Understand and Prevent Shoulder Injuries

BY Doug Keller

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This shoulder-strengthening, chest-opening asana routine targets injuries in the rotator cuff and restores muscular balance. No surgery required!
Each time you lift your arms, your shoulder muscles—both big and small—initiate a dance full of subtle nuances. The complex interaction of those muscles, coupled with the unique structure of the shoulder joint, gives your arms a wide range of motion. In fact, the shoulder is one of the loosest joints in the body. But this freedom of movement comes at a price: shoulders are vulnerable to injury both from sudden falls and from repetitive action such as throwing a baseball. The muscles of the rotator cuff, the most delicate movers of the shoulders, are particularly susceptible. But here’s the good news: a regular, targeted asana practice can help you maintain healthy rotator cuffs by bringing awareness to your alignment, strengthening your shoulder muscles, and opening your chest. And several of the poses described in the pages that follow can even encourage the healing of rotator cuffs if you’ve already injured them.

The Anatomy of the Shoulder

Let’s take a look at the special nature of the shoulder joint and, in particular, its relationship to the shoulder blade. Though it is considered a type of ball-and-socket joint, the shoulder is unusual because the rounded “ball” or head of the humerus (i.e., the arm bone) doesn’t have a corresponding socket. Rather, the ends of the collarbone and shoulder blade come together to form a shelf under which the humerus hangs. This shelf is known as the acromion process. Beneath it there is a rounded depression that is part of the shoulder blade. This is as close as the shoulder gets to having a “socket”; the head of the arm bone glides against this surface as it rotates, and the steady contraction of the rotator cuff helps to hold the joint together. 
The rotator cuff actually comprises four separate muscles—the supraspinatus, the infraspinatus, the teres minor, and the subscapularis—which wrap over, in front of, and behind the head of the humerus and stabilize the joint. These deeper muscles are layered over by larger, stronger muscles that attach directly to the acromion process. The muscles of the rotator cuff guide the actions of the arm bone itself, while other larger muscles control the actions of the shoulder as a whole, with both arm bone and shoulder blade functioning as a unit.

How Injuries Occur

The most common rotator cuff injury occurs at the outermost corner of the shoulder, beneath the deltoid (the large muscle you use to lift your arm). The injury is to the supraspinatus, a small muscle that attaches directly to the head of the humerus and assists the deltoid in lifting the arm overhead. The very strength of the deltoid is often the cause of injury to the supraspinatus.When you take your arms overhead, the deltoid is able to raise the arm to about 80 degrees from the body. At this point, the deltoid can’t do much more lifting on its own: the arm bone is almost level with the shoulder, and from this angle the deltoid can only pull the arm bone into the joint rather than lift it higher. As the arm continues to rise, the deltoid relaxes somewhat and the supraspinatus jumps in to help: it raises the arm for the next 30 to 40 degrees, after which the deltoid can resume its work. 
It is within this range of 80 to 120 degrees that the supraspinatus can get hurt. The tendon of the supraspinatus, which is about the size of a large rubber band, is the part of the muscle most often injured, though the muscle itself can also tear. This can happen especially in hasty and aggressive adho mukha shvanasana (downward-facing dog) poses, as well as in flamboyant versions of the newly popular vasisthasana (side plank pose), and in advanced arm balances such as tittibhasana.
Simple accidents can also injure the supraspinatus tendon. For example, if you slip in an icy parking lot and use your arm to break the fall, the humerus gets jammed in the socket, pinching the supraspinatus against the acromion process or even tearing the tendon. The simple repetitive action of raising your arm can also be at fault. When you reach for something on a shelf above you, the deltoid can pull the arm bone up too hard, pressing it against the acromion process, thus pinching the supraspinatus. Over time, these little injuries add up to a more serious problem. 
The shoulder is built to avoid this pinching, but our patterns of use and everyday life lead to imbalance, pain, or lack of mobility. The problem starts with postural habits: many of us overuse the muscles of the shoulders to support the weight of our arms. The muscles closest to the neck (the rhomboids) and those running from the tops of the shoulder blades up into the neck itself (the levator scapulae) take the brunt of the weight. This is especially problematic during arm-intensive activities such as typing, when your shoulders become set in a perpetual shrug. Chronic tension builds up, pulling the inner corners of your shoulder blades up toward your ears, causing your back to round and your shoulders to hunch. This is the beginning of a vicious cycle: the more your shoulder blades creep up the back from the pull of these muscles, the more your muscles tense and shorten, pulling your shoulder blades up even higher. As a result of this tension and the postural misalignment that ensues, the deltoid is far less likely to relax when it’s supposed to. If your shoulders roll foward and the deltoid remains fully engaged as you lift the arm from 80 to 120 degrees, it can cause the humerus to press against the acromion process, pinching the rotator cuff tendon. 
There are a variety of yoga poses that can help break the cycle and restore strength and balance to the shoulder muscles—from simple standing poses in which you hold your arms aloft in various positions to those in which your arms directly support the weight of the body. The standing poses described below can help you reestablish the healthy mobility of the shoulder blades as you lift your arms; they will also enable you to activate other muscles to ease the burden on the rhomboids and levator scapulae. The inversions, particularly the headstand, strengthen the shoulder muscles, keeping them more open and stress-free. 

