Some time ago I threatened to write an article about pain showing up in the joint that connects the collarbone to the breastbone. I just had a couple more recent requests to talk about this potential injury in supta kurmasana. As always I try to look at the anatomy and its function, and make some observations about the yoga posture itself. Then we can look at how that information can inform the way we work in the posture or adjust it.
The sternoclavicular joint
I’m gonna get technical on you for half a second. I’m going 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 is called 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 supta kurmasana.
The requests for information about causes of pain and injury in supta kurmasana, as of late, have unfortunately come out of injury during adjustments in this posture. But injury in supta kurmasana at 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. Okay, I’m gonna get anatomical on you 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.
Rotation of the sternoclavicular 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 padottanasana C with hands interlaced behind the back are other examples.
The sternoclavicular joint in supta kurmasana
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 supta kurmasana you happen to be doing this combination of movements while going around your thighs. This “obstacle” in the way forces us to reach further and creates more general tension through the sternoclavicular joint when we bind.
Adjusting the pose
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 are a number of additional factors that could be 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 (1st ed.) of my book Functional Anatomy of Yoga.
I don’t want to get too deep into how to adjust this yoga posture. 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! The teacher should fit the adjustment to the student of course. I would suggest that we look at our ability, or at our students’ ability, to bind in postures such as parsvottanasana, prasarita padottanasana C (second most common place for injury at this joint with palms facing out behind the back), and the marichyasanas.
Should you adjust the arms or legs first?
It is common for many teachers to bind the arms first in this posture and then put the legs behind the head. In many poses we bind the pose before the rest of the posture happens fully. For example, that happens 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, let’s assume 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. 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. But, other people are different. Someone with thinner legs and longer arms might not have a problem either way they are adjusted.
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 hands. Think about it, does binding the legs to the side of the body allow those legs to move more or less easily? This is a place where that pop, that sound of an injury in supta kurmasana, can happen.
Adjusting the arms
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 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 for an injury in supta kurmasana 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 were 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 forms whenever there is an injury to soft tissues in the body. If you do nothing, it gets tighter and more restricted.
Compensations in the body
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 an injury in supta kurmasana at the sternoclavicular joint may cause a number of compensations 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). Its 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 an injury in supta kurmasana, which can happen, then the balance is thrown off. When 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.
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.
Recently I have managed to cross my feet and bind my hands without adjustments I have been doing it for sometime but I also feel some discomfort to my left shoulder. Also it seems that the acromium is protruding up higher than the right. And I feel tender if it is being depressed from the top. Its not pain but like soreness and tenderness. Raising that arm up also feels uncomfortable. Any advise? Should I stop Supta K?
Thank you so much for this article. I’ve been doing kumasana/supta for the past month and half now, and have always felt pressure in my right clavicle (however, never any pain or pops). As my mysore practice has progressed, I have recently found that deep backbends cause me to experience a temporary numbness in my right thumb and pointer finger (for about an hour after practice). This numbness is recent, and I was wondering if the pressure felt in supta kurmasana (right clavicle) could have been causing a nerve pinching in my right shoulder/neck. Do you think these two things could be related? Is there something I can focus one during kurmasana/supta to help reduce the pressure on the right side?
Mary….I have had similar issue which led me to this article. Have not seen reply on your comment but would love to hear more regarding.
There’s definately a lot to know about this issue.
I love all of the points you made.
Can an injuruy in the sternum, or clavicular join lead to a neck injury.
One year ago I expirienced very uncomfortable pain in the sternum. I could hardly breath. After that I got shoulder pain, and 4 months ago i got a neck proble. After making a xray, it showed that I have a cervical spine straightening.
It has taken me one year to come back, but still in some poses I can feel a felling of tension in my sternum. This mainly after kapot asana, cobra, supta kurm asana also in some of the back bends.
Do you have any suggestion?
The answer is… YES, an injury in the sternoclavicular joint can lead to neck trouble. There are muscles in the neck that attach to the clavicle and the first rib. It’s possible that the neck straightening was there even prior to all of this, we don’t really know. However, it is also quite possible that the same muscles that attach to the clavicle could create or add to the neck straightening problem.
The first thing that I would do is to check the following muscles and treat them as thoroughly as possible.
All of them have attachments to or over the clavicle and could be part of your problem. I hope you can find a good therapist to help you. I would suggest that before trying to do some particular yoga posture to help.
Excellent article and I know a few friends who have suffered exactly this during a Supta K adjustment. A few months ago when I was adjusted in this pose I had a severe pain in my sternum. It caused me some pain afterwards and left me with a bump 1/3 down right in the middle of the sternum. Also it seems that the rib on the right is depressed and the one on the left is raised slightly. It still bothers a little during Supta K, Baddha K. and jump backs. I guess whenever there is pressure in this region. Do you have any ideas about this or what can be done to help it? Thanks greatly. Loved your anatomy videos also 🙂
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What do you recommend for the pain that might be created on neck and shoulders after a kurmasana class?
What do you recommend to keep the joint moving around?
Thank you for this wonderful article — very helpful!
I have a question regarding the use of the word “popping” in this joint. If you feel a pop, is that always a bad thing, or can you pop the joint (like popping your knuckles) without injury? I recently felt a dramatic pop on the right side after I had been deepening my Prasarita Paddotanasana C for the past week. (It didn’t even happen during practice, but while I was riding in a car). It felt sore for about 2 days and then was largely fine. Does this sound like an over-stretched ligament, or just gaining mobility in that area?
Did you do anything treatment-wise for the two days you were sore? Mine popped today while I was swimming. Wondering what you did: meds, ice, sling, rest or practice. … any advice would be appreciated! Thanks!
Thank you for this excellent article. I emailed you asking about this injury and no sooner then I checked back was there an article up and ready to read. I am beyond words grateful for the amazing community that yoga can offer and especially grateful that you took the time to write this article. I experienced this pop and it is now much better. It was definitely a learning experience and this injury certainly forced me to take that pause in my practice that you mentioned. I hope one day I can have a chance to learn from you face to face but for now I’m pretty happy for the internet and a chance to learn from you via the web! Thank you again for an extremely clear and thoughtful article. All the best, Erica (Angie’s friend!)
David in prasrita C do you recommend hands facing inward to the back or outward?
thank you for sharing
I look at the three possible hand positions as a progression to open the shoulders if needed. The first most simple one is with fingers interlaced, palms facing toward the back. Second hardest, more pressure into shoulders. Third is with the palms facing out. Usually most difficult and maximum pressure into the shoulders. The “ideal” would be to have your hands like this. Hope that helps!
yes it helps, thank you (:
Another side note. The chest generally collapses inwards and potentially “pops” due to lack of strength or engagement in the back of the body. To lessen the chance of injury in the front, the student should engage the rhomboids to squeeze the shoulder blades together, and thereby opening the chest, making more room and less stress in the area you are talking about 🙂 Hope this helps!
I would totally agree with you if we were limiting the discussion to Kurmasana. In Supta Kurmasana the shoulder blades do naturally move back when we take our arms behind our back. As I said in the article, the combination of rotation and pulling the clavicles back is often the culprit in this.
In Kurmasana, they can get over compressed in the other direct. I agree that a press back with the shoulder blades against the legs that are on the upper arms is a good idea in this pose to avoid the compression.