Do-It-Yourself myofascial release to reduce pain, restore flexibility, hydrate tissues, and re-establish healthy movement to relieve common pain-causing tension.
Do you suffer from pain in your shoulders and neck? Maybe it’s the result of working at your desk, driving a car, picking up kids or perhaps you hold tension in this region of the body when you are feeling stressed. Whatever the reason, nagging pain in the shoulders and neck can be exhausting. The good news is, there are some simple self massage techniques you can do any time to relieve this aching pain.
Myofascial Release (MFR) is a massage technique that works with both the muscles and fascia. Myo refers to the muscles, while fascia refers to the connective tissue and fascia. MFR can be very simple but it’s also incredibly complex. The goal of myofascial release is to reduce pain, restore flexibility, hydrate tissues, re-establish healthy movement between the myo-fascia and allow for free passage of signals through the connective tissue system.
What is Fascia?
The fascial web is one continuous interconnected system of connective tissue that exists from head to toe without any interruption. In quite recent history, connective tissue was believed to be a ‘space filler’ and was cut away in a cadaver. However, in more recent years its relevance has become increasingly important as body worker and the medical community are realizing its vital role in creating support, providing separation, protection, hydration and communication for the body.
When coming to practice MFR, there are some fundamentals to consider:
Avoid bone: you won’t cause damage to the bone but it will just feel uncomfortable.
Avoid areas of acute injury/ inflammation/ swelling. If you have an area of acute pain, work around that region softly rather than irritating even more.
Change the position of the ball if you feel numbness, tingling, shooting or sharp pain.
Less is more: the aim of MFR is to reduce pain and deep seated tension. If applying pressure on the massage balls is causing you to tense up more and screw your face up (!) then ease off as there’s every chance that you’ll be causing more tension rather than less, making the practice counter productive.
Neck Release on a Block
Good For: releasing tension in the sub-occipital muscles at the base of the skull, which work hard all day holding the head up right.
Props: 1 block and a blanket
Lie supine on the ground with both knees bent and your feet on the floor. Lift your head and place the block on its medium height. The bottom edge of the block should be pressing into the base of the skull (approximately where the hair line is). Allow your head to be really heavy on the block. Very slowly, start to move your head from right to left (as if you were shaking your head to say ‘no’). Make sure that as your do this you are keeping your head really heavy on the block. When you find a point of tension that you can work with, pause for a couple of breaths at the spot. Allow the weight of your head and gravity sink down into the block, releasing deep seated tension at the base of the skull. When you feel even on both sides, move the block to one side to lie the back of your head on the ground. If you suffer from headaches or find that the block alone is too intense, place the blanket over the block to reduce the intensity.
Corners of the Neck
Good For: Releasing tension in two common trigger points for the upper portion of the Trapezius muscles. This is a common area of the body that people tend to hold onto stress.
Props: 2 tennis balls/massage balls, blanket and a block
Lie on your back and use your right hand to place the ball at the left ‘corner of the neck’ and use your left hand to place the ball on the right side. This might already feel tender for some people, in which case stay as you are. If you would like to apply more pressure onto the balls, lift and place your hips on the block. If you would still like to apply more pressure onto the balls, raise your arms up above your head so the backs of your hands are resting on the ground behind you. Stay here for about one minute and breathe deeply. Just as before, you can place a blanket over the balls to reduce the intensity.
Between the Shoulder Blades
Good For: Releasing tension in space in between the shoulder blades, the Rhomboid muscles. This tends to be a common area of tightness and tension, especially for people who sit for a large portion of the day.
Props: 2 tennis balls/massage balls, pillow and a blanket
Lie on your back and bend both knees so your feet are on the ground. Use your right hand to place the ball between the left shoulder blade and the spine and use your left hand to place the ball on the right side. At this point, you may like to lie your head on a pillow. Bring your arms out in a ‘T’ position, with the palms of your hands turned up toward the ceiling. If this is already tender, stay as you are and breath deeply. You can also bring your arms across your body as if you were giving yourself a hug. When you find a point that you can work with, stay there and breath. After about one minute, remove the balls and lie flat on your back.
Follow along with this 4 minute shoulder release yoga sequence with Rachel Land. The Lats, or Latissimus Dorsi, are a common source of tension on the shoulder complex. When tight, they can draw our arms down and in toward the ribcage, closing off our chest and making it difficult to expand into full and effortless breathing. The same pattern can make it difficult to lift our arms comfortably overhead, both in life and in yoga poses like downward facing dog. Follow along with Rachel to release shoulder tension, open the shoulders and experience the difference between sides before moving on to complete the sequence.
Do you have a yoga pose that you really want to master, but that feels completely unrealistic and beyond reach? For me, that pose used to be one legged king pigeon, or eka pada raja kapotasana.
When I first started practicing this pose, I felt like I was miles away. I was confused – my hips and legs had the necessary flexibility needed. I had no problem bending the back leg in pigeon pose. Though I have never been an extreme back bender, I had been a dancer for most of my life. Still, it was just plain impossible for me to reach and hold on to that foot behind my head without feeling like I was about to snap in half. I couldn’t even think about breathing while in the pose!
It wasn’t until I started learning more about shoulder anatomy and function that I realized how my shoulders had uncharacteristically limited range of motion compared to the rest of my body. The last pieces of the puzzle started falling into place.
I had never before made a distinction between backbends with arms overhead like urdva dhanurasana (wheel) and the backbends where the arms are reaching back behind you, such as ustrasana (camel pose), which I actually quite enjoyed. The challenge when the arms are over head lies not as much in the flexibility of the spine, as in the shoulders.
An overhead backbend will challenge your shoulder mobility in a very different way than when your arms are reaching back behind you. Taking a closer look at my own shoulders, I realized that a lot was lacking.
Investigating the Anatomy of Abduction & Flexion
First, I needed my arms to be able to come into full abduction and flexion, in other words, I needed to freely extend my arms overhead. When I reached my arms overhead, my upper arms were nowhere near my ears. For example, in gomukasana my upper elbow would be pointing more to the window than to the ceiling.
To have full range of movement of the shoulder joint, it is crucial that the scapula is able to move with the arm into upward rotation, which means that the shoulder joint is actually to some extent following the arm upward as it moves. If this movement of the scapula is restricted, the shoulder joints are presented with a much greater challenge that often causes a pinching sensation at the top of the shoulders. This is what I felt when reaching my arms overhead.
A muscle that can typically restrict the movement of the shoulder blade in upward rotation is the levator scapula. At first glance, this may not seem so obvious but bear with me. Levator scapula runs from the medial top corner of the scapula to the transverse processes of the vertebrae of the neck. Its primary task is to elevate the shoulder blade into a shrug.
