As many of you know I love yoga. Now that I am not able to run (Find out why in my book: Racing Heart), I practice as often as I can to clear my head, stay strong and be active. I wish I had realized the benefits of yoga long before I lost my ability to run, bike and swim because there is no doubt it would have helped me.
However, like any other sport, there can be injuries in yoga. Shoulder injuries in yoga are extremely common. Just last week I saw three people who hurt their shoulders in yoga! Each of them presented the same way. Their pain was in a similar location, they described it the same way and they injured their shoulders while performing the same pose. Since I keep seeing this injury in my yogis, I decided to name this injury “yoga shoulder."
What is yoga shoulder?
It is pain and discomfort that is in the anterior (front) aspect of the shoulder near or on the long head of the biceps. The long head of the biceps attaches into the shoulder labrum and capsule. The shoulder will feel achy, and there will be sharp pain when the shoulder is loaded or behind the back. The poses that typically bother it are most often chaturanga, side planks and binds behind the back.
What causes yoga shoulder?
I believe the cause of yoga shoulder is multifaceted. Essentially, the biceps tendon on the shoulder becomes aggravated when it is overused and overloaded. Sometimes, if it has been happening for a long time, it will also aggravate the labrum. One of the contributing factors is likely decreased motion in the thoracic spine (middle of the spine), rounded shoulders, poor postural awareness, tightness in the anterior musculature and weakness in the rotator cuff muscles and scapular stabilizers.
The glenohumeral joint (shoulder joint) relies on its musculature to maintain its stability. The shoulder joint is inherently unstable because the socket is shallow and the head of the humerus is large. Imagine a golf ball on a golf tee. The rotator cuff muscles are its main source of stability, followed by the scapular stabilizers (serratus anterior, lower trapezius, etc.). When there is weakness in these muscles, stronger muscles like the biceps, pectorals and upper trapezius take over.
The thoracic spine rotates, sidebends, flexes and extends. The combined movement of the thoracic spine and shoulder allows us to reach overhead, internally and externally rotate the shoulder, perform binds during various poses and much more. When the thoracic spine is hypomobile (tight), then the shoulder tries to compensate because of its inherent instability and flexibility. This causes more stress at the glenohumeral joint and soft tissues around the front of the joint, such as the biceps tendon, often causing pain and dysfunctional movement patterns.
Poor postural control, including rounded shoulders, can lead to muscle imbalances, tightness and shortening in the anterior musculature, such as the pectoralis minor and major. It can also contribute to the lengthening and weakening of the posterior musculature, such as the middle trapezius, lower trapezius, rhomboids and serratus anterior muscles. This imbalance will cause us to improperly use our shoulder during yoga. It can be difficult to determine which came first: poor posture or the muscle imbalance. Either way, both issues must be addressed to restore balance and harmony in the shoulder.
How do I avoid yoga shoulder?
Slow down.If you find that you cannot keep up with what the teacher is saying in class, it's okay - going fast doesn’t make you a better yogi! When you slow down, you can be more aware of where your shoulders are in space
Keep your rib cage down and shoulders back. This doesn’t mean stick your chest out. It means glide your shoulder blades down and back toward the opposite back pocket. When you do this, notice and ask yourself, “Is my rib cage sticking out?” If it is, gently pull it back down.
Roll your shoulders back.Many people don’t realize it but they roll their shoulders forward to assist in chaturanga or lowering themselves down to the floor from a plank position. If your shoulders are rounding, then the pose you are doing is likely too difficult. Put your knees down, and modify the pose until you are truly strong enough to perform it correctly. This applies to poses on your side as well.
Use the rotation in your thoracic spine first, then move from your shoulders. If this means the pose doesn’t look like you think it should, it's okay - again, ask yourself, “Why am I doing this? To show everyone else how good I am or to improve how my body is moving?” If you are truly there to help yourself, who cares it you can’t reach your arm all of the way back.
What do I do if I am already having pain in the shoulder?
If your symptoms are similar to the symptoms I have described above, you can start to improve your thoracic mobility on a foam roller, stretch out your pectorals in a doorway or on the roller and start strengthening your scapular and rotator cuff muscles.
If you have pain for more the seven days, I always think it is important to have someone look at it to make sure it isn’t serious. I might be biased, but a physical therapist should be the first line defense against shoulder pain! There are several possible shoulder injuries that you may have; yoga shoulder may not be why your shoulder is hurting. Physical therapists will likely do manual therapy to help improve the tightness and flexibility of the thoracic spine and shoulder musculature so as to help you strength your muscles and improve your posture!