Let me take you back in time again to summer circa 2015. I was sitting in an orthopedic clinic staring at an x-ray of my neck and shoulders. The doctor had just explained to me that my shoulder was absolutely fine and with a bit of Vitamin B12, all should be well in a week. He’d taken one look at me, pointed me toward the x-ray room, and had (in less than the time of a full sun salutation) decided I had a pinched nerve, though the lack of numbness and presence of a lot of pain shooting down my arm was a bit puzzling to him. The x-ray confirmed that my neck was degenerating but “not to worry as we all have crumbly necks” (!?).

Six weeks later and I was sitting in another clinic, this time having spent a good twenty minutes with the doctor answering in my best Japanese her questions about which asana specifically hurt to do, how long it had been hurting, and how it began. This time, no vitamins to take, but instead a list of exercises to do and a strict “no yoga until you feel no pain” command. A couple of weeks after that and I was back into a regular yet heavily modified practice

You see, in my quest to be considered a worthy practitioner, I pushed myself into an Ashtanga yoga practice. I had believed without question some dogma in a dusty old corner of the internet that Ashtanga should be practiced in full, daily. So there I was huffing and puffing my way through what barely resembled a 90-minute primary series practice for a few weeks before the increasingly nagging pain in my left shoulder became too much to ignore. I had chaturanga’d my way to a painful rotator cuff injury. 

Shoulder pain, much like wrist pain, can interfere with everything. You aren’t really aware of how much we use our shoulders each day until we can’t use them. In my case, typing, cooking, teaching, writing, cleaning, folding laundry, taking a shower, and sleeping were all affected by the pain.

What I wish I’d known back then was how chronically weak my shoulders were and how terrible my alignment was in poses that really made use of the shoulders. 

I ended up taking some videos of my practice to see what needed improving in terms of alignment. I highly recommend doing this if you have the means. I could clearly see that although I was following the cues of the teacher, I was doing so in a fairly sloppy manner, though it didn’t feel sloppy at the time. I kept dumping into my shoulders in inversion poses like Adhomukha svanasana (Downward facing Dog), and I was rolling my shoulders forward and down as I pressed down through Phalakhasana (plank) into chaturanga (a push-up). My poor shoulders never stood a chance.

1. Consult a doctor to gauge underlying sources of pain and how to alleviate it.
2. Understand basic shoulder anatomy and correct alignment before mat work. 
3. Know what to avoid in yoga for healthy shoulders
4. Learn how to stretch and strengthen the muscles around the shoulder joint.
5. Get familiar with how to modify asana to protect the shoulder joint.

As always, step 1 is a given. If you are concerned about your shoulders and whether or not yoga will help or hurt, consult a trusted physician first. They will have the physiological and anatomical knowledge to decipher exactly where the pain is coming from, why it exists, and if a particular pose will help or hinder your healing process. You might even get some vitamin B12 thrown into the mix. As with our wrists and knees, the sheer amount that we use our shoulders daily and in yoga means there is a risk that some poses can exacerbate pre-existing conditions, or even create ones that were never there before.

Anatomy has never really been my strong point, but I still LOVE studying it. Why? It actually helps me to understand exactly what is going on inside, which for me does two things:

1. It alleviates the anxiety that overstays its welcome whenever I have inexplicable pain
2. It helps me to develop a deeper connection to and fascination with my body. Yes, it may not always do what I want it to do but it does do a huge amount of things that I am massively unaware of each day. 

For these reasons, I believe it is important for every practitioner to have a simple understanding of the shoulder anatomy, and how to align the shoulder in relation to other body parts in asana practice so that the muscles are not overworked. 

The shoulder has three main muscles called deltoids. We have the anterior (or front) deltoid, the medial (or lateral) deltoid, and the posterior (or rear) deltoid shown below.

