THE ESSENCE OF EDUCATION IS THE EDUCATION OF THE BODY.
—BENJAMIN DISRAELI
THE WAY WE carry our shoulders and arms sends a message to the world. Not surprisingly, many common expressions incorporate these messages into our daily conversations: shoulder a burden, shoulder to the wheel, lean on my shoulder, pull your shoulders back, chip on your shoulder, broad shoulders, stoop-shouldered, shouldering responsibility, standing on someone’s shoulders, built upon someone’s shoulders, looking over your shoulder, carrying the weight of the world on your shoulders, having a good head on your shoulders. These expressions convey a mood, an attitude, a certain level of competence, which we assume by how we carry our shoulders. When we stand with our shoulders open and back, we feel more alive and positive. When we stand with our shoulders drooped and forward, we feel less energetic and sadder.
Arm positions can be as revealing as shoulder positions. Habitually standing with arms crossed over the chest is a way to shut off, separate, and protect oneself. Becoming aware of your habitual shoulder and arm positions (and teaching your students to do the same) will not only improve your asana practice but may improve your life as well, by bringing awareness to this important area.
The shoulder girdle, unlike the pelvic girdle, is constructed more for movement than for stability (Figures 13.1 and 13.2). The pelvic girdle is a solid bony ring, while the shoulder girdle is more loosely joined together. Try this experiment. Whatever position your body is in right now, move one of your hip joints an inch in any direction. You will find that the other hip joint invariably moves. Now try the same experiment with one of your arms. Move one arm around and you will find that the other arm stays still. Of course, the arms are indirectly connected through the scapulae and clavicles, but that connection is much looser than the hips. The shoulder girdle is not designed for bearing weight, as is the pelvic girdle. For this reason alone, understanding the structure and function of the shoulder girdle is important for the teachers and students of yoga who regularly use it for weight bearing in poses such as Salamba Sirsasana, Salamba Sarvangasana, and Adho Mukha Vrksasana. This understanding can help you to prevent injuries to this area of the body.
13.1 (RIGHT) BONES OF THE UPPER EXTREMITY AND BONES OF THE HAND, ANTERIOR VIEW
13.2 (FAR RIGHT) BONES OF THE UPPER EXTREMITY AND BONES OF HAND, POSTERIOR VIEW
BONES
For asana practice, the most significant bone of the shoulder girdle is the scapula. Understanding the position of the scapula, how it moves and what muscles make that happen, is imperative if you are to understand the upper extremity in asana. In addition, understanding the need for the scapula to be stabilized well in poses demanding strength is equally important.
The scapula is a triangular-shaped bone that, while curved, sits in an almost vertical position when the student is standing in Tadasana. The important anatomical bony landmarks on the scapula are:
▶ vertebral border (medial side): the long side of the scapula near the vertebral column
▶ axillary border (lateral side): the long side of the scapula on the lateral side near the armpit
▶ inferior angle: the angle located at the base of the bone
▶ spine: on the posterior side of the bone, running almost horizontally from the medial side of the bone, ending in the acromion
▶ acromion: the wide shelf of the scapula which covers the superior gleno-humeral joint
▶ supraspinatus fossa: the hollow on the posterior surface above the spine, which is the origin for the supraspinatus muscle
▶ infraspinatus fossa: the flattened posterior surface inferior to the spine, which is the origin for the infraspinatus muscle
▶ subscapular fossa: the anterior surface of the scapula, which is the origin for the subscapularis
13.3 (ABOVE) ACROMIOCLAVICULAR AND STERNOCLAVICULAR JOINTS
13.4 (RIGHT) HUMERUS
▶ glenoid fossa: the shallow, curved surface on the lateral scapula, which articulates with the head of the humerus to create the shoulder joint proper
▶ coracoid process: or “crow’s beak,” the curved finger-like projection of the scapula that protrudes anteriorly and can be palpated distal to the clavicle. It is the only portion of the scapula that is anterior; it serves as an attachment site for muscles. (Note: While it is true that the subscapular fossa is on the anterior side of the scapula, it is not on the anterior half of the body. Only the coracoid process is on the anterior half of the body.)
