Shoulder impingement...what to watch for?

Yoga Discussion General Yoga
#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?

#21

amz,

Sorry. By “standing,” I mean you are not pushing or pulling, but rather standing statically on the elbows and toes. Just holding it and standing tall in the shoulder and breathing is enough.

The impingement usually occurs between the acromion process of the scapulae and the head of the humerus. Medial over-rotation of the the humerus, or inward toward the midline of the body, or scapular instability pulls the acromion down against the head of the humerus pinching anything in between. For example, when carrying anything heavy with that hand, don’t let that arm rotate inwardly, rather turn out to maximize the space between these two bones. Here’s a link to an x-ray I hope will help. There are many more online.
http://home.comcast.net/~wnor/xrayleftshoulder.jpg

siva

#22

^ thanks, I’ll check that out.

So I guess you meant the usual dolphin pose. Well unfortunately that pose brings the most pain to my shoulder and its the first pose I started feeling pain in.

#23

That’s great that you are already somewhat familiar with the spacious alignment I offered. Part of the key to the alignment approach I use for the shoulders is keeping that spaciousness throughout the practice, especially in the side body - from the hips to the armpits. If you have more length through the sides and a fullness in the back body, it helps the shoulders come back to their optimal alignment more easily.

The other thing I want to add is that it is more important to keep the head of the armbones back than to have the elbows in during chaturunga. I know, this is something most of us were taught (elbows close in to the ribs) but it can actually restrict freedom in the shoulders and pull the shoulder blades off the back. Instead, think about the side body being long from the inside (use your breath to create space), keep the throat open and take the head of the armbones back (NOT down away from the ears which would restrict the length of the side body) so the scapula come more on the back and the chest feels open without sagging forward in the ribs and belly (use your core to support).

Note that the above alignment is general instruction I would give someone and, of course, I can’t see you to address specifics. For instance, if your thoracic tends toward flatness I would help you breathe in a way that creates more fullness.

I hope this gives you helpful ideas.

#24

amz,

Woah. I see. You have some real instability there then.

Give yourself lots of time. I would say in general don’t do anything overhead until you can support your weight on your elbows in a static dolphin position.

siva

#25

Give yourself lots of time.

Siva - this is advice I think we could all use. :slight_smile: Ah, patience.

#26
#27

amz said: 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?

Hello AMZ,

As a yoga teacher I’m delighted to hear how you are using this thing that has come up as a bridge to cross deeper into who you are as a person and what things you might be ready to look at, what messages from the physical body you might be ready to respond to. That sort of inner work will almost always be more fruitful than dealing only with the physical body.

The sort of shoulder issue you outline comes about (from asana) due to a lack of engagement of the serratus anterior in Adho Mukha Svanasana, Adho Mukha Dandasana, Utkatasana, Urdhva Hastasana, Virabhadrasana I, Vrksasana, Pincha Mayurasana, and Adho Mukha Vrksasana. It is an action that leads to alignment. Since there are always multiple ways to view the forest, there are also some ways of moving toward alignment that are wholesome and others which are less so.

Shoulder injuries are very common in the styles of asana you ascribe to. There are three reasons for this; fatigue which deteriorates postural integrity, lack of appropriate action and alignment to begin with, and simply an inappropriate pose for the person doing it. For example, a student with a year and half of asana practice who has not totally learned the action and application of the serratus mentioned above, that student should not be doing handstand while holding an expectation of remaining injury free.

Why? Because it is that action which protects the shoulder joint (as Siva mentions) AND the limbs are weight-bearing. It is not as big a deal to have the shoulder “out of joint” when the arms are not weight-bearing BUT it develops a certain samskara (habit or pattern) in the student’s consciousness that may come to bear later on.

There is no reason you cannot have a robust yoga practice but there are a myriad of reasons you would have to modify an asana practice. Working through an injury is not the same as working with an injury. Working with it takes only some modifications to your postures. Working through it mandates looking carefully at how you feel you bear the weight of the world (on your shoulders), the complexities of your responsibilities, your meditation practice, your lifestyle and nutrition, and the ways in which you are (or are not) living your life’s mission or Svadharma.

If you are in the UK then I’d recommend you look up Drew Stallcop (who is the only certified Purna Yoga? teacher in the country) or go and spend some time with Aadil as he is heading that way very soon.

gordon

#28

Shoulder anatomy

#29

Willem: GREAT link, thanks!

Gordon: Thanks for your response. No, I’m not in the UK. I’m located north west of Toronto, Ontario. I’m fairly confident that if I spend some time reseraching, I will come up with a practitioner (i.e. yoga therapist) that I could consult with in person. If you, or anyone knows of anyone they’d recommend in the Toronto or York Region area, please do share. Gordon, apart from a Purna Yoga teacher, what other types of practitioners would you recommend? I really want to find the correct person for my issues.

Thanks.

#30

My friend, Marinella, teaches at this studio in Toronto. There are a number of instructors here that I think could help you. http://www.mykulatoronto.ca/our-teachers.php Contacting Marinella may be a good place to start to find a therapist that you want to work with. Marinella was at the last yoga therapy training I took with John Friend, and I would feel confident with her if I were seeking a yoga therapist myself.

I respect the tone you’ve taken in considering all that you’re receiving here and yet staying very grounded in your own abilities to discern what is right for you.