What happens for many of us is that the levator scapula works extra hard to stabilize the head and neck when we hold the head anterior to the shoulders, typically looking at our phones or computer screens. When the levator is chronically tight, it will not let the top of the scapula move down to allow the other side of it, where the arm is attached at the shoulder joint, to follow the arm (into upward rotation). Taking a closer look at my posture, I noticed that my shoulders were rounded forward, and my head held further forward than my shoulders.
Even if your scapulae can upwardly rotate, you might still find it hard to reach your arms overhead. The next part of this equation looks at how freely the arm bone /humerus is able to move relative to the torso and the scapula.
The arm is connected to the upper body and the shoulder blade by a number of muscles. What I previously thought of as my posterior armpit is really a cluster of different muscles crossing each other here, connecting the humerus to the posterior side of the upper body, and the scapula. Latissimus dorsi (that big “wing” covering large parts of the back), its little helper teres major, and the long head of the triceps muscle all pass each other in this area at the back of the arm.
Furthermore, if you have limited movement repertoire or lack of the right kind of movement, it’s likely that the fascia surrounding this braid of muscles and tendons can stick together, making it more challenging to move the arm into full flexion and abduction. Again, if you feel pinching at the top of the shoulder joint in abduction, there is good indication that you could benefit from taking a closer look at this group of muscles.
Another big and strong muscle that has the potential to limit the arm in abduction is the pectoralis major. It connects the arm to the front of the upper body, and is often tight and overworking, especially when the shoulders roll forward.
Freeing up all these areas can have a huge effect on the movement of the arm.
Back to My King Pigeon
To be able to grab that foot behind my head in raja kapotasana, or keep the elbows from splaying out to the sides in urdva dhanurasana. I also needed sufficient external rotation of the arms in full flexion, which I would argue is even more challenging than externally rotating the arms in most other positions, since the lats are being stretched here.
The latissimus dorsi, teres major, pectoralis major, and subscapularis on the underside of the scapula are all internal rotators of the arm, as they connect the front of the upper arm bone to the torso or the scapula. Consequently, most of these muscles are recruited for inward rotation of the arm and forward shoulder carriage.
Releasing this group of muscles not only made it easier to reach my arms over head, it also made a tangible difference in the potential for passive external rotation of the arm. I found it extra helpful to both release the internal rotators and activate the external arm rotators.
The infraspinatus and teres minor muscles at the back of the shoulder actively help to externally rotate the arm bone as it abducts. In addition to turning the arms to reach the foot behind you, this action creates more space in the joint socket for the head of the humerus to move into full abduction without any of that pinching at the top of the joint. If your shoulders slump forward like mine did, these muscles at the back of the shoulder can become both weak and tight.
When a muscle is held in a lengthened position for a long time, the fascial fibers interweaving the muscle tissue can “lock” it in that position. The muscle loses the ability to contract effectively, and with less movement there is a loss of hydration and glide.
To bring it back to a more supple and responsive state, using myofascial release techniques could be greatly beneficial.
As I started working to improve the mobility of my shoulders, my dream pose was literally coming within reach.
Here are Four Ways That I’ve Improved My Shoulder Mobility:
1. Armpit Release
Lie on your side with a foam roller or a block on its middle height under the armpit. One long edge of the block is in contact with the crease of your posterior armpit, the rest of the block is under your side ribs. Rest your head in your hand. If this feels like too much, put a blanket on top of the prop to make it softer. The sensation might be intense, but shouldn’t be intensely painful.
Spend a few moments here to soften against the prop while breathing into your side ribs. Then slowly start to roll back so the block is more directly in contact with the posterior armpit –lats/teres/triceps tendon. Rock back and forth here a few times, staying with points that feel tender while breathing and waiting for an incremental release.
Next, roll even further back, so you feel the block more on the back of the shoulder blade, where your infraspinatus is located. Again, spend some time to breathe and encourage the tissues to release. Stay until the sensation is less intense, or for as long as you are comfortable.
Lastly, roll forward until the edge of the block touches your anterior armpit, where the pectoralis major passes from the arm to the chest. Place both your forearms on the floor in front of you and look towards the ground. You can rest your head on your other arm if that’s accessible. Breathe here until the sensation is less intense, or for as long as you are comfortable.
Remove the block and lie on your back for a few breaths between sides, just noticing any differences in sensation between your sides.
Repeat on your other side.
2. Activate the External Arm Rotators
Lie prone with one arm bent in a cactus shape, elbow around 90 degrees, hand and wrist on a block or a folded blanket, depending on your ROM. The arm will be in external rotation here, adjust the height of the prop so your elbow is still on the floor and you feel a slight stretch. The other arm can support your forehead on the floor.
Just stay in a passive stretch here for a few deep breaths, as the muscles start to relax and lengthen.
Activate the core by pushing your legs and pubic bone into the floor, feel your belly lifting. Then start pushing your hand and wrist down on the block/blanket, activating the internal arm rotators, the muscles that were previously lengthening. Hold the pressure for 5-10 seconds before relaxing again. Repeat this 1-2 more times.
Again, activate your core, and now let the hand/wrist get lighter, and maybe even lift it away from the prop. This activates your external arm rotators. Hold for a few breaths before relaxing the arm. Repeat this 1-2 more times.
Repeat on the other arm.
3. MFR Levator
To release the levator scapulae, lie on your back with your legs bent, feet on the floor. You might want to keep a block near by. Place two tennis balls or therapy balls on the top medial corners of your scapulae. Take a few moments here to notice how this feels before moving on. Stop at any stage along the way if the sensation gets too intense.
When you are ready, use your legs to lift your pelvis off the floor, gradually pouring more weight over the balls. You can lift and lower a few times here, or just stay. If you want, you can place the block under your pelvis.
Make snow angel movements with your arms along the floor. You could also try crossing them in the air in front of you. Keep breathing, and picture how the shoulder blades are moving with your arms.
To finish, remove the block from under you and lower the pelvis back to the floor. Move the balls and stay on your back for a moment to rest.
4. Puppy Pose with Block – Externally Rotate Arms
Give your internal arm rotators a stretch with this exercise.
Come into puppy pose, placing your hips over your knees, stretching your arms forward along the floor. Make sure your elbows are no more than shoulder-width apart and place a block on the floor between your hands. Adjust the width of the block according to the stretch you feel; a wider distance between your hands will produce more stretch.
To begin, just stay here for a couple of breaths and let your sternum sink towards the floor as you release any tension in your arms and shoulders.
When you are ready, start lifting the block off the floor and above your head. When you get there, again, breathe deeply and release any tension in the neck and shoulders. Stay for as long as you are comfortable.
To come out, slowly lower the block down to the floor and rest in child’s pose.
