To all the yoga lovers and those interested in doing yoga, but are sidelined with a shoulder injury, here are some tips to get you back on track with your yoga practice.
Perhaps you are simply afraid of reinjuring your shoulder or maybe you are unsure of how to safely transition into your usual yoga practice after an injury.
It can be very frustrating when you are unable to engage in your favorite poses due to pain or discomfort in your shoulder.
The good news is a pose can be always modified to accommodate for your injury.
You can safely get in and out of your favorite poses using props such as blocks, straps, bolsters or by performing a simplified version of the pose.
Three common shoulder injuries will be discussed including shoulder bursitis, tendinitis, and impingement syndrome. To better understand the nature of each these injuries, I will discuss some basic shoulder anatomy.
A bursa is a fluid filled sac, which sits between the bone and the tendon and acts as a cushion protecting the tendon from rubbing on the bone. The bursa may become inflamed due to an injury or from overuse resulting in shoulder bursitis.
Depending on how severe the inflammation is you may have limited movement in all directions, and you may not be able to raise your arm overhead.
Another common injury is shoulder tendonitis. Four tendons and muscles create the rotator cuff (SITS), which stabilizes the ball and socket joint while allowing maximum mobility in the shoulder.
Tendinitis is inflammation of a tendon, which is the structure that attaches the muscle to the bone. There is usually pain with movement and depending on how chronic the injury is you may have some loss of motion in the affected arm.
A third common disorder is impingement syndrome. The rotator cuff tendons become pinched due to narrowing of space above the shoulder joint (ball and socket) better known as the subacromial space.
Shoulder impingement usually occurs over time with repetitive overhead activities, an injury, poor body mechanics or due to bone spurs.
The acromion is part of the shoulder blade also known as the scapula. It is the most lateral extension of the spine of the scapula, and it sits above the shoulder joint creating a subacromial space.
The subacromial space houses the 4 rotator cuff tendons. When the space becomes constricted, the tendons are compressed.
As a result, the tendons rub against the acromion and create friction, which causes inflammation. Over time, this leads to loss of movement and weakness in the shoulder.
In the acute phase of your injury or flare up of an old injury, a period of rest is essential.
Your doctor may provide you with anti-inflammatory medication and some form of immobilization possibly a sling for a couple of weeks depending on the severity of your symptoms.
After you have completed this phase, you may perform gentle exercises as directed by your occupational or physical therapist.
Make sure to inform your yoga instructor of your injury and limitations and consult with your therapist regarding the safety of the poses.
When returning to yoga after a shoulder injury adhere to the following 5 tips:
1. Focus more on your alignment cues
Make sure to turn your palm facing up or externally rotate your arms to prevent the tendons from pinching or encroaching on the acromion.
In warrior I and reverse warrior II, turn your arms so that your thumbs point behind you so that you can see your palms. Draw your shoulder blades down engaging your lower trapezius and latissmus dorsi muscles to allow of increase mobility (draw your shoulders away from your ears)
Make sure to lengthen your torso and point your fingertips to ceiling in revolved wide legged forward fold as in the 2nd diagram above. If shoulder pain occurs with the lifted arm, keep the hand on your hip.
2. Use different variations of arm movements
Avoid going into the full expression of poses that require your hands overhead or clasping hands overhead, for instance as in warrior 1 tree pose, or chair pose.
Instead, raise arms to shoulder level or to pain free range using modifications. If maintaining the arm in elevated posture is painful, simply remain with prayer hands at heart’s center. You may use cactus arms in warrior 1 as well.
3. Use props such as straps to accommodate for limited range and prevent re-injury.
If you have a shoulder impingement, limit poses that require internal rotation.
Be careful performing poses that require you to bind the hands from opposing directions. For instance, Cow Face pose, where one hand reaches from overhead and the other behind your back, which is internally rotated.
Another example would be binding in Side Angle pose. The arm that reaches around the thigh would be in internal rotation. You may use a strap to maintain alignment and prevent muscle strain. Avoid curving your shoulders and keep your spine elongated.
4. Avoid direct pressure to shoulder joint in poses such as thread the needle or 8-point pose as they would increase your symptoms.
Use blocks to modify and safely get in and out of pose. Keep palm facing up. You may modify thread the needle pose, by drawing the arm across the chest for a stretch of the posterior shoulder muscles. The 8-point pose can be modified by placing a blanket under the involved shoulder.
5. Limit full weight bearing poses such as down dog, dolphin pose, side plank or chaturanga.
Avoid these poses if you have pain. You may use blocks in down dog for limited range, for side plank you may keep your lower knee on the mat for more support and less pressure on the shoulder. Do Chaturanga, with your knees on the mat and progress as you get stronger to full expression of pose.
If you are doing yoga at home after a shoulder injury and you are new to the practice, perform simple poses and focus on your alignment. You may start warming up the shoulders in seated cross-legged position simply reaching forward and then to R and L within pain free range. Separate arms further if there is any tension. Also, seated cat cow is a great way to ease into your practice.
Most important, be patient and allow your injury to heal. Follow the 5 tips provided to help you safely resume your yoga practice. If you have any questions, feel free to contact me by email @ firstname.lastname@example.org