{ ASANA SOLUTIONS }

How to Heal (and Prevent) Shoulder Injuries

This shoulder,strengthening, chest'opening asana routine targets injuries in the rotator cuff
and restores muscular balance. No surgery reQ..uired!
By DOUG KELLER

Each time you lift your arms, your shoulder muscles-both big and small-initiate a dan ce full of subtle
nuances. The complex interaction of those muscles, coupled with ~e uni<{.ue structure of the shoulder joint,
gives your arms a wide range of motion. In fact, the shoulder is one of the loosest joints in the body. But this
freedom of movement comes at a price: shoulders are vulnerable to injury both from sudden falls and from
repetitive action such as throwing a base'
ball. The muscles of the rotator cufT, the
most delicate movers of the shoulders, are
particularly susceptible. But here's the
good news: a regular, targeted asana
practice can help you maintain healthy
rotator cufTs by bringing awareness to your
alignment, strengthening your shoulder
muscles, and opening your ehest. And sev'
eral of the poses described in the pages that
follow can even encourage the healing of
rotator cuffs if you've already injured them.

THE ANATOMY OF THE SHOULDER

Let's take a look at the special nature
of the shoulder joint and, in particular,
its relationship to the shoulder blade.
Though it is considered a type ofball,
and'socket joint, the shoulder is unusual
because the rounded "ball" or head ofthe

Pull of Supraspinatus y
----""'.."".~._ /' ,
Supraspinatus
Pinched
humerus (i.e., the arm bone) doesn't
have a corresponding socket. Rather, the
ends of the collarbone and shoulder blade
in front of, and behind the head of the
humerus and stabilize the joint. These
deeper muscles are layered over by larger,
- ... Pull of Deltoid
::- / come together to form a shelf under which stronger muscles that attach directly to
the humerus hangs. This shelfis known the acromion process. The muscles of the
as the acromion process. Beneath it there rotator cuff guide the actions of the arm
is a rounded depression that is part of the bone itself, while other larger muscles
shoulder blade. This is as close as the control the actions of the shoulder as a

////~ shoulder gets to having a "socket"; the

head ofthe arm bone glides against this
whole, with both arm bone and shoulder
blade functioning as a unit.
",-'
surface as it rotates, and the steady con'
traction ofthe rotator cuffhelps to hold HOW INJURIES OCCUR
the joint together. The most common rotator cuff injury
The rotator cuff actually comprises occurs at the outermost corner ofthe
THE SUPRASPINATUS is the most commonly four separate muscles-the supraspina' shoulder, beneath the deltoid (the large
injured rotator cuJJmuscle. It amsts the deltoid tus, the infraspinatus, the teres minor, muscle you use to lift your arm). The
in lifting the arm overhead. and the subscapularis-which wrap over, injury is to the supraspinatus, a

-0 I YOGA + JOYFUL LIVING NOVEMBER ' DECEMBER 20 07 YOGAPLUS.ORG

 THE DELTOID lifts the arm
80 deg;ees; then the supraspinatus
assists the deltoidJor the next
Ja to 40 deg;ees.

AS THE ARM LIFTS a shortened

deltoid muscle causes the arm bone
and the acromion process to pinch
the supraspinatus.

small muscle that attaches directly to the supraspinatus tendon. For example, if you
head of the humerus and assists the deI, slip in an icy parking lot and use your arm
toid in lifting the arm overhead. The very to break the fall, the humerus gets jammed
strength of the deltoid is often the cause in the socket, pinching the supraspinatus
of injury to the supraspinatus. against the acromion process or even
When you take your arms overhead, tearing the tendon. The simple repetitive
the deltoid is able to raise the arm to about action of raising your arm can also be at
80 degrees from the body. At this point, fault. When you reach for something on a
the deltoid can't do much more lifting on shelf above you, the deltoid can pull the
its own: the arm bone is almost level with arm bone up too hard, pressing it against
the shoulder, and from this angle the del' the acromion process, thus pinching the
toid can only pull the arm bone into the supraspinatus. Over time, these little in'
joint rather than lift it higher. As the arm juries add up to a more serious problem.
continues to rise, the deltoid relaxes some' The shoulder is built to avoid this
what and the supraspinatus jumps in to pinching, but our patterns of use and
help: it raises the arm for the next 30 to everyday life lead to imbalance, pain, or
40 degrees, after which the deltoid can lack of mobility. The problem starts with
res urne its work. postural habits: many of us overuse the
It is within this range of80 to r20 de' muscles of the shoulders to support the
grees that the supraspinatus can get hurt. weight of our arms. The muscles closest to
The tendon ofthe supraspinatus, which is the neck (the rhomboids) and those run'
about the size of a large rubber band, is the ning from the tops of the shoulder blades
part of the muscle most often injured, up into the neck itself(the levator scapu'
though the muscle itself can also tear. This lae) take the brunt of the weight. This
can happen especially in hasty and aggres' is especially problematic during arm'
sive adho mukha shpanasana (downward' intensive activities such as typing, when
facing dog) poses, as weil as in flamboyant your shoulders become set in a perpetual
versions of the newly popular pasisthasana shrug. Chronie tension builds up, pulling
(side plank pose), and in advanced arm the inner corners of your shoulder blades
balances such as tittibhasana. up toward your ears, causing your back to
Simple accidents can also injure the round and your shoulders to hunch. This