Our arms and hands are in front of the body most of the time, creating a common postural pattern where the head of the shoulder drifts forward in its socket. This pattern can impact our posture, breathing, and the weight-bearing position of the joint. In this video with Rachel Land, E-RYT 500 yoga teacher and Yoga Medicine® Therapeutic Specialist, you will learn how to activate one of the muscles on the posterior shoulder, our external rotator Infraspinatus, to help draw the head of the shoulder away from the chest back into the centre of its socket. You’ll then use that muscle activation to create central joint positioning in side plank.
Senior Yoga Medicine® teacher Rachel Land shares a simple sequence that can unlock common areas of resistance and make your backbends feel better.
Backbends have undeniable benefits. In a world where most of us sit in cars or at computers for hours each day, poses that create spine and hip extension help to balance out the biomechanical patterns created by sitting.
However, the benefits of backbends are not always accessible. We all differ in our bone structure, our proportions, and the consistency of our soft tissue. Because our range of motion in any given pose is unique, the deep backbends enjoyable to some of us are not achievable for all. In fact, chronic tightness in the front body (the very tension backbends seek to alleviate) can prevent us from being able to comfortably find our range in backbends; instead of creating the desired feeling of space, backbends may do the opposite—cause compression or claustrophobia, and take our breath away.
That’s where self myofascial release (SMFR) can come in handy. It is one of my favorite tools for unlocking habitual areas of tension, and it’s perfect for people who struggle to find freedom in backbends.
A Sequence to Make Backbends Feel Better
The key areas for focus in this SMFR sequence are:
The hip flexors
Rectus femoris, tensor fascia latae (TFL), iliacus, and psoas. When chronically short and tight, these muscles draw the pelvis into anterior tilt, in which the front of the pelvis tips forward and thus deepens the curve in the lumbar spine. When we backbend in anterior pelvic tilt we come to the end of our range in the lumbar spine more quickly. Instead of giving the hip flexors a much-needed stretch, we can end up feeling pressure or compression in the low back—especially when gravity deepens the backbend, as it does in upward facing dog (urdhva mukha svanasana) and camel pose (ustrasana). Releasing our hip flexors to reduce anterior pelvic tilt may allow us to explore our range of motion without crowding the low back.
The rectus abdominis
This familiar abdominal muscle draws the base of the sternum toward the front of the pelvis. While subtle engagement can provide helpful support in backbending poses, excessive tension there can leave us feeling constricted and unable to find free range of motion or easy breathing. A tight rectus abdominis isn’t an issue for everyone, but it can be for athletes and those who unconsciously brace the belly or hold it in.
Muscles that limit arm and shoulder movement
The pectoralis major and latissimus dorsi in particular. The pectoralis major is our main chest muscle, while the latissimus connects the inner upper arm with the low back. Sitting doesn’t just influence the hips and spine; the arm and chest muscles also tend to get short and tight when we chronically slump forward with our arms in front of our body. This can be a limiting factor in backbends, most of which involve the arms as well as the hips and spine.
Backbends that require the arms to move behind the body into extension, such as bow pose (dhanurasana), require the pecs to lengthen. The deepest backbends—including wheel, or upward bow pose (urdhva dhanurasana), and the overhead bind in dancer pose(natarajasana)—take the arms into overhead flexion, which requires elasticity in both pecs and lats. So relaxing chronic tension in these muscles can make backbends feel significantly freer, increasing the mobility of the arms and reducing the required range from the spine.
The upper portion of the gluteus maximus.
The lower portion of gluteus maximus is a hip extensor, which makes it a huge help in backbends, but the upper portion assists hip external rotation. When our glutes fire strongly both movements tend to occur (which is why the knees tend to flare wide in backbends). Hip external rotation in backbends is not problematic for some, but in others it can crowd or compress the sacrum (the triangular bone at the base of the spine that joins the two halves of the pelvis). Releasing the upper portion of gluteus maximus might just help us find more hip extension without feeling the glutes grip or clench around the sacrum.
This SMFR sequence will help you unlock some of these common areas of resistance, creating space for you to feel freer and easier in your unique range of motion. You will need two same-size massage or tennis balls (shown below are the Recovery Rounds by RAD and Yoga Medicine® and a yoga block.
Before you try the sequence, practice a backbend you usually experience as limited. That will give you a baseline for comparison after myofascial release.
Note: Self myofascial release on the abdomen is not recommended during pregnancy. If you are pregnant, either skip these locations (iliacus, psoas, and rectus abdominis) entirely or seek advice from your healthcare provider.
The sequence begins with the hip flexors. To work on the right rectus femoris, set up on all fours with a massage ball on the floor in front of your right kneecap. Slide your left knee forward and toward the left side of your mat, and then lean onto your forearms so that your right lower thigh sits on top of the massage ball. Tuck your right toes under and use that leverage to move your leg forward and backward, rolling up and down the bottom third of your right thigh until you find an area that feels tense or tender. Then either rock side to side across the muscle fibers or bend and straighten your right knee to pin the superficial fascia in place while the deeper layers glide with that movement.
Spend 10 to 15 seconds on whichever option feels the most helpful, and then rest on that spot for 5 to 10 seconds, encouraging your right thigh to soften as much as possible. Now inch your body down your mat until the massage ball is roughly halfway between your right kneecap and hip crease. Roll up and down the middle of your thigh until you find a tender area to work with, and then rock from side to side or bend and straighten your knee for up to 30 seconds before moving on to the right TFL.
Tensor Fascia Latae
To investigate the right TFL, remain in the same position but place the massage ball roughly an inch below and an inch to the right of your right frontal hip bone (so that it is between the front and side of your pelvis). Remain still or rock gently side to side for 15 to 20 seconds.
Then remove the massage ball and lie down on your belly with your left knee still bent out to the side.
For the right iliacus, place your massage ball just inside your right frontal hip point or ASIS so that the edge of the ball is almost touching the inner surface of that bony ridge.
Make your head and neck comfortable (perhaps by resting your head on stacked hands or turning it to one side). Take a few slow breaths, deliberately relaxing your lower belly with each exhalation and allowing the massage ball to melt in.
Once you feel your abdomen relax, either remain as you are for 10 to 15 seconds or bend your right knee to 90 degrees and rock your lower leg from side to side like a windshield wiper.
For the final 5 to 10 seconds, release your right leg back to the mat and feel the massage ball sinking in toward the inner rim of your pelvis.
To move on, remove the ball and slide your left leg down beside your right leg. Take a few breaths lying prone, and see if you can feel a difference between your right and left sides. Then press back up to hands and knees to repeat the sequence on your left side.
After you have worked on the left rectus femoris, TFL, and iliacus, move on to our primary hip flexor—the psoas. Lie on your belly with your two massage balls an inch apart just below your navel.
Make your head and neck comfortable and allow your belly to expand and push the balls out as you inhale; then soften to allow the balls to sink in as you exhale.
Either stay as you are or tuck your toes and lift your knees to lean more weight onto the massage balls. Breathe here for another 15 to 20 seconds, and then remove the balls and take a few relaxing breaths.
