Shoulder impingement...what to watch for?

Yoga Discussion General Yoga
#1

About 1.5 months ago, after having 3-4 months of right shoulder pain, I went to see a physiotherapist who diagnosed me with a shoulder impingement. I realized that the pain started developing when I began increasing the frequency of yoga classes from 2x/week to 4-5x/week. The discomfort/pain is felt in the front of the shoulder. The poses that brought the most pain were downward dog, dolphin, handstand and any pose that required a sweeping of my hands above my head. Along with the pain I would feel my shoulder “click” and “grind” every time I would sweep my right arm, extended, above my head.

I decided to take a full month off from yoga to rest the shoulder, as well I implemented an icing routine to my shoulder and went to a few appointements where the physiotherapist worked on my rotator cuff to try and loosen some of the muscles. Before starting the therapy I would feel pain in my shoulder mostly after yoga class but also while at rest. After resting for a month and getting a few treatments, my pain at rest went away. I still experienced some discomfort with any motion that required me to bring my extended arms over my head.

I returned to yoga classes a few weeks ago to see how the shoulder would feel when I put it back to work. After the first few classes it felt fine but I’ve started to experience some discomfort again in my right shoulder. I’ve asked a few of the teachers at the studio for their advice in terms of proper alignment to make sure its not improper alignment that is the cause for the impingement.

Their advice included:

-in downward dog, ensure the the elbows are pointing (wrapped) forward and not to worry to much about the positioning of the shoulders (I was always thinking that I wasn’t wrapping my shoulders properly and that might be the cause of the pain)

-ensure elbows are pointing down in downward facing dog

-in Chaturanga, ensure that elbows are tucked beside the body and don’t come down farther than the body making a straight line

-avoid jump backs and jump forwards until the problem is resolved

Is there any other advice anyone could add as to a) what might be causing the impingement and b) how to still practice, while avoiding movements that would aggrevate the shoulder?

Thanks.

EDIT: Just realized I should probably add that I am a 29 year old female, in good health, who’s been practicing mainly Ashtanga/Vinyasa based yoga for about 16 months.

#2

Downward dog is still too much for your shoulder.

The “joint” needs to be aligned, stabilized and strenghtened before putting on that much weight.

For me ( I had and still have to some extent the same problem) what works is chest opening/upper back strenghtening exercises, arm exercises with a mild strap (green color), under guidance, paying attention that the shoulder is always aligned (drawn back and down, shoulderblades in V).

Healing requires at least three months to be painless and half a year to bear full weight. I would see a teacher who is knowledgable /certified in recovery practices, physiotheraphy.

Opinion of fellow practitioner, perhaps others can be more specific/helpful.

On the spiritual side, you need to let things happen, instead of trying to force them to. Yeah, yadda, yadda, you heard this before, you know this … but the shoulder incident shows that theory is one thing, and practice quite another. It is amazing how much can be achieved through patience - I am form nature very inpatient, so I 've been there, done that, still doing that. 29 huh … way to go. There is no hurry. :slight_smile:

#3

Just a few thoughts:

You will agree that you have returned to your practice too soon. Please be patient and take some more time. Avoid poses with arms overhead (e.g. down dog) and poses stressing your shoulders (e.g. chaturanga) for the moment.

Work on shoulder mobility and strength first. Did your physiotherapist prescribe some exercises for you to do? If you were seeing a structural yoga therapist, you would probably be doing gentle exercises for mobility first (joint freeing series). Then you would be given poses to strengthen the muscles below the shoulder area and finally exercises for strengthening the rotator cuff.

Would you consider switching to another style of yoga practice? You have developed shoulder issues and have mentioned osteoporosis in another post. Asthanga/vinyasa has you moving into and out of poses rapidly, hardly giving you time to find proper alignment. A slower or alignment-based style may be more beneficial for you (viniyoga, hatha yoga, Iyengar yoga).

