Demystifying the shoulder in yoga and shoulder pain
If you’ve arrived on this page, you’re probably experiencing some shoulder pain. You might want to know more about the anatomy of the shoulder girdle. You might be interested in why we sometimes experience shoulder pain. Or, you might want to know how to work with shoulder pain in yoga. Shoulder pain is one of the top three most common types of pain that yoga practitioners report. Couple the high mobility of the shoulder joint with the popularity of vinyasa style yoga practices and the allure of arm balances, and we definitely have a recipe for potential pain to arise.
My years of teaching students how to practice in a way that is healthy for their shoulders over the long-term, is informed by knowledge of anatomy, by my experiences in practice, and by the experiences of hundreds of students who have worked with me. So, let’s break down the shoulder. Find out why pain so often comes up there. And learn how you might change your practice in a way that works better for your shoulders.
Anatomy of the shoulder
Before we dive into the shoulder, it’s important to point out the most common associations with the word itself. Shoulder is too vague for a detailed conversation. When you say shoulder, are you referring to the shoulder joint itself (glenohumeral joint)? Are you referring to the top? Front? Side? Are you including the scapular movements as well?
For our conversation, we need to clarify things. This is a highly mobile area that has layers of structure as well as layers of muscle tissue that affect more than one layer of structure. See how complicated it’s getting already?
What do we mean by shoulder?
In terms of structure, we have the shoulder joint itself, called the glenohumeral joint. It is composed of the head of the humerus (the upper arm bone) AND the scapula (the shoulder blade). Both of these bones are also part of the shoulder girdle which is also referred to as the shoulder complex. Each of these bones, the humerus and the scapula, has its own movements. The movement of either of these can affect the other.
Muscularly, you have muscles that move the humerus at the shoulder joint, such as the rotator cuff muscles. You also have musculature that moves the shoulder joint directly, and which indirectly creates movement at the shoulder girdle, such as latissimus dorsi. As a result of this “layering”, the positioning, movement, and stability of the shoulder girdle impact how the muscles of the shoulder joint function.
Let’s break down the anatomy, movements, and musculature of the shoulder girdle and the shoulder joint as separate but related structures.
The shoulder joint
In general, our shoulder is a highly mobile structure that allows us to place the hand in nearly any position. Our shoulders also allow us to reach overhead and to the side, which is something that most primates can do, but quadrupeds cannot. Not all of this functionality comes from the shoulder joint itself as we’re about to see.
When we say shoulder joint, remember we are talking about two different bones coming together, the scapula and the humerus. The depression in the scapula called the glenoid fossa is the “socket” of the shoulder joint. The head of the humerus is the “ball” of the ball and socket joint. When you put these two together glenoid + O + humerus, you get the technical name of the shoulder joint, the glenohumeral joint.
It’s important to note that at the end of the scapula there is a ledge that hangs over the head of the humerus. This flat area is called the acromion process. I mention it here at the shoulder joint because the acromion process impacts movement at the shoulder joint.
We describe all movements in anatomy as if they begin in anatomical position (AP). That position looks like a person standing with palms facing forward. All of the following movements are relative to AP.
Movements of the shoulder joint (glenohumeral joint) include:
- Flexion (forward)
- Extension (return to AP)
- Abduction (to the side)
- Adduction (return to AP)
- Rotation (twisting along the axis of the humerus)
- Circumduction (combination movements)
The movements of the shoulder joint are flexion and extension. Those movements swing the arms forward and back respectively. The shoulder joint also does what we call abduction and adduction. Those actions swing the arm swing out to the side and then back to the body respectively. Finally, we have internal rotation, sometimes referred to as medial rotation, and external or lateral rotation. Internal rotation happens, for example, if you take your hand behind your back and move from the shoulder joint to do that. External rotation is the return to neutral and/or continued movement in that direction. Circumduction is a circular motion that moves in the shape of a cone with the head of the humerus at the small end of that cone.
From a functional standpoint, we are talking about a ball and socket joint. Therefore, all of the movements just described are a form of rotation if you were watching the ball move against the socket itself. It’s also important to point out the connection I made to the acromion process sitting atop the head of the humerus. When we abduct at the shoulder joint, eventually, the head of the humerus bumps into the acromion. Most people can abduct their shoulder joint to about ninety degrees only. There is a small percentage of the population who have a different shaped acromion that allows them to abduct higher than the typical ninety degrees.