Freeing the Shoulder Blades

To begin, extend your arms out to either side in warrior II pose. Make sure your arms are in the same plane as your shoulders or slightly forward of the shoulders. To experience “the shrug,” rotate your hands and arms so your thumbs face downward: feel how the muscles on either side of your neck hunch upward, the deltoids tense, and the shoulders feel blocked. 

Tense Warrior II: If your deltoids are tense they will cause your shoulders to hunch.

Now rotate your hands and arms so the palms face up, even reaching your little fingers upward. The hunching dissipates: the upper inner corners of your shoulder blades release down your back, softening the sides of your neck. Feel how the weight of your arms is supported more by your shoulder blades, which are planted firmly on your back, and less by your neck: you’ll especially feel a firming of the muscles at the outer edges of your shoulder blades, as the deltoids soften and the shoulder joints begin to feel more open and free. Do a few small arm circles to feel the support offered by the shoulder blades. 

Relaxed Warrior II: If your shoulders are relaxed, you’ll feel the upper inner corners of your shoulder blades release down, as the neck softens.

The same hunching tends to happen in parshvakonasana (side angle pose) when you extend the top arm overhead. Many students have trouble straightening the arm: the deltoid is tight, the shoulder is pinched, and the neck feels cramped, making it uncomfortable to turn the head. The problem begins once again with the shoulder blade, which fails to release down the back so that the arm can swing into place in the shoulder joint. 

Side Angle Pose: Avoid pinching in the shoulder by bringing your arm slightly forward and sweeping it in a C-shaped arc. Feel the shoulder blade release as the arm swivels into place.

To release the shoulder in the side angle pose, take your top arm slightly in front of your body and, while extending out through the little finger, rotate your arm in a tiny arc, making a C shape with your hand, as if you were dipping your little finger in a bowl of ice cream. The shoulder blade will release down your back and away from your ear, and the humerus will swivel into place next to your ear, making space for your head to turn. It’s this simple yet elegant movement of the shoulder blade that opens the shoulder, and also, through a subtle downward pull of deeper muscles in the back and shoulders, prevents pinching of the rotator cuff. 

Protecting the Shoulder Joint

Freeing the shoulder blades is just the beginning. Protecting and healing the rotator cuffs—the supraspinatus in particular—involves not just realigning the bones, but activating and strengthening the muscles meant to counteract the upward pull of the deltoid. Straight-arm poses such as downward-facing dog and adho mukha vrikshasana (handstand) certainly make use of these muscles, but the shoulder is also at its most mobile and vulnerable in these positions. It’s safer to begin with variations on shirshasana (headstand), in which the position of the arms and shoulders is more stable. And since the aim of these headstand preparation exercises is to make the arms more weight-bearing, the neck can remain safe: little, if any, weight needs to be placed upon the head. 

Downward Dog on the Wall

This exercise will help you establish correct alignment in your shoulders without putting weight on your arms. Stand facing the wall and place your forearms on the wall in headstand position, with your fingers interlaced and your elbows shoulder-width apart. Keep the palms of your hands separated so that your arms form an upside-down U shape, rather than a V. Walk your feet back as you bend forward from the hips. Maintaining the U shape, let your arms slide down the wall until your body is at more or less a right angle (knees can be bent if necessary), and your head is in line with your upper arms; the top of your head should not touch the wall. 

Downward Dog On the Wall: Create more space within the shoulders by pressing your forearms and elbows into the wall.