Not all yoga teachers are qualified to work with people in pain. The advice you have been given on alignment is incomplete. For example, I am missing ?shoulders back and down? and other instructions for keeping your supraspinatus tendon from impinging on your acromium. In the absence of proper alignment, you are likely to slip back into injury. I will leave the alignment issue for more knowledgeable people to comment on (InnerAthlete). Keep in mind that answers on a forum are not a proper substitute for a teacher who is looking at you in person.

So, in the short term, be a little bit more patient and avoid poses that cause discomfort, let alone pain. If more time doesn?t do the job, change your yoga style and teacher. If that doesn?t work, you could spend some money on private sessions with a yoga therapist.

#4

I would reiterate willems advice,it is common for shoulder , back and knee injuries to occur during the faster vinyasa style practices,of course the practice may also highlight structual weaknesses in our bodies,but with shoulder injuries my advice would be to back of from jumping around and unmindfully bearing weight on the shoulders.(what body type are you?) and find a skilled teacher who can properly address your condition.It is a shame to stop yoga when people hit injuries because with mindfull awareness and good help (not always easy to find with ten a penny teacher trainings)these issues can be addressed very quickly. I would do the exercices im sure your physio offered you. As always it is difficult to give specific advice without seeing you.Your shoulders are precious look after them.
may your shoulders be free of pain

#5

Namaste amz155,

A few years ago I hurt my shoulder in an accident. It wasn’t an impingement, but I remember the physio telling me that most shoulder injuiries usually takes about 6 months to heal properly. Take it slow and heed the already good advice you have received here.

#6

Hubert:

By green strap do you mean those elastic-y resistance bands? I have a red one and I’m wondering if that’ll do. Any specific moves you’d recommend?

I don’t know any teachers that are certified in recovery/physio in my area so that isn’t really an option for me.

I know there is no hurry and that healing cannot be forced. It’s just that I feel restless and not myself when I cannot practice yoga. Taking 6 months, even 3 months off from yoga is terrifying because I’m at a point where I just can’t get enough of yoga and love learning new things. Maybe I should have rested the shoulder longer. I tried yoga again upon the suggestion of the physiotherapist and also because I didn’t have any pain in the shoudler after I took a month off.

I just couldn’t imagine having to stop right now altogether to rest my shoulder for 3+ months. I just I have to (eventually) suck it up and take an extended break.

Willem:

Yes, maybe I returned too soon. And alothough returning brought some pain back to my shoulder, my mood and spirit immediately felt better :slight_smile:

I find that it would be hard in my practice to avoid downward dog. Its so common in the classes I take that I don’t know yet how I’d get around skipping that asana.

My physiotherapist did give me some exercises but I’m not impressed at all. All he asked me to do was plank on the forearms and taple top pose with one arm extended along with the opposite leg, hold, and switch. I don’t see how these help my problem directly. I asked another time about other exercises and all he added to the regime was something similar to cow faced posture arms.

I’ve never even heard of a structural yoga therapist and don’t know how I’d find one near me. Though the regime you suggested they might provide sounds like a good one.

I’d consider switiching yoga types but here are only two yoga studios in my area and one is a hot yoga studio while the other is a mainly vinyasa yoga based studio but also has a weekly technique and yin yoga class. I’ve tried those classes but I just find that none of the teachers at my studio know enough about my issue to offer any advice that will really help me. I’d love for them to show me proper alignment so that my supraspinatus does not get impinged but frankly I don’t think they are qualified.

I feel like none of the teachers at my studio nor my physiotherapist is detailed or knowledgeable enough to help my problem :frowning: So I don’t know what to do next except stop doing yoga which would make me miserable.

charliedharma

yes it would be unfortunate for me to stop altogether because of the pain. however like I mentioned above I dont have a local skilled teacher to help lead me to proper alignment so that i do not further aggravate the problem and perhaps even help me improve my shoulder’s condition with shoulder opening exercies.

#7

[QUOTE=Pandara;23599]Namaste amz155,

A few years ago I hurt my shoulder in an accident. It wasn’t an impingement, but I remember the physio telling me that most shoulder injuiries usually takes about 6 months to heal properly. Take it slow and heed the already good advice you have received here.[/QUOTE]

Sigh…yes I’m realizing that more time is needed. I just have to be less stubborn and accept that its okay to take the time to heal.