72 I YOGA + JOYFUL LIVING NOVEMBER ' DECEMBER 2007 YOGAPLU$.ORG

 WHEN THE SHOULDER
blade releases down, tbe bead of
tbe arm bone drops into tbe
joint, wbicb makes spaceJor tbe
arm to 11ft furtber.

is the beginning of a vicious cyde: the more

your shoulder blades creep up the back
from the puII of these musdes, the more
your mus des tense and shorten, puIIing
your shoulder bl ades up even higher.
As a result of this tension and the
postural misalignment that ensues, the
deltoid is far less likely to relax when it's
supposed to. If your shoulders roll foward
and the deltoid remains fully engaged as
you lift the arm from 80 to I20 degrees, it
can cause the humerus to press against
the acromion process, pinching the rotator
cuff tendon.
There are a variety of yoga poses that
can help break the cyde and restore
strength and balance to the shoulder
musdes-from simple standing poses in
which you hold your arms aloft in various
positions to those in which your arms
directIy support the weight of the body.
The standing poses described below can
help you reestablish the healthy mobility
of the shoulder blades as you lift your
arms; they will also enable you to activate
other mus des to ease the burden on the
rhomboids and levator scapulae. The
inversions, particularly the headstand,
strengthen the shoulder musdes, keeping
them more open and stress,free.

Doug Keller's yoga journey includes 14 years of

practicing in Slddha yoga ashrams, intensive traiw
ing in the lyengar and Anusara methods, and nearly
a decade ofteaching in the U.S. and abroad.

YOGAPL US . ORG NOVEMBER ' DE C EMBER 20 0 7 YOGA + JOYFUL LIVING 73

 TENSE WARRIOR " IJyour deltoids are terlSe RELAXED WARRIOR " IJyolir sholilders are
they will cause your sholilders to hund). relaxed,yoll'!lfeel the IIpper inner corners ofyollr
sholilder blades release down, as the neck softem.

FREEING THE SHOULDER BLADES fingers upward. The hunching dissipates:

To begin, extend your arms out to either the upper inner corners of your shoulder
side in warrior II pose. Make sure your blades release down your back, softening
arms are in the same plane as your shoul, the sides of your neck. Feel how the weight
ders or slightly forward of the shoulders. of your arms is supported more by your
To experience "the shrug," rotate your shoulder blades, which are plan ted firmly
hands and arms so your thumbs face on your back, and less by your neck: you'll
downward: feel how the muscles on either especially feel a firming ofthe muscles at
side of your neck hunch upward, the del, the outer edges of your shoulder blades, as
toids tense, and the shoulders feel blocked. the deltoids soften and the shoulder joints
Now rotate your hands and arms so the begin to feel more open and free . Do a few
palms face up, even reaching your little small arm circles to feel the support offered
by the shoulder blades .
The same hunching tends to happen
in parshvakonasana (side angle pose)
when you extend the top arm overhead.
/ Many students have trouble straightening
the arm: the deltoid is tight, the shoulder

SIDE ANGLE POSE Avoid pinching in

the sholilder by bringingyollr arm slightly
forward and sweeping it in a C'shaped arc.
Feel the shoulder blade release as the arm
swivels info place.