Lightly engage the inner edges of your biceps, drawing energy from your inner elbows toward your armpits. This action stabilizes and protects your shoulders because, when engaged, the biceps draw the arm bones back into the shoulder joints. To keep your shoulders open and prevent pinching in the joints, isometrically squeeze your elbows toward each other while firming the biceps, as if you were squeezing a beach ball between your elbows. Feel how your upper back broadens, much as it did when you turned your little fingers upward in the warrior II exercise. 
Press your forearms into the wall to stretch your upper body through the shoulders and away from the wall. If you are nursing an injury, go only as far as you can without pain or stiffness in your shoulders; your head may only be an inch or two from the wall at first. That’s fine. Notice how pressing through your elbows makes your shoulder blades firm into the back, creating more space within the shoulders. For comparison, press more with your wrists and see how your triceps and deltoids activate, making your shoulders tighten and hunch. Pressing through the elbow when the arm is weight-bearing activates the deeper muscles—latissimus dorsi, subscapularis, and teres major—that pull the head of the arm bone down and back, away from the acromion process; this prevents the pinching of the supraspinatus. While extending back as you press through your forearms into the wall, avoid overly rounding your upper back: let your spine descend from between your shoulder blades toward the floor, while keeping your arms active. Hold the stretch for about 30 seconds. 

Headstand with a Chair

In the next variation, the arms bear more weight. This is where a prop becomes helpful. Place a sturdy chair against a wall so that it will not slide. Sit in front of the chair, facing away from it, and extend your legs so that you can measure a leg’s distance from the chair. When you go into the pose, you will place your elbows where your heels are. 
Now come away from the chair and place your hands and arms in headstand position, with the elbows on the floor at the spot you just measured. With your feet on the floor, toes curled under, lift your hips up as if you were doing downward-facing dog. Lightly engage your inner biceps and push your forearms down and away from you as you lift and stretch your hips back, creating a straight line from your elbows to your hips. Rest the crown of your head on the floor between your hands, pressing through the arms firmly enough so that most of your weight is on your arms, not your head. Hold the stretch for about 30 seconds, keeping the arms engaged. 
If you can keep most of your weight on your forearms and do not experience pinching in the shoulder joints, then step first one foot and then the other onto the chair to elevate the hips, bringing more weight into your arms. (To protect your neck and build strength in your shoulders, you may want to practice with your head entirely off the floor, lifting so that your head comes in line with your upper arms.) Press the whole forearm into the floor, especially through the elbows. 

Variations in Headstand: Build strength in your shoulders and protect your neck by pressing the length of the forearms into the floor.

Headstand Variations

In the next exercise, remove the chair, then measure a leg’s distance from the wall. Rest the crown of your head on the floor between your hands, with your fingers interlaced, your hands cupped around the back of your head, and your wrist bones perpendicular to the floor. If you have neck concerns, you’ll still want to keep your head off the floor, although it will be rather demanding. Come into the downward dog version first, then step your feet up the wall, so that your body is at a right angle—an upside-down version of the exercise with which we began. This pose is sometimes called urdhva dandasana. Press through your arms to take the weight off your neck and to lift your shoulders away from your ears and toward your waist. This engages and strengthens the muscles that pull your arm bones away from the acromion process, keeping the supraspinatus safe and allowing it to heal. 
How effective are these exercises for mending rotator cuff injuries? In one study published in the International Journal of Yoga Therapy in 2006, 10 people with rotator cuff injuries practiced similar variations of the headstand for 30 seconds daily for six weeks, with follow-up sessions every six weeks, for an average of 4.9 months. Nine out of 10 patients reported improved range of motion in the shoulders and reduced shoulder pain after the initial 30-second session. At the final follow-up, eight patients showed significantly improved range of motion and a 75 percent reduction in pain. None went on to surgery, which is unusual for people with rotator cuff injuries who report a significant amount of pain. 
If you already practice the full headstand and are aware of the alignments and precautions, you can include this asana in your shoulder-strengthening-and-healing routine. While in the pose, your whole forearm should press fully into the floor to distribute your body’s weight.

Headstand: Collapsed shoulders cause the body to arch into a banana shape (left), which strains the rotator cuffs. To prevent this from happening, press through the forearms while lifting the shoulders away from the neck (right).