The second bone of the shoulder area is the clavicle, which connects to the sternum at the sternoclavicular joint. It joins the scapula at the acromion, or the acromioclavicular joint (Figure 13.3). The clavicle is convex anteriorly on its medial portion but concave anteriorly on its lateral portion. In other words, the clavicle lies in a gentle S shape when viewed from above.
To feel this shape, place the fingers of your right hand gently over the anterior head of the humerus. Now move your fingers medially toward the sternum along the body of the clavicle. Note how the clavicle is concave here, with the concavity anterior. At about one-third of the way toward the midline, the clavicle begins to curve out anteriorly as it approaches and joins the sternum. At this point, the clavicle is decidedly convex. The major function of the clavicle is to act as a strut to maintain the width and shape of the shoulder girdle. Without clavicles, your shoulder sockets would come very far forward in the front body and almost touch.
The final bone that forms the shoulder joint is the humerus (Figure 13.4). The important anatomical bony landmarks of the humerus are:
▶ head: the rounded, convex surface which sits in the glenoid fossa of the scapula to create the shoulder joint. The head is overlaid one-third with a thin layer of hyaline cartilage because this joint needs a high degree of mobility.
▶ anatomical neck: the portion of the bone that separates the head from the tubercles
13.5 LATERAL GLENOID, WITH GLENOID LABRUM
▶ greater tubercle: found lateral to the head of the humerus and having three distinct flat impressions, which serve as the insertion points for three shoulder muscles: the supraspinatus, the infraspinatus, and the teres minor
▶ lesser tubercle: projects medially just distal to the neck of the humerus. It serves as the attachment of the subscapularis muscle.
▶ body: the long shaft of the humerus
▶ deltoid tuberosity: the attachment for the deltoid muscle, about halfway down the shaft on the lateral side
▶ condyles: the two distinct rounded medial and lateral structures at the distal humerus that articulate with the radius. The lateral structure is called the capitulum; it articulates with the medial head of the radius when the elbow joint is flexed. The medial condyle of the humerus is called the trochlea; it articulates with the ulna.
▶ lateral epicondyle: a small protruberance on the distal lateral humerus that provides for the attachment of ligaments and muscles
▶ medial epicondyle: a small protruberance on the distal medial humerus above the condyle that provides for the attachment of the ligaments and muscles
▶ coronoid fossa: a depressed hollow area on the anterior distal humerus where the ulna articulates with the humerus during flexion of the elbow
▶ olecranon fossa: a depression on the distal posterior humerus for the ulna to articulate with the humerus during extension of the elbow
JOINTS
The shoulder joint, also called the gleno-humeral joint, is a synovial joint consisting of the articulation of the humeral head with the glenoid fossa of the scapula. Not only do the muscles and ligaments of the joint help hold the humerus in place in the glenoid fossa, but also these elements—ligaments, tendons, and muscles—help maintain the essential integrity of the shoulder capsule. This integrity ensures, in part, the health of the hyaline cartilage by maintaining a watertight compartment so the synovial fluid can provide oxygen and nutrients to the cartilage and thus ensure that various movements of the humeral head are almost frictionless.
Many yoga teachers do not realize that the glenoid fossa of the scapula actually faces approximately 15 degrees anteriorly, as well as laterally and slightly upward (Figure 13.5). This is called anteversion of the shoulder joint. Note the position of the head of the humerus in yourself and in your students during the practice of Tadasana. Pulling the head of the humerus backward to face exactly laterally actually involves external rotation and is not the basic anatomical position.
The glenoid fossa is pear-shaped. Visualize a snowman: the top rounded portion is smaller than the lower rounded portion. The glenoid is similar: the upper, shallower portion allows for smaller movements between the humerus and scapula, and the lower, deeper one allows for larger movements. When movements of the humerus are mainly in the lower portion of the glenoid, they are more stable because there is more congruence between the humerus and glenoid.
