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:
- Sun Salutations – the motion of folding into Mountain Pose (Tadasana) into Standing Forward Bend (Uttanasana) often incorporates a large sweeping motion of the arms over the head.
- Extended Side Angle Pose (Parsvottanasana)
- Extended arms in Child’s Pose (Balasana)
- Half Moon Side Stretch Pose (Ardha Chandrasana)
- Gate Pose (Parighasana)
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.
Quadratus Lumborum and Mindful Back Health in Yoga
Low back pain is an increasing issue in our society dominated by poor posture, sedentary lifestyles, and chronic sitting patterns. The source of low back pain can vary, but a great deal of these muscular dysfunctions emanate from the quadratus lumborum muscles.
Most of us are quite familiar with the erector spinae muscles that travel from the hip crest/sacrum to various points up the vertebrae and ribs. These muscles function primarily as extensors of the back. Few people (including yoga teachers) are aware of the all-important quadratus lumborum muscles that are located deep toward the erector spinae.
The quadratus lumborum muscles sit on either side of the vertebrae. They originate on the iliac crest (hip bone) and insert on the transverse processes of the lumbar vertebrae and the 12th (last) rib.
When both sides contract, they extend the spine (and/or depress the ribcage from behind). When only one side contracts, the spine flexes laterally and/or elevates the ilium (hip) on that same side. In forced expiration, the quadratus lumborum will fix the 12 ribs.
When Back Pain Can Occur
Dysfunction and low back pain can settle into the quadratus lumborum under a few conditions:
- If the erector spinae are weak or inhibited (as they often are in chronic seated postures), the quadratus lumborum attempts to take up the slack and loading in back extension and spinal stabilization leading to overall muscle fatigue.
- If muscle imbalances build up across the pelvis (e.g., tight hip flexors), the lower vertebrae can shift into chronic excessive curvature (lordosis), which will shorten and weaken the quadratus lumborum and erector spinae.
- If poor posture and upper body muscle tension forms across the chest and shoulders, rounded-back posture (kyphosis) will pull the rib cage up and away from the hip crest. This places stress and drag on the quadratus lumborum and portions of the erector spinae.
- The deep gluteals (gluteus medius and gluteus minimus) are responsible for hip abduction and pelvic stabilization in walking and other gait patterns. If these deep gluteal muscles are weak and inhibited, the quadratus lumborum and tensor fascia latae have to compensate to stabilize the pelvis.
- Some physical experts have also found that tight hip adductor muscles (groin) can inhibit (through reciprocal inhibition) the gluteus medius muscles. As mentioned above, the quadratus lumborum muscle may compensate for the gluteus medius muscle’s lack of activity and pelvic stabilization.
How to Keep Your Back Healthy with Yoga
Understanding that the dysfunction residing in the quadratus lumborum is often the result of dysfunction and tension imbalances coming from other muscles, here are some initial approaches to maintaining health of the quadratus lumborum:
- Develop a strategy to maintain fluid balance in upper and lower body posture patterns to avoid chronic hip flexor tightness, back extensor tension, and loss of natural vertebral curvature and pelvic placement
- Stretch the chest, front of the shoulders, hip flexors, groin, and lower back frequently
- Strengthen back extensors and overall core stabilizers
- Strengthen and stretch deep gluteals to unload unnecessary engagement of the quadratus lumborum
- Engage in proper therapeutic treatments when discomfort and pain develop
Need help with yoga for back pain? Sign up for our Yoga Foundations Guide with Rodney Yee & Colleen Saidman Yee!
Do These Yoga Poses for Back Pain
Here are some basic, accessible stretches readily prescribed to restore and maintain flexibility in the quadratus lumborum muscles:
When aiming to stretch the quadratus lumborum muscles and other lower back musculature, I would personally recommend avoid using forward bends like Uttanasana (Standing Forward Bend), Paschimottasana (Seated Two Leg Forward Bend) and other similar poses.
Due to the nature of intervertebral disc compression in spinal flexion, these types of forward bends would be better served to actually involve engagement of the back extensors and transverse abdomen in order to extend the spine, shift the ‘flexion’ into the hips, unload the lower vertebrae and protect against disc compression.