In the headstand, the shoulders have a tendency to hunch toward the ears. As a result, the body takes on a “banana pose.” If you feel compression in your lower back or neck, it’s a sign that you are indeed in a banana shape. Press a bit more through your elbows. At the same time, with your thighs firm and steady, take your hips back slightly to align them more directly over your shoulders, and take your feet forward, reaching up through your inner heels and the mounds of your big toes. Keep your lower belly firm to steady yourself; you should feel your neck lengthen as you extend down through the crown of your head. 
As you press your elbows more fully into the floor, you will be able to broaden your shoulders, lifting them away from your ears and toward your waist. Feel how the outer edges of your shoulder blades engage. The muscles you are using are the very muscles which, when awakened and strengthened through practice, create balanced action within your shoulders and protect the rotator cuffs from injury.
Because your shoulders play an important role in so many daily activities—playing musical instruments, typing, driving, not to mention practicing yoga and playing sports—it’s well worth the effort to include inversions and shoulder-strengthening exercises in your daily routine. And in the end, when the burdens of the world prove to be a bit too much for your shoulders, the work of turning upside down can give them some welcome relief. Atlas himself could have used a good headstand.

ABOUT Doug Keller Doug Keller has a master’s degree in philosophy from Fordham University. His yoga journey includes 14 years of practicing in Siddha Yoga ashrams, intensive training in the Iyengar and Anusara methods, and nearly a decade of teaching in the U.S. and abroad. Asana instruction, essays, and other enlightening information are available on his website.

Heal Your Neck & Shoulder Pain

Find out how postural awareness and a targeted yoga practice can bring you long-lasting relief from neck and upper back pain.

BY Carol Krucoff 

Like many yoga teachers, I often begin my classes by asking students if there are particular places in their bodies where they feel tension, tightness, or discomfort that they’d like our session to address. The single most common reply is “neck and shoulders.” In fact, neck pain and its associated disorders are much more common than previously believed, according to a task force established by the World Health Organization (WHO). Most people will suffer from neck pain at some point in their lives, the task force reported in the journal Spine in 2008, with some evidence indicating that 10 to 20 percent of adults suffer from chronic or persistent neck pain.

While neck pain sometimes results from trauma—such as an injury from playing sports or whiplash from a car accident—by far the most common cause is stress on muscles and ligaments stemming from poor postural habits, typically related to our computerized, stressful, sedentary lifestyle. One of the most widespread postural problems is forward head posture, a misalignedrelationship between the head and the shoulder girdle, where the head protrudes in front of the shoulders and the upper back rounds. This causes the muscles of the neck, shoulders, upper back, and chest to alter their length and efficiency as they struggle to counterbalance the weight of the heavy head against the pull of gravity—with the muscles in the neck and front body becoming tight and short and those in the mid back and the back of the shoulders becoming weak and overstretched.

Typically the muscles complaining in pain in forward head posture are the overworked posterior muscles of the neck, which serve to extend, rotate, and laterally bend the head. These include the suboccipital muscles at the base of the skull; the deep neck extensors, located alongside the cervical vertebral column; and the upper trapezius, which extends down from the base of the skull and the cervical vertebrae, and also serves to move the scapulae (shoulder blades).

The most common cause of neck pain is stress on muscles and ligaments stemming from poor postural habits, which are often related to our computerized, stressful, sedentary lifestyle.

Prolonged postural distortion pulls the scapulae up toward the ears and causes the muscles in the front of the neck and chest—including the sternocleidomastoids, anterior and medial scalenes, and pectoralis major and minor—to tighten and shorten, drawing the head even farther forward and rounding the shoulders. As the chest collapses, the chin juts out to keep the gaze forward, creating further compression in the neck.

Forward head posture can have a number of adverse effects throughout the body. The shortening of muscles in the front of the chest puts pressure on nerves and blood vessels in the arms, which can increase the risk of repetitive stress injuries, such as carpal tunnel syndrome. The elevation and forward movement of the scapula, combined with a weakening of the lower trapezius and supraspinatus, can compromise the shoulder joint, leading to pain and inflammation in the rotator cuff. Forward head posture can also compromise your lower back, because the curve in your lumbar spine may change to offset the shift in your cervical spine. In addition, continual “slumping” compresses the lungs and internal organs, so it’s not surprising that this rounded posture can interfere with proper breathing, circulation, and digestion. Healthy diaphragmatic breathing is difficult if you’re in a slumped position, and shallow “chest breathing” can lead to or exacerbate neck pain because it uses accessory respiratory muscles, especially those around the neck, to lift the chest, which creates compression on the cervical spine.

One of the most pain-producing postural problems is forward head posture, where the head protrudes in front of the shoulders and the upper back rounds.

To determine whether you have forward head posture, try a simple self-test: stand with your back and heels against a wall; if the back of your head doesn’t easily touch the wall, you may have this misalignment and be at increased risk for neck pain. The WHO task force reported that for most people struggling with neck pain, the best strategy is self-care. That’s where yoga comes in. Yoga asks us to pay attention to the many factors that can influence neck and shoulder pain—including our postural habits, body mechanics, thoughts, and emotions—and move with diligence and compassion in the direction of health.