The position of maximum stability for the glenohumeral joint is extension, adduction, and internal rotation of the humerus. This is similar to the position of the gleno-humeral joint in Halasana, with the arms behind the back, especially with the elbows straight and hands interlocked. However, most yoga students externally rotate their shoulder joints in the pose, so they lose one of the components of stability. An example of a position of instability in the upper extremity is hanging over the chair in a supported back bend. Sometimes it is even possible to see the head of the humerus bulging out in the armpit. If this happens, the student should immediately externally rotate the humerus and fully extend the elbow to bring the head of the humerus into a more stable position in the joint. Yoga teachers should be vigilant to make sure students do not habitually overstretch the shoulder joints in this pose, thus contributing to serious hypermobility and possible injury.
The position of most instability for the glenohumeral joint is flexion, abduction, and external rotation of the humerus. In this position the head of the humerus is moved forward into the upper and shallower portion of the glenoid and is moved anteriorly, to where the ligaments around the joint are less strong. An additional instability factor is that there are few muscles on the anterior shoulder joint that can lend stability to the area.
The acromioclavicular joint is a gliding joint made up of the medial acromion and the lateral end of the clavicle. There is some rotation at this joint during flexion and abduction of the shoulder joint.
The sternocavicular joint consists of the sternal end of the clavicle, the lateral manubrium, and the cartilage of the first rib. This articulation allows very limited movement in most directions.
The final joint of the shoulder area is the scapulo-thoracic joint. This is the articulation of the scapula over the posterior rib cage; whenever the scapula moves, it does so over the bones of the rib cage. In fact, the scapula slides over the ribs on a “bed” of fascia and adipose tissue, which serves as a cushion for the rib cage during scapular movements.
CONNECTIVE TISSUE
The ligaments of the gleno-humeral joint do not function well to keep the bones together; at this joint, they mainly function to limit movement.
The main ligaments of the gleno-humeral joint are:
▶ articular capsule: This completely encircles the joint and is attached outside the glenoid labrum and to the neck of the humerus. The gleno-humeral ligaments are incorporated in the capsule itself. The head of the humerus is about three times bigger than the glenoid fossa, so the ligaments are very important for stabilization of the shoulder joint (Figure 13.6).
13.6 ANTERIOR LIGAMENTS OF THE ARTICULAR CAPSULE
The capsule is pierced by the tendon of the long head of the biceps brachii. The capsule folds and covers the biceps tendon into the intertubular groove of the humerus.
It is important to note that the humerus bone hangs loosely in a dependent position in the capsule in Tadasana. Thus the upper portion of the capsule is stretched taut, and the inferior portion is loose and pleated at the axillary fold (armpit). The opposite occurs in full abduction. Here the superior capsule is lax, and the axillary portion is taut.
To better visualize the state of the capsule, look at the top of your student’s sleeve in Tadasana. In this pose, the top of the sleeve will be taut. When she raises her arm overhead, the top of the sleeve bunches, and the fabric at the bottom of the armpit is stretched taut. The capsule of the shoulder joint is the same. When the humerus is in a recumbent position, the top of the capsule is stretched; when the humerus is in full flexion, the bottom of the capsule is stretched. When she abducts her humerus to perform Vrksasana, however, holding her arm over her head, the opposite is true. In full abduction, the top of her sleeve is loose and bunched, and the axillary portion is stretched. So is the capsule.
With the humerus in the dependent position of Tadasana, the superior tautness helps to prevent the downward dislocation of the humerus. The superior laxity of the capsule that is created during abduction helps make this motion possible. Remember the superior laxity of the capsule during abduction. Because of this laxity, there is the possibility of impingement of the superior capsule between the humerus and the acromion during abduction, which can cause pain and inflammation and can contribute to a decrease of normal function in the shoulder joint. An example of an asana in which this can happen is when your student raises her arms over her head to practice Vrksasana.