Next, work on the rectus abdominis, the primary trunk flexor. Remain prone with your head and neck in a comfortable position.
Move the massage balls higher until they are side by side, pressing into the soft tissue below the base of your sternum in between your ribs (not into the bones themselves). Use the rhythm of your breath to encourage your muscles to relax so that the massage balls melt into your upper abdomen.
Either stay prone or prop yourself up on your forearms, using your body weight to pin the muscles in place as you lengthen them. Stay another 15 to 20 seconds in your chosen position, and then remove the balls and breathe deeply for a moment or two. Take the opportunity to notice how you feel so far.
Now shift focus to the chest and shoulders, starting with the pectoralis major, the large (and often tight) superficial chest muscle. From your prone position place your block on its lowest height under your right shoulder and place one massage ball on top of it. Then adjust your props so that the massage ball nestles into the hollow below your outer right collarbone (just inside the head of your shoulder).
Put your right arm in a cactus position and relax as much as you can so that the weight of your arm and shoulder creates pressure on the massage ball. Relax your head and neck, resting your forehead or temple on the back of your left hand or the floor.
Stay for 20 to 30 seconds, breathing slowly and fully into your chest. If you’d like more sensation, reach your right arm forward and back, using your body weight to pin the muscle in place as you lengthen it. When done, remove your props and take a couple of breaths with your arms down by your sides to see if the right and left shoulders feel any different. Then repeat the process on the left side of your chest.
When you are ready to move on to the latissimus dorsi, press up to all fours, and then sit upright. Take your left thumb to your right armpit, and catch the thick strap of muscle at the back of your armpit between your left thumb and fingers. That is the target area: the top of the right latissimus dorsi as the muscle fibers gather to insert onto the inner right upper arm.
Lie down on your back with knees bent and feet on the floor, supporting your head on your block. Use your left hand to hold one massage ball against the target area on the upper right latissimus as you take your right arm out wide. Once the weight of your body pins the ball in place, you can release your left hand and start to roll toward your right, using your body weight to create the desired intensity of sensation: The more you roll toward your right, the more intense the sensation.
If you feel enough sensation, remain still for 20 to 30 seconds, breathing freely. If you want more sensation, slide your right arm along the floor toward the top of your mat—using body weight to pin the latissimus in place as you lengthen the muscle—and then slide it back toward the side of your mat. Repeat the arm movement two or three more times before resting still for a final breath.
When you are finished, remove the ball and roll onto your back. Stretch both arms overhead to see if you feel a contrast between the right and left sides before repeating the process for your left latissimus.
Finish the sequence by releasing the upper fibers of the gluteus maximus. Lie on your back, bend your knees, and place your feet on the floor. Lift your hips high enough to pin both massage balls beneath you on either side of the pelvis about an inch below the top rim and an inch wide of the sacroiliac joints.
Slowly rock your knees from side to side, feeling the weight shift from one massage ball to the other. If that feels helpful, stay with that gentle movement for 15 to 20 seconds.
If you’d like more sensation, prop yourself up on your forearms to roll your body an inch or two toward the top of your mat and back again, gliding the massage balls up and down either side of the upper half of your sacrum to release any tension there.
For the final 5 to 10 seconds find a position in which you can remain still and soften the skin over your buttocks. Then remove the massage balls and take a breath or two lying flat on your back. See if you can feel a sense of softness or spaciousness around your sacrum.
Now that the sequence is complete, repeat your chosen backbend, paying particular attention to the areas you have worked on. Aim to lengthen the front of the thighs, hips, and torso, and open the chest and side ribs, while softening the tight grip the glutes might have on the sacrum. Notice how it feels to breathe in this position before moving out of the pose.
Remember that the benefits of backbends stem not from the depth we achieve, but from their capacity to balance life’s tendency to compress the front of the body. Range of motion differs for each of us, but releasing the areas that stop us from finding our mobility can turn feared or dreaded backbends into poses we can all enjoy.
Arm balances and inversions occupy a special place in yoga practice. They defy us to flip our perspective, to challenge our courage and confidence. Because they also test muscles that are seldom asked to carry our full weight, our upper body deserves time for self-care after a practice peppered with these poses.
This self-myofascial release sequence will refresh and revitalize tired arm, chest, core, and shoulder muscles. You’ll need two same-size massage or myofascial release balls (shown below are the Recovery Rounds by RAD and Yoga Medicine®), a yoga block, and a blanket or towel. You may also want a sock or stocking to hold the balls together toward the end of practice.
As their names suggest, this group of muscles on the posterior forearm is responsible for bringing the wrists into extension—drawing the backs of the hands toward the forearms. Every arm balance and inversion (barring those on our forearms) entails weight-bearing on the hands with the wrists in extension, which shortens the extensors. Because daily activities like driving and typing keep our wrists in extension, the wrist extensors are prone to muscle tension even without adding the rigors of yoga practice, and they will doubly welcome the opportunity to release.
Take a seat on your mat with your block at its middle height in front of you. Place your right forearm along the top of your block—palm facing down and your hand off the block. You’ll find trigger points for this muscle group just below the elbow crease on the thumb and forefinger side of your forearm, so use your left hand to gently palpate the muscle mound there, looking for a couple of areas that feel tight or tender (but not so much so that they make you catch your breath or grit your teeth).
Once you find an initial trigger point, shorten your wrist extensors by drawing the back of your hand toward your upper arm, and then apply pressure to the tender spot with a massage ball held in your left hand. Maintain the downward pressure of the massage ball, pinning the extensors in place as you slowly stretch them by flexing your wrist and curling your knuckles down. Lighten the pressure of the ball and draw your knuckles back up toward your forearm. Repeat the “pin and stretch” technique two or three more times before moving on to another trigger point.
After a minute or so, lift your right arm off the block. Roll your wrist a couple of times, noticing any change in sensation in your wrist or forearm, and then move on to the left side.
Serratus Anterior and Latissimus Dorsi
The serratus anterior connects the underside of the scapula to the upper side ribs. It protracts the shoulder blades toward the outer ribs, as is necessary in poses such as crane (bakasana) and headstand (sirsasana). The latissimus dorsi originates on the lumbar spine and top rim of the posterior pelvis and sweeps up the back body before inserting on the upper arm bone. Among other roles, the lats are responsible for drawing the arms down from overhead toward the torso. This action is crucial for helping the hip flexors and abdominals pull the upper and lower body toward each other, as is necessary in arm balances like crane and firefly pose (tittibhasana).