For lasting relief of neck and shoulder pain, it’s essential to bring your postural awareness and yoga practice into daily life. The following set of postures includes three chair-based yoga practices that you can weave into your workday to cultivate proper sitting posture and enhance circulation in the neck, shoulders, and supporting muscles. Two gentle on-the-floor backbends help counteract the effects of forward head posture on the muscles of the back, neck, shoulders, and chest.

3 Poses In a Chair

Seated Mountain Pose

In this well-aligned sitting posture, the head is balanced directly over the shoulder girdle, relieving supporting muscles of the extra burden of holding it up against gravity. Sit tall, with your feet planted firmly on the ground and your sit bones dropping down into the seat of the chair. From this place of grounding, extend the crown of your head up toward the sky, lengthening your spine. Soften your shoulders away from your ears and rest your hands on your thighs. Be sure your chin is parallel to the ground, neither poking up nor tucked in. Imagine that you have a headlight in the center of your chest at your sternum, and shine that light directly forward. Relax your face. With a soft gaze and smiling eyes, look toward the horizon. You might visualize yourself resting your head back against a supportive headrest. If someone looked at you from the side, they’d see your ear directly over your shoulder, and your shoulder directly over your hip.

Angel Wings with Circles

Geared toward enhancing circulation in the shoulders and upper back, this posture helps free the scapulae, which are suspended by a network of muscles and ligaments that attach to the neck and upper spine.

From seated mountain pose, extend your arms forward; then bend your elbows and place your fingertips on your shoulders. On an inhalation, open your elbows out to the sides as you draw your shoulder blades together in the back of your body; imagine that you have a nut on your spine and your shoulder blades are moving together like a nutcracker to squeeze it. On an exhalation, bring your elbows forward and together, as you feel your shoulder blades sliding apart in back of your body. Continue for 3 to 6 breaths.

Then, keeping your fingers resting lightly on your shoulders, imagine that your elbows are felt-tipped markers, and draw large ovals in the air with them. Keep the breath slow and easy as you circle in one direction for 3 to 5 breaths and then reverse direction for 3 to 5 more breaths.

Ear to Shoulder

This posture helps stretch muscles that are involved in rotating and tilting your head, including the scalenes and upper trapezius, which often become extremely painful and sore in people who sit at a desk for long periods.

From seated mountain pose, reach your arms behind you and clasp your elbows with your opposite hands. Then release your right hand and place it on your right thigh, with your left hand holding your right arm just above the inside of the elbow. Inhale as you lengthen the crown of your head toward the sky; then exhale and release your right ear down toward your right shoulder, trying not to lift the shoulder toward the ear. Drop your left shoulder down and breathe into the left side of your neck. Stay here for several breaths, then exhale and gently rotate your head so that your nose moves toward your right shoulder.

Inhale and rotate your head the other way so that your nose moves toward the sky.

Continue for a few breaths, synchronizing your movement with your breath. Then relax, release your arms, and let your head float back over the shoulder girdle, crown lifting to the sky. Repeat on the other side.

2 Poses On the Floor

Baby Cobra

Unlike other variations of bhujangasana, in which the arms can help raise the back, this version requires the back muscles to do all the work. As a result, this pose helps strengthen many of the muscles that tend to be weakened and stretched by forward head position, including the middle and lower trapezius, latissimus dorsi, rhomboids, and serratus posterior.

Lying on your belly, bring your arms down by your sides, palms facing down, and your chin or your forehead to the floor (you can place a small folded towel under your forehead if you like). Root down through your pubic bone, and press your legs and the tops of your feet down into the earth, lengthening back through your feet. Find your breath. On an inhalation, lift your head, neck, shoulders, and upper back as high as you comfortably can, keeping the hands on the floor. The goal is to create a slight backbend in the upper spine without stressing the low back. On an exhalation, relax everything back down. Continue with this practice, inhaling up and exhaling down for 3 to 6 breaths. For an extra challenge, stay in the lifted pose for several slow, deep breath cycles. Be sure to keep your neck long so that you’re not just cranking your neck up and down but using your back muscles to lift the back and shoulders; imagine that you have an eye in the back of your neck, and try to keep that imaginary eye wide open.

Arm VariationClasp your hands behind your back, keeping the elbows soft. On an inhalation—as you lift your back, shoulders, and head—also lift your clasped hands up away from the tailbone and extend your arms back. Allow this action to help draw the shoulders back, and invite the arms to straighten without locking the elbows.