YO GA + JOYFUL LIVING NOVEMBER ' DECEMBER 2007 YOGAPLUS.ORG

is pinched, and the neck feels cramped,
making it uncomfortable to turn the
head. The problem begins once again
with the shoulder blade, which fails to
release down the back so that the arm can
swing into place in the shoulder joint.
To release the shoulder in the side
angle pose, take your top arm s!ightly in
front of your body and, while extending
out through the !ittle finger, rota te your
arm in a tiny are, making a C shape with
your hand, as if you were dipping your
!ittle finger in a bowl of ice cream . The
shoulder blade will release down your
back and away from your ear, and the
humerus will swivel into place next to
your ear, making space for your head to
turn. It's this simple yet elegant move'

A regular, targeted asana practiee

ean help JOU maintain heafthJ
rotator euJfs by bringing awareness
to Jour alignment, strengthening
Jour shoulder muscles, and opening
Jour ehest.
ment of the shoulder blade that opens
the shoulder, and also, through a subtle
downward pull of deeper muscles in the
back and shoulders, prevents pinching
of the rotator cuff.

PROTECTING THE SHOULDER JOINT

Freeing the shoulder blades is just the
beginning. Protecting and healing the
rotator cuffs- the supraspinatus in par'
ticular-involves not just realigning the
bones, but activating and strengthening
the muscles meant to counteract the
upward pull ofthe deltoid. Straight'arm
poses such as downward'facing dog and
adho mukha vrikshasana (handstand) cer-
tainly make use of these muscles, but the
shoulder is also at its most mobile and
vulnerable in these positions. It's safer
to begin with variations on shirshasana
(headstand), in which the position of the
arms and shoulders is more stable. And
since the aim of these headstand prep'
aration exercises is to make the arms
more weight'bearing, the neck can remain
safe: !ittle, if any, weight needs to be
placed upon the head.

YOGA P LUS.O R G NOV E M B ER ' DECEMBER 2007 YOGA+ JOYFUL LIVING I 75

 upside'down U shape, rather than a V. shoulders and away from the wall. If you
Walk your feet back as you bend forward are nursing an injury, go only as far as you
from the hips. Maintaining the U shape, let can without pain or stiffness in your shoul,
your arms slide down the wall until your ders; your head may only be an inch or two
body is at more or less a right angle (knees from the wall at first. That's fine. Notice
DOWNWARD DOG can be bent if necessary), and your head is how pressing through your elbows makes
ON WALL Create more in line with your upper arms; the top of your shoulder blades firm into the back,
space within the shoulders your head should not touch the wall. creating more space within the shoulders.
by pressingyour forearms Lightly engage the inner edges of For comparison, press more with your
and elbows info the wall. your biceps, drawing energy from your wrists and see how your triceps and del'
inner elbows toward your armpits. This toids activate, making your shoulders
action stabilizes and protects your shoul, tighten and hunch. Pressing through the
ders because, when engaged, the biceps elbow when the arm is weight'bearing acti,
draw the arm bones back into the shoul, "ates the deeper muscles-latissimus
der joints. To keep your shoulders open dorsi, subscapularis, and te res major-
and prevent pinching in the joints, iso' that pull the head of the arm bane down
DOWNWARD DOG ON THE WALL metrically s-ueeze your elbows toward and back, away from the acromion pro'
This exercise will help you establish cor' each other while firming the biceps, as if cess; this prevents the pinching ofthe
reet alignment in your shoulders without you were s-ueezing a beach ball between supraspinatus. While extencling back as
putting weight on your arms. Stand facing your elbows . Feel how your upper back you press through your forearms into the
the wall and place your forearms on the broadens, much as it c1id when you turned wall, avoid overly rounding your upper
wall in headstand position, with your fin' your little fingers upward in the warrior II back: let your spine descend from between
gers interlaced and your elbows shoulder' exerClse. your shoulder blades toward the floor,
width apart. Keep the palms of your hands Press your forearms into the wall to while keeping your arms active. Hold the
separated so that your arms form an stretch your upper body through the stretch for about 30 seconds.

76 YOGA+JOYFUL LIVING NOVEMBER' DECEMBER 2007 YOGAPLU$.ORG

 between your hands, pressing through
the arms firmly enough so that most of
your weight is on your arms, not your
head. Hold the stretch for about 30 sec-
onds, keeping the arms engaged.
If you can keep most of your weight
on your forearms and do not experience
pinching in the shoulder joints, then step
first one foot and then the other onto the
chair to elevate the hips, bringing more
weight into your arms. (To protect your
neck and build strength in your shoul-
ders, you may want to practice with your
head entirely off the floor, lifting so that
your head comes in line w1th your upper
arms.) Press the whole forearm into the
floor, especially through the elbows.

