Some time ago I threatened to write an article about pain showing up in the joint that connects the collarbone to the breastbone. I have had a couple of more recent requests to talk about this potential problem in Supta Kurmasana. As always I try to look at the anatomy, its function, observations about the yoga posture itself and perhaps some ways that information may inform the way we work in the posture or adjust it.
I’m gonna get technical on ya for half a second if for no other reason than to teach you my algebraic (not really) equation for coming up with the technical name of any joint in the body.
The equation is bone + O + bone = Joint Name
The breastbone is technically called the sternum, the collarbone the clavicle. Add them together, make a couple of changes to the endings of each one, and you have the stern-o-clavicular joint. And it’s the sternoclavicular joint that can go “pop” while doing a Supta Kurmasana.
The requests for information about causes of pain in supta kurmasana, as of late, have unfortunately come out of injury during adjustments in this posture. But injury to this joint doesn’t only come during an adjustment. We can easily do it to ourselves if we’re not careful, and to be fair, even if we are being careful.
It seems strange to talk about being careful when talking about putting our legs behind our head and then binding our arms behind our back while face down. It can occasionally leave one to wonder why on earth we would ever do such a thing to ourselves? I believe that question might be better left for a different article some day in the future.
The joint itself is quite unique. OK… I’m gonna get anatomical on ya again. Joints are classified by their shape and/or function. Some joints live outside of the normal classifications that have been created. This is one of them. This joint is usually classified as a saddle joint, imagine two horse saddles, flip one upside down, rotate it ninety degrees and the curves forward and back meet up with one another in such a way that the saddles move along one another in two directions.
The sternoclavicular joint is shaped almost exactly like this except its curves are not quite so deep as a horse saddle. In the case of this joint, it moves forward and back in what we call protraction and retraction. It moves up and down in what we call elevation and depression. This fits nicely with the design of a saddle joint.
However, there is one additional function that lies outside the normal saddle shape. This joint also has the ability to rotate. It is in this function that the injury in Supta Kurmasana most likely occurs.
It’s not that this is the only place that we utilize the rotation at this joint. Most bindings behind our back such as Marichyasana A, B, C, D, and Prasarita Paddotanasana C with hands interlaced behind the back are other examples. What happens here in Supta Kurmasana is that we have to mix the rotation of the clavicle with retraction. Retraction is when the lateral or outer end of the clavicle is moving back in space. In this case, it happens by virtue of us reaching our arms behind our back. Mixing the two together increases the amount of pressure in the joint.
In a Supta Kurmasana you happen to be doing this combination of movements while going around your thighs. By virtue of this “obstacle” being in the way it forces us to reach further, and create more general tension through the sternoclavicular joint when we bind.
All of this makes adjustments a bit precarious depending on the student and their individual factors. Do they have short arms? Tight shoulders? Wider thighs? Wider torso? There could be a number of additional factors that could be seen as potential restrictions in the binding component of a pose such as this one. I talk more about what is required from the body to move safely in and out of supta kurmasana on pages 258-260 of my book Functional Anatomy of Yoga.
I would suggest that we look at our ability or at our students’ ability to bind in postures such as Parsvattonasana, Prasarita C (second most common place for injury at this joint with palms facing out behind the back), and the Marichyasanas.
Adjusting the Pose
I don’t want to get too deep into how one should adjust this yoga posture. The teacher should fit the adjustment to the student of course. Not to mention I’m not going to take on how to adjust the legs here. All of it together is a whole other article and perhaps even a book!
It is common to bind the arms first in this posture and then put the legs behind the head. In many poses the binding comes before the rest of the posture happens fully, for example, in those Marichyasanas I mentioned earlier. We would naturally bind our arms first and then fold forward or twist fully.
This posture might be an exception to that rule. For instance, assuming that some of you out there put yourself into a full Raja Supta Kurmasana where your legs are completely behind your head. Do you do this with your hands bound first? No, you don’t. You sit up, put your legs behind your head and then lower yourself down to the floor using those hands and arms and then after your forehead is on the floor, you bind your arms.
I’m not sure why this same order of operations shouldn’t apply to putting someone else into the pose if you’re helping them. I know for me personally, if I bind my hands first and then someone tries to put my legs behind my head, it isn’t going to happen easily for them or for me. It isn’t going to be very comfortable for me either.
Other people are different. Someone with thinner legs and longer arms might not have a problem either way they are adjusted. Think about it, does binding the legs to the side of the body allow those legs to move more easily or less easily?
Trying to adjust someone’s legs after binding their arms may even make them tighten up. Why? Because they’re trying to hold onto the binding between their fingers or hands. This is a place where that pop can happen.
The other place where the joint tends to get injured in this posture is when the arms are being adjusted more deeply behind the back. Often the elbows are squeezed together from behind. If it’s you trying to bind your own shoulder, or you trying to adjust an arm deeper, don’t forget to help the shoulder get further forward.
The shoulder should move down toward the floor before the arm tries to reach back and rotate. Moving it down toward the floor first tends to alleviate pressure at the sternoclavicular joint and make more space for the rotation to happen around the leg if it’s already behind the head.
What to do if you have an injury here?
The most likely culprit in an injury here is a torn ligament (there are always other possibilities). Before you freak out over the word tear, let’s define what that means to a ligament. Tear implies that the fibers in the ligament have been stretched past a point where they can return to their original shape/position. It’s like your old slinky. Once you stretched it out, as we all did at some point in its life, it never went back together in the same way. There would be slightly larger gaps between the coils than when it was new.
A better way to describe it is to say it was over-stretched. What do we do about this? Ice it. Reduce inflammation, and swelling if there happens to be any and keep moving the joint around. Remember that scar tissue is going to start forming whenever there is an injury to soft tissues in the body. If you do nothing, it gets tighter and more restricted.
Don’t necessarily move the joint around to the degree that tore it, but keep moving it. Just keep in mind that at a joint like this, you may quickly realize how interrelated things are in your body. Your clavicle moves with each breath you take. Muscles that attach to it also attach to your head and neck. It’s possible that injuring the sternoclavicular joint may cause a number of compensations to go on in and around your neck.
The sternocleidomastoid attaches very close to the sternoclavicular joint and then just behind the ear on the skull. Your trapezius muscle is attached to the end of your clavicle and scapula (which both move together). It’s other end attaches to the back of your head and neck. The subclavius muscles that sit under (sub) the clavicle (clavius) also attach to the clavicle. All of these muscles exert their forces on the clavicle itself and the joint. If they are in balance, then the clavicle is in balance. If some of them tense up in response to injury, which can happen, then the balance is thrown off. If the balance is off, the repercussions can be neck and shoulder pain as a result of the initial injury to the joint. So it can be much more widespread than we might initially think.
With the recent articles coming from many sources, including the NYT article that I responded to, we should all take pause and consider how we’re practicing, as well as what and how we’re teaching. If there is one thing I’ve learned over the years as a teacher observing my teachers, it is that I should be observing my students. It is my responsibility to help the student, sometimes this includes helping them go deeper and sometimes it is about holding them back from the posture and sometimes from themselves.
In a yoga posture as deep as Supta Kurmasana, it is very easy for tension to build in the tissues and joints. Pay attention to the sensations in your own body. If you’re the yoga teacher, try to imagine being that student.