Neck Turn Variation
Each time you relax down on an exhalation, turn your head to one side, being sure to alternate sides.

Restorative Backbend

This pose can be particularly soothing after a day behind the desk since it stretches the muscles in the front of the shoulders and chest that tend to get short and tight in forward head posture—particularly the front of the deltoids, subclavius, and pectoralis major and minor.

Place a block underneath one end of a bolster so that the bolster rests at a slant. Sitting on the floor with bent knees, bring your sacrum against the lower portion of the bolster and ease yourself back into a comfortable reclining position, arms resting at your sides, palms up. Feel free to cover your eyes with a cloth or a small pillow and use additional blankets, if necessary, to support your head. Set a timer for 5 to 15 minutes, then turn your attention inward, allowing your breath and gravity to help the pose deepen and unfold.

Bringing Your Yoga into Daily Life

The best strategy for people struggling with neck pain is self-care.

Remember, good posture is not just something reserved for yoga class; it can offer profound healing when practiced off the mat, too. Try integrating yoga into your daily life by noticing what’s happening physically, energetically, mentally, and emotionally throughout your day. While you’re at your desk, plan to take a 30-second break every hour to check your posture and watch your breath. After a restroom break, try a few rounds of angel wings and ear-to-shoulder stretches. With awareness and practice, you can find profound relief from neck and shoulder pain, cultivating lasting balance.

This article was written in consultation with Matthew J. Taylor, PT, PhD, immediate past president of the International Association of Yoga Therapists. Portions adapted from Healing Yoga for Neck and Shoulder Pain: Easy, Effective Practices for Releasing Tension and Relieving Pain by Carol Krucoff (New Harbinger, 2010).

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3 Poses for Neck and Shoulder Pain

Neck and shoulder pain is epidemic in our Web-surfing society, and the typical yoga practice may not cure it. Here are three easy poses to keep you pain-free.

BY Doug Keller 

One of the most common problems my yoga students complain about is chronic pain around the shoulder blades and in the upper back and neck. This kind of pain plagues those of us who work with our arms extended in front of us, whether we’re typing on the computer, cooking, carrying children, lifting heavy objects, or washing dishes. Let’s face it: that includes just about all of us. Because these activities are especially demanding on the arms, shoulders, and upper back, it’s not surprising that back pain is so widespread, even among the most dedicated yoga students.

Shoulder work is a foundation for nearly all hatha yoga poses.

Upper back pain commonly stems from the tendency to slump in the spine and round the shoulders. Slumping causes the shoulder blades to slide away from the spine, chronically overstretching and weakening the muscles around them. Eventually these muscles harden into tough bands to protect themselves from this constant strain. As they tire, these weakened fibrous muscles go into spasm, creating hot, persistent pains along the edges of the shoulder blades and the sides of the neck.

Common shoulder stretches reduce the upper back pain only marginally, and some can even make the problem worse. That’s because stretching often focuses on the pain without addressing its deeper causes. The cause of the slumping, paradoxically, lies in the front of the body, deep within the shoulder area of the upper chest. Tightness in the upper chest muscles pulls the shoulders forward and down, while rotating the upper arms inward. By releasing the tension in these muscles, we can undo the most persistent cause of chronic upper back pain.

Challenges in Your Yoga Practice

Tightness in the upper chest makes it difficult—and sometimes even harmful—to perform basic asanas. Tense muscles draw the shoulders forward and rotate the upper arm bones inward, straining the shoulder joints in a number of common poses. For example, if you tend to hunch your shoulders while extending your arms to the sides in poses such as virabhadrasana II (warrior II), the deepest part of the shoulder joint can be harmed where the misaligned bones pinch the rotator cuff muscles. Moreover, hunched shoulders cause the upper back to round and the shoulder blades to “wing out” to the sides, weakening the muscles of the upper back.

The tightness also shows up in poses in which the arms are extended overhead, such as virabhadrasana I (warrior I) and adho mukha shvanasana (downward-facing dog). The same tightness that causes shoulder problems in warrior II will make it difficult for you to fully extend your arms overhead or open your chest in these poses. In warrior I, your elbows may bend out to the sides as the upper arm bones rotate inward, again causing the bones of the shoulder joints to pinch the rotator cuff muscles deep in the shoulder sockets.

Tenderness in the muscles of your chest indicates that problems will persist until the muscles are relieved of their chronic tension through focused stretching.