#8

One more thing…let’s say I stay true to myself and decide to take the required time off to rest my shoulder. what should I do when i’m ready to get back into yoga to ensure that the problem doesn not come back? How do I know if a teacher is qualified and skilled enough to assess my alignment?

#9

May I recommend that you rather try and find a yoga therapist in your area, that way you’ll have less stress about wondering if your teacher know enough and if it is the right time for you to get back into practice. Next to the back, the shoulder is for me so imoprtant in yoga as we use it quite a lot in doing the various asanas that I always feel that a shoulder injury should be treated with much love and respect and proper care.

#10

I have begun searching for yoga therpists in my area :slight_smile:

I have also made another appt. with my physiotherapist for tomorrow to get my shoulder worked on a bit (loosened up) and to discuss exercises for my shoulder.

Can anyone advise me on what exactly I should be asking the physiotherapist for? Exercises that open the shoulder joint? Stretch the shoulder? Strengthen the shoulder or upper back? I’d like him to suggest both immediate and longer terms exercises for me to work towards.

#11

Hello Andrea,

Yoga is not just about the body, but also about the mind. So I’m going to be very stern here. Would you please envisage a yogasana practice without downward dog for the moment? Life is a funny thing you know. If it is going to take three shoulder injuries and a collapsed vertebrae or so to make you see the light, that is what will happen.

Think about this instead: Together with an experienced teacher or yoga therapist, you could come up with a satisfying yoga routine that is challenging to you, makes you feel good and addresses your distressed shoulder and bones as well. You could do this practice at home a few times a week.

If you need the additional inspiration, go to your studio of choice, skipping all the contraindicated poses. There is nothing wrong with cat/cow instead of downward dog. If your teachers cannot provide safe modifications to their routine, beware! And go somewhere else.

Now may be the time to delve into the broader field of ashtanga yoga. Your shoulder injury is not stopping you from taking on pranayama and meditation, right? Never forget that yoga starts with prescriptions for life, the first one being “first, do no harm”.

(Looks like we cross-posted!)

#12

Hi amz155.
I’ll bet a physiotherapist is like a computer programmer (my profession) – we do best when we are presented with the problem holistically, and allowed to bring our own education and experience to bear on designing a solution. You should ask your physio to teach you what is next for you to do, and you should converse with him/her to find the exercises with will do the right work and that you will actually do; you should also realistically present when you think you will next be able to have an appointment so that you can get a specific time frame for ‘immediate’ and ‘longer term’.
And, if your physiotherapist is going to insist you treat your body with the love and patience it needs/deserves, please don’t be distracted by an inability to find a yoga therapist yet. This person might be the teacher who has appeared. Respect his/her instructions regarding when you can return to classes with someone who is not as well trained. (bringing in a photo yoga book might help that conversation.)
Best of luck, and lots of patience . . .

#13

[QUOTE=Willem;23609]Hello Andrea,

Yoga is not just about the body, but also about the mind. So I’m going to be very stern here. Would you please envisage a yogasana practice without downward dog for the moment? Life is a funny thing you know. If it is going to take three shoulder injuries and a collapsed vertebrae or so to make you see the light, that is what will happen.

Think about this instead: Together with an experienced teacher or yoga therapist, you could come up with a satisfying yoga routine that is challenging to you, makes you feel good and addresses your distressed shoulder and bones as well. You could do this practice at home a few times a week.

If you need the additional inspiration, go to your studio of choice, skipping all the contraindicated poses. There is nothing wrong with cat/cow instead of downward dog. If your teachers cannot provide safe modifications to their routine, beware! And go somewhere else.

Now may be the time to delve into the broader field of ashtanga yoga. Your shoulder injury is not stopping you from taking on pranayama and meditation, right? Never forget that yoga starts with prescriptions for life, the first one being “first, do no harm”.

