SHOULDER TO SHOULDER The Range Of Possibilities

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1 mouse click to advance the slides SHOULDER TO SHOULDER The Range Of Possibilities

2 HATHA YOGA Hatha yoga asanas Take the shoulders through every possible range of motion in both weight-bearing and relatively non weight-bearing situations Are practices of very specific forms of shoulder movement that finetune the actions of the shoulders. What is needed: A clear understanding of the movements of the shoulder blades moving in harmony with the arm and collar bones. Basic points of assessment for fine-tuning the movements of the shoulders. Awareness of the key muscles which impede shoulder movement, and targeted exercises and stretches for working with them. Expression of the movements that are simple and memorable enough to practice both in asana series and in daily life. The Goal: Open Shoulders: freedom and stability in self-aware movement, providing the greatest range of motion without irritation of the joint.

3 STRUCTURE OF THE SHOULDER Four Joints of Shoulder Girdle Sternoclavicular Joint AC (Acromioclavicular) Joint Glenohumeral Joint The Shoulder Blades Most Common Injuries (apart from traumatic injuries/accidents) Tendonitis: Rotator Cuffs Muscular and Trigger Point Pain Disk Herniation (neck) through postural tension Sternum & Collarbone Acromion & Collarbone Humerus & Glenoid Shoulder Blades Common Link: Alignment and Movement of the Shoulder Blades

4 ROTATOR CUFF INJURY The Deltoid and Supraspinatus in the Arc of Pain The rotator cuff muscles attaching to the shoulder blade hold the head of the arm bone snugly in the glenohumeral joint, while yet allowing it great mobility. Rotator Cuff (Supraspinatus) Deltoid Arc of Pain indicating injury Deltoid Rotator Cuff (Supraspinatus) Arc of Pain indicating injury Deltoid Deltoid The simple act of lifting your arm involves a fine interplay between the deltoid muscle and the rotator cuff muscle, supraspinatus. The supraspinatus tendon runs underneath the acromion process the outer shelf of bone formed from the shoulderblade and can easily get pinched in the process of lifting the arm. Pull of Supraspinatus Supraspinatus Pinched Pull of the Deltoid Rotator Cuff (Supraspinatus) Rotator Cuff (Supraspinatus)

5 FIRST STEP: CORE ALIGNMENT Adjust and Center from the Foundation or Root in Feet and Pelvic Floor Adjust and Center from the Hyoid / Root of the Palate

6 SHOULDER BLADE ACTIONS Arms Overhead Initial Phase Hands forward, Shoulders Back Adduction, Posterior Tilt Lift to T Position: Setting Phase Rotate Arms to Thumbs Up External Rotation & without overuse of Rhomboids, Levator Scapulae Setting Phase for scapulae (moving up to 60 o ) Scapula is seeking stability relative to humerus: stationary, with slight lateral or medial rotation

7 BEYOND THE ARC OF PAIN During shoulder flexion, as the arms are lifted overhead, the following movements of the shoulder blades have to take place: The outer corners of the shoulder blades rotate upward: the lift comes from the upper trapezius, which allows the deltoid to relax somewhat, and the humerus to drop downward. The shoulder blades abduct The shoulder blades tilt posteriorly The bottom tips ( inferior angle ) of the shoulder blades rotate laterally, moving away from the spine. As the arms come overhead, they ideally rotate about 60 degrees Upward Rotation Posterior Tilt Upward Rotation less than 1/2 protrusion Lateral Rotation Abduction Lateral Rotation 60 o

8 LIMITERS OF MOVEMENT Tight Muscles Levator Scapula and Rhomboids upper back tension from patterns of use Pectoralis Minor Levator Scapula Supraspinatus Rhomboids Coracoid Process Pectoralis Minor Coracobrachialis

9 KEY FEATURES OF HEALTHY SHOULDER MOVEMENT 1. No Winging Winging is when the inner edge (vertebral border) of the shoulder blade comes away from the rib cage during shoulder flexion and usually abducts excessively as well. The cause of winging : the scapulohumeral muscles those deep muscles that attach the arm bone to the scapula are short, while the axioscapular muscles those muscles that hold the shoulder blade to the trunk (especially the serratus muscles) are weak It can be the case that the shoulder blade does not wing on the way up, but does when the arm is returned down. This shows more a failure of timing among the muscles rather than of strength. 2. Some Scapular Elevation from the Upper Trapezius There is some elevation ( shrugging ) of the shoulders as the arms come overhead, but not during the setting phase of flexion and abduction. The right kind of elevation comes from the upper trapezius, which can be strengthened by practicing shrugging when the arms are overhead. The upper trapezius brings the proper upward rotation of the scapulae, while allowing the levator scapulae and upper rhomboids to release.