If we continued to raise our arm as if we were pointing at an airplane flying overhead, we would move the scapula in addition to the abduction at the shoulder joint. The movement at the scapula is upward rotation. This is the first and most obvious place where we see the interaction of the shoulder joint with the rest of the shoulder girdle. This interaction between the shoulder joint and the other parts of the shoulder girdle is required in order for us to raise our arm in this manner.
There are a number of muscles that cross the shoulder joint and therefore create movement at this joint specifically.
Muscles that cross the shoulder joint include:
- Rotator cuff group: supraspinatus, infraspinatus, teres minor, and subscapularis
- Biceps brachii (long head)
- Triceps brachii (long head)
- Teres major
- Pectoralis major
- Latissimus dorsi
The shoulder girdle
The shoulder girdle is a larger delineation we can make around the word “shoulder”. It includes, but is not limited to, the shoulder joint itself. Since we’ve now discussed the shoulder joint itself, let’s talk about the rest of the shoulder girdle in terms of its structural anatomy, movements, and the muscles included in this broader view of the “shoulder”.
There are two bones we need to add to the conversation now: the clavicle (collarbone) and the scapula (shoulder blade). One end of the clavicle attaches to the torso of the body at the sternum (breastbone) and the other end attaches to the acromion of the scapula. The technical name where the clavicle joins to the sternum is the sternoclavicular joint, created by sternum + O + clavicle. The technical name of the joint where it joins to the scapula is called the acromioclavicular joint, created by joining acromion + O + clavicle.
Keep in mind that the scapula is primarily held in place by muscle tissue. It does have a relationship with the rib cage which is sometimes referred to as a false joint. This is because it is not a direct bone to bone connection like most joints. That relationship is usually referred to as the scapulothoracic joint, combining scapula + O + thoracic to get the name, which refers to the general area of relationship in the torso.
It is important to note that these additional joints and their relationship to the torso are a key part of how it’s possible to put the hand in nearly every position possible. But we can break down these movements a little more clearly for you.
Clavicular movements for the moment are limited to the clavicle. However, it’s important to note that the end of this bone that attaches to the scapula is bound to the scapula through strong ligaments. As a result, there isn’t much movement at the acromioclavicular joint. Therefore, the basic movements of both the clavicle and the scapula overlap.
Movements of the clavicle
- Elevation (lateral end goes up)
- Depression (lateral end goes down to AP)
- Protraction (lateral end goes forward)
- Retraction (lateral end goes back to AP)
- Rotation (clavicle rotates on its axis)
Movements of the scapula
- Elevation (scapula goes up)
- Depression (scapula goes down to AP)
- Protraction (scapula slides forward on the rib cage)
- Retraction (scapula slides back to AP or further)
- Upward rotation (acromion end of scapula goes higher)
- Downward rotation (acromion end of scapula goes lower)
There is one additional movement of the scapula that most of you are already familiar with but isn’t typically listed in its normal movements. That movement is called “winging” as in winged scapula. It’s often seen in high plank or chaturanga.
The scapula is primarily held in its position by muscular tension. The only place it attaches to the torso is indirectly through the clavicle and the sternoclavicular joint at the front of the body. As a result, you have muscles that surround the scapula. Together, they create a balance in the position of the scapula relative to the torso.
The following are muscles that move the scapula directly:
Tying it all together
Now that we have the parts and pieces defined, what’s really important is how it all functions together. Because the shoulder joint is part of the larger shoulder complex, when we move our scapula, we also change the shoulder joint’s position. That is not a named movement of the shoulder joint. If you move your shoulder girdle forward and back you can see the position of the shoulder joint also move. And, if your shoulder joint is moving forward and back, it means your humerus, forearm, wrist, and hand have all been affected.
We need to recognize the difference between movement in an anatomical sense of flexion, extension etc., and the placement of a joint as movement out of its normal or anatomically neutral position. So, if your shoulder girdle does protraction, then as a result, your shoulder joint is in a different position than its anatomically neutral position.
An interconnected chain
In yoga particularly, it’s helpful to see the entire upper extremity which includes the shoulder girdle, shoulder joint, elbow, wrist, and hand as a long chain of interconnected bones and joints. This is because the entire shoulder girdle is highly mobile and in yoga we put our hands on the floor and then load weight into them. For instance, when you are in a high plank position, depending on which muscles are engaged or not engaged, your scapula will often change its position relative to neutral.