▶ glenoid labrum: The word labrum means “lip.” The glenoid labrum is a fibrocartilaginous ring on the perimeter of the glenoid fossa that helps to create a deeper shoulder joint socket.
In contrast, the acetabulum is created by a much deeper bony indentation in the pelvis. While the depth of the shoulder socket is increased by the glenoid labrum, it is nonetheless much less stable than the hip joint.
The shoulder joint is further supported by the glenohumeral ligaments, which are the main ligaments of the joint. These are three in number: the superior, the inferior, and the medial glenohumeral ligaments. These ligaments thicken the anterior portion of the joint.
Other important ligaments (Figures 13.6 and 13.7) that help to reinforce the shoulder joint include:
▶ acromioclavicular ligament: runs from the acromion to the clavicle
▶ coracoclavicular ligament: runs from the acromion to the coracoid process
▶ coracoacromial ligament: attaches from the acromion to the coracoid process
▶ coracohumeral ligament: covers and reinforces the upper part of the capsule and is attached from the coracoid process to the greater tubercle of the humerus
▶ sternoclavicular ligament: has an anterior and posterior portion that connects the sternum and the clavicle
▶ costoclavicular ligament: runs from the superior first rib to the inferior surface of the first rib
The shoulder joint is surrounded by bursae to protect the tendons of shoulder muscles from too much wear and tear around the joint. These include:
▶ subdeltoid bursa: located between the deltoid muscle and the humerus
▶ subacromial bursa: located between the acromion and the capsule of the shoulder joint
13.7 POSTERIOR/SUPERIOR LIGAMENTS OF THE SHOULDER CAPSULE
13.8 BRACHIAL PLEXUS
▶ subcoracoid bursa: located between the coracoid and the shoulder capsule
▶ coracobrachialis bursa: located between the coracoid and the coracobrachialis
▶ infraspinatus bursa: located between the tendon of the infraspinatus and the capsule
▶ others: bursae between the tendons of the latisimus dorsi and the humerus, the teres major and the humerus, and the pectoralis major and the humerus
NERVES
The nerves to the upper extremity are a complex structure called the brachial plexus. It is formed by nerve roots from C5 to T1, which give rise to many branches that innervate the shoulder muscles. These nerves course distally down the arm and forearm, eventually forming the radial, medial, and ulnar nerves (Figure 13.8).
It is important for yoga teachers to be aware of all the origins of the nerves of the brachial plexus in order to be able to recognize signs of irritation to the plexus if it manifests during asana practice. Any numbness, tingling, or radiating pain in the student’s arm or hand should be cause for concern. If it continues beyond a few minutes, the student should seek the counsel of a qualified health practitioner.
If you are not experiencing any problems with the nerves of your brachial plexus, there is a simple way to feel what overstretching these nerves feels like. Either standing or sitting, stretch your right arm out in abduction, about half way up to full abduction. Now extend your wrist strongly, and turn your head as far as you can away from your wrist. This should put some traction on the nerves of your right brachial plexus and create a slightly uncomfortable feeling along the pathway of the nerves. Do this only for a moment, to feel the stretch.
Pressure on the nerves of the brachial plexus is sometimes felt by students during the practice of Salamba Sarvangasana. A common example is when students with tight shoulders attempt to hold the back in the pose and state that their hands are feeling a tingling sensation or are going numb.
If this happens, it is not immediately obvious if the compression on the nerves is coming from the student’s neck or from the brachial plexus. Here’s how to find out. Have your student practice Salamba Sarvangasana with his feet on the wall, so his tibias are parallel to the floor and his back is straight. Now ask him to remove his hands from his back and stretch out his arms to the side. Make sure he keeps his feet on the wall for balance. If the tingling is relieved almost immediately, it is likely that the compression of the brachial plexus nerves as they pass through this axillary area has been relieved.