(Looks like we cross-posted!)[/QUOTE]

Thank you…I agree with everything you said :slight_smile: I am going to try to find a good yoga therapist near me so that I can get the exact help that I need for my shoulder (and osteopososis).

#14

You are welcome.

Just see your physiotherapist with an open mind and ask for a solution for your pain. I’m sure that he/she will do the best to his/her abilities to help you with physiotherapy.

Techne’s suggestion of a photo book is a good one. It could initiate a conversation on what poses would be suitable from a physiotherapy point of view. I once asked my physiotherapist what to do for herniated disc in this manner and his suggestions were useful (in hindsight).

Best regards.

#15

Pain is no fun, but a great communication tool from your body. It definitely lets us know when something isn’t working. I like what Charliedharma said:

Your shoulders are precious look after them.
Yoga, when done in optimal alignment, can be enormously healing. When done misaligned, yoga can be one of the most risky things you can do.

The advice you’ve received about being patient with yourself, doing physio, and finding a yoga therapist are good. I offer you this perspective to add to your considerations:

Personally, as an Anusara-Inspired yoga therapist, I wouldn’t advise you to stop doing yoga as long as you can do it in alignment. The trouble comes when you don’t know or haven’t been taught what this is.

Learning how to align the shoulders can bring you out of pain and into freedom very quickly. Once you understand what optimal alignment is and how to do it, you apply it to your practice and use poses that bear as much weight as possible IN ALIGNMENT. This strengthens the muscles around the area of injury in a healing pattern.

For example, if you can’t quite maintain the alignment in Down Dog, you come to your hands and knees with arms out further in front at an angle like Down Dog so you can work the alignment without as much weight. If that is too much you continue to modify until you can stay in alignment.

The alignment of Anusara yoga has been life changing for so many people. I’ve helped people in chronic pain to find total freedom in a matter of minutes by teaching them the principles of alignment and how to apply them to their lives. I know you said there isn’t a qualified teacher in your area. You may want to think about traveling to one if it’s reasonable.

If you are able (and if it resonates with you), try to find a certified Anusara yoga teacher to help you understand the principles of alignment from this school of yoga. Their teacher directory is here: http://www.anusara.com/index.php?option=com_contactmanager&view=teachers&layout=certified&Itemid=128

Also, if there isn’t anyone close to you, Martin Kirk does yoga therapy online via Skype using video. This may also be an option for you. http://www.kirkyoga.com/private.html

Finally, if you’re interested in learning more about the approach of this yoga, including the philosophy, meditations, and some alignment, I invite you to try my free online offering.

Lots of links there, I know. I wish I could teleport myself or another skilled teacher there to help you. May your path lead you to radiant, beautiful health.

Blessings,

Katrina

#16

The red resistence band might be too strong. The aim is to do many repeats with very little effort, not to strenghten healthy muscles. About the exercises, I am not qualified to give them, seek somone knowledgable in your area. Even if I would show/describe you what I usually do, you would need supervision.

They are not that hard and complicate though, so you need not despair.
Anyone who is certified in physical recovery will be able to help you.

#17

Dear amz,

I can fully relate to this in particular, it being the problem that initially led me to yoga and which after 20 years or so of practice, is still an occasional problem for me. Optimal alignment may not be possible for you in the short-term. Even if and when the shoulder heals, the misalignment causing the impingement may not, and may involve a much longer-term resolution. You have to continue seeking its cause.

In my case, I finally learned the source of my problem to be compromise in spinal alignment due to injury at an early age, which led to a fault at T-12 and dislocation of the adjacent ribs. The intercostals, serratus, oblique and part of the abdominal wall on one side had been lifeless for most of my life and not supporting the scapulae and thoracic spine, contributing to this collapse over time, most likely due to a peripheral nerve impingement at the spine. It caused me to have what’s classically called winged scapulae and a flattened thoracic curve, which I am still working on. Although I was always hurting myself with hatha, it was through pranayama and meditation that I became aware of this problem, where one will tend to learn the deepest instabilities and imbalances in the body.