The same is true in downward-facing dog. Though it is generally easier to straighten the arms in this pose, the upper arm bones still tend to rotate inward toward the ears. The weight-bearing nature of the pose makes this inward rotation all the more dangerous if you (like many students) push your chest toward the floor, straining your shoulders at their weakest point.

Finally, when you extend your upper arms behind your body in poses such as sarvangasana (shoulderstand), the same tightness in the fronts of the shoulder joints turns the shoulders strongly inward and causes the elbows to slide out laterally. This misalignment severely compromises the shoulders and causes the chest to collapse, putting harmful weight on the bones of the neck.

The Root of the Problem

What’s the common denominator in these poses? In each case, the upper arms rotate inward as the shoulders roll forward and down, bringing the shoulder blades with them. The cause of these problems is tightness in a trio of muscles that run from the inner arm through the armpit to the chest.

Two of these muscles run along the inner edge of the upper arm: the brachialis, which (along with the biceps) bends the elbow, and the corachobrachialis, which adducts the upper arm, bringing it closer to the body. A third muscle, the pectoralis minor, attaches at one end to the coracoid process, a thumb-like forward extension of the shoulder blade, and at the other end to the ribs of the upper chest. The role of this muscle is to draw the shoulder forward and down. When we reach forward to move or manipulate objects—an action we perform frequently—the pectoralis minor, corachobrachialis, and brachialis muscles all contract.

Among the three, the pectoralis minor is most responsible for postural problems. Although it is a relatively small muscle, its attachment to the coracoid process allows it to exert a good deal of leverage on the shoulder. As we reach for something, contractions of the pectoralis minor draw the shoulder forward, in turn pullling the shoulder blade away from the spine and rounding the upper back. Chronic tightness in the pectoralis minor, then, promotes forward-slumping shoulders, while tightness in the muscles along the inner arms further aggravates problems by causing the arms to rotate inwardly.

Although the muscles responsible for causing our discomfort are in the front of the body, the pain we feel is in the upper back. It is caused by a misalignment of the shoulder blade that has been persistently pulled away from the spine by the slumping in our shoulders. This pull causes painful muscle spasms along the edges of the shoulder blades. The muscles that are most affected are:

• The rhomboids, muscles that con-nect the shoulder blades to the spine. The upper rhomboids are particularly strained by their effort to pull the shoulder blades back into place, countering the pull of the pectoralis minor.
• The levator scapulae, which extends from the top edges of the shoulder blades to the upper vertebrae of the neck. These muscles elevate the shoulder blades and are strained by the pull of the shoulders as they slump forward and down.

Tension in the rhomboids causes chronic pain along the edges of the shoulder blades nearest the spine, while tension in the levator scapulae creates pain in the sides of the neck, which can make it difficult to turn the head. If, for instance, your right shoulder is hunched forward, tension in the levator scapula on the right side of your neck will make it more difficult to turn your head to the right. This pain may also shoot down through the inner edge of your shoulder blade.

Skillful body work concentrating on these upper back muscles will help ease your pain, but it will not eliminate the cause, which is tension in the front of the chest, in the pectoralis minor. If you suffer from upper back pain, try massaging just beneath your collarbones, especially between the third and fifth ribs, which will likely be quite tender. (You may be surprised to feel a corresponding twinge under your shoulder blade, a hint of the neurological link between these areas.) It is just as important for you to massage the muscles in the front of your upper chest as it is to have your upper back massaged. Tenderness in the muscles of your chest indicates that problems will persist until the muscles are relieved of their chronic tension through focused stretching.

How to Stretch and Open the Chest (Correctly)

Hatha yoga gives us powerful tools to stretch and open the chest. However, we must be attentive to some simple details to ensure that these stretches properly target the problem. One of the most common stretches for the upper chest, for example, is often performed incorrectly. In this stretch the hands are clasped behind the body, and the arms are drawn away from the back to stretch the fronts of the shoulders. But if you are not careful, the very muscles you are trying to stretch can cause the arms to become misaligned, further straining the shoulders.

To perform the stretch correctly, bend your elbows and interlace your fingers behind you, separating the palms of your hands. Keeping the elbows bent, lift and square your shoulders; then draw your shoulders back, moving your elbows toward each other so that your upper arms are parallel. Flexible people will be tempted to straighten the arms and hyperextend the elbows, but this is a temptation to resist, since it reduces the effectiveness of the stretch. The proper action of squaring the shoulders, bending the elbows, and bringing the upper arms parallel will rotate the upper arms outward, opening the space between your upper chest and the fronts of your shoulder joints. Moreover, the arm bones will “hug” the shoulder joints, protecting your rotator cuff muscles.