10 3. Reversal of Direction at the End of Range When the arms come fully overhead, a slight reversal of direction has to take place: the shoulder blades should slightly depress, posteriorly tilt, and adduct in order to complete the motion to 180 degrees Virabhadrasana 1: Hands forward, shoulders/armpits back. These actions can be limited by shortness in pectoralis minor and kyphosis 4. Head of the Arm Bone (Humerus) stays centered in the joint ( glenoid ) throughout the action How well this is done will be a function of the scapulohumeral muscles which pull down upon or depress the head of the humerus, offsetting the upward pull of the deltoid muscle. Key actions: hugging and retracting the beach ball inner bicep & pinky connection Key poses: weight-bearing inversions such as Sirsasana 1 and Pincha Mayurasana prep variations Otherwise, if pectoralis major and latissimus dorsi dominate in depressing the head of the humerus, they will also cause the arm bone to rotate medially (internally, as opposed to the correct lateral/ external rotation), thus complicating the timing and coordination of the humeral motion with that of the shoulder blades. Prime example: Downward Facing Dog Pose with shoulders pinching.

11 5. Movement of the spine should be minimal Often the chest opening or heart opening is confused with/substituted for proper action of the shoulder blades, when it is actually a compensation for impaired movement of the shoulder blades. Kyphosis rounded upper back will tilt the shoulder blades anteriorly, limiting the range of motion. Kyphosis needs to be addressed progressively in order to enable greater flexion, and practices of shoulder flexion will help overcome kyphosis: But beware of compensations in the spine, and of forcing the shoulder/glenohumeral joint. 6. The rhomboids should not dominate in arm rotation This dominance results in shrugging and especially accompanies kyphosis and forward head. Key Practice: Robot Arms as practiced at the wall or in Setu Bandha. The right action is that the humerus rotates in the glenoid on its vertical axis (especially during the first 35 o of rotation), without adduction of the shoulder blades. The shoulder/humeral head should not move forward (anteriorly) or superiorly (shrugging up toward the head, shortening the neck). These actions show that the back (posterior) portion of the deltoid is dominating over the deeper but more appropriate rotator cuff muscles, the infraspinatus and teres minor muscles.

12 MISALIGNMENT SCENARIOS PART 1: Impaired Shoulder Blade Movement 1. Initial alignment of shoulder blades is correct; movement of shoulder blades is impaired. 2. Initial alignment of shoulder blades is incorrect; movement of shoulder blades is impaired. Recognizing Impaired Movement of the Shoulder Blades Impairment of movement (regardless of misalignment) shows up in the first part of movement There is a great deal of variation among individuals during the setting phase : the first 60 degrees of shoulder flexion and 30 degrees of abduction. Thus it is better to compare one shoulder to the other (comparing the movement of the bad shoulder to the good ) to provide a reference point. Watch the timing when the pain begins during the movement and by comparison figure out which kind of movement is insufficient or impaired Often the shoulder blade will stop moving at about 140 degrees of shoulder flexion; the rest of the movement happens entirely in the glenohumeral joint. This impairment in the movement of the shoulder blade itself arises from tightness in the muscles controlling the shoulder blade.

13 MISALIGNMENT SCENARIOS PART 2: Misaligned Shoulder Blades 1. Initial alignment of the shoulder blades is incorrect, and while the shoulder blades have a normal range of movement, it is not enough to make up for the initial misalignment. 2. The initial alignment of the shoulder blades is incorrect, and the excessive range of movement of the shoulder blades is enough to make up for it but is at the root of other problems caused by that overcompensation. Attending to Misalignments of the Shoulder Blades In these cases, we have to attend more to the initial alignment of the shoulders, since the actual movement of the shoulder blades is judged to be at least OK. In the case of an excessive range of movement in the shoulder blade, the misalignment has to be addressed first, and then the shoulder blade must be stabilized.