MUSCLES
The muscles of the shoulder joint are myriad, and their interactions are complex. In order to fully understand the movements at the gleno-humeral and related joints, it is strongly recommend that you memorize the origins, insertions, and actions of all the following muscles: the muscles that connect the scapula to the vertebral column (Figures 13. 9 and 13.10), the muscles that connect the upper limb to the trunk (Figures 13.11 and 13.12), and the muscles of the shoulder joint proper (Figures 13.13a, 13.13b, 13.13c, 13.14, and 13.15).
KINESIOLOGY
A little-appreciated aspect of the kinesiology of the biceps brachii muscle can be helpful to yoga teachers when they are assisting students. Most of us think of the primary action of the biceps muscle as being elbow flexion, and indeed it is. It is the muscle most often used to show “muscle man” strength. The biceps is also a shoulder flexor. But the strongest action performed by the biceps brachii is supination of the forearm.
In order to experience this, sit with your vertebral column in its natural curves, with your right shoulder joint in about 45 degrees of flexion and your elbow joint in 90 degrees of flexion and pronated. Now lightly palpate your right biceps brachii muscle as you flex your elbow against an imaginary force.
Notice the amount of force you generate in your biceps as you flex your elbow joint. Now try it again, and this time as your flex your elbow, gradually supinate your forearm, again against a strong imaginary force. You will feel a greatly increased amount of force of contraction in your biceps when you are supinating while flexing, as compared with flexion and pronation.
In fact, the biceps brachii’s greatest action is to act as a supinator. Therefore, if you want to maximize the strength of your biceps as an elbow or shoulder flexor, always flex your elbow and shoulder joint in supination. Placing your forearm in supination, with your palms up, will allow you a stronger mechanical advantage as a teacher when you perform an aid like pulling back on a strap in poses like Adho Mukha Svanasana or when pulling with a pole to help your student stretch her shoulders. And if you want to perform the classic callisthenic movement of a pull-up, it will be easier in supination because your biceps will have the greatest mechanical advantage as an elbow and shoulder flexor with your elbow joint in supination.
THE GLENO-HUMERAL RHYTHM
The most significant aspect of movement in the shoulder joint is the gleno-humeral rhythm. This rhythm is a special action around the shoulder joint which involves the scapula, humerus, and clavicle in a rhythmic way. The gleno-humeral rhythm accompanies the shoulder movements of flexion and abduction. If the rhythm is disturbed by injury, pathological process, or weakness, the result can be pain and a reduction in healthy movement.
The easiest way to learn the gleno-humeral rhythm is to remember that it involves four muscles, four bones, and four movements. The four muscles are called either the rotator cuff muscles, or equally often, the SITS muscles, for the first letter of each muscle’s name (Figure 13.16). The SITS muscles, charted in Figure 13.15, are the supraspinatus, infraspinatus, subscapularis, and teres minor.
13.9 MUSCLES CONNECTING THE SCAPULA TO THE VERTEBRAL COLUMN
13.10 MUSCLES CONNECTING THE SCAPULA TO THE VERTEBRAL COLUMN
13.11 MUSCLES CONNECTING THE UPPER LIMB TO THE TRUNK, (LEFT) ANTERIOR AND (RIGHT) POSTERIOR VIEWS
13.12 MUSCLES CONNECTING THE UPPER LIMBS TO THE TRUNK
The four bones are the scapula, the humerus, the clavicle, and the thoracic spine. (The thoracic spine actually consists of twelve bones, but for the ease of learning the gleno-humeral rhythm, we will count it as one bone.) Here’s how the glenohumeral rhythm works. The four SITS contract in a specific overlapping order to create the smooth movements of flexion and abduction. The bones are moved in the following way: the scapula protracts, and the glenoid is rotated cranially; the head of the humerus is cinched into the joint, descends to the part of the glenoid that is deeper and larger, and externally rotates; the clavicle rotates longitudinally inward toward the chest cavity; and the thoracic spine extends. When all these actions are coordinated perfectly, you are able to flex and abduct your shoulder joint normally.
