Preventing Shoulder injuries in Yoga

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Steve Galindo
Steven GalindoChicago Health & Wellness Examiner

May 6, 2013

One of the frequent complaints from practitioners of vinyasa and ashtanga vinyasa yoga is shoulder injury. This may present as pain and compression on the front of the shoulder, biceps pain, pain within the shoulder capsule or pain in the back of the shoulder. The yoga sutra that applies to Yoga Asana is “sthiram suhkam asanam.” This translates, “The pose is stable and comfortable.” This sutra although meant to describe the meditative seat is equally applicable to the kinesiology of the shoulder joint. Shoulder joint injures usually result from a lack of stability that leads to habitual misalignment during movement and thus chronic wear on the structure of the shoulder.

It is a fact that shoulders are designed for mobility, not stability. This mobility allows for an amazing range of motion compared to that in the hips. If you have healthy shoulders you can move your arms forward, back, across the body, and in 360-degree circles. But the relatively loose joint relies on a delicate web of soft tissue to hold it together, which makes it more vulnerable to injury. (The soft tissue includes ligaments, which connect bone to bone; tendons, which attach muscle to bone; and muscles, which move and stabilize the bones.)

The main ball-and-socket joint is also quite shallow, adding to the flexibility but putting the joint at risk. It is like sitting a basketball on top of a plunger. (The basketball is the head of the humerus, or upper arm bone, and the plunger is where it meets the scapula.) The rotation of a big ball on a little base makes the shoulder mobile.

When the soft tissue around the joint is strong and toned, the system works flawlessly. But factor in years of repetitive movements, like throwing a baseball, swimming, or the chaturanga to upward facing dog transition in yoga, and shoulder ligaments can overstretch and lose elasticity, like worn rubber bands. Plus, as muscles age, they lose tone, making it even more likely that the ball will either slip off the plunger at some point or that the muscles will tear. What is the best way to prevent injury? Be diligent in your quest for proper alignment and build balanced strength around the joint to create stability.

So when we look at a movement like chaturanga, we are not moving out of the normal range of motion of the shoulder joint. However, in order for the shoulder joint to function optimally, the rest of the girdle must be stabilized during the movement of the humerus which will prevent the movement from over burdening or stressing the muscles that move the joint. The scapulae or shoulder blades are where much of the effort and mindfulness will lie if you are to develop proper stability during chaturanga.

Some of the main muscles used in controlling or stabilizing the scapulae are the trapezius, rhomboids, pectoralis minor, and serratus anterior. When you see a shoulder not in the “right” position in a chaturanga, it’s not because of the shoulder, it’s because the scapulae are not, or cannot be held in the appropriate place. Why not? Because the muscles that create the stability of the scapulae are either not strong enough or not patterned correctly to make this possible.

This can potentially lead to a strain of various muscles at the actual shoulder joint such as rotator cuff muscles, deltoids or bicep tendons.

There are other issues at play here as well, including where the shoulders line up with the hands. The further forward the shoulders are from the hands, the more strain ends up in the shoulders. This happens because bulk of the upper body weight is too far out in front to be supported by the hands under it. Imagine holding a twenty pound weight directly over your shoulder, shouldn’t be a problem, but now move it forward just a few inches and gravity starts to work on your shoulder in a very different way.

If someone has shoulder pain, you should also look at the posture that follows it most commonly which is upward facing dog. We often see a pattern of chaturanga that has people forward on their toes and in their shoulders and the up dog that follows tends to put the shoulders way out in front of the hands underneath it. This has a series of effects that play themselves out. One is, it puts a lot of stress on the wrist, second is it has a tendency to put stress in the back by trying to make the back bending aspect of up dog happen, this also tends to lead to a buttocks that is over tightened for the wrong reasons. Third is it puts a load of stress on the shoulders once again.

Another common problem is people taking on too much practice too quickly. This by itself can be enough to inflame a number of areas in the body, especially the shoulders. This is especially true if you’re practicing one of the myriad styles of vinyasa yoga.