These muscles help the arms flex, press, and extend respectively among many other functions. We also have a rotator cuff muscle along the top and side of the shoulder and the pectoralis (or pecs) across the top of the chest (Sears, 2022). There are plenty more muscles in the shoulder and upper body that work in conjunction with these main muscles to allow for shoulder and arm mobility and stability (Inverarity, 2022).

Shoulder alignment is key. When in weight-bearing poses such as adhomukha svanasana (Downward facing dog) and Phalakhasana (plank) we want to avoid putting too much weight on weak shoulders. In poses like chaturanga (Yoga push-up) we want to avoid rolling our shoulder heads forward and down. To practice good shoulder alignment, follow along to the instructions given by the wonderful Doug Keller (2023) here. Once you’ve practiced the instructions he gives in the first section titled “How to identify good shoulder alignment”, you can practice the same movements with a little weigh-bearing included just by bringing yourself closer to a wall and placing your hands on the wall. This might help to identify with a little more clarity the muscles that get activated when in good alignment. 

Phalakasana (plank)

ISSA (2021) labels five reasons for a shoulder injury in yoga. These include poor technique, improper alignment, inadequate cueing from the teacher, using excessive force, and practicing with a previous injury, claiming that poses like adhomukha svanasana (Downward facing dog) and Phalakhasana (plank) (which require a fair amount of hard work from the shoulder) as potential culprits for causing or exacerbating shoulder injury.

I would add one more to this list and it refers to a little bit of yoga philosophy. The Yoga Sutras of Patanjali (often referred to as the Bible Yoga, compiled around 200CE by yoga master Patanjali) is a collection of 196 short guidelines for every yoga practitioner. However, only three of them refer to asana (the physical practice that is often equated to yoga, especially in the west). One of these I find to be a shining light when it comes to discerning if a pose needs modifying, more research, more practice, or scrapping from my practice for the time being. This is Sutra 2.46 which reads Sthira Sukham Asanam. Literally translated, this means “Steady, comfortable, is asana”. 

Ram Jain (2022) gives a far more in-depth meaning of this sutra here, but for now, I’m going to give a very rudimentary interpretation of this sutra. Essentially, if you feel steady and comfortable in the practice, even if you find it a little challenging, then you’re good to continue. If you experience pain, likely you are not comfortable or steady and may even be holding your breath. In that case, adapt, modify, or come out of the pose.

You can read more about Patanjali and the eight limbs of yoga here.

Chaturanga Dandasana (Yoga push-up)

Back to Doug Keller’s article again, this time to the section titled “How to activate key shoulder muscles). Here Doug outlines some simple but effective exercises to strengthen the muscles of the shoulder to help prepare for weight-bearing poses like plank, downward facing dog, and chaturanga. Only do these with the go-ahead from your doctor. Issa (2021) recommends a few asana to help with shoulder pain which you can read about here, but for ease of use, I have listed some beginner-friendly poses below. Click on each one to see an illustration of the pose on the excellent website www.tummee.com. Again, only attempt these after consulting with your trusted medical professional. 

3 Strengthening poses:

Mountain Pose

Cat-Cow

Plank (modified, to begin with).

3 Stretching poses:

Seated Cat-Cow pose

Thread-the-needle pose

Downward-facing Dog

3 strengthening and stretching poses:

Seated Eagle Pose

Low lunge pose (with arms lifted or interlaced fingers behind)

Warrior 1 (with arms lifted).

Urdhva Mukha Pasasana (Thread the Needle)

Some yoga poses like Phalakasana (plank) and Chaturanga (yoga push-up) can put a not-so-easy-to-discern-until-its-too-late strain on the shoulder muscles. With repeated misalignment using weak muscles, eventually, the shoulder will start to let you know things are going a bit wrong. The ego may not like it, but modifying from the start until you are feeling stronger in your shoulders is the way to go. In the above two poses, modifying means either practicing them standing up using a wall or on the floor bit with your knees resting down just behind your hips. Engage the core and breathe.