What is healthy shoulder joint function?
For healthy shoulder function, we need a balance between stability and mobility. We need sufficient scapular stability to create a stable base of movement for the shoulder joint and the rest of the arm. This creates the balance between stability and mobility.
For a simple example, when we abduct our arm, the early part of the action should be primarily from muscles that move the humerus (supraspinatus and then deltoids). Muscles that stabilize the position of the scapula (primarily serratus anterior and the lower trapezius) should be doing their part to stabilize the scapula to the rib cage. If these muscles are weak or not firing as they should, or if other muscles that elevate the scapula (levator scapulae and upper trapezius) are over-active, then we can have too much scapular movement too soon in the movement. This moves the socket of the glenohumeral joint and changes the position of the humerus within the socket.
Although we’re using the example of abduction of the arms here, you can imagine that the same important relationship exists between the humerus and the scapula for any other movement at the shoulder joint. Perhaps this is never as important as when we add on the complexity of weight bearing on our hands, and then want to move at our shoulder joint.
When that balance of muscle tension at the shoulder girdle is off in any way, whether as a result of an acute injury or accident, or as a result of chronic repeated motion or habits (which we all have), then we can experience shoulder dysfunction.
There are far more possibilities for shoulder dysfunction and pathologies than we could list here. If you have significant shoulder pain, particularly outside of a yoga practice, seek out the appropriate wellness or medical professional and get a thorough assessment. In this post, we are focused on the types of shoulder pain that frequently come up around and interact with our yoga practice. An acute injury in yoga is possible. For example you could fall out of a posture and catch yourself on your hands or go beyond where you should. But, injury in yoga is more likely to come from chronic overuse or misuse. That often happens with repetitive motions while weight bearing, such as lowering into chaturanga.
Repetitive motion issues
Repetitive motion actions in sports or work can lead to chronic shoulder issues. Those include things such as tendinitis or impingement. Those issues crop up when the muscles around the shoulder girdle get over-worked or out of balance with one another. A common postural pattern where you create an imbalance of the muscles around the head and neck is called upper crossed syndrome. This is a fancy name that encompasses the specific muscular imbalances that result in the forward head posture.
Chronic imbalance between the muscles of the shoulder girdle, or asking the wrong muscle to repeatedly do a job better suited to a different muscle, can lead to tendinitis, trigger points, or even muscle tears. Both chronic overuse of shoulder muscles, as well as acute injury, can result in frozen shoulder, technically called adhesive capsulitis. Short, tight muscles from overuse or injury can put pressure on the bundle of nerves that run from the neck out to feed the arm and hand. And that can cause issues like thoracic outlet syndrome and/or cause symptoms that mimic carpal tunnel syndrome.
Common types of pain or sensation in the shoulder
- Pinching sensation
- Dull ache (like a toothache)
- Tingling or numbness
- Sharp pain
- Arm feels heavy or dead
- Inability to move very much (limited range of motion)
Before we discuss issues and injuries, it’s important to point out that you should always get an objective perspective on things. If you have significant pain, or pain that is not going away with rest and simple care, go seek a professional opinion.
Rotator cuff issues in yoga
When it comes to the rotator cuff muscles, the main story here is one of balance. That is, the job of the four rotator cuff muscles is to maintain the multi-directional balance of tension which minimizes the translation (movement within a single plane) of the shoulder joint in its socket. While the rotator cuff muscles are movers of the shoulder joint, we tend to forget that movement is also often under tension. Another way to say that is: muscles don’t simply contract and move a joint. They also allow movement while maintaining tension (contraction). They also, at times, contract to maintain a position without any movement happening.
Therefore, when it comes to the rotator cuff muscles, think of them more as controllers than movers of the shoulder joint. When I find issues in any of these muscles, I find it helpful to look at the balance between the tension created by all of these muscles. In other words, take a larger perspective.
The most common injury that people are familiar with is a rotator cuff tear. The most common muscle that tears is supraspinatus, followed by infraspinatus. There are a number of factors that can lead to these tears. They can be acute or build up over time due to repetitive use. Another factor that we should not ignore is age. Without getting lost in the weeds, there is evidence that age alone makes the supraspinatus muscle more susceptible to tears.