Roll onto your right hip, using your right elbow and forearm to prop your torso up. Slide your yoga block on its middle height under the right side of your rib cage, positioning it so that one block edge is just below your armpit crease and the other edge is further down your side ribs. Once again, find an area that is tender, but where you can relax enough to stay a while. If the whole area feels too sensitive, pad the block with a towel or blanket and try again. Once you’ve found a trigger spot, allow your right hand to support your head. Take a few slow and steady breaths, and then roll slightly back until the edge of the block presses into the latissimus muscle on the back side of the armpit. Take a few deep breaths there, and then press the floor away with your left hand and come up to sit.
Move the block away. Bring your right elbow to the floor, and then slide it away from your right hip until you come to rest on your right side, ready to release your right triceps.
The triceps run down the back of the upper arm from shoulder to elbow, contracting to straighten the elbow and draw the upper arm behind the body into extension. These muscles work surprisingly hard during arm balances and inversions—either to straighten the arms, as they do in handstand (adho mukha vrksasana), or contracting eccentrically to hold a bent-elbow position against the weight of the body and gravity, as they do in forearm stand (pincha mayurasana) and eight angle pose (astavakrasana). Eccentric strength work is a common source of delayed-onset muscle soreness (DOMS). This means that after an arm balance and inversion practice, your triceps deserve priority in a recovery practice.
Place one massage ball under your right upper arm, a couple of inches below your armpit, looking for a trigger point in that general area. Place your left hand on the floor in front of you for support and bend your right elbow so that you can support your head with your right hand. Lean in to the massage ball for a couple of deep breaths, and then roll it an inch or two toward your elbow, looking for another sensitive area. Take two or three slow breaths there, and then press back up to sitting.
Roll your shoulders a few times and notice whether the right side feels different from the left. Then move on to work on the left serratus anterior, latissimus dorsi, and triceps.
Running from the base of the sternum to the pubic bone, the rectus abdominis is responsible for two actions that make arm balances and inversions possible. Its contribution is obvious in the scooped belly and rounded spine of arm balances like crane and firefly. It also acts more subtly to knit the front ribs back in poses like handstand and headstand, where we would otherwise have a banana-like arch in the back. These actions, while incredibly helpful during practice, may be less helpful after it; releasing the rectus abdominis can return us to a more upright posture and freer breathing.
Lie on your belly. Place your massage balls side by side in the soft tissue immediately below the base of your sternum, making sure they press into your upper abdomen and not into bone. Relax the weight of your body as much as you can, turning your head to one side or resting it on stacked hands. If the sensation from the massage balls is too intense, pad them with a blanket or towel. Once you are comfortable enough to stay, take a few deep breaths. Focus on the rhythmic movement of your abdomen—feeling it expand to push the balls away as you inhale, and then soften to allow them to melt in toward your spine as you exhale.
When you’re ready to move on, place your hands alongside your rib cage and press up through all fours to come into child’s pose (balasana), stretching your hips back toward your heels.
Pause there for a breath or two. Allow your belly to relax on or between your thighs, paying attention to sensations in your abdomen. When you are ready to move on from child’s pose, lift your torso up to vertical and come into a sitting position.
Even without arm balances and inversions, the upper trapezius muscles are notoriously tense. They run down the sides of the neck to catch the tops of the shoulder blades. Their roles include elevating our shoulder blades against the downward pull of gravity and upwardly rotating our shoulder blades to allow our arms to lift overhead. This means they work when we lift our shoulders to drive or use a computer; in inversions they work even harder when we press overhead with our arms, as we do in handstand and headstand.
Lie down on your back with your hips elevated on your block, knees bent and feet on the floor. Place a massage ball on either side of your spine at the base of your neck, just under the tops of your shoulders. As usual, look for an area that feels tender or achy, but doesn’t generate a sharp sensation. Once you’ve found one, either rest still or see how it feels to take your arms overhead, bending your elbows as much as necessary to rest them comfortably on the floor. Let your head be heavy and your neck and shoulders soft. After a couple of breaths, look for another trigger point, either farther out to the side or farther down. Pause there for a couple of slow breaths before working on one final spot.
After a minute or so of working on your upper traps, remove the massage balls and block and find a comfortable position to rest in. Bring your awareness to what you feel in your shoulders, neck, and upper back before moving on.
These four small muscles (rectus capitis posterior major and minor, obliquus capitis superior and inferior) crisscross the back of the neck and the base of the skull to extend and rotate the head. Given that many arm balances and inversions require these head positions—including side crow (parsva bakasana), handstand, and forearm stand—you can see why this is a helpful place to finish your recovery practice.
Set your block on its lowest height at the top of your mat, and then place your massage balls side by side on top of it. Lie down with the base of your skull resting on top of the balls, and your neck draping free. If the balls slide out from under you, or move apart, place them in your sock or stocking, knotting it loosely to secure them next to each other.
Once you are in place, take a breath or two to relax your head and neck completely. Then either remain still or trace tiny circles or figure eights with your nose so that the balls gently massage the base of your skull. Breathe slowly and evenly, allowing your head to feel heavier with each exhalation.
After a few long breaths, slide your block and massage balls away from you and gently release your head onto the mat. Pause to notice what you feel in your neck and the base of your skull, and also around your temples (where these trigger points can refer).
Investing the final few minutes of practice in savasana, a potent recovery pose, allows both body and mind to rest while fresh blood and lymphatic fluid revitalize the tissues you’ve worked on.
Take time to get completely comfortable. That may mean stretching out your arms and legs or using your blanket or towel as either a cushion for the back of your head or a comforting weight over your hips. Once you’ve found a position you can rest in, close your eyes or soften your gaze. Let go of any effort to control your breathing, allowing your breath to find its own easy passage through you. Feel your arms and shoulders heavy, your chest soft, and heart open. Let any residual tension, tenderness, or tiredness melt away.
Stay in savasana as long as you like. When you are ready to move on with your day, take a couple of deeper breaths. On an inhalation, stretch your arms overhead, and then exhale out through an open mouth. Bend your knees and roll to one side, then press up to a seated position, feeling rested and refreshed.
Jessica Rasmussen-Williams for Yoga Medicine® shares two routines to strengthen and stretch your shoulders. Use these routines to increase mobility and range of motion.
Stretch, Strengthen & Stabilize Your Way Back into Mobility
Remember the days when hanging from a jungle gym, climbing trees and throwing a ball came as easy as reaching for your keyboard to check your email, picking up your phone to make a phone call or check in on social media? In early childhood, our joints are at their maximum mobility and over time we build strength through exploration and curiosity. For example, we slowly built the stability for load bearing on the shoulder joints through “tummy time”, learning to crawl and eventually the power to pull ourselves upright to resemble the humans around us. From there, we moved to jungle gyms, trees and fields for ball throwing. Without thought, we launched ourselves across the monkey bars, reached for the next branch to pull ourselves further up the trees and played catch with our friends for hours without waking up injured or sore.
