“. . . according to the Yoga Sutra (3.1), the term [Bandha] refers to the ‘binding’ of consciousness to a particular object or locus (desha), which is the very essence of concentration.”
Georg Feuerstein



Friday, November 6, 2015

Stabilizing Your Shoulders In Downward Dog

Hi Folks,

In our last post, we discussed joint rhythm for the shoulders. In this blog post I want to share some of my recent investigations on the biomechanics of the shoulder joint, with some specific tips for Down Dog. Shoulder pain is one of the problems that comes up in yoga, especially with folks who are doing Vinyasa based practice. The underlying cause of the pain can be multifactorial, but it is frequently related to impingement of the rotator cuff and subsequent inflammation of the cuff tendon (specifically the supraspinatus muscle). Inflammation of the tendon, in turn, affects function of the shoulder. Weakness or instability in the shoulder can then lead to abnormal pressures at the wrist, causing pain there as well. Thus, stabilizing the shoulders has beneficial effects beyond the shoulders. is a complex process involving strengthening the core and then linking the strong core to the shoulders.

With this in mind, let’s look at one of the key factors in shoulder impingement, namely, the acromio-humeral interval. This refers to the distance between the undersurface of the acromion and the humeral head, as measured using radiology intruments (x-ray, ultrasound, mri). The acromion is a shelf of bone on the scapula, above the spine (seen in Figure 1). It serves as the attachment for the deltoid muscle. The humeral head articulates with the shoulder joint and serves as the attachment for the muscles of the rotator cuff (on the greater and lesser tuberosities). Factors that decrease the space between the acromion and humeral head can lead to inflammation of the cuff tendon due to compression between the two bones.

Figure 1: The acromio-humeral interval. 

Research has shown that contracting the main adductor muscles of the shoulder serves to increase the acromio-humeral distance. These include the pectoralis major and latissimus dorsi. Co-contracting the biceps and triceps muscles when the arms are overhead can also draw the humerus away from the glenoid, as shown in Figure 2. Finally, externally rotating the shoulder humerus moves the vulnerable area of the supraspinatus tendon away from the area where it would impinge on the acromion (click here to learn more).

Figure 2: The long head of the triceps and short head of the biceps in relation to the gleno-humeral joint with the arms overhead.

Here’s the cue…

Warm up first a bit. Then, take Downward Dog pose. I use three steps for the shoulders. Go slowly and use gentle engagements.

  1. Contract the triceps to straighten your elbows. Then, press the mound at the base of your index fingers into your mat to engage the forearm pronator muscles.
  2. Next, fix your palms into the mat and try to drag the hands towards each other. This engages the adductor muscles of the shoulders as well as the biceps.
  3. Finally, gently roll the shoulders outward. This externally rotates the humerus bone and helps to bring the greater tuberosity away from the undersurface of the acromion.

Figure 3 illustrates the various muscles involved in these cues.

Figure 3: Attempt to drag the hands towards one another. This engages the shoulder adductors. Then externally rotate the shoulders.

As a final adjustment, I like to link the action of the shoulders to the lower extremities. The cue for this is to engage your lower gluteus max and adductor magnus muscles by drawing in with the upper inner thighs and then attempt to drag your feet away from the hands. Feel how this stabilizes your pose. See Figure 4 for the graphics.

Figure 4: Engage the lower parts of the gluteus maximus and adductor magnus as you attempt to drag the feet away from the hands to stabilize the pose.

Bear in mind that shoulder stability is a complex process. The shoulders are linked to the core; so building a strong core leads to stable shoulders. Stable shoulders help to protect the wrists, and so on. Click here to read more on your core. If you would like to learn more anatomic sequencing to improve your poses, click here to take a tour of The Yoga Mat Companion Series.

Thanks for stopping by—see you in a couple of weeks for another post on combining anatomy, biomechanics and yoga.

