DrRic Yoga for Shoulder Rehab Lecture for Bikram Yoga Naperville 2010 (slide share edition)

Yoga for Shoulder RehabYoga for Shoulder Rehab

What’s in a shoulder?What’s in a shoulder?

wikepedia

deltoidsdeltoids

Scapular StabilizersScapular Stabilizers

“The Middle Child”

rhomboidsrhomboids

Levator scapuleaLevator scapulea

Secondary stabilizersSecondary stabilizers

TrapeziusTrapeziusRhomboidsRhomboidsLatisimus dorsiLatisimus dorsiPectoralis major and minorPectoralis major and minorSerratus anteriorSerratus anteriorTriceps Triceps

Skeletal structureSkeletal structure

scapula humerus

clavicle

ribs

“honorable mention”-the sternum?

The Shoulder GirdleThe Shoulder Girdle

R

Party Pooper

The JointThe Joint

Anatomy of a Standard JointAnatomy of a Standard Joint

Cartilage Surfaces can last 80 Cartilage Surfaces can last 80 years!years!

Side note for less “mortal injuries”Side note for less “mortal injuries”

These concepts go for any joint

hip

kneeback

The Rotator CuffThe Rotator Cuff

SupraspinatusSupraspinatusInfraspinatusInfraspinatusTeres minorTeres minorSubscapularisSubscapularis

R

RCRC

L

Rotator Cuff Strain/TearRotator Cuff Strain/Tear

The supraspinatus gets pinched The supraspinatus gets pinched (impinged)(impinged)The muscle through repetitive injury The muscle through repetitive injury continues to break down and not get the continues to break down and not get the chance to repairchance to repairFibrous tissue instead of plump muscleFibrous tissue instead of plump muscleTear, retraction, dysfunction, pain, more Tear, retraction, dysfunction, pain, more dysfunction, more tearing….dysfunction, more tearing….

Reasons for strain/tearReasons for strain/tear

RepetitionRepetitionPoor anatomyPoor anatomyScapular dyskinesisScapular dyskinesisPoor form at work or the gymPoor form at work or the gymFatigueFatiguePoor protoplasm/health/healingPoor protoplasm/health/healingAccidentsAccidents

Good note, muscle tissue heals!Good note, muscle tissue heals!

Viva Viagra!!Viva Viagra!!

The CapsuleThe CapsuleThe BursaThe BursaThe NervesThe NervesThe Labrum:The Labrum:

Soft parts heal but not great!Soft parts heal but not great!

Glenolabral TearsGlenolabral Tears

The Season Ender

““He’s got a lot of He’s got a lot of nerve!”nerve!”

R

Trigger pointsTrigger points

Referred pain point Referred pain point Chronically associated with FMSChronically associated with FMSWill cause contracture to the region the Will cause contracture to the region the muscle traverses and pain above and muscle traverses and pain above and belowbelowBehaves like a pinched nerveBehaves like a pinched nerve

MRI Arthrogram with SLAPMRI Arthrogram with SLAP

Bankart LesionsBankart Lesions

Bankart with Anchors INBankart with Anchors IN

Arthroscopic repairArthroscopic repair

Adhesive CapsulitisAdhesive Capsulitis

Stage I - IV

R

RSDRSD

“Permanent fight or flight to the arm”

RehabRehab???

MovementMovement

Rotation (circumduction)Rotation (circumduction)AbductionAbductionAdductionAdductionExtensionExtensionFlexion Flexion

Standard exercisesStandard exercises

Overhead pressOverhead pressLateral raiseLateral raiseUpright rowsUpright rowsInternal/External rotation therabandsInternal/External rotation therabandsShoulder shrugsShoulder shrugsIncline bench pressIncline bench press

Standard therapyStandard therapy

Resistance bandsResistance bandsWeightsWeightsIsometric exercisesIsometric exercisesManual therapy (only a select few Manual therapy (only a select few therapists)therapists)Iontophoresis, TENS Unit!!!!Iontophoresis, TENS Unit!!!!

Dr Saguil Doesn’t like handoutsDr Saguil Doesn’t like handouts

Pump You Up!Pump You Up!

Note the amount of weight-good and pants-bad

No Pain No Gain!No Pain No Gain!

Weight and form-good, pants-doesn’t go with couch cover

Exercise with veggies!Exercise with veggies!

Low Tech/High IntensityLow Tech/High Intensity

Theraband!Theraband!

Therabore!Therabore!

(For real: I love the concept but I expect you to do this for a very long time.)

External Rotator StretchesExternal Rotator Stretches

“Effective Stretch”

GarudasanaGarudasanaEagle Eagle Now that’s a Stretch!

Leslie Kaminoff

The toe hook is a killer!The toe hook is a killer!

Ardha MatsyendrasanaArdha MatsyendrasanaHalf Lord of the FishesHalf Lord of the Fishes

Stretch and work at the same time

Leslie Kaminoff

Lord of the FishLord of the Fish

Parivrtta Baddha ParsvakonasanaParivrtta Baddha ParsvakonasanaRevolved Side Angle Revolved Side Angle

Leslie Kaminoff

RSARSA

BhujangasanaBhujangasanaCobraCobra

1 Side body up 2 Humeral heads back 3 Back bend

Leslie Kaminoff

CobraCobra

Everybody Now!Everybody Now!