HEADSTAND VARIATIONS
In the next exercise, remove the chair,
then measure a leg's distance from the
wal!. Rest the crown of your head on the
floor between your hands, with your fin-
gers interlaced, your hands cupped
around the back of your head, and your
wrist bones perpendicular to the floor.
If you have neck concerns, you'll still
want to keep your head off the floor, al-
VARIATIONS IN HEADSTAND Buzld strength though it will be rather demanding. Come
in Jour shoulders and protect Jour neck bJ press- into the downward dog version first, then
ing the length 01the forearms into the jloor. step your feet up the wall, so that your
body is at a right angle- an upside-down
HEADSTAND WITH ACHAIR version of the exercise with which we
In the next variation, the arms bear more began. This pose is sometimes called
weight. This is where a prop becomes urdhva dandasana. Press through your
helpfu!. Place a sturdy chair against a arms to take the weight off your neck and
wall so that it will not slide. Sit in front of to lift your shoulders away from your ears
the chair, facing away from it, and extend and toward your waist. This engages
your legs so that you can measure a leg's and strengthens the muscles that pull
distance from the chair. When you go your arm bones away from the acromion
into the pose, you will place your elbows process, keeping the supraspinatus safe
where your heels are. and allowing it to heal.
Now come away from the chair and How effective are these exercises for
place your hands and arms in headstand mending rotator cuff injuries? In one study
position, with the elbows on the floor at published in the International Journal oJ
the spot you just measured. With your Yoga Therapy in 2006, IO people with rota-
feet on the floor, toes curled under, lift tor cuff injuries practiced similar variations
your hips up as if you were doing down- of the headstand for 30 seconds daily for six
ward-facing dog. Lightly engage your weeks, with follow-up sessions every six
inner biceps and push your forearms weeks, for an average of 4.9 months. Nine
down and away from you as you lift and out of IO patients reported improved range
stretch your hips back, creating a straight of motion in the shoulders and reduced
line from your elbows to your hips . Rest shoulder pain after the initial3o-second
the crown of your head on the floor session. At the final follow-up, eight -,..>

YOGAPLUS.ORG NOVEMBER - DECEMBER 2007 YOGA+JOYFUL LIVING I 77

 paoents sho\\-ed significantly improved firm to steady yourself; you should feel
range of motion and a 75 percent re duc' your neck lengthen as you extend down
tion in pain. None went on to surgery, through the crown of your head.
which is unusual for people with rotator As you press your elbows more fully
cuffinjuries who report a significant into the floor, you will be able to broaden
amount of pain. your shoulders, lifting them away from
If you already practice the full head, your ears and toward your waist. Feel how
stand and are aware of the alignments and the outer edges of your shoulder blades
precautions, you can include this asana in engage. The muscles you are using are the
your shoulder'strengthening'and'healing very muscles which, when awakened and
routine. While in the pose, your whole strengthened through practice, create bal,
forearm should press fully into the floor anced action within your shoulders and
to distribute your body's weight. protect the rotator cuffs from injury.
In the headstand, the shoulders have Because your shoulders play an
a tendency to hunch toward the ears. As important role in so many daily activi'
a result, the body takes on a "banana ties- playing musical instruments, typ'
pose." If you feel compression in your ing, driving, not to mention practicing
lower back or neck, it's a sign that you yoga and playing sports-it's weil worth
are indeed in a banana shape. Press a bit the effort to include inversions and shoul,
more through your elbows. At the same der'strengthening exercises in your daily
time, with your thighs firm and steady, routine. And in the end, when the burdens
HEADSTAND Collapsed shoulders cause the take your hips back slightly to align ofthe world prove to be a bit too much
body to arch into a banana shape (lift), which them more directly over your shoulders, for your shoulders, the work of turning
strains the rotator cuffs. To prevent this from hap' and take your feet forward, reaching up upside down can give them some welcome
pening, press through the forearms while lifting through your inner heels and the mounds relief. Atlas himself could have used a good
the shoulders away from the neck (right) . of your big toes. Keep your lower belly headstand. +

78 YOGA + JOYFUL LIVING NOVEMBER' DECEMBER 2007 YOGAPLUS.ORG