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September 14, 2019

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April 1, 2014

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Shoulder Pain and Down Dog

March 15, 2014

Down dog is a pose that I consistently see people having trouble with and/or find painful.

 

The client’s posture speaks volumes why they would have trouble with the asana. Forward head posture, rounded upper back (thoracic kyphosis), rounded shoulders are common place and leads to many dysfunctions from headaches, neck/shoulder pain, loss of lung capacity and even gastrointestinal agitation.

 

They come to class hoping to correct the postural dysfunction or at least relieve the pain that has been created by the long hours of sitting in front of a computer. But instead of relieving pain it creates pain, specifically in the shoulder.

 

So let’s back up and look at posture and what is happening.

 

Yoga styles using physical postures for the practice is in its essence is a strength and conditioning class. We migrate to our strengths, whether it be in the right position or not and yoga is no different. When people get into down dog they migrate to their strength right away, rounded back, rounded shoulders, forward head posture and they place a majority of their body weight into their shoulders.

 

There is a lot happening in the body and yoga instructors do their best to realign the body. In my opinion down dog is a posture that when corrected, the strength created carries over to our upright posture.

 

Here are just a few of cues I give to realign down dog both for posture and to see if their shoulders are even suppose to be loaded from an overhead position.

 

  • I ask them to bend the knees, which will help them find length in the spine or come out of a rounded spine; it will help stretch upper hamstring attachment at the pelvis. When the upper hamstrings become tight they will begin to pull the pelvis into a posterior pelvic tilt (rounded low back). This also helps them shift more body weight to the legs.

  • I then ask them to slide the shoulders down and away from the ears. This will action helps engage upper back muscles and create integrity in shoulder girdle. I have the client begin to pull the ears back over the shoulders, just like we would in Tadasana. This encourages the long cervical extensors f the neck to start to work to pull the head back in an optimal posture position and stabilize the neck, instead of letting it act as a weight; this just continues to encourage a dysfunctional postural problem and the head is hanging off of passives structures.

 

If we don’t correct head position we do not correct breathing patterns or posture.

 

Yet after all the corrections they still experience shoulder pain/discomfort. Down dog is really an overhead press with a good portion of our body weight, whether or not the weight has been minimized after aligning the posture. When we bring our arms overhead there must be an upward rotation of the scapulae coupled with movement at the gleno-humeral joint (shoulder). These two movements must happen together and often times don’t.

 

If you were to bring your arms up overhead, 180° is normal range of motion. In order to achieve the 180 ° there must 60° from the upward rotation of the scapulae and 120° coming from the gleno-humeral joint and this happens in a 2:1 ratio.

 

When we are asking someone to find length in the spine in down dog we are asking them to lift the rib cage off of the diaphragm in order to pick up the first rib angle, even though they are able to do this action does not mean that the shoulder is ready to be loaded over head.

 

In a classroom situation it is difficult to qualify the individual’s shoulder before they go into the classroom, the trained eye can see the position of the scapulae while in down dog. When the arms are overhead the inferior angle of the scapulae should lie at the mid-point of the shoulder. If it does not, then there was not enough upward rotation scapular rotation and loading the shoulder has become compromised.

 

Here’s why---the head of the humerus sits in the glenoid (shoulder) and as the arms move up, the scapulae need to rotate up 60°. This brings the convex aspect of the joint to be sitting directly below the humeral head. Now the compressive loading of our body weight in down dog can be directly passed through the scapulae and becomes a very stable position for the structures to be loaded. If it doesn’t rotate up the 60° the scapulae will not be lined up directly under the humeral head. The humeral head will now be shearing down and traumatizing the passive structures. Even if they have good thoracic extension, even if they have 60° upward scapular rotation, does not mean we can load them overhead yet.

 

We still need to qualify the gleno-humeral joint since 120° of the 180 °comes from here. What position should they take if down dog creates pain even after all the corrections…table top is the most stable position for the shoulder at this point.

 

References: Mark Buckley, FMA Strength

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