If age is not a factor, and someone describes symptoms including weakness, a dull achy sensation, or traveling pain, then I tend to look at trigger points as a cause. This is especially true in the yoga community. This is because, with the amount of work we do on our hands and through our arms, these little muscles do a lot of work. When you mix in a lack of stability of the shoulder in yoga while doing postures such as chaturanga, it only increases the possibility of trigger points. These can be self treated and I would recommend reading our general article about trigger points. Take a closer look at the trigger points that form in both the infraspinatus and the subscapularis. I find these to be the most common trigger points that are activated in vinyasa style yoga.
Frozen shoulder in yoga
We have already written a full blown article on frozen shoulder in yoga. In short, what I have found over the years is that a build up of overworking the rotator cuff muscles, as well as other muscles around the shoulder joint, can lead to this condition. It’s also worth noting that it is also often diagnosed as idiopathic. This means, no known cause. Sometimes it may be age and/or hormonal changes in the body.
To help us avoid frozen shoulder, like I’ve been saying, stabilize the shoulder girdle first. Make it more likely that the rotator cuff muscles work with their mechanical advantage. The technical name for this condition is adhesive capsulitis. The capsule referred to here is the joint capsule that surrounds the shoulder joint. Guess which muscles become part of the capsule via their attachments which are simply connective tissue? The rotator cuff muscles.
Stages of frozen shoulder
Frozen shoulder goes through three main stages: freezing, frozen, and thawing. The time it takes to move through all of these stages varies greatly. Freezing represents the earliest symptom, which is limited range of motion. Frozen is exactly what it describes. There is minimal range of motion at this stage. It would be very difficult to do a normal yoga practice at this point. Finally, we have the thawing stage which you don’t want to rush, as doing too much can potentially send you back into the frozen stage.
Classical impingement syndrome is typically caused by overhead movements of the shoulder girdle and shoulder joint itself. Those are movements like a tennis serve, or the action of painting. I don’t think it’s likely that reaching our arms over our heads as we do in sun salutations would cause this. In theory, that movement could exacerbate an underlying condition that contributes to impingement syndrome, however. What’s more likely is that you come to yoga with impingement syndrome and it affects your ability to perform certain yoga postures.
The repetitive (typically overhead, but not necessarily) movement at the shoulder joint leads to general inflammation of the tendons where they run under the acromion process of the scapula. The inflammation can cause a couple of additional effects. The formation of bone spurs, bursitis, or even rotator cuff tears are possible.
In the case of bone spurs, what most commonly happens is that there is a small bony growth underneath the acromion process. Bony growths are more common in areas of inflammation. Recall that during abduction the head of the humerus eventually bumps into the acromion. If you have a bony growth there it could restrict movement. Due to inflammation and pressure, it could also cause pain.
More typically, the inflammation also reduces the already limited space under the acromion. By reducing the space, I mean that the tissues in this area are compressed due to swelling associated with the inflammation. There is a bursa in this area, called the subacromial bursa, which essentially sits on top of the supraspinatus muscle. Things can get a little circular at this point. Let’s say you overwork your rotator cuff muscles and as a result they get a little swollen. This can cause your bursa to get irritated and swollen, further reducing the space, causing more inflammation in the supraspinatus. Impingements of this type can also lead to rotator cuff tears.
The shoulder joint in yoga
There are many places where the shoulder joints are relevant to our yoga practice. Probably the two most common places for questions to come up about the shoulders in yoga are chaturanga and arm balances. This makes sense as in these two types of postures we ask a lot of the shoulder girdle because we ask it to bear weight. While it is certainly possible for us to bear weight in our hands, either instead of our feet (like arm balances), or in addition to our feet (chaturanga), our body has to make some compensations in order to make that happen.
Weight-bearing with the upper body
The biggest compensation we need to make when we bear weight through our hands instead of our feet is to use muscles to increase stability. The hip joints are strong, stable joints that are ideally suited to weight-bearing through the structure itself. The shoulder joints, in contrast, are far more mobile and are ideally suited to positioning the hand in just about any position. For those reasons, the relationship between the position of the scapula and the position of the arm/humerus particularly comes into play when we start talking about chaturanga and arm balances, as does the balance between mobility and stability of the shoulder joint.