To have a clearer experience of the external rotation component of the gleno-humeral rhythm, try this. While sitting or standing, place one hand over the anterior surface of your other arm, about midway between the elbow and the shoulder joint. Now perform flexion with the straight arm, and feel the external rotation that occurs under your hand. Try it again on the other side. External rotation of the humerus is a key movement of both flexion and abduction of the shoulder joint.
The longitudinal rotation of your clavicle can be felt by placing your index and middle finger tips on either side of the opposite clavicle. Find the place where the clavicle is rounded out, just lateral to its articulation with the sternum. Lightly but firmly hold the bone between your fingers while you abduct that arm. You will feel your clavicle rotating inward, back, and down as you abduct. This rotation is a necessary part of the gleno-humeral rhythm and helps allow the scapula to move as it needs to for full abduction and flexion.
STABILIZATION
After the gleno-humeral rhythm, the other important kinesiological principle necessary to understand the shoulder joint is stabilization. The ability to practice poses requiring strength from the shoulder joint depends on stabilization of the scapula. This means that the scapula is held stable against the rib cage in a neutral position. This requires the action of the intrascapular muscles like the middle trapezius, the rhomboids, and the serratus anterior.
Here is a simple way to feel the importance of stabilization. Sitting or standing, flex your shoulder joints to 90 degrees, and extend your wrists so you are looking at the back of your hands. Now let your scapulae protract. Next pretend that you are pushing away an elephant. Really use your muscles as if you were actually doing this task. You will find that you do not have much power in this movement.
Keeping your arms in flexion, draw your scapulae down and slightly together so they are in a neutral position and held firmly against your rib cage. Now push outward, as if you are pushing the imaginary elephant. You will notice a great increase in the power you experience in this movement.
Stabilizing the scapulae against the rib cage in a neutral position keeps the glenoid in a neutral position and thus facilitates the maximum power of all the shoulder muscles. Remember to suggest that your students place their scapulae in neutral for such strength poses as Chaturanga Dandasana and Adho Mukha Vrksasana.
13.13A, B, AND C MUSCLES OF THE UPPER EXTREMITY, ANTERIOR VIEW
13.14 MUSCLES OF THE SHOULDER JOINT, POSTERIOR VIEW
13.15 MUSCLES OF THE SHOULDER JOINT
13.16 ROTATOR CUFF MUSCLES: SUPRASPINATUS, INFRASPINATUS, TERES MINOR, AND SUBSCAPULARIS
SPECIFIC SHOULDER PROBLEMS
The shoulder joint is prone to a number of problems that range from annoying to serious. They include:
▶ dislocation: when the head of the humerus is pulled out of the glenoid fossa. It is both very painful and very serious and requires immediate medical aid.
▶ shoulder separation: when the clavicle is forcefully separated from the scapula at the acromioclavicular joint. This separation usually occurs in athletic injuries when the individual falls on the top of the shoulder. It requires immediate medical aid.
▶ bursitis: the irritation and inflammation of the bursal sac of the shoulder. Bursitis is a secondary condition created by a primary problem with the biomechanical function of the rotator cuff. It is usually caused when the head of the humerus does not move down in the glenoid during abduction, so the greater tuberosity presses up against the subacromial bursa. This can occur in any pose in which the arm is repeatedly abducted and sometimes by repeated flexion. Bursitis of the shoulder joint can also occur at the subdeltoid bursa. It usually occurs after a sudden unguarded movement or after unusually long repetitive movements.
▶ tendonitis: an irritation to a tendon. The most common forms of tendonitis in the shoulder joint are to the suprascapular, or long head of the biceps tendon.
▶ frozen shoulder: an effect of a long-lasting dysfunction of the gleno-humeral rhythm, causing the shoulder to be used less. A downward spiral is created by an initial injury that creates pain, which leads to less movement, which leads to more pain and guarding. Eventually movement can become less painful but more and more restricted, until the shoulder joint is referred to as frozen.
