Reducing Shoulder Impingement

Many Yoga poses and flows involve large movements at the shoulder joint. Some of these movements have the potential to create shoulder impingement when improper technique and movements line are applied. If this shoulder impingement continues over time, chronic injury can form leading to pain and dysfunction.

What is Shoulder Impingement?

Shoulder impingement is caused when the arm is lifted above the line of the shoulder. The head of the arm bone (humerus) lifts and rotates into a portion of the shoulder blade (acromion on the scapula). Covering the head of the arm bone are the 4 rotator cuff muscles: the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. Acting as cushioning against pressure and friction, there are bursa sacs that lie between the muscular capsule and the acromion.

When the arm is lifted high over the level of the shoulder, the head of the humerus presses into the acromion. This pressure and friction can develop into inflammation of the bursa (bursitis) or the tendons the muscles (tendonitis). This inflammation can worsen due to repeated impinging actions that can eventually lead to increased pain and limited movement.

Where can Shoulder Impingement Occur in a Yoga Practice?

Shoulder impingement can occur in variety of Yoga postures and flows. Here is list of common yoga postures that set the arm bone above the line of the shoulder and can generate damaging frictional forces in the shoulder joint if one is not mindful:

How to Reduce the Incidence of Shoulder Impingement in Yoga Poses

The first method in reducing the pressure caused by shoulder impingement is to eliminate arms transitions that move the arm bone through large sweeping motions. In Sun Salutations, consider keeping arms in the forward plane, instead of lifting arms out to the side, back, up and then over head. By lifting the arms forward instead, there is less pressure being created against the head of the humerus as the arm bone moves back and up.

The greatest amount of pressure tends to occur where the arm is situated high above the shoulder line with the arm bone back in line with the neck and the arm bone rotated internally (medially) so the palm faces forward.

If the yoga posture requires the arm to be overhead and in line with the neck (like Extended Side Angle Pose), take extra note of the position of the hand. The hand should be turned inwards towards the body creating an external rotation of the arm bone. This external rotation has a tendency to draw the head of the humerus down from the acromion and scapular structures. This outward rotation of the arm bone offers secondary benefits as it encourages the shoulder blades to draw down away from the ears, thus bringing more integrity to the shoulder girdle and freedom to the trapezius and neck regions.

If you are ever experiencing regular pain in the shoulders, consult a health care professional to have your condition properly diagnosed and treated. Continue to acknowledge that Yoga poses are a means to create expansion and vitality. With mindful alignment and awareness to joint positioning, you can maintain space and energy flow through the shoulders and readily avoid impinging movements.

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mariamineo, posted on June 17, 2015

I'm so happy to read this article and get some direction on how to avoid further damaging my shoulders. I've been suffering with pretty severe pain in both shoulders, my right being unbearable. I've had cortisone shots, nerve block, physical therapy and acupuncture. All the while I was trying to get answers about what in my practice aggravates the inflammation. They just thought it was cute that I do yoga but never explained what Kreg does in this article. I'm so grateful for the rich source of valuable information that MyYoga offers. Thank you Kreg for outlining how to avoid further damage to my shoulders!!
Maria

B-health, posted on June 24, 2015

It is possible to consider a wider view of your shoulder problem. Whenever both shoulders are involved, I always am concerned about what is going on in the neck. In addition, are you having trouble with your Achilles's tendons, wrists and or ankles. If so, it is possible that a systemic problem ales you. I recommend you see a good physiatrist (doctors or PA's who specialize in non-surgical approaches to physical musculoskeletal ailments) who can analyze your body as a whole; systematically and physically. Once you have a good, working diagnosis, you may choose to go wherever you'd like for therapy/treatment.
All the best to you, I know first hand how bad this pain can be.
Blessings.

kregweiss, posted on June 22, 2015

You are very welcome MARIAMINEO. Great to hear that you are exploring various types of rehabilitative modalities. I do recommend that you explore even deeply some more holistic alternatives to reduce the inflammation - possibly a naturopath can offer some suggestions. There are many supplements and even anti-inflammatory foods available that could offer some benefits. Namaste, Kreg

ConTodo, posted on June 16, 2015

Thank you, Kreg for bringing this up! I experienced pain the left shoulder, too, especially in quick vinyasa classes I found here. It has become better due to specific exercises strengthening the shoulder.
I would suggest keep this topic in mind for further videos - by practicing too quickly, it's hard to be present, concentrate on proper alignment and on breathing.

kregweiss, posted on June 22, 2015

Thanks ConTodo. Yes, I prefer (even if a vinyasa style practice) to go considerably slow and methodical through transitions - especially ones that load the wrists, shoulders, knees, and/or back. My approach is let the breath dictate the pace of any movement, so if the breath is slow and rich, the transition also will be slow, patient, and contain more integrity. Namaste, Kreg

kenna, posted on June 13, 2015

I have been having pain in my left shoulder which radiates down my arm to my elbow for several months now. There are several everyday activities that are quite painful or I simply cannot do. Gentle stretching helps some but I am not experiencing significant improvement. I have considered seeking help from a healthcare provider but I am not sure what type of provider to see. Any suggestions?

kregweiss, posted on June 15, 2015

Hello kenna, Thank you for your question. Yes, it would be ideal to receive a proper diagnosis so you have a more clear idea on how to rehabilitate this shoulder condition. I recommend finding a physiotherapist, osteopath, or physical therapist (i.e. exercise science background). When working with a specialist, get them to right down exactly what the condition is (i.e. what has been injured or affected?), the tissues involved in this condition (i.e. what muscles, tendons, connective tissue etc) as well as what movements you should avoid or engage to help with recovery. This is info will be very valuable when you go to yoga or other physical activity modalities as the instructors will have this information to help modify your practice. All the best. Kreg

emassu, posted on June 6, 2015

Good article. I was taking my arms up from the sides and my supraspinatus tendon developed a tendinitis. Then automatically I started taking my arms up through the front which stopped the pain. Good to have the solution confirmed here.

kregweiss, posted on June 9, 2015

Thanks EMASSU. Along with using flexion instead of abduction of the shoulders, it is beneficial to play with extra external rotation of the upper arm bone as well as allow the shoulder blade to flow out and up (upwards rotation). These combos readily reduce the impingements between the acromion process (shoulder blade) and the greater tubercle (upper arm bone). Cheers, Kreg

Lolotte, posted on April 9, 2013

Thank you so much for these advices.

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