How do we convert the shoulder into a weight-bearing joint?
In order to effectively turn the shoulder into a weight-bearing joint, we need to first stabilize the shoulder girdle, so that the force coming up through the arm meets the scapula at the glenoid fossa that is stable. The primary muscle that creates stabilization of the shoulder in yoga is serratus anterior. Of course, trapezius, rhomboids, and other muscles that affect the shoulder girdle all play a role as well. Without this stability, you are more likely to overuse smaller muscles in and around the shoulder joint itself that then try to play a dual role of both allowing movement as well as trying to maintain stability of the joint.
To be fair, this is a subtle difference from the felt-sense point of view. It’s also difficult for many students to separate out how to use scapular stabilizers (like serratus anterior) to maintain that tension and at the same time isolate and allow the shoulder joint muscles to do their work without letting the scapular stabilizers relax too much. It is helpful to have the objective perspective of a teacher when first learning this.
Keeping those shoulders out of your ears
As yoga teachers we are drawn to helping students keep those shoulders in yoga out of their ears. What we’re actually describing when we say this, is maintaining an ideal position (or close to ideal) of the scapulae in relationship to the ribcage. A healthy balance of tension between the muscles that elevate and depress the scapulae on the ribcage is necessary for that positioning.
What muscles are working?
The primary muscles which resist those scapulae creeping up the ribcage are pectoralis minor and lower trapezius, with assistance from latissimus dorsi and the lower fibers of pectoralis major. What’s also necessary for keeping those shoulders out of your ears is depression of the scapulae. The general laxity that we see in people who have their shoulders in their ears is often corrected by saying that the shoulder blades need to move back and down. The rhomboids are often suggested here.
As usual, I depart slightly from this. I actually don’t think the shoulder blades need to be brought together in what we call retraction as much as the depression part. Typically, I would start with just depression of the scapulae. What most people miss is that, although we are using the muscles that depress the scapulae, what literally moves is not the scapulae. Instead because our hands are often on the floor, in a posture like chaturanga for example, we are suspending our body weight. So, the movement is not of the scapulae. Instead it is the torso being lifted between the two scapulae. It’s the same muscles, it’s just not created by thinking shoulder blades down. It’s created by trying to push the hands into the floor.
Shoulder pain in yoga
One of the reasons why students experience shoulder pain in yoga when doing chaturanga or arm balances, is not taking the time to develop strength in the stabilizing muscles. It’s easy to get excited about those vinyasas or handstands and do too much weight bearing on the hands before your body, and more specifically your shoulder girdle, is ready for it. When that happens, other muscles, like the small rotator cuff muscles, try to pick up the slack and we can end up with an injury.
Finding shoulder stability
If shoulder pain is coming up specifically in yoga, but not in other daily activities, then one of the most common reasons for pain is recruiting the small rotator cuff muscles to do the job of other bigger muscles. If we look specifically at shoulder pain in chaturanga and arm balances, then I’m going to suggest that most of the time it all comes back to a lack of sufficient stability for weight bearing. Most likely we haven’t spent the time developing a long-term relationship with serratus anterior to keep the scapulae stable while we bear weight on a very mobile joint. Without that stability first, the head of the humerus moves around as does the scapula itself and the potential for impingement, tendinitis, and muscle tears goes up.
Shoulder pain in yoga does seem to come up more often for women, particularly around chaturanga. It does seem women generally experience greater mobility in the shoulder joints than men. But, with consistent practice focused on stabilizing the scapula to the torso with the right muscles, gaining sufficient strength in the right places to do a pain-free chaturanga is certainly achievable. It may just take a little longer for those with the more mobile joints than those who generally come to practice with stiffer bodies and perhaps strength in other muscles that they can rely on temporarily, like pectoralis major.
Postures that can stress the shoulder
The following are some of the most common places where shoulder pain, injuries, and issues can develop. The movements or positions in these postures can and should be extrapolated into other similar movements and positions in our yoga practice. What’s most important is the pattern of engagement or the recognition of the lack of healthy patterns. It’s not that in X posture you should do Y to fix it. Corrective patterns take time to develop.