14 Abduction of the shoulder blades The shoulder blades move laterally away from the spine often accompanied by an anterior tilt of the shoulder blades causing the lower tips of the shoulder blades to protrude from the back. Cause: tightness or shortness of the muscles of the front body (pectorals); weakness in the upper back. Effect: the upper back is rounded sharp pains or spasms in the rhomboids and middle trapezius because of that weakness. Muscular Factors: Shortness of (anterior) deltoid or supraspinatus Long/weak trapezius and rhomboid muscles are unable to hold the scapulae in normal alignment, (3 inches from the spine) Short pectoralis major muscles hold the humeri in medial rotation and horizontal adduction; combined with short scapulohumeral muscles, the pectorals pull the scapulae into abduction when taking the arms overhead (shoulder flexion) Over-emphasis in exercise upon muscles of the front body

15 Structural Factors in Abduction: Kyphosis, or rounded upper back the curvature of the ribs moves the scapulae laterally Long and/or heavy arms Large chest or thorax, large breasts: contributes to shortened deltoids and serratus anterior muscles Scoliosis: the thoracic hump poses a barrier to movement, causing the scapula abduct Challenges associated with Abduction: Medial (inward) rotation of the humerus especially from shortness of pectoralis major can contribute to abduction. Appearance of medial rotation can actually be due to abduction: when the shoulder blades are properly placed, it turns out that the arms had the proper rotation. Appearance of proper rotation can actually turn out to be laterally (externally) rotated when abduction is corrected. Winging of the Shoulder Blades: (in Plank or Chaturanga): the serratus anterior muscle has adaptively shortened, affecting how well the serratus muscles can hold the shoulder blades to the back. Stiffness or shortness in the scapulohumeral muscles (which include the rotator cuffs, e.g. subscapularis) can also contribute to winging by limiting how far back the shoulder can be drawn into adduction.

16 Adduction of the shoulder blades The shoulder blades move medially toward the spine often accompanied by an posterior tilt of the shoulder blades causing the lower tips of the shoulder blades to press into the back. In the extreme, this presents itself as an exaggerated chest opening Cause: the combination of adduction and posterior tilt is more often than not a yogi s disease arising from exaggerated or simplistic instructions regarding shoulder blade actions. Hypermobile students end up pinching their shoulder blades together. Effect: Adduction tends to tighten both the upper rhomboids and the levator scapulae: the chest seems thrust forward, and the head is often forward, with the back of the neck short and tight This flattens or even begins to reverse the normal thoracic curve, create unnecessary tension in the rhomboids.

17 Anterior Tilt of the shoulder blades The shoulder blades tilt forward the collarbone pressing downward into the chest, while the lower tips of the shoulder blades may protrude from the back The shoulder blades may appear vertical and flat on the back, but the upper body is actually tilted back in a swaybacked posture; the shoulder blades are actually tilted anteriorly. Cause: tightness of pectoralis minor is a significant cause of both the anterior tilt and of the pressure on the nerves and vessels Effect: thoracic outlet syndrome, in which the collarbone impinges upon the nerves of the brachial plexus and auxiliary artery running from the neck down through the arm.

18 Posterior Tilt of the shoulder blades A certain amount of posterior tilt of the scapulae is necessary when taking the arms overhead (shoulder flexion). The shoulder blades should have the freedom to tilt posteriorly when it needs to do so for movement, so it is something we usually have to work toward creating. The problem comes when our efforts to create or increase this tilt are accompanied by exaggerated adduction of the shoulder blades squeezing the shoulder blades together Practices for Adduction & Posterior Tilt

19 Elevation of the shoulder blades the shoulders and shoulder blades lift toward the ears like earrings. Cause: tension in the levator scapulae as well as the upper rhomboids often caused by activities in which the arms and shoulders are held in a lifted and unsupported position, such as with typing and can be accompanied by a sunken or collapsed chest. Often accompanied by upward rotation of the outer corners of the shoulder blades. Depression of the shoulder blades The shoulders and shoulder blades drop away from the ears, sloping downward like coat hangers. Cause: can be due to the upper trapezius being long and/or weak, or overcome by shortness of the latissimus dorsi and pectoralis major and minor; it can also be due to structural factors such as: long neck, accompanied by narrow shoulders and long arms long trunk, relatively short arms arms don t reach arm rests in chairs unless shoulders are depressed heavy (i.e. muscular) arms large breasts This is often accompanied by downward rotation of the outer corners of the shoulder blades; the rotation can come from shortness of the deltoid and supraspinatus.

20 Stretches Covered

21 DoYoga Productions Doug Keller