To increase the stretch, keep your chest elevated as you draw your hands away from your back. Ultimately, you can straighten the arms, but only if this does not make the shoulders rotate in and downward. Since many of us are too quick to straighten the arms, it’s better to keep the elbows slightly bent.

Seated Stretch

Purvottanasana (upward-facing plank) is a posture that stretches the brachialis (inner arm muscles) as well as the chest. To begin, sit on the floor with your knees bent and your feet a comfortable distance in front of you. Place your hands on the floor 12 to 16 inches behind you, wider than your hips and (ideally) with your fingers pointing forward. (If you feel wrist pain in this position, place a support such as a folded towel under the heels of your hands or turn your hands outward.) Bend your elbows slightly, and, as you exhale, soften your chest downward, bowing your head. As you inhale, draw your shoulders back, keeping your elbows bent and your upper arms parallel. Lift and open your upper chest, feeling the stretch just below the lines of your collarbones. Keep your hips on the floor.

Next, with each inhalation, lift your chest and straighten your arms, maintaining the open space between your chest and the fronts of your shoulder joints. The more you straighten the arms while pressing downward through the mounds of your index fingers, the more you feel the stretch along the inner edges of your biceps and forearms.

Progress in the pose by raising your hips. Don’t take your head back at first—keep it lifted, looking toward your knees. Continue to lift your chest. Ultimately you can take your head back by lengthening through the crown of your head.

Avoid throwing your head back in a way that collapses your chest and hyperextends your neck. Do not lift your hips if your arms turn in, if you feel a sharp pulling deep inside your shoulder, or again, if your chest collapses.

In the full pose, the legs are extended straight out in front of you. Isometrically draw your heels toward your hands to activate your hamstrings. Extend through your toes, lift your hips, and open your chest.

Standing Stretch

This stretch addresses some of the deepest levels of tightness in the arm, shoulder, and chest. Stand next to a wall with your feet parallel and comfortably separated. Place the fingertips of one hand on the wall at shoulder height with your arm fully extended. Place your other hand on your hip. Cup your fingers so that only the fingertips touch the wall, and rotate your arm outward slightly so that your thumb (rather than your index finger) points upward. Keep your shoulder aligned with your hand and begin to lift and open your chest with your breath, rolling your collarbones back.

Now, twisting from the waist, turn just your upper body, extending through your arm to the fingertips, as if the wall were moving away from you. This stretch extends from the chest and the armpit down through the entire length of the inner arm to the thumb. You may feel the stretch at any point along this line. It is a deep fascial stretch that feels unlike most muscle stretches—it may tingle, which indicates a lengthening of the tougher fascial tissue. Breathe. The tingling is normal and fine, as long as it does not become a sharp localized pain. This stretch reaches some of the deepest levels of tension in the arm and shoulder, and opens the flow of circulation to the entire area.

How to Get the Best Results

Shoulder work is a foundation for nearly all hatha yoga poses. Lengthening the chronically short muscles in the inner arm and chest establishes better alignment in the shoulders and frees you of fatigue and painful spasms in your upper back. When your shoulder joints are aligned, they enjoy their fullest range of motion. Your chest feels broad and open, and the lower tips of your shoulder blades stay firmly and comfortably in place on your back.

When your shoulder joints are aligned, they enjoy their fullest range of motion. Your chest feels broad and open, and the lower tips of your shoulder blades stay comfortably in place on your back.

If you take a quick inventory of your body as you progress with these three easy stretches—the chest opener with the arms clasped behind the back, the upward-facing plank, and the standing stretch near a wall—you’ll notice that the muscles between the shoulder blades and the spine feel broad and lightly toned. Your arms hang easily at your sides with a slight outward rotation, maintaining the feeling of breadth across your upper chest. Your head turns from side to side without difficulty, and you experience greater freedom when you extend your arms to the side and overhead. When your arms are stretched overhead in warrior I, for example, you will feel the inner edges of your shoulder blades release downward as your chest opens. There will be no bunching up of the muscles at the base of your neck. These are all signs of progress, signs that you are dissolving the chronic pain in your upper back and creating space for a more fruitful asana practice.

ABOUT Doug Keller Doug Keller has a master’s degree in philosophy from Fordham University. His yoga journey includes 14 years of practicing in Siddha Yoga ashrams, intensive training in the Iyengar and Anusara methods, and nearly a decade of teaching in the U.S. and abroad. Asana instruction, essays, and other enlightening information are available on his website.

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