumbar spine. Maintainingfirm contact between your shoulders and the wall, and keeping your elbows bent at a90-degree angle, slowly slide the arms up the wall. Ultimately, you may be able totouch your fingers overhead, but it may take time to get there. The key thing is to keepyour shoulder blades flat against the wall. Repeat up to 10 times.

Strap Jacket

Getting the strap set up can be tricky the first time you do this pose, but it's worth it.The harness supports and stabilizes your shoulder girdle by lifting the fronts of theshoulders up and drawing the bottom tips of the shoulder blades down.

Start in Tadasana and make a large loop in a 10-foot-long strap. (If you don't have one,you'll need to hook two straps together to create a big round loop.) Hold the loopbehind you and put your arms through it, as though you're putting on a jacket. Makesure the strap buckle is at the bottom of the loop, so you can reach back and adjustthe length of the strap easily. The strap will pass over the tops of the shoulders andunder the armpits.

Reach back and take hold of the part of the strap that is lying horizontally behind yourneck. Grab this top part of the strap with one hand and pull it all the way down towardthe floor. As you pull it down, the bottom part of the strap will pass over it and move upyour back, creating a harness.

Reach behind you and twist the strap several times to help keep it in place. Now holdthe dangling loop and pull down firmly. When the top part of the strap is pulled all theway down, it should be about hip level. The strap should roll your upper shouldersback and down while pressing your lower shoulder blades into your back. Don't archyour lower back. Keep your legs and pelvis in Tadasana.

Stay here with your hand pulling down on the strap or, to go a step further, take adowel or a broom and thread it horizontally through the bottom of the strap. Press yourhands down onto the broom. Stay for at least 10 breaths.

SetuBandha Sarvangasana Bridge Pose

According to Iyengar-Certified teacher Roger Cole, when you clasp your hands behindyour back in Bridge Pose, you stretch the muscles on the fronts of the arm bones,which makes it more difficult to lift your chest. For this version of Bridge Pose, you'lluse a strap around the ankles to help counteract this.


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Lie on your back with your feet flat on the floor and hip-width apart. Your heels shouldbe about six inches away from your buttocks. Place a strap around the front of yourankles and take hold of the strap, one end in each hand. Walk your hands down thestrap, toward your ankles. Lightly shrug your shoulders toward your head and roll theheads of your arm bones back, rooting them into the floor. Keeping the backs of yourshoulders pressed into the floor, pull on the ends of the strap and begin to lift yourchest. Then, by pressing down through your legs and feet, lift your hips toward theceiling. Lengthen your tailbone toward your knees. Keep pulling on the strap to

encourage the heads of the arm bones toward the floor as you breathe and lift yourchest.

Catherine Guthrie is a freelance writer based in Bloomington, Ind iana.

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