During our early teenage years, playground antics, tree climbing and ball throwing gave way to sitting at a desk in middle school without an option for the ever popular recess. Our physical priorities changed even more as we moved into high school and for some, made our way through college. As adults, many of us have unintentionally lost some of our physical curiosity and exploration as new priorities entered the game: computers and cell phones.
Posture & Lifestyle
While we begin to spend more hours of the day occupied with these computers and phones, our daily range of motion (ROM) that we practice begins to adapt to a new formation. It’s easy to get caught up in the eye catching information that these devices are putting in front of us these days. If we aren’t mindful, we can easily lose sight of the fact that we begin to round our shoulders and upper back as our head moves forward and drops to observe the luminous screen. Our posture takes the hit from this decreased ROM as the muscles in the front of the shoulder and chest tighten and the back of the shoulder and upper back strain and weaken. One day, we find ourselves feeling a bit rusty or even injured when we step back in time and attempt something outside of our new norm.
Joint Structure: A Brief Overview
The shoulder is made up of two joints, the glenohumeral and acromioclavical (AC) joints. While they are both a synovial joint, meaning that they have a joint capsule and secrete synovial fluid for lubrication, the two move in a completely different manner. The glenohumeral joint is a ball and socket joint which allows for movement of the humeral head in all directions in an ideally healthy ROM and stability. The AC joint is a gliding joint which offers up very small gliding movements and allows for the movement of the scapula on the back of the rib cage.
While the structure of the two joints differ significantly, the stabilization of both is equally important. The level of efficiency in the structure of the shoulder as a whole is negatively impacted when only one joint is stabilized. There are 2 types of stability that come into action here, passive and active.
Passive and Active Stability
Passive stability is where we are unable to energetically control the cartilage, capsule, ligaments and bone structure. Our skeletal structure and unique history of both healthy and injured joints limits our individual range of motion (ROM).
Active stability is where our mindful movement enters the playing field with muscles stretching and strengthening to keep the integrity of the joint and surrounding areas. We are able to control our destiny in preventing injuries along with wear and tear on the joint if we are able to find a balance in tension. The optimal joint positioning will make a world of difference in prevention, but how do we get there? Unless there is a genetic disposition to degeneration or abnormal bone structure, the answer is tensegrity.
Stedman’s Medical Dictionary for Health Professions and Nursing defines tensegrity as a concept of muscular-skeletal relationships based on the work of architect Buckminster Fuller. The concept refers to the forces of tension (provided by muscles, tendons, ligaments, and fascia) pulling on the structure (bones and joints) that help keep the body both stable and efficient in mass and movement.
The tensegrity system is responsible for managing tension and compression in the body. In the case of the shoulder, the basics of this concept suggest the integrity of the tension determines the stability of the joints. If there is a weakness on one side of the system, there will be increased tension distributed to other areas of the structure. To find those areas of weakness, first look for the tension. For example, notice your own posture. If the shoulders and upper back are rounded forward, the tension will likely lie in the pectoral muscles and internal rotators, resulting a weakness or straining in the external rotators, scapular stabilizers and erectors.
To combat this common postural limitation, we will take a look at a few ways to stretch the areas of tension, strengthen the areas of weakness and find the stability necessary to restore healthy function in the shoulder. In other words, we are looking for a community effect in the body.
Roll up a portion of your yoga mat so it is about 3-4 inches thick. Find a comfortable place to lay down on the rolled part of the mat along the length of the spine with the back of the hips on the floor and the head resting on the roll.
Bend the knees so the soles of your feet are on the floor a little further than hip distance apart.
Then let the knees fall together to touch, or place a block between the thighs as a resting place for the legs.
Take the arms out in a T position with the palms facing up for a few rounds of breath.
If this feels like too much already, remove the mat and come flat on your back. Regardless of which option you have chosen for yourself, bend the elbows into a goal post shape with the palms facing the ceiling. Stay here for a few breaths to check in with how the body responds to this shape.
Feel the broadening of the rib cage with each inhale as that expansion stretches the pec major and minor in the front of the chest.
Find a heaviness across the front of the chest and outer edges of the shoulders with each exhale as you soften and allow the back of the rib cage and arms to get heavier on the roll and floor.
If you would like a little more, keeping the elbows at the 90 degree angle and start to glide the arms overhead until the fingers touch.
If at any point the arms raise up off of the floor, simply glide the arms back toward your starting point until the entire arm comes back in contact with the floor. Once you’re there, come back to the breath to expand on your inhale and settle into the heaviness of the exhale.
Find your way to tabletop on your mat with the wrist crease directly below the head of the shoulder, a micro-bend in the elbows (to avoid a hyperextension in the joint), knees directly below the hips and gaze at the floor. From here we will work to strengthen the scapular stabilizers along the side of the rib cage (serratus anterior) and in between the shoulder blades themselves (rhomboids).
First, on your exhale, press firmly into the mat as you lift the chest away from the floor.
Maintain length in the spine without rounding in the upper back by pressing forward through the crown of the head and occipital bone at the base of the skull. Find the shoulder blades wrapping themselves to the outer edge of the ribcage and imagine pressing the hands slightly forward and toward one another while keeping the shoulder head hugging into the socket of the joint itself. The hands themselves won’t actually move with this action, although, the head of the humorous will stabilize into the joint. Hold this position for three breaths.
On your next inhale, keep the same position in the arm, lower the chest and squeeze the shoulder blades back behind you.
Shoulder heads are softening away from the ears and hugging into the joint. Again, look for the length along midline by hugging the belly away from the floor to keep from extending the spine. Hold here for three breaths to check in with how that feels.
Finally, when you are ready, start to move on your breath.
Exhale to press into the palms, lift the chest away from the floor. Inhale to lower the chest, squeeze the shoulder blades back behind you. Move back and forth on your breath through 10 rounds of each. When you’ve completed those 10 rounds, make your way back to child’s pose to rest with the arms extended overhead. Repeat 3 times and see where you feel strong and even where you feel a bit of weakness.
To ramp up the intensity, feel free to walk the knees back to a modified plank or come into full plank.
This will increase the load of weight bearing in the shoulder. If you find that you are straining or losing the ability to be stable, simply back off by staying in table top until you find the strength to move to the next level. There is strengthening to be found in all options, you may just need to increase or decrease the number of repetitions to find the right combination that works for you on that particular day.
Now that you have a couple of tools for stretching and strengthening, work to consistently incorporate them into your personal practice. Pairing these simple, yet powerful exercises with a mindfulness of your posture and time spent with your computer will bring you the stability you need along with an increased accessibility to your natural mobility that makes way for movement without injury.
 Stedman, Thomas Lathrop (2012), Stedman’s Medical Dictionary for Health Professions and Nursing 7th Edition, New York, NY: Stegman
Andrea Ferretti for Prevention Online shares 15 deep stretches that can help with everday aches and pains. These stretches allieviate stress in commonly injured joints, help correct back pain from office work, and can be done almost anywhere. Yoga Medicine founder Tiffany Cruikshank shares some insight on the importance of stretching as we age.