For poses that are not weight-nearing but that go beyond the scope of your current mobility, introduce a strap (or belt or scarf) to your practice so that the muscles can get used to slowly stretching over time. Actually, I usually use a strap at the beginning of my practice anyway, as with all the sitting and typing I do, it’s not a good idea for me to go right into a deep shoulder stretch without letting my shoulders know gently that this might be asked of them later in the practice. It’s only polite. 

For poses like Warrior 1 and Warrior 2 that aren’t weight-bearing but do enhance strength and may include a little bit of a stretch, modify by placing your hands on your waist instead of up to the sky (for Warrior 1) or at shoulder height (for Warrior 2). 

Parvatasana (Seated Mountain Pose)

Over time, your shoulders will get stronger and more stable, and the journey to this goal is quickest with strong and steady foundations set first. Rushing into a full plank or push-up because you feel you have to is clearing the longest path to strong and stable shoulders as it will increase the risk of being wrought with injury. After consulting with a doctor, learn a little bit of shoulder anatomy, practice correct alignment, build strength and mobility, and modify every time you need to (and maybe even when you don’t just to be sure).

If you’d like to know more about how to set up a safe and sustainable home yoga practice then fill in your information below to get my FREE guide explaining how to do just that (with a couple of extras thrown in, too).

Next week we will be looking at a very common problem area and how yoga asana can help or hinder – the lower back. 

As always, please consult with your doctor first before attempting any new exercise. 

Until then, much love,

Ellie

References

Inverarity, L. (2022, October 17). The Anatomy of the Rotator Cuff. https://www.verywellhealth.com/the-rotator-cuff-2696385 

ISSA (2021, January 15) Yoga and shoulder injury: from healing to prevention. https://www.issaonline.com/blog/post/yoga-and-shoulder-injury-from-healing-to-prevention 

Jain, R. (2020, February 11). Sthira Sukham Asanam: Deepen your practice with this ancient principle. https://www.arhantayoga.org/blog/sthira-sukham-asanam-deepen-your-practice-with-this-ancient-principle/ 

Sears, B. (2022, April 15). The Anatomy of the Pectoralis Major Muscle. https://www.verywellhealth.com/pectoralis-major-anatomy-4691799 

Next week we will be looking at a very common problem area and how yoga asana can help or hinder – the lower back. 

As always, please consult with your doctor first before attempting any new exercise. 

Until then, much love,

Ellie

References

Inverarity, L. (2022, October 17). The Anatomy of the Rotator Cuff. https://www.verywellhealth.com/the-rotator-cuff-2696385 

ISSA (2021, January 15) Yoga and shoulder injury: from healing to prevention. https://www.issaonline.com/blog/post/yoga-and-shoulder-injury-from-healing-to-prevention 

Jain, R. (2020, February 11). Sthira Sukham Asanam: Deepen your practice with this ancient principle. https://www.arhantayoga.org/blog/sthira-sukham-asanam-deepen-your-practice-with-this-ancient-principle/ 

Sears, B. (2022, April 15). The Anatomy of the Pectoralis Major Muscle. https://www.verywellhealth.com/pectoralis-major-anatomy-4691799 

Next week we will be looking at a very common problem area and how yoga asana can help or hinder – the lower back. 

As always, please consult with your doctor first before attempting any new exercise. 

Until then, much love,

Ellie

References

Inverarity, L. (2022, October 17). The Anatomy of the Rotator Cuff. https://www.verywellhealth.com/the-rotator-cuff-2696385 

ISSA (2021, January 15) Yoga and shoulder injury: from healing to prevention. https://www.issaonline.com/blog/post/yoga-and-shoulder-injury-from-healing-to-prevention 

Jain, R. (2020, February 11). Sthira Sukham Asanam: Deepen your practice with this ancient principle. https://www.arhantayoga.org/blog/sthira-sukham-asanam-deepen-your-practice-with-this-ancient-principle/ 

Sears, B. (2022, April 15). The Anatomy of the Pectoralis Major Muscle. https://www.verywellhealth.com/pectoralis-major-anatomy-4691799