Side body up, shoulders to the earsSide body up, shoulders to the earsShoulder heads back, squeeze Shoulder heads back, squeeze Now hold it? Hold it? Hold it?Now hold it? Hold it? Hold it?Takes energy, right?Takes energy, right?We are used to a defensive posture as a We are used to a defensive posture as a society.society.Fight or flight for life!?Fight or flight for life!?

Setu BandhasanaSetu BandhasanaBridgeBridge

Leslie Kaminoff

Bridge Bridge

Salamba SarvangasanaSalamba SarvangasanaSupported Shoulder StandSupported Shoulder Stand

Leslie Kaminoff

Shoulder StandShoulder Stand

Easier than it looks –alignment!Easier than it looks –alignment!

Leslie Kaminoff

Muscle strength important but Muscle strength important but alignment is key-FYIalignment is key-FYI

Yoga’s conceptYoga’s concept

EngageEngageAlignAlignStretchStretch

Ah Grasshopper, when you can take the pebble from my hand -you can leave the temple.

Engage! Engage! Align!Align!Stretch!Stretch!

Secondary GainSecondary Gain

Other joint stretching, full body fitnessOther joint stretching, full body fitnessBreath controlBreath controlBlood pressure, heart rate controlBlood pressure, heart rate controlHeart fitnessHeart fitnessRelative lack of exposure to injuryRelative lack of exposure to injuryDropping into the relaxation responseDropping into the relaxation responseControlling fight or flightControlling fight or flightImproving function of every cell in the bodyImproving function of every cell in the bodyDigestion improvementDigestion improvement

Circulatory benefitsCirculatory benefits

Lymphatic movementLymphatic movementSynovial wringingSynovial wringingMuscle perfusionMuscle perfusionBrain perfusion (inversions)Brain perfusion (inversions)

Other cells (controversial in Other cells (controversial in western medicine):western medicine):

FibroblastsFibroblastsChondroblastsChondroblastsLymphocytesLymphocytesNeuroblastsNeuroblastsMyoblastsMyoblastsKiller T CellsKiller T CellsRibosomes? Genetic Expression?Ribosomes? Genetic Expression?

Honorable mention to the RRHonorable mention to the RR

Herb BensonHerb BensonJohn Kabat ZinnJohn Kabat ZinnEkhart TolleEkhart TolleDeepak ChopraDeepak ChopraWayne DyerWayne DyerFr GabeFr GabeTerri (Bikram)Terri (Bikram)

Pointers for injured shoulderPointers for injured shoulder

Work first to mobilize the shoulder girdleWork first to mobilize the shoulder girdleControl pain (spasm) flare up with usual Control pain (spasm) flare up with usual measuresmeasuresAfter flexibility is gained, work on muscle After flexibility is gained, work on muscle “tone” and continued flexibility (exhale and “tone” and continued flexibility (exhale and push)push)Once accustomed to movement, advance Once accustomed to movement, advance to shoulder challenging posesto shoulder challenging poses

Chronic or acute!

A home exercise program by Eric A home exercise program by Eric SchiffmannSchiffmann

The Spirit and Practice of The Spirit and Practice of Moving into StillnessMoving into Stillness

-Eric Schiffmann-Eric Schiffmann

Understand your pathologyUnderstand your pathologyMost common injury is rotator cuff overuse and Most common injury is rotator cuff overuse and inflammation/tearinflammation/tearThe space between the humerus and the The space between the humerus and the acromial arch is narrow thus creating a acromial arch is narrow thus creating a “guillotine” especially if the scapula moves “guillotine” especially if the scapula moves poorly (as in fatigue or sloppy movment)poorly (as in fatigue or sloppy movment)Once injured, the shoulder joint collects more Once injured, the shoulder joint collects more fluid than it is used to holding (bursa)fluid than it is used to holding (bursa)Frozen shoulder ensues causing smaller space Frozen shoulder ensues causing smaller space and poor perfusion of muscle and tighter and poor perfusion of muscle and tighter shoulder space etc etcshoulder space etc etc

Surgical pathology?Surgical pathology?

Once the movement of the scapula is Once the movement of the scapula is impaired, the humeral head will not sit impaired, the humeral head will not sit correctly in the glenoid fossa and it will correctly in the glenoid fossa and it will start to clunk out of space tearing labrum start to clunk out of space tearing labrum (cartilage) or muscle (supraspinatus)(cartilage) or muscle (supraspinatus)Attempt physical therapy with a ‘shoulder Attempt physical therapy with a ‘shoulder trained therapist’trained therapist’Time for surgeon or injection with Time for surgeon or injection with conventional medicine …….or…….conventional medicine …….or…….

Don’t feel bad…..

……if needed, call in the Calvary!if needed, call in the Calvary!

Too painful (narcotics)Too disabling (no can work)Too long to wait (got a world competition)Too many issues getting out of control

Surgery or not get a goodSurgery or not get a good physical therapist! physical therapist!