15 Deep Stretches To Ease Everyday Aches And Pains
Dealing with achy joints doesn’t have to be part of getting older. By improving your posture and doing gentle exercises to strengthen muscles that support your joints, you can avoid becoming one of the 100 million American adults who live with chronic pain.
Years of hunching over can put pressure on the soft disks between vertebrae. Tissues that surround joints lose elasticity as we age. But, thankfully, these changes can be remedied, says Steven E. Sampson, a sports medicine physician at Ortho-Healing Center in Los Angeles. “Stretching improves blood flow to muscles and tendons, which can tighten with inactivity,” he says. “Strengthening the muscles around our joints helps alleviate stress and inflammation.”
These simple moves can be done almost anywhere with minimal equipment. Work them into your day three times a week to ease aches or head them off before they begin.
Jenni Tarma shares how, despite misconceptions, shoulder mobility can be improved by working on joint stability. She demonstrates several excercises to help the region with both mobility and stability.
Shoulder Mobility through Scapular Stability
We tend to think of mobility and stability as opposing ends of the spectrum: increased strength comes at the cost of flexibility, and vice versa. Similarly, we typically associate strong muscles with tightness, as per the stereotypical, muscle-bound athlete who can’t touch her toes. While there can be a correlation between strength and tightness (and athletes do need tension in their muscles in order to perform well), simply equating strength with tightness leads to a limiting and over-simplified understanding of a relationship that is inevitably more nuanced in real life.
Rather than forcing the relationship between stability and mobility into binary parameters, it’s more useful to think of them as two sides of the same coin. Much like the forces of yin and yang, they do oppose each other, but they are also interdependent and more significantly, feed into each other. To put it simply, we need stability to create the conditions necessary for mobility. Let’s explore this relationship in the context of some real-life movement, and see how creating stability and strength in the scapulae can actually pave the way for freer, easier movement in the chest and shoulders.
Stability creates mobility
Stability as the foundation of mobility is a well-established concept in the field of physical therapy, and can easily be applied to yoga asana. In order to understand how this works, let’s backtrack to consider what “good mobility” actually means. Having pliable tissues that allow for a wide range of motion is an obvious prerequisite so our movements aren’t hindered by the mechanical limitations of a muscle that cannot lengthen.
However, it’s not actually our muscles that govern how and how far we move; rather they are operating at the command of the nervous system. The nervous system’s primary concern is safety, and as the regulator of mobility, it grants a range of motion based on whether a particular movement is perceived as being safe. Safety, in this instance, requires an active integration of the joint (stability!) as well as limiting the movement to a range that we can control. Most of us know that simply flinging our bodies passively into deep stretches contributes little in the way of functional, usable range of motion.
In fact, extreme passive stretching can even have a counterproductive effect as muscles (at the command of the nervous system, of course) grip in response to the perceived threat of an overly intense stretch in a range of motion that it can’t control.
The notion of control is pivotal, since it determines whether the nervous system accepts or rejects movement, depending on muscles’ ability to engage in, and therefore control, that particular range of motion (ROM). With this in mind, we can further highlight the interdependent, interconnected nature of stability and mobility. In effect, stability and mobility are two words that we use to describe different aspects of the same thing. Stability is ROM with control and is therefore perceived as safe by the nervous system. Conversely, mobility is ROM without control, and is perceived as unsafe. It stands to reason that by engaging mindfully within a ROM where muscles can operate with strength, we stand to gain mobility by satisfying the nervous system’s need for safety and controllable ROM.
Investigating ROM through active engagement in asana
Let’s explore this relationship through real-life asana scenarios, more specifically in the shoulders, upper back and chest. Some prerequisites for successfully opening the chest include engaging the upper back muscles and integrating the shoulder joint. These actions are also interrelated: squeezing the shoulder blades together broadens the chest, but also creates the foundation of stability needed for the glenohumeral joint to stabilize; think of the humerus moving downwards as the shoulder joint “packs itself” into its socket. Let’s follow a gradual path through these actions, in increasingly more challenging poses.
1. Basic scapular stability
In tabletop position, scoop your low belly in to find a flat back. Soften the elbows with a small bend so they’re not locked, but commit to keeping your arms straight and your spine long. Actively squeeze your shoulder blades in towards each other and feel your chest lower towards the floor. The Rhomboids, located between the scapulae, will turn on as you do so (see Tabletop 1).
Then do the opposite: move the shoulder blades apart; notice the area around the side ribs (Serratus Anterior) engage to create the action, and emphasize it further by pressing the floor away with your hands (see Tabletop 2).
Go through several more rounds of the movement, inhaling to squeeze the shoulder blades and exhaling to widen them. Periodically checking in to make sure you haven’t strayed into a cat-cow movement as the arms should still be straight and the movement limited to the scapulae, rather than the spine.
To make this more challenging, you can repeat the scapular stability movements in a modified plank pose with the knees down (more challenging) and full plank (even more challenging).
2. Shoulder joint integration
Next, let’s add the “packing in” action of the shoulder joint. Start in Side Angle Pose, right leg forward, right forearm resting on the thigh. Move your left arm up to the ceiling, and then slightly behind you, if it’s available. Notice that while your arm is able to go further back in space, doing so causes the humerus to slide forward in its socket and destabilize the shoulder joint as you enter into passive ROM. This is what NOT to do.
Instead, start by building the foundation of shoulder stability in the left scapula. Reach your left arm horizontally out to the left and allow the shoulder blade to go with it as it moves away from the spine and towards the side ribs (see – Side Angle 1).
Keep your arm reaching forward and then draw the shoulder blade back to the spine. Repeat this motion a several times to familiarize yourself with the movement and the engagement of the Rhomboids and the Serratus; think about ‘gliding” the scapula on the back of the rib cage (see below – Side Angle 2).
Now, add the shoulder: firmly retract the scapula towards the spine, stack the left arm on top, but without losing the engagement around the shoulder blade and letting your arm passively flop behind you (see below – Side Angle 3).
Finally, hollow out the armpit by hugging the humerus down and back into its socket with a slight external rotation of the joint- the resulting sensation should be one of firm integration and support. Repeat on the second side.
3. Accessing chest-opening
Let’s further refine these action by adding the rotational element of the torso. Begin in Triangle pose with the right leg forward. Wrap your left arm across your chest and to the right side ribs, allowing the chest to roll down and the upper back to slightly round as part of the movement (see Triangle 1). Then, roll the chest open, using the left hand to guide the right side ribs down (see Triangle 2).
Repeat the action, adding in the movement of the scapula. The chest rolls down as the scapula protracts and arm reaches forward and then rolls up as the scapula retracts (see Triangle 3-4). End with retracting the scapula, hollowing out the armpit, and stacking the arm on top (see Triangle 5).