All the Best,

Ray Long, MD



References:


  1. Graichen H1, Bonel H, Stammberger T, Englmeier KH, Reiser M, Eckstein F. Subacromial space width changes during abduction and rotation--a 3-D MR imaging study. Surg Radiol Anat. 1999;21(1):59-64.
  2. Hinterwimmer S1, Von Eisenhart-Rothe R, Siebert M, Putz R, Eckstein F, Vogl T, Graichen H. Influence of adducting and abducting muscle forces on the subacromial space width. Med Sci Sports Exerc. 2003 Dec;35(12):2055-9.

23 comments:

  1. Hello,
    It's very useful and you r doing a great job on this. This gives more knowledge about the anatomical movement of our body parts during yoga practices. I will teach these informations to my students also. Thank you very much for sharing.

    Regards,
    Sundar.S
    (VISHAARAD YOGA)

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  2. YES! And Bravo! This totally makes sense to me!

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  3. I'm a little confused, you say "Research has shown that contracting the main adductor muscles of the shoulder serves to decrease the acromio-humeral distance" and you say "Factors that decrease the space between the acromion and humeral head can lead to inflammation of the cuff tendon due to compression between the two bones." and then you say to "Next, fix your palms into the mat and try to drag the hands towards each other. This engages the adductor muscles of the shoulders as well as the biceps." but if activating the adductors decreases the acromio humeral interval which can lead impingement of the rotator cuff tendon and thus inflammation why do you cue to activate the adductors? What am I missing? thank you

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    Replies
    1. Thanks Juliet--was a typo, fixed it.

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    2. aha now it all makes sense thank you and fits with cues i have learnt such as broadening across the shoulders while squeezing in the armpits -which activates teh adductors, and to externally rotate the upper arm while internally rotating the lower arm by pressing into thumb and forefinger... slightly different cues but same effect. I will have to explore the lower body actions you talk about here, they are new to me. (I must also delve deeper into your books which are sitting on my book shelf... not doing much good if not studied - thanks for all your sharing of your expertise. Namaste

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  4. Thank you for this clear example. These are indeed complex movements but I find that when I pay very close attention to the cues, focus on the areas and muscles involved, I can feel an immediate difference in the down dog pose. I appreciate the increased body awareness that comes from your discussion and illustrations of the mechanics and anatomy of our yoga practice. Thank you Ray, Chris and Bandha Yoga.

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    1. Hi Tish,

      Thanks for commenting--you're welcome. I found this helped me a lot in Down Dog as well. Best~Ray

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  5. Hello,

    Interesting article, like always. I've already seen this kind of advice elsewhere, but your explanation and 3d images are always making things clearer. Thanks for that.

    Small feedback: you forgot to add a link to a shoulder article it seems. You left this text in your post: (link to shoulder article).

    Finally, a more personal comment regarding shoulder pain. I've been suffering for something about 3 years from shoulder pain. I stopped swimming after 1 year of pain but refused to stop yoga. Even 2 years later my pain was not gone. I used my (very good) teacher's feedback as well as yoga web sites and books like yours to take better care of my shoulders and, ultimately, fix my pain. In parallel I’ve sought physician advice, got my tendinitis diagnosed and started physio therapy. I got some relief but felt tendinosis was always ready to come back.

    Finally, I found a book written by a yet retired orthopedic surgeon (John M. Kirsch M.D.) which recommended dead hanging exercises. His book (Shoulder Pain? The Solution & Prevention) contains an interesting study where he used CT scan to validate his theory. I've never felt my shoulder better.

    So why am I taking the time to explain all that, it is because yoga has always been promoting the use of the body in every possible movement. But the current yoga props don't include anything for hanging (even the rich set of Iyengar yoga props). Think about that one moment: how many years have been passed since we were hanging and brachiating to trees?