By far chaturanga is the most commonly blamed posture for injuring the shoulder in yoga. This is for good reason, especially if you remember that the shoulder joint is interacting with the shoulder girdle in every movement. Basically, the movement of lowering into chaturanga makes it difficult to maintain both stability and movement simultaneously. As a result it does make it more likely that performing this posture repeatedly with bad biomechanical patterns can cause problems over time.
Everyone’s idea of alignment in chaturanga needs to evaluate who the student is, what kind of strength they have, and whether right angles are actually helpful or not for that particular student. Personally, I’m not a fan of ninety degrees at the elbow and wrist as the “rule”. If it works, that’s fine, but for many students, I’ve found that this is more stressful on both the wrist and the shoulder. This should be an article all to itself so I can break down my anatomical reasoning.
Stabilizing the shoulder in chaturanga
The most common reason that I see chaturanga lead to shoulder pain is emphasized in the thread that has been running through the entirety of this article. Basically, there is a lack of stability in the shoulder girdle, and as a result, the smaller muscles such as the rotator cuff muscles are forced to work at a mechanical disadvantage. Another way of saying that is that the rotator cuff has to work twice as hard because the shoulder girdle is neither stabilized nor held in the most ideal position.
The simplest technique to address the issue of shoulder stabilization in chaturanga is to engage the stabilizers of the scapula (primarily serratus anterior) and maintain that while relaxing the triceps enough that you are lowered down to the final position. It sounds simple enough, but having sufficient muscular awareness to actually do that usually takes time and practice to cultivate. If you do have the kinesthetic awareness that I’m referring to, then that is all you need to do in chaturanga. But if you don’t, then you need to develop the awareness of what it feels like to have serratus turned on throughout the entire movement starting at high-plank.
If you’re unsure as to whether or not you are already engaging this muscle, look no further than your scapulae. Are they winging? If the answer to that is yes, then you haven’t engaged serratus.
More on chaturanga
For a more in-depth look at chaturanga, read these associated articles specifically on chaturanga. They will give you a good grasp of the information I’m highlighting here:
The shoulder joint in chaturanga: Who are you going to blame?
What is the right alignment in chaturanga?
Should we jump into plank or chaturanga?
Should you land in plank or chaturanga?
Chaturanga and shoulder injuries in yoga – what’s going on?
Sun salutations 6: Lowering into chaturanga
Upward facing dog
Upward facing dog is yet another posture where shoulder, and even wrist pain issues, can arise. This shoulder pain is different from what was just discussed in chaturanga. In this case, we do need stabilization, but pain in upward dog is typically more of a problem of strain on the shoulder joint which leads to stress on the musculature that surrounds the shoulder joint, particularly at the front.
I’ve written about this many times. Since we delineated the shoulder girdle from the shoulder joint in yoga, it helps us here as well. One of the most common verbal cues that I hear for shoulder correction in upward facing dog is to squeeze the shoulder blades together and down. I would say, the intention behind this cue is right. I think the intention is to reset the scapula to a place where it is in a more “optimal” position and the muscles surrounding this area are not placed in a mechanical disadvantage. The part that is often missed, however, is looking at what has set the student up in a position which has made their shoulder blades go too far forward so that they now need to be brought back.
Setting up upward dog
It is very common for students to end up with the upper body too far forward by the time they arrive in upward facing dog. This can come from the technique that they use to arrive in upward dog from chaturanga, which often precedes this posture. Essentially, they do not have enough distance between their hands and their feet in upward dog relative to the amount of backbending that is possible at that moment. This leads to the shoulder in upward dog ending up too far forward and puts them in a less than ideal position which makes it harder to lift up and away from the floor through the hands, so the shoulders end up in the ears. Too far forward means that as teachers we want their shoulders back, so, then we ask for the squeeze.
However, if the foundation is not set up at the right distance from the beginning, the student will not have access to the muscular strength needed for the two parts we are talking about here in the shoulders. It will be hard to lift their torso through their shoulder blades (keeping shoulders out of ears) and they will feel like they need to squeeze the shoulder blades back because they are not easily sitting in a neutral position.
Downward facing dog
Downward dog has its issues with shoulders as well. One of those issues is students having the shoulders in the ears just like they might in upward facing dog. The other issue, which is partly related to the shoulders-in-the-ears issue, is a pinching sensation somewhere around the top of the shoulder.
