Why Does My Shoulder Hurt?
Shoulder Impingement Syndrome (Rotator Cuff)
Bridging the Gap: Physical Therapy and Yoga Therapy
By: Meryle Richman, PT, DPT, MS, CST, 500 Hours- RYT, Advanced Teacher of Therapeutic Yoga
Have you wondered why your shoulder might be hurting?
Shoulder pain can occur from a large variety of activities such as overhead activities which include manual labor, vigorous and overhead sport activities that involve elevation and rotation of the shoulder joint (tennis serve, baseball pitchers, swimming, weight- lifters, volley- ball players), repetitive movements, poor posture, and performing a common yoga pose, such as “downward dog”, incorrectly.
What Is Shoulder Impingement Syndrome?
According to the American Physical Therapy Association, “Shoulder impingement syndrome develops when tendons, ligaments, or bursa in the shoulder are repeatedly compressed or “impinged.” This causes pain and movement problems”.1
The shoulder is made up of three bones, called the:1
- Humerus (the long bone of the upper arm)
- Scapula (shoulder blade)
The rotator cuff is literally a cuff over the top of the humerus (upper arm bone). Since the shoulder joint is such a shallow joint, (minimal contact between the humerus, scapula and clavicle: collar bone), it requires a strong muscular component to prevent unwanted motion. The four muscles (also known by the acronym as the SITS muscles— the supraspinatus, infraspinatus, teres minor and subscapularis — control your ability to rotate your arms and lift them overhead.
These four muscles work together to stabilize the shoulder and work individually. The supraspinatus helps hold the ball up in its socket against the downward pull of gravity on the arm, and it initiates abduction, or lifting the arm up from your side; the teres minor and infraspinatus control the external rotation of the shoulder and position the ball in the socket as you raise your arm overhead. The subscapularis is a powerful internal rotator. Conversely, their weakness can contribute to common shoulder problems such as shoulder impingement, tendinitis, and bursitis.2
- Your physician can help you determine the best treatment options for your shoulder pain, which includes rest, ice, recommend physical therapy and/or therapeutic yoga, before considering anti-inflammatory medication, and /or a cortisone injection.
- “Heal Thyself”
Integrating body awareness as a primary treatment for the prevention of shoulder impingement can be accomplished through use of correct training routines. An emphasis is placed on improving your posture, breathing, stretching, improving endurance, and strengthening of the rotator cuff muscles with activity.
3. Stretching and gradually rebuilding strength with Therapeutic Yoga
- A simple self-stretching technique to decrease tension and help restore range of motion of the shoulder region and arm function is:
Modified Downward-Facing Dog at the Wall3:
- Place your palms flat on the wall at shoulder height and walk your feet back directly under your hips. Hinge forward from your hips. Lengthen the back of your neck, as the crown of your head reaches to the front wall. Allow your face and eyes to be parallel to the floor and focus with a soft gaze (driste). Your head is between your arms and your spine is parallel to the floor. Slightly engage your abdominal muscles towards your spine.
- While keeping both hands pressed into the wall, turn your lower arms inward.
- Turn your upper arms outward so the heads of your arm bones engage in the shoulder sockets (noticing the crease on the inner sides of your elbows). Also, imagine you are “hugging” a big tree which will help to stabile or protract the sides of the rib cage (serratus anterior muscle).You can also turn your hands slightly inwards3. By improving body awareness, you will begin to ”create a little muscular action between your shoulder blades by bringing the bottom tips slightly towards each other”.4 (This will help activate the teres minor and infraspinatus muscles).
- Practice 1 – 3 repetitions/ breathing 5 breaths in and 5 breaths out.
4. Shoulder Exercise and Yoga Tips
(a) By practicing mindfulness of how you use your muscles and following proper alignment principles, you can help ease shoulder pain while exercising or during yoga for rotator cuff syndrome:
- In standing, lift your arms straight out in front of you (or slightly away from your body/scaption) and to shoulder height. Turn your palms facing each other with thumbs pointing upwards (breathe in).
- Externally rotate your upper arms, by slightly turning them away from your trunk and notice how your shoulders relax down your back.
- Engage your abdominal muscles in towards your spine and lengthen the sides of your torso
- Gently release your arms to your sides (Breathe out slowly).
- Practice 10x/2 -3 sets
(b) Body Awareness (Interocepton):
- Practice feeling the sensations of correct shoulder alignment while performing rotator cuff strengthening exercises and modified therapeutic yoga poses.(instructed by your therapist). This will help to avoid impingement when lifting your arms.
(c) Prevention and Activities
- Develop good habits with mindful alignment and shoulder awareness when you exercise or practice yoga. If pain persists, check with your therapist to review your alignment, or stop your activity and see your physician.
- Retraining of activities such as throwing, swinging a racket, a work activity, modified yoga poses to not aggravate your shoulder
- Maintaining proper strength in the shoulder and shoulder-blade muscles. A healthy shoulder relies on the proper balance of muscle strength in the shoulder region.
- Maintaining proper shoulder, neck, and -back posture, range of motion and mobility. The shoulder relies on the mobility of neighboring joints to maintain healthy, proper function.
- Avoid forward-head and rounded-shoulder postures (such as spending a lot of time hunched over, sitting at a computer).
Caring for your shoulder means developing healthy movement habits. This can be practiced with body awareness while stretching and performing gradual strengthening exercises, proper breathing, and safe yoga postures.
Check with the American Physical Therapy Association, The International Association of Yoga Therapists or Yoga Alliance to find a qualified therapist that can help you live a healthier lifestyle.
- https://www.yogajournal.com/practice/beginners/how-to/shoulder-saver-2/, J. Gumsestad, June 25, 2008.
- https://www.yogajournal.com/teach/anatomy-yoga-practice/yoga-shoulder-pain-downard-facing-dog/, J. Lasater,PT, PhD.April06,2021.
- www.iayt.org. The International Association of Yoga Therapists (IAYT).
- https://my.yogaalliance.org .Yoga Alliance.