    Regards,
    Yann

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  6. I love this stuff and I share it on my facebook yoga group all the time . Do you ever come to the UK or Ireland ? Keep posting

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  7. Yann, - just a correction, the rightly named rich set or suite of Iyengar props do indeed include ropes for hanging, as the RIMYI has always included. Just so you know, Mr. Iyengar himself often hung from robes in backbends often with the aid of many mats, atressler for the tops of his dangling feet, a stool of some sort and of course his trusty little stopclock. I agree more hanging would be great, and would point you towards the book "Yoga: Critical Alignment" if you don't already know/have it. The author has quite an interesting headstand/shouldstand small bench of sorts, that allows one to hang freely while supported: Jatukasana, a form of Bat Pose :-)

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    1. Thank you so much sliversides for correcting me. Indeed I wasn't aware of this rope prop and work. I'll jump on the book you mentioned !

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  8. Ray, thank you for your continuously engaging write ups and beautiful illustrations.

    Regarding step #1: it seems to me that - all else equal - straightening elbow in downdog will bring humerus closer to the acromion and diminish the subacromial space. Straight elbow in downdog would thus counteract the "space-creating" effects of adductors' contractions.

    I keep my elbows slightly flexed, drawn medially with the effect on the arms being rotated laterally/externally. When I straighten my elbows I can feel the increased compression in the shoulders (regardless of how wide apart my palms are on the floor). When I flex the elbows "too much", I can feel the increasing strain (shear force buildup?) in the shoulder. So, what I am focusing on is bringing the shoulder joint in a conformation wherein the humerus presses perpendicularly, if you will, into the glenoid cavity. This seems to be the least strenuous and the most stable/enjoyable position of the shoulder joint in a downdog to me.

    I am making this comment because straight elbows in downdog are ubiquitously encouraged by yoga instructors. My understanding and experience suggest that straight elbows put unnecessary strain on (otherwise healthy) shoulder joint and increase the likelihood of shoulder injury at a later time.

    Best regards,
    martin

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  9. Love your books & so grateful to be able to share this online with others! Thank Dr. Long :)

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  10. Awesome illustrations and explanation. Very helpful!

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  11. Very helpful. Thank you for sharing.

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  12. So what I get here (in simpler terms, perhaps) is that you've got a subtle internal rotation of the forearms as you press firmly into the index knuckle for pronation while there is a baby external rotation of the humerus, thus creating this little spiral of motion where the actions are "just so". If I do this the way I think you're describing, it is a) similar to how I teach, just totally different languaging and b) feels like I'm floating in suspension rather than hanging out in my shoulder joints.

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  13. Very, very helpful. My shoulder has been uncomfortable for while which has meant i havent been able to put any pressure on it or move it eaxily. I wondered if the daily sun salutations i had been doing was the cause and now feel confident that your detailed description above is describing the problem of my shoulder. Thank you.

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  14. When teaching yoga, a place I commonly find people's shoulders getting into trouble is when doing Sun Salutations: they bring their arms up from Tadasana to Urdhva Hastasana (standing w/ arms at sides to bringing them overhead from the side). I see people externally rotating their arms WAY too soon - with hands still at their sides, they rotate palms forward /immediately going into external rotation. Consider automatic rotation of the arm bones: arms internally rotate to reach behind "for a baton" and externally rotate to "reach for an apple off the tree". When the hands are at your side, the palms face your hips naturally. Many people I teach find greater ease in their shoulders when I invite them to bring their arms up w/ palms facing the floor until shoulder height and then rotate them externally w/ palms facing as the arms come overhead. Try it. See what you experience, and let me know. It makes sense to me to work with the natural rotation of the bones.

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  15. I have found that getting people to work the hands, wrists and forearms in cat pose with fingers forward, to the side and to the rear, has given them much greater awareness of the shoulders and upper arms when we then go to downward dog. Just as you suggest. I don't understand the arrows in the final diagram that show the upper leg rotation. In iyengar land the instruction is to rotate the inner thighs inwards and project towards the rear to open the back of the knees. The rotation of the pelvis then allows a straighter projection of the spine which in turn provides a point of stability for the action of the shoulder blades.

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  16. Thanks so much for this (and other!) clear, helpful series of insights. I'm recovering from shoulder surgery (after 2 1/2 years of shoulder pain) and have for a while been trying to help my students (and myself) have healthier shoulders in their practice.

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