I hate to beat the drum of serratus anterior and its importance, but I’m going to beat the drum of serratus anterior and how important it is. To avoid shoulder issues and shoulder pain in yoga, I keep coming back to getting the shoulder girdle into the right place first. Then, allow the shoulder joint to make smaller corrections if needed and allow those muscles to work at their mechanical advantage. Just to say that in reverse, we shouldn’t correct the shoulder joint/humerus before making sure that the shoulder blades are in the right place first.
Where to place the shoulders
What is the right place for the shoulder blades? To start with, in neutral at a minimum. Some students will try to hang through their shoulders in downward dog. Because of the nature of the position of the body in downward dog, this will pull the torso through the shoulder blades. Hanging through the shoulders in downward dog puts the scapulae in a retracted position, which can put a lot of stress at the top of the shoulder because the scapulae are NOT in their most secure position. With the scapulae fixed in this less secure, retracted position, the body weight and force goes into the shoulder joint itself, putting that stress at the top of the shoulder.
Engaging serratus in downward dog
The way out of this is to engage serratus anterior, which you’ll remember is a protractor of the scapula. Using serratus anterior to protract the scapulae in this position will bring the torso back through the shoulder blades. Interestingly, this action is often enough to get the shoulder blades out of the ears as well. If it’s not, then there is no harm in a little depression of the scapula as well. If that’s what’s needed to get the shoulders out of the ears then that’s fine.
It is after the shoulder blades are in place that you would then make any corrections to the arms or shoulder joint itself. Not everyone should have the crease of their elbow facing forward in any posture. So, try not to make that a thing unless it is specific to that person for a reason. This rotation at the shoulder joint can be used to help alleviate the pinching sensation at the top of the shoulder joint if stabilizing the shoulder girdle and repositioning the scapulae has not already achieved that.
The takeaway here, in my mind, is the order of operations. First, use the larger more impactful muscles and structures. Then, fine-tune that with the smaller more vulnerable joint only after doing that.
Everyone loves the challenges of arm balances. But, too many arm balances not built on a solid foundation can become problematic relatively quickly. I’ve written a detailed post specifically about handstands, So You Want To Do A Handstand, that lays out the hard work it takes to build up the right patterns to make you successful.
This is another posture where people often focus on the line created between the hands/wrist/shoulder and the rest of the body. I don’t think that there is anything wrong with alignment, but if it is to the exclusion of function then it might simply be inappropriate. Remember, postures evolve over time. What we think of as the ideal version of any posture is somewhere that we are heading, not necessarily where we start or where we are now. I mean, should someone who is new at handstands really be trying to make themselves look like someone who has been doing it for years?
Stabilize your arm balances
Unfortunately, I’m going to repeat myself yet again. Arm balances require a large number of muscles to be in a stabilizing mode of operation. This stabilizing once again needs to start at the shoulder girdle level with muscles like serratus anterior engaged, but not limited to those muscles. From there, we can use the smaller muscles that stabilize the shoulder joint itself such as the deltoids and rotator cuff muscles.
The muscles we use to stabilize the shoulder girdle in arm balances should be built up over time and through movements that we do in our regular practice. I talk about this a bit in the sun salutation series that I did. It makes sense to me to build up the strength in postures that are less demanding than a full fledged arm balance. Get the pattern and training of the muscles right first, and then build up into more full or intense arm balances.
How to develop those patterns of shoulder stability
When you’re looking to develop long-term patterns that take time to acquire, like training shoulder strength and stability, one of the best things that you can do is to consistently use each of the smaller opportunities to train those actions. One of the most common sequences of movements that we do in yoga is some variation of a sun salutation. The sun salutation offers many points to connect to serratus anterior in particular, and to start training a pattern of stability in the shoulders. Every time our hands connect to each other, as in the “arms up” position, or to the floor, as in the “look up” position, we can be intentional about pressing into them. This activates serratus anterior. The more often we do these small actions in simple poses, the easier it is to find and maintain them in a more challenging shape, like chaturanga.
The other important piece that is necessary for cultivating a pattern of stability in the shoulder girdle is a willingness to be patient, practice consistently, and take time. Avoid doing too much practice, too many vinyasa transitions, or too many arm balances too soon! Do what you need to do to take care of your body while slowly cultivating strength in the shoulders. Put your knees down in chaturanga, don’t lower down so far, and just do fewer vinyasa transitions or chaturangas until you have gained sufficient strength to add more.