D. Keller- - Key poses: weight-bearing inversions such as Sirsasana 1 and Pincha Mayurasana prep variations

SHOULDER TO SHOULDERThe Range Of Possibilities

Doug Keller www.DoYoga.com

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Monday, March 9, 2009

HATHA YOGAHatha 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 fine-

tune 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.



STRUCTURE OF THE SHOULDERFour 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

Common Link:‣ Alignment and Movement of the Shoulder

Blades

Sternum & Collarbone

Acromion & Collarbone

Humerus & Glenoid

Shoulder Blades



Rotator Cuff (Supraspinatus)

‘Arc of Pain’

indicating injury

‘Arc of Pain’

indicating injury




Deltoid

Deltoid

Deltoid

Deltoid

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.

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 the Deltoid

Supraspinatus PinchedPull of Supraspinatus

ROTATOR CUFF INJURYThe Deltoid and Supraspinatus in the ‘Arc of Pain’



FIRST STEP: CORE ALIGNMENTAdjust and Center from the Foundation or ‘Root’ in Feet and Pelvic Floor

Adjust and Center from the Hyoid / Root of the Palate



SHOULDER BLADE ACTIONSArms 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 60o)

‣ Scapula is seeking stability relative to humerus: stationary, with slight lateral or medial rotation



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

Lateral Rotation

Upward RotationUpward Rotation

Lateral Rotation

Abduction

Posterior Tilt

60o

less than 1/2”

protrusion



LIMITERS OF MOVEMENTTight Muscles

— Levator Scapula and Rhomboids —

upper back tension from patterns of use

Levator Scapula

Supraspinatus

Rhomboids

Pectoralis Minor

Coracobrachialis

Coracoid Process

— Pectoralis Minor



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.



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.



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 35o 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.Doug Keller www.DoYoga.com


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.



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.



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



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.Doug Keller www.DoYoga.com


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.



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 sway-

backed 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.



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



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.Doug Keller www.DoYoga.com


Stretches Covered



DoYoga ProductionsDoug Keller

www.DoYoga.com 2009


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D. Keller- - Key poses: weight-bearing inversions such as Sirsasana 1 and Pincha Mayurasana prep variations