Our shoulder is a precision instrument that simultaneously has a vast scope in its range of motion. With pinpoint precision we can synchronise our shoulder muscles to maneuver our arm to point our finger precisely at our object of choice – an action that requires the coordinated recruitment of numerous muscles that surround our shoulder joint like a clock. Your shoulder blade or scapula has 12 muscles which attach to it, each pulling it in different directions, and that is without counting those muscle that attach to your arm!
You can broadly categorise shoulder problems into two causative groups: 1) trauma induced, whether this be macro or micro (which also includes the micro-trauma of poor posture) and 2) structural. Here a small number of people have their shoulder joint shaped in such a way that impingement of the shoulder tissues is inevitable when the arms are repeatedly placed above their head. And this is what we do all the time in yoga! In fact, we usually have our arms overhead and additionally bear our weight in this position, eg, downward dog, vinyasa jump throughs, back bends (Urdhva Dhanurasana), arm balances and handstands.
Shoulder problems that are felt and aggravated by having your arms above your head are usually a problem of impingement of some of the tissues of the shoulder joint. You can easily perform an impingement test. The test is more accurate when done passively, i.e. if someone else performs the test on you. Relax your arm and have someone turn your arm into its maximum internal rotation. Maintain this internal rotation as they take your arm above and close to your head (into flexion). If this reproduces your pain then your shoulder problem is one of impingement. The tissues that can be impinged are the biceps tendon, the supraspinatus muscle or the shoulder bursa (fluid filled sac that lie beneath tendons). As you raise your arm overhead one of these tissues is being pressed against the bony arch of the acromion process. Whichever tissue it is, the result will be the same – pain! Turning the hands out in postures where your arms are overhead can decrease or alleviate the symptoms but this will not fix the problem.
From my experience many students develop shoulder problems when they too quickly introduce ‘floating’ into their sun salutation transitions. This is when you transit from Trini (the third position in the sun salutation), through a partial handstand into Chatvari or the Rod. The same transition can be done when you jump back from Downward Dog (Shat) into Sapta, the seventh position. Especially here in the first sun salutations where the shoulders are not yet warmed up, these strong transitions put the tissues under a great amount of load. Here, the biceps tendon, acting as a shoulder flexor is especially vulnerable.
It is better to develop this strength and control in the vinyasa between postures when the shoulders have been thoroughly warmed up instead of during the sun salutations. The other culprit in the development of shoulder problems is an excess of handstands.
Shoulder problems often have an insidious onset. This is especially the case with repeated micro-trauma, where the tissues are stressed a little over a long period of time versus one large macro-trauma, when we hurt ourselves in an accident or a single incident. With micro-trauma the first symptom is often simply a decline in upper body strength. The reason for this is that all functional shoulder problems are a result of, or result in, an imbalance in the ability of the muscles to work together effectively and harmoniously. Our intelligent, adaptable body, in an attempt to protect the stressed or injured tissues, recruits other muscles to get the same job done, albeit less effectively. This compensation pattern sets up a mechanical disadvantage, as the substitute muscles cannot produce the same efficiency and power in this ‘fill-in’ role. We experience this as a lack of strength or a greater effort required to perform what was previously easier for us to do.
Many of our shoulder imbalances come from our long hours of working in static, hunched upper-body posture, the predominance of pushing versus pulling in our vinyasa practice and the long-standing fact that we no longer swing in trees! One could conclude that correcting our posture, incorporating pulling exercises and/or hanging from our arms would be therapeutic and generally speaking this is correct. However, our compensation patterns may be complex and layered, i.e. we may have poor posture, which we translate into our yoga practice and without the ability to recruit the correct muscles develop a dysfunctional compensation pattern in our yoga practice. So, whilst hanging from the arms might be therapy for one person’s shoulder problem it may exacerbate the problem for someone else. As you could imagine even monkeys hurt their shoulders swinging in the trees whilst showing off to their monkey mates. In this monkey’s case their therapy needs to be working from the ground up, so to speak. 🙂
For the same reason grounding the base of the thumb may be balm for one person’s shoulder pain but its excess may be the reason someone else develops shoulder pain. This makes perfect sense when we look at the functional anatomy. When we work with our arms overhead, the muscles at the base of our thumb (thenar eminence) via connective tissue, link to the biceps as well as the pesky pec minor muscle. Grounding the base of the thumb activates this chain of tissues and can exacerbate an already hyperactive biceps and/or pec minor. Pec minor is involved in both rounded shoulders and pushing and often dominates movement patterns, inhibiting the effect of many important stabilising muscles of the whole shoulder complex.
Unless your shoulder problem is of the structural type or you have significantly torn a tendon or ligament, it should not require surgery and can be rehabilitated. However, be aware that the therapeutic approach can be slow and requires persistence and dedication to do the appropriate exercises and/or modifications on how you do your postures. For the fastest, most effective results find a therapist that understands muscle relationships and can give you specific recommendations on how to recreate a harmonious balance of your shoulder muscles. If you are interested to learn more I cover these intriguing relationships in every area of the body in our 300-hour Immersion each year in Bali!
The muscles of the shoulder function in complex patterns and although there are certain shoulder exercises and/or stretches that often generally can help the problem, it is often not that simple or straightforward. What usually happens in the yoga classroom is that if the teacher themselves has had a shoulder problem they will prescribe their student the same regime that worked for them. Sometimes you get lucky and this will suffice and be of help but in many cases it will require a closer examination of the muscle relationships that have gone wrong and a restoration of balance and harmony.
I have been practicing Ashtanga for about 8 years, dealing with shoulder problems much of that time. Currently, I am almost fully recovered from a left shoulder rotator cuff repair 6 months ago and my practice was about 80% back to my normal. Now, I’ve been diagnosed with moderate to severe degenerative joint disease in the glenohumeral joint on the right side. My practice is once again back to ‘very modified’.
My question – should other treatments fail and my doctor recommends a right shoulder replacement, is a return to full practice possible? I know you can’t say for sure, but have you any experience with students for whom this was possible?
I have benefited greatly from Gregor’s books and from your articles and Youtube videos. Thanks so much for all the information you’ve shared and for any help you can give me with this question.
Thanks for your kind feedback.
I don’t have any experience with shoulder replacements but I do with arthritic shoulders.
How much you can do will depend on too many variables for me to give you any accurate feedback (eg, degree of degeneration, what you practice and how, age, diet, genetics, etc). You will probably be able to teach me a few things about what you can and can’t do. What is most important is that you listen to your body because it will tell you and then you must respect it’s limitations and willingness to move.
Wishing you still much enjoyment with your yoga practice, whatever that may be.