Shoulder impingement...what to watch for?

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

^ 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.

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.

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

Give yourself lots of time.

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

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

Shoulder anatomy

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.

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=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

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:

[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.

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?

Excellent questions. Studying with a teacher who can explain the alignment in person will really help you gain an understanding and clear up confusion.

The alignment in question is always done in balanced action. How much you apply each principle varies with each individual. However, to clear up your questions at least somewhat I’d like to give a bigger picture of the alignment you’re discovering.

The explanation I give here is simply one way to approach understanding it, and I think you’ll really appreciate getting a more complete understanding with a teacher in your area.

Yes, taking the head of the arm bones back is toward the back body, opening the chest. To balance this action though, FIRST there is a fullness created overall in the body, including the back body. Keeping this fullness allows the shoulder blades to come onto the back without pinching together or having the ribs jut out in front. Bringing the head of the arm bones back is only one component of an alignment system that really works when done in sequence, completely, and with balanced action.

The actions that seem contradictory are balancing actions. It does actually make sense when you get into it and feel it in your body. :wink:

This is one example where reading about something and actually experiencing a thing really show their differences, eh?

[QUOTE=Katrina;23775]Excellent questions. Studying with a teacher who can explain the alignment in person will really help you gain an understanding and clear up confusion.

The alignment in question is always done in balanced action. How much you apply each principle varies with each individual. However, to clear up your questions at least somewhat I’d like to give a bigger picture of the alignment you’re discovering.

The explanation I give here is simply one way to approach understanding it, and I think you’ll really appreciate getting a more complete understanding with a teacher in your area.

Yes, taking the head of the arm bones back is toward the back body, opening the chest. To balance this action though, FIRST there is a fullness created overall in the body, including the back body. Keeping this fullness allows the shoulder blades to come onto the back without pinching together or having the ribs jut out in front. Bringing the head of the arm bones back is only one component of an alignment system that really works when done in sequence, completely, and with balanced action.

The actions that seem contradictory are balancing actions. It does actually make sense when you get into it and feel it in your body. :wink:

This is one example where reading about something and actually experiencing a thing really show their differences, eh?[/QUOTE]

Yes, yes, thank you! And yes, I know it would be infinitely more effective to have this alignment demonstrated in person. I just wanted to get a jump start on some ideas so I can experiment with alignment a bit on my own. I also took out 6 yoga books from the library today and will review them to see if I can get some other good tips that I can discuss with a practitioner when I find one.

In tonight’s yoga class, I did try doing what I thought was meant by keeping the head of the arm bones back and I experienced very little pain. I also took things a bit slower, and omitted some positions. Obviously I know my problems are not solved but I’m very encouraged at the enormous help I’ll get by having my shoulder alignment reviewed. After that I’m sure my practice will improve infinitely by going over alignment in a variety of other asanas.

Hello Andrea,
The topic of finding, and being recommended, a Yoga therapist has come up several times in your various threads, so I am going to post some links for you now, and I am choosing this thread to do this.

This is a link to a threadof a previous forum discussion on some of the parameters regarding what it can mean to be a Yoga therapist. And here is a link to International Association of Yoga Therapists where you can find a therapist in your area, and read even more about Yoga therapy and Yoga therapists from this group of professionals.

I would like to add to the excellent discussion in your other, therapeutic-inclined threads. Deeper questions certainly promote deeper discussion–thank you for adding yours to this forum.

Take care,
Nichole

Thanks Nichole. Your link has led me to find two yoga therapists in the Toronto area.

I’m debating whether I should find a yoga therapist or an Anusara based yoga teacher.
I suppose the yoga therapist would be better for learning about asanas that could improve my osteoporotic condition, while some Anusara based lessons would help me discuss the particulars of alignment.

I’m pretty sure if a yoga therapist cannot help you with “the particulars of alignment” there’s something amiss with that person’s claim to be a yoga therapist. However, you might find several other reasons to blend time with each . . . just let them know that this is part of your situation, and listen to advice this might provoke.

[QUOTE=Techne;24449]I’m pretty sure if a yoga therapist cannot help you with “the particulars of alignment” there’s something amiss with that person’s claim to be a yoga therapist. However, you might find several other reasons to blend time with each . . . just let them know that this is part of your situation, and listen to advice this might provoke.[/QUOTE]

yeah, a blean of both practitioners would probably be a good recipe for success. Of course, I do not have unlimited funds :slight_smile: so I may just have to choose one practitioner for one or two sessions.