The trapezius muscles play an important role in stabilizing the shoulder blades on the back, balancing the action of an important set of “pushing” muscles called the serratus muscles, which are involved in chaturanga and related poses. The serratus anterior muscles attach to the ribs at the sides of the chest and connect underneath the shoulder blades. When they contract, they pull the shoulder blades forward, effectively helping us to push through the arms. In conjunction with the pectoral muscles of the front body, they help hold us steady in a simple plank pose. When the serratus muscles are weak, the shoulder blades will “wing out” or lift away from the ribs as we push through the arms in plank pose. This leads to tightness and strain at the fronts of the shoulders, especially from the action of the pectorals.

While the serratus anterior muscles play a large role when we push our shoulders forward, the trapezius and rhomboid muscles help us to pull our shoulders back. Thus these two sets of muscles work in dynamic opposition to each other. They, along with the “posterior” portion of the serratus muscles, are the glue holding the shoulder blades to the back when we exert force through the arms, protecting the fronts of the shoulders from injury by overexertion. Chaturanga dandasana is an exercise in learning how to balance the “pushing” muscles (serratus anterior, triceps, and pectorals) and the “pulling” muscles (serratus posterior, trapezius, and rhomboids).

The first step in understanding correct shoulder alignment for Chaturanga is to start by exploring tadasana (Mountain Pose). First, lift your shoulders slightly so they line up with the base of your neck. Simultaneously, draw the heads of the arm bones back, toward the wall behind you. Keeping a slight curve in the back of your neck, draw your shoulder blades down toward your waist. Your shoulder blades should lie flat on your back, instead of winging out. Feel your chest rise, but resist the temptation to pinch your shoulder blades together. With your hands at your sides turn your palms away from you rotating your arm bones externally. You will feel more connection to your scapulae. This will strengthen the muscles on the back of the rotator cuff (the infraspinatus and teres minor), which are typically weaker than the front. Now holding your elbows tightly against your ribs bend your forearms so they are parallel to the ground with the palms spread wide facing forward. Does this look familiar? It is a standing chaturanga. Now press your arms straight out while holding everything stable on your back. Press your feet into the ground while engaged your leg muscles. Press your low belly forward and create a slight arch to your low back. This will connect your lower body to your upper body. Finally hold all of this and draw your upper arms back to your side body. Repeat this process and become aware of the sensations necessary to maintain stability and alignment. Next you can practice lowering to chaturanga with your full body weight.

You will use the same process you used during the tadasana exercise. Start by making sure your alignment is correct: hands shoulder width apart right below your shoulders, middle fingers facing straight forward, and as you lower your elbows come back near your rib cage.

Next, keep your core engaged, if when you try to lower with straight legs and the knees off the ground you find yourself shaking, your hips sagging or sticking up, or you just collapse straight to the ground with no control, then try doing the pose with your knees on the ground in mini plank first to build strength. Push your low belly out and lengthen your tailbone while maintaining a slight curve to the low back.

Squeeze your arms towards one another and hug your arm pits toward the ribcage. Imagine one long straight line from the tip of your tailbone to the crown of your head. Gaze only slightly forward or straight down to lengthen, keeping the back of your neck long and throat open.

Draw your elbows in line with your shoulders while lowering halfway down. (Bring your knees to the floor if your lower back begins to drop or sag.)

Make sure that the shoulder heads do not drop below the line of the elbows (they should form a 90-degree angle).

Hold the alignment you have created and press back to plank. You can now rest in child’s pose or transition to another pose like up dog or down dog.

Chaturanga dandasana presents a significant challenge and test of true shoulder strength and integrity. If you jump into it too quickly, relying on your chest and arm strength, you risk injury. But if you approach it progressively and mindfully, you will succeed in cultivating a strong and open-hearted posture with good stability and without the pain that comes from instability and misalignment.
http://www.examiner.com/article/preventing-shoulder-injury-yoga

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