The shoulder is a complex joint that allows for motion in nearly 360 degrees. It’s no surprise that anything that intricate can also experience dysfunction. In yoga it’s not uncommon for practitioners to intermittently experience some kind of pain or discomfort of the shoulder. In fact, in our survey of yoga injuries, the shoulder was the third most common place for practitioners to report pain or injury. And when we experience pain, we tend to want to know what is causing it! That can lead us to wonder about reasons for shoulder pain that we’ve either heard or read about. One of those potential causes that comes up is shoulder impingement. In this article we’ll take a look at what shoulder impingement is and what it isn’t. We’ll also explore some ways to adjust your yoga practice for shoulder pain.
What is shoulder impingement?
The full technical name for shoulder impingement is: subacromial impingement syndrome. The name says something about what it is. Shoulder impingement occurs when the space in the subacromial area is reduced and pressure, or impingement, is placed on the supraspinatus and/or bicipital tendons. The subacromial area is the space underneath the bony ledge of your scapula that juts out over the head of your humerus (upper arm bone).
Symptoms and diagnosis
Symptoms of shoulder impingement usually include pain at the front and lateral side of the shoulder near the acromion. Lying on the affected shoulder or raising that arm up overhead may also cause pain. The pain symptoms are sometimes accompanied by a feeling of weakness in the affected shoulder.
Diagnosing shoulder impingement syndrome can be tricky as symptoms are sometimes very similar to other shoulder issues. Symptoms can even mimic those of the early stages of frozen shoulder. Diagnosis is done by getting a thorough medical history, possibly doing an MRI, and likely includes diagnostic tests for different types of shoulder range of motion. Physical diagnostic tests can help your doctor determine what the cause of your pain may be by determining specifically which shoulder motions elicit your symptoms. Diagnosis is something that is done by an orthopaedist or other qualified medical professional. So, if you think you might have a shoulder impingement issue, see your doctor.
What causes shoulder impingement?
Subacromial impingement can be caused by anything that reduces the subacromial space and results in pressure and/or rubbing of the tendons that attach in that area. Specific causes include things like rotator cuff tears, swelling or irritation of rotator cuff tendons, or swelling of the bursa in the shoulder. Conditions like bone spurs can also result in shoulder impingement conditions. Causes are often related to repetitive motion type activities or sports. Sports like swimming in particular, where you are reaching your arm up and over your head, create a potential for over-use. Tissues in the subacromial space can become inflamed and start to rub against the acromion.
Is your pain in yoga shoulder impingement?
While it’s possible your pain is a shoulder impingement, it’s probably not. The shoulder joint is a delicate, complex joint, with potential for many different kinds of dysfunction that can present pinchy pain sensations. But that doesn’t mean that you have a shoulder impingement. Because the shoulder and its associated structures is so complex, it’s actually possible that you may never know, anatomically, exactly what is causing some intermittent pinchy sensations.
Working with pinchy shoulder sensations in yoga
Even if you haven’t pinned down the exact anatomical cause of your shoulder pain, you can still make adjustments to your yoga practice to eliminate that pain, however. Two of the most common poses where that pinchy shoulder pain comes up are downward dog and urdhva dhanurasana (wheel pose). So let’s take a look at how you might work with shoulder pain in those two poses. Just remember that those two poses aren’t the only place where pinchy shoulder pain might come up. We’re just looking at two of the common poses as examples.
When we start looking for how to avoid shoulder pain in downward dog, it’s important to remember that our shoulders are connected to the rest of our body. When we place both our hands and feet on the ground, we’ve created a closed chain with our body. This means tension both above and below our shoulder joints can affect what we feel in our shoulders. If we’re feeling shoulder pain, then we need to look for some ways to change that tension. One of the simplest ways to change that tension is by moving the hand and wrist end of the upper body kinetic chain.
There are several ways I work with students to explore eliminating their shoulder pain in downward dog. I might first try having them just turn their hands a little bit out. Yes, that violates the “rule” of having some particular finger pointing forward, but that’s not a rule that I subscribe to anyway. What can happen for some students, is that the action of turning the hands just a little bit out rotates the shoulder joint a little bit more externally too. And that adds enough additional room to the subacromial space to stop that pinchy feeling. I might also give students the cue to bring their elbows towards each other just a bit. That cue can have the same result of rotating the shoulders more externally and creating more space at the joint.
Just like downward dog, when we’re in wheel, or backbend, we have both our hands and feet on the floor. So we’re in a similar closed chain with our body as we are in downward dog. In fact, the parts of our upper body kinetic chain of hands, wrists, arms, and shoulders are in a similar relationship to one another in wheel as they are in downward dog. For that reason, the changes that I might start exploring with a student who is feeling shoulder pain are very similar. I might start by having a student explore turning their hands out a bit and/or bring the elbows towards one another. The intention of those cues is to create that additional external rotation of the shoulders.
In wheel, we have the added tension from the hip flexors that can restrict the shoulders, however. Working with that tension is really the subject of a separate article. You can read more about how to do pain-free backbends in my previous article: How To Avoid Low Back Pain In Urdhva Dhanurasana. The important takeaway is that if the tension you’re experiencing in your shoulders is really the result of tension in the hip flexors influencing where you can place the shoulder girdle, then you may need to back out of the pose and spend some time lengthening those hip flexors first.
Creech, J.A. and S. Silver. Shoulder Impingement Syndrome. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554518/
Koester, M.C., M.S. George, J.E. Kuhn. 2005. Shoulder impingement syndrome. The American Journal of Medicine. 118(5):452-455.