You are peeling an onion back to its root. Part of the process of yoga practice is to learn these things about yourself as much as it is to try and change them. So, take your time. This may be your lifelong struggle. By all means, modify your postures, especially those involving the arms overhead. Take a close look at the anatomy of an impingement. Understand where and how it occurs and what positions cause that compromise. It is more important to avoid its reoccurance than it is to return to doing any asana.

Also, since we don’t really understand its nature, I personally would not advise any repetitious strengthening of any kind, which is more likely to further aggravate it. Rather weight-bearing, stabilization and lengthening which is going to involve concentration on and control of your breathing as much as anything else.

A standing-dolphin pushup, meaning just standing on your toes and elbows and doing nothing more than imperceptibly swaying with your breathing, and I mean i-m-p-e-r-c-e-ptibly, just enough to change direction of force, and also chataranga can be very good. Also, a one-armed-standing incline plane. Focus on opening and increasing the space in the shoulder, pulling it away from the spine and holding it.
[B]B-r-e-a-t-h-e.[/B]

I feel for you. Good luck.

peace,
siva

#18

Dear Amz,

May I add another view to your issue as well. Siva’s peeling an onion back to its roots got me think about how all our illnesses and dis-eases have their roots somewhere in our emotions. We have the expression which explains it very well - carrying the world on your shoulders. In this instance I want to ask whose world (read problems) are you carrying on your shoulders or do you load too much unnecessary problems of your own onto your shoulders? Study those problems as well, how many is really problems and how many already carry its solution on its own back? This shoulder might be a message of the body telling you it is overloaded and couldn’t take on more.

Just another view.

#19

I love this forum. So many wonderful ways to see things!

Along with Siva and Pandara’s thoughts, I see injuries as an invitation to shift into a different space. They teach us to accept and allow, and also help us learn how and what we want to change.

Part of the alignment that I practice and teach for the shoulders is a simple spaciousness inside. This offers space on all levels of being. Here is a mini instruction for it, also a good way to align for meditation.

Sit beautifully.
From the inside, expand.
Get spacious with your awareness.
Invite your breath to fill this space.
Notice you naturally lift up through the heart.
The ribs and shoulders float higher.
On your next inhale, lengthen up from your hips to your armpits.
Then, gently take the head of the arm bones back so your heart is lifted and shining.
Let your throat be naturally open (chin neither lowered or overly raised).
Enjoy your breath.

See how that feels. :slight_smile:

Katrina

#20

Yes, katrina you’re right…so much good and varied advice!

Katrina: You’re also right about pain being no fun. That’s why I’m taking the opportunity to investigate where and why the pain is originating instead of just ignoring it and trying to will it away. I definately appreciate the great importance of proper alignment. I’m constantly asking my instructors for tips on alignment on some of the littlest things that may seem unimportant to someone new to yoga but that I myself realize are critical. I am seriously going to try to find a yoga therapist so that I can have my alignment analyzed in detail. I would love to try a one on one session with one of my current teachers and have them critique their alignment but I don’t get a good enough feeling about any of them that they’d have a detailed enough eye to help me with what I need. I’m not saying they aren’t good enough teachers, I’m just saying I want to find someone who is very critical about alignment. I will check out the directory you posted.

And thanks for the mini instruction. It’s very much like what my instructors add to the start of their classes.

Hubert: I got a few exercises to try from my PT today. One involves no apparatus and a few involve an exercise/stability ball. I will try those first and then maybe ask about specific moves I could do with a resistance band. I bought the red band originaly for some home weight training so yes, the red one may be a bit too hard for what I need it for.

Siva: I like the analogy of the onion you gave. I will give that some more thought. About the anatomy of an impingement, maybe I will try to find some videos that show a moving cartoon of an impingement. I have looked at diagrams accompanied by written descriptions but honestly I still can’t exactly picture what’s going on and causing the pain. About the standing dolphin push up, I’m not sure exactly what that is. I’ve done dolphin push ups (which REALLY aggrevate my shoulder) but I’ve not heard of the standing variation. What is this?