The important thing is that the left shoulder blade moves ahead of the humerus, and therefore always precedes the stacking of the arm. Even if the arm should eventually move further back behind you, that movement is still prefaced by the retraction of the shoulder blade, so as not to lose the necessary foundation of stability. Once the mechanics are familiar, focus on the overall feel of the action.
The movement of the shoulder blade in particular should have a fluid, sliding quality, rather than wrenching or muscling your way through the action. Remember, we’re trying to combine stability and mobility in appropriate ratios to create a movement that is both supported and controlled. This is, effectively, an exercise in balancing sthira and sukha: having enough effort to create support and safety while still maintaining a sense of ease.
If you’d like to challenge yourself by adding a balancing element, repeat all of this in Half Moon (see below).
4. Putting it all together
Next, we’ll combine these actions in Chapasana. This presents the opportunity to use scapular retraction to access deeper (but still supported) opening of the chest, whilst keeping the humeral integration. Start in Half Moon pose with the right leg as the standing leg. A block under the under the right hand can be helpful here so you don’t have to use too much brain power on balancing. Find the familiar actions in the left shoulder: scapula retracted, armpit hollowed out, humerus down in its socket. Reach your left arm towards your left foot and rotate the thumb down; bend the left knee and grab hold of the foot (see Chapasana 1). Finally, draw both shoulder blades strongly in towards each other as you move your sternum forward and your left shin back (see Chapasana 2). Stay and hold before repeating on the second side.
It’s worth noting that these movements, executed mindfully and with control, are beneficial in and of themselves. Trying the actions in more difficult poses adds variety and challenge. But, that isn’t necessary in order for them to be effective. For purely therapeutic purposes, you could choose to stay with the simpler poses and focus on observing which portions of the movement feel easy vs difficult. Or, if there are significant differences between left and right. Many people have some degree of weakness in their scapular stabilizers, and can gain much in terms of shoulder strength, posture, rotator cuff stability, and general functionality from doing even the simplest of the exercises outlined here. “Achieving” the more difficult versions shouldn’t necessarily be seen as an end goal.
As Yoga teachers, we will often have students who struggle with pain. It is not our job to diagnose or treat. However, it is our role to support, nurture and protect the student from suffering. As well as facilitate a place for growth of the physical, psychosocial and spiritual being. This can feel like an impossible task when pain is a complaint. Especially when the pain is one that is persistent, irritable and sensitive. We all know students with these pains the ones that are made worse by “everything” and made better by “nothing”. My purpose with this article is to shed just a little light on the topic of pain and the neurobiology behind it.
Neurobiology of Pain
The human body and brain are directly connected through the nervous system. Containing 400 different nerves that if stretched end to end would extend 45 miles. These nerves sit at a resting level of excitement, ready at every moment to communicate necessary information from the peripheral (body) to the central system (brain). Each nerve contains a series of receptor sites. These sites are specifically sensitive to changes in the internal environment such as mechanical, chemical, temperature and touch.
To the surprise of many, no nerve in the body or brain contain receptors specific for pain. Instead, the nerves are armed with something called Nociceptors directly translated these are danger receptors. Nociceptors will fire along with the other receptors if any of the changes detected are severe enough that the body has a potential of harm. The nerves will send the messages of sensation to the brain via the spinal cord. The brain receives the messages and interprets it with a series of complex events involving multiple cortical regions to determine if said event is indeed dangerous.
If the brain believes that danger is imminent, then a painful experience will be expressed. If the brain decides this is not a place that requires action, pain will not be produced. This might sound confusing but it is really no different than the process used by all of our senses. For example, you do not have vision receptors in your eyes. You have light receptors. It is the brain that produces the visual experience. Evidence has shown us that nociception is neither required nor enough for pain to occur.
Have a look at this simplified case example. A 48-year-old female student comes to you for a private session with the report of shoulder pain.
Her pain has been present for multiple months and she cannot recall a mechanism of injury. She has seen doctors and therapists and they have all told her nothing is actually wrong with the shoulder. Maybe bursitis or tendonitis but her MRI is clear. She has been offered injections and medications but has declined. She is choosing an alternative path.
You applaud her for this and begin your yoga medicine intake. Her range of motion and strength appear normal. Her resting posture is quite good. The mechanics during standing asanas are good. Chatarunga alignment is good. Hmm, but she is in pain and many of the motions you ask her to perform are done with a grimace and apprehension.
At this stage, you might begin to wonder if you can actually help her. You can, with just a little bit of knowledge. I would recommend requesting permission to discuss her case with her primary care provider to know you have all the necessary medical facts.
Reminders About Pain
All individuals with pain can benefit from these bits of knowledge.
Pain Is Normal
Pain is simply the body’s alarm system
The role of pain is to communicate actual or perception of threat
Pain commands action in order to promote survival
Pain, regardless of how long it has been present, how severe it is or if an injury has occurred or not, is always an output of the brain or central nervous system
Tissue damage is neither sufficient nor necessary for pain to be experienced
Hurt and harm are not the same.
You then as a yoga teacher are not protecting the shoulder in this scenario but rather the central and peripheral nervous systems. In medical terms, this individual could most likely be classified as someone who has central sensitivity, not mechanical dysfunction.
You might be thinking, great, but what do I do with that??
Energy goes where attention is given. You need to facilitate a place of safety for the nervous system. Knowledge of the human pain system comes first (see the 7 points above) then you put it into practice.
How’s this for a practice starter?
Have her place one hand on the belly and one hand on the heart and begin to breathe a little deeper.
This simple act can be like a self-hug, assuring the nervous system you got this, and there is no need to suffer or protect. After creating a greater sense of awareness and connection to her breath, you could begin a gentle seated meditation. Bringing in the ability to be aware of a variety of sensations without the need to react to them. Visualization of movements or positions of the arm that tend to elicit pain can be utilized to practice this idea of observing the sensation without reaction and with the security of mind that harm is absolutely not present even if hurt is.
Once these steps are mastered, transition your client into a moving meditation or asana practice. Remember to keep the conscious presence on the breath and let the body naturally begin to take shapes. If sensations of discomfort present themselves, challenge her to come back to the practice of observation, awareness of safety and letting go of the need to overprotect.
Following these 3 simple steps can begin to desensitize the nervous system:
Return to the breath
Awareness of safety
Movement without the need to protect,
It should not take too long to see a shift in the student’s pain patterns and complaints. It may take a long time for the pain itself to completely resolve but the functional ability and movement tolerance will progress with gentle facilitation.
For further reading I recommend, Explain Pain, Butler and Moseley. And Therapeutic Neuroscience Education, Louw and Puentedura.
by Marnie Hartman, PT, DPT, CSCS, RYT.
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