#31

[QUOTE=Katrina;23744]My friend, Marinella, teaches at this studio in Toronto. There are a number of instructors here that I think could help you. http://www.mykulatoronto.ca/our-teachers.php Contacting Marinella may be a good place to start to find a therapist that you want to work with. Marinella was at the last yoga therapy training I took with John Friend, and I would feel confident with her if I were seeking a yoga therapist myself.

I respect the tone you’ve taken in considering all that you’re receiving here and yet staying very grounded in your own abilities to discern what is right for you.[/QUOTE]

Ok great…I just came across her name on the list of Anusara-Inspired teachers in Toronto. And some other names as well. Good to know there are lots of resources in my area. I’m just wonering the difference between a yoga therapist and an Anusara yoga teacher.

I’m looking for someone who can help me with the issue of the shoulder impingement (proper shoulder alignment but would also LOVE to learn about overall alignment) and as well someone who can advise on the best asanas for someone with osteoporosis (as I mentioned in another pose).

From what I’ve learned recently, I take it that someone trained in Anusara would be the one to help me with detailed proper alignment while the yoga therapist could advise on a specific health matter and how to tailor my practice in terms of appropriate asanas?

I’d rather just see one practitioner and deal with both concerns as the matters may definately be related and also because proper alignment is going to be the remedy for both issues. So should I aim for a yoga therapist or an Anusara yoga teacher? I know there may not be a one-size-fits-all teacher, but I’d like to hear what people’s advice is on choosing a practitioner that can deliver advice on both matters.

Cheers,

amz

#32

Amz,

Definitely agree with you in wanting to have one person to help you, rather than two people in different roles, which wouldn’t necessarily be bad as much as inconvenient. It will also be good to have the consistency provided by one person.

Certified Anusara? yoga teachers are also yoga therapists. Anusara-Inspired? instructors may also be yoga therapists, as is my own case. It depends on the training they have had.

From my own experience, the alignment developed by John Friend, Anusara yoga’s founder, has been the most effective I have seen and felt as far as informing how to optimally align on and off the mat.

When you contact an Anusara-Inspired teacher, ask them how much training they have had in yoga therapy, if any of it has been with John Friend himself, and how much experience they have had one on one with clients in the role of yoga therapist. It would also be good to ask how many hours of Anusara yoga training they have.

The alignment of Anusara is therapeutic, so even if someone has only had one or two therapy specific trainings, if they have several hundred or more hours of Anusara yoga training they are likely to know the alignment intimately. If someone has studied extensively with John Friend or one of the more experienced certified teachers of Anusara yoga, it tells you they are very dedicated and have had access to some of the most skilled teachers in the world.

It would also be helpful to tell them both about the shoulder condition and the osteoporosis consideration when you contact them to see how they respond. They may want to do more research themselves as far as the osteoporosis goes to help you in the most comprehensive way, and this would give them a chance to be fully prepared to help you at the time of the session.

If you choose to go this route I look forward to hearing about how it goes. :slight_smile:

#33

[QUOTE=amz155;23743]Willem: GREAT link, thanks!

Gordon: Thanks for your response. No, I’m not in the UK. I’m located north west of Toronto, Ontario. I’m fairly confident that if I spend some time reseraching, I will come up with a practitioner (i.e. yoga therapist) that I could consult with in person. If you, or anyone knows of anyone they’d recommend in the Toronto or York Region area, please do share. Gordon, apart from a Purna Yoga teacher, what other types of practitioners would you recommend? I really want to find the correct person for my issues.[/QUOTE]

Oh I see, Canada, of course. The only teacher I know well enough to recommend is Cassie McCall in Alberta. Not close enough to you.

You said " what other types of practitioners…" which threw me but I’m certain you meant teachers. Unfortunately I cannot (and will not) speak for other types of practice. I simply know them for me not for someone else. If you PM me I would gladly share with you some things I personally would look for in the searching.

What makes a yoga therapist is a very broad issue and I have not seen one answer or one definition that fits well.

#34

Just to clarify the term keeping “the head of the arm bones back”, which Katrina mentioned and is also mentioned in the yogajournal article…

-Would this be the [B]opposite[/B] of trying to cave ones shoulders in toward each other across the chest as if trying to touch the shoulders together?

-Would this mean that the chest is opening at the same time?

It seems that when rolling the heads of the arm bones back that the shoulder blades would want to pinch together. But the yogajournal article says NOT to try to pinch them together? So how does one move the head of the arm bones back toward the wall behind oneself, without the shoulder blades moving together as if they wanted to pinch together to hold a pencil?

(I know this will be hard to explain over the internet in writing but I’m just dong a bit of reading and until I can get hands on help, I’d just like to see if someone can explain this in words a bit further so I know what it should ffel like to properly “move the head of the arm bones back”.)

AND I just noticed that in the article when explaining Urdhva Hastasana it says that before sweeping arms up:
-rotate arms bones externally and move the head of the arm bone down

But then it says that once arms are overhead to:
-spread shoulder blades away from each other
-as shoulder blades wrap around toward the front of the rib cage,move space will be created for lengthening

To me, the arms rotated externally when down and then shoulder blades wrapping toward the front of the rib cage when arms are extended overhead seem contradictory. If the shoulder blades wrap in, wouldn’t then the arm bones be turning inward as well?