The three stages of a frozen shoulder are:
stage one: The individual can lie on the involved side on that shoulder, does not have pain to the wrist, has no pain at night. When tested by a trained professional, the joint will exhibit an elastic passive joint movement with a limitation of movement of only 20 to 30 degrees. Pain is only felt on extreme movement.
stage two: The individual can still lie on the involved side, does not have pain to the wrist, but does have pain either in the day with extreme movements and/or at night at rest.
stage three: The individual cannot lie on the involved side, has pain to the wrist, the shoulder hurts at night only, the capsule has lost all elastic passive movement, and there is an extreme capsular limitation. The least limited movement is internal rotation, then abduction, with external rotation being the most limited. The individual needs to be under the care of a physical therapist or other knowledgable health care professional and should not attend asana classes until movement improves.
EXPERIENTIAL ANATOMY
For Practicing
13.17 TADASANA, WITH THE HAND ON THE SHOULDER
Applied Practice 1: Feeling the Rotational Movement of the Humerus in Abduction
Prop: 1 nonskid mat
Take Care: Avoid this practice if you have pain on abduction.
TO FEEL the rotational movement of your humerus during abduction, sit or stand with your feet on your mat and normal spinal curves in place, and then place your left fingertips across the upper outer portion of your right shoulder, where your sleeve begins (Figure 13.17). Abduct your right humerus at a moderate speed. Notice the spontaneous external rotation that begins after about 30 degrees of movement. Try it on both sides to see if there is any difference.
13.18 TADASANA
Applied Practice 2: Feeling the Effect of No Rotation of the Humerus on Full Abduction
Prop: 1 nonskid mat
Take Care: Avoid this practice if you have pain on abduction.
TO FEEL the external rotation component in abduction, begin by sitting or standing on your nonskid mat, with all the curves of your vertebral column in neutral (Figure 13.18). Now internally rotate your left humerus and, while keeping it internally rotated, try to abduct it. You will be unable to do it, as the head of the humerus will hit against the shelf of the acromion and stop the movement of abduction. Start again in internal rotation, but this time when you feel the bony block occur, immediately externally rotate the humerus and let it swing out under the shelf of the acromion, thus permitting full abduction.
For Teaching
13.19 TADASANA
Applied Teaching 1: Palpating the Shoulder Area
Prop: 1 nonskid mat
Take Care: Be sure to ask for your student’s permission before touching her.
HAVE HER STAND in Tadasana on a nonskid mat (Figure 13.19). Standing in front of the student, gently trace the clavicle from the sternum to the acromion. Then palpate the coracoid process under the lateral clavicle. Now walk around behind her and trace gently the vertebral border and axillary border of the bone. You may need to ask your student to abduct her humerus to at least 90 degrees in order to do this latter palpation. Now trace the spine of the scapula from its medial border to the acromion. Finally, locate the inferior angle.
13.20 TADASANA
Applied Teaching 2: Observing Gleno-Humeral Rhythm
Prop: 1 nonskid mat
Take Care: Avoid these movements if they produce pain.
ASK YOUR STUDENT to stand in Tadasana on a nonskid mat (Figure 13.20). Stand behind him. It is helpful if his clothing allows for an easy viewing of his scapula. Ask him to abduct both his humerus bones from neutral to full abduction several times in a row, at a moderate speed. Note the rhythmic movement of the scapulae as he does so. Now have him flex from neutral to full flexion, and again observe the scapular movements. One interesting variation of this observation is to have him abduct one extremity and flex the other, and note that the end point of both of these actions is the same. You can even have him do the movements while your eyes are closed. Upon the completion of the movements, open your eyes and try to guess which extremity was abducted and which was flexed.
13.21 ADHO MUKHA SVANASANA
Applied Teaching 3: Observing the Gleno-Humeral Rhythm in Adho Mukha Svanasana
Prop: 1 nonskid mat
Take Care: Avoid these movements if they cause pain in the shoulder joint.
ONE OF THE most commonly practiced poses to stretch the shoulder joint is Adho Mukha Svanasana (Figure 13.21). Have your students practice this pose on a nonskid mat and observe their shoulder joint movement. Remember that in order to obtain full flexion of the shoulder joint, we need to externally rotate the humerus as well.