Naperville PT (630) 369-1015 Naperville PT (630) 369-1015 http://www.napervillept.comhttp://www.napervillept.comPersonal Best Performance Downers Personal Best Performance Downers Grove (630) 435-1800 Grove (630) 435-1800 Hand/Shoulder Therapy Plainfield/ Hand/Shoulder Therapy Plainfield/ Lombard (630) 393-0968Lombard (630) 393-0968

Alternative HealingAlternative Healing

With poor healing comes the introduction With poor healing comes the introduction of ‘stagnation of energy’of ‘stagnation of energy’Meridia’s in TCM or Nadi’s in AyurvedaMeridia’s in TCM or Nadi’s in AyurvedaAcupuncture or Marma therapyAcupuncture or Marma therapyLess invasive would be Qi Gong or YogaLess invasive would be Qi Gong or Yoga

(with massage to both arts) (with massage to both arts) remember- this is the long cut!remember- this is the long cut!

Hands on HealersHands on Healers

Reiki therapistReiki therapistMassage therapist (oil knowledge)Massage therapist (oil knowledge)Physical therapist (Manual therapy, shoulder Physical therapist (Manual therapy, shoulder training, kinesio taping)training, kinesio taping)ReflexologistReflexologistAcupuncturistAcupuncturistChiropractorChiropractorMarma practioner, Thai Massage, Yoga Marma practioner, Thai Massage, Yoga TherapistTherapist

ReflexologistReflexologist

Jennifer Adams in Aurora (630) 710 0304

Acupuncturist Acupuncturist

Frank Grill Frank Grill Naperville Acupuncture CenterNaperville Acupuncture Center 1324 e ogden ave1324 e ogden ave suite 102suite 102 naperville, il 60563naperville, il 60563

(630) 369-3237(630) 369-3237

Yoga “Therapist”Yoga “Therapist”

Bikram YogaBikram YogaLiving Yoga AuroraLiving Yoga AuroraTotal Body Yoga MundeleinTotal Body Yoga MundeleinThe Chopra Center California SSLYThe Chopra Center California SSLY

Ayurvedic MedicineAyurvedic Medicine

The antiinflammatory diet for the long runThe antiinflammatory diet for the long runSpecific supplements for the short runSpecific supplements for the short runTopical oilsTopical oilsHomeopathyHomeopathyEnergy healingEnergy healingMassage (thai, deep tissue, hot stone, Massage (thai, deep tissue, hot stone, lymphatic)lymphatic)

Control InflammationControl Inflammation

The Antiinflammatory DietThe Antiinflammatory DietTurmericTurmericVitamin D3Vitamin D3Omega 3 fish oilOmega 3 fish oilWaterWaterAbstinence from damaging intakeAbstinence from damaging intake

(etoh, high GI foods, tobacco,dairy)(etoh, high GI foods, tobacco,dairy) --Nutritionist Andrea Klouda (630) 855-7907Nutritionist Andrea Klouda (630) 855-7907

““Food as Medicine”Food as Medicine”

SupplementsSupplements

TumericTumericVitamin D3Vitamin D3Omega 3 fish oilOmega 3 fish oilWhite willow bark, shark cartilage, White willow bark, shark cartilage, oregano, ginger, holy basiloregano, ginger, holy basilHelicrysium, tea tree, traumeel, Helicrysium, tea tree, traumeel, frankinsence. menthol, marjoramfrankinsence. menthol, marjoram

My favoritesMy favorites

My favesMy faves

Traumeel by Heel (homeopathic cream)Traumeel by Heel (homeopathic cream)PanAway by Young Living (essen oil)PanAway by Young Living (essen oil)Turmeric FSE by New Mark (cap)Turmeric FSE by New Mark (cap)Vitamin D3 by NaturesSunshine (tab)Vitamin D3 by NaturesSunshine (tab)Super Omega 3 EPA by NS (cap)Super Omega 3 EPA by NS (cap)

Challenge the company…..Challenge the company…..

……Call them out!Call them out!

Call the 800 numberCall the 800 numberAsk for R&D departmentAsk for R&D departmentAsk if the supplement has been tested for Ask if the supplement has been tested for level of “bioavailability”level of “bioavailability”Ask if the supplement has been tested for Ask if the supplement has been tested for mercury contentmercury contentAsk if you can get a copy of the studyAsk if you can get a copy of the study

The Saguil ApproachThe Saguil Approach

Do no further harmDo no further harmStop inflammation (ice therapy)Stop inflammation (ice therapy)Relative restRelative restSling at night (8 hours)Sling at night (8 hours)Gentle movement at dayGentle movement at dayJob alterationJob alterationWatch for secondary spasmWatch for secondary spasmDevelop the Relaxation ResponseDevelop the Relaxation Response

Engage! Engage! Align!Align!Stretch!Stretch!

Thanks and NamasteThanks and Namaste

Q&A time!Q&A time!

www.herbal411.comwww.herbal411.comEnrique Saguil, MDEnrique Saguil, MD

(630) 689-7986(630) 689-7986