However, if at the full range of shoulder flexion in Adho Mukha Svanasana the student continues to externally rotate, she will actually begin to limit her movement. Beginning students do well to focus on allowing external rotation to naturally occur as they come into the pose. But once the full flexion is just about reached, have your experienced student internally rotate instead. This will actually create more freedom in her shoulder joint.
You can experience this first before teaching it by doing the following. Sit or stand with your vertebral column in its neutral curves. Then fully flex one shoulder joint; notice how the humerus externally rotates as you do so. At the end of the movement, try to continue externally rotating. It will feel as if the humerus is dropping into the glenoid and that there is actually less freedom if you attempt to flex more. Now do the opposite: at the end of flexion, begin to internally rotate. Paradoxically you will experience more freedom to fully flex at this point. To review, external rotation of the humerus in the glenoid is absolutely necessary for normal and full flexion. However, for yoga students who are close to being at the full range of flexion, try teaching them internal rotation as they settle into Adho Mukha Svanasana.
Applied Teaching 4: Strengthening the Shoulder Muscles
Prop: 1 nonskid mat
Take Care: Avoid these movements if they cause discomfort in the shoulder joint.
AN EFFECTIVE MOVEMENT you can offer students to strengthen the muscles around the shoulder joint is a movement based on preparation for Salamba Sirsasana (Figure 13.22). This movement will strengthen the rotator cuff muscles, the chest muscles, and the muscles of the back and abdomen.
Have your student get down on his hands and knees on a nonskid mat, interlock his fingers as for Salamba Sirsasana, and then lift his hips by straightening his knees. He should then move forward with an exhalation as if to place his body into a straight line over his hands (Figure 13.23). He then moves backward to create the inverted V shape again (Figure 13.22). Be sure that he keeps his elbows on the floor and the breath moving with each back-and-forward movement. Have him practice these movements for 5 to 10 repetitions, exhaling as he moves forward and inhaling as he moves backward.
13.22 + 13.23 ARDHA SALAMBA SIRSASANA
After a brief rest, have him reverse the interlock of his fingers so that the opposite thumb is on top and all the fingers fit together one slot over, and repeat the movements. To make the movement easier, have him move his feet back, widening the distance between elbows and feet. To make it more challenging, have him move his feet closer to his elbows.
Applied Teaching 5: Stabilizing the Scapula in Chaturanga Dandasana
Prop: 1 nonskid mat
Take Care: Avoid this practice if it causes pain in the shoulder area and during menstruation, pregnancy, and for three months postpartum.
HAVE THE STUDENT spread her nonskid mat on a level surface and practice Chaturanga Dandasana by first coming into a plank position and then lowering into the pose (Figures 13.24 and 13.25).
To avoid injury to the shoulder in Chaturanga Dandasana, the keys are the positions of the scapula and the humerus. Remember, the scapula is the core stabilizing bone of the shoulder joint. To keep the shoulder joint safe in this pose, make sure that the scapulae are held down toward the waist as well as slightly adducted, especially at their lower tips.
13.24 + 13.25 PLANK POSE + CHATURANGA DANDASANA
Additional protection for the shoulder joint in Chaturanga Dandasana can come from paying attention to the position of the top of the humerus bone. Make sure that it is pulled firmly down toward the waist and is externally rotated, elbows close to the body. The top of the humerus bone needs to roll back and downward toward the waist, and at the same time the elbows press downward toward the floor. These two actions of stabilizing the scapula in neutral and descending and externally rotating the head of the humerus in the glenoid decrease the chances of injury.
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A simple and helpful book for rehabilitating the rotator cuff muscles is The 7-Minute Rotator Cuff Solution: A Complete Program to Prevent and Rehabilitate Rotator Cuff Injuries by Joseph Horrigan, D.C., and Jerry Robinson (Los Angeles: Health for Life, 1991).