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Tech Neck? Try These Three Simple Techniques to Relieve that Nagging Neck and Shoulder Pain

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. 

Some Fundamentals

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.

Shoulder Tension Release

By Rachel Land for Yoga Medicine®.

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.

Find the original video on Yoga Medicine®’s Youtube channel.

The Shoulder Mobility Drill That Changed My Backbend Practice

By Gry Bech-Hanssen for Yoga Medicine®.

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.

Yoga for Shoulders: Healthy Shoulder Positioning in Common Yoga Poses

By Rachel Land for Yoga Medicine®.

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.

Find the original video on Yoga Medicine’s Youtube channel.

Self Myofascial Release Practices for Better Backbends

Senior Yoga Medicine® teacher Rachel Land shares a simple sequence that can unlock common areas of resistance and make your backbends feel better.

A Sequence to Make Backbends Feel Better

Rectus Femoris

Tensor Fascia Latae

Iliacus

Psoas

Arm Balance Recovery

Senior Yoga Medicine teacher, Rachel Land, shares with Yoga International a feel-good self-massage sequence that you can use to relieve upper body soreness.

Increase Mobility: Stretch, Strengthen & Stabilize

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.

Tensegrity

Stedman’s Medical Dictionary for Health Professions and Nursing[1] 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.

Stretch

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.

Strengthen

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.

Conclusion

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.

Footnotes

[1] Stedman, Thomas Lathrop (2012), Stedman’s Medical Dictionary for Health Professions and Nursing 7th Edition, New York, NY: Stegman

Deep Stretches To Ease Everyday Aches And Pains

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.

Read the rest of the article here.

Shoulder Mobility through Scapular Stability

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.

Joint 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).

Tabletop 1
Tabletop 2
Modified Plank 1
Modified Plank 2
Plank 1
Plank 2

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.

1: Side Angle
2. Side Angle
3. Side Angle

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).

1. Triangle
2. Triangle
3. Triangle
4. Triangle
5. Triangle
Half Moon

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.

Chapasana 1
Chapasana 2

Conclusion

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.

The Neurobiology of Pain and Yoga as its Medicine

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.

Case Study

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.

  1. Pain Is Normal
  2. Pain is simply the body’s alarm system
  3. The role of pain is to communicate actual or perception of threat
  4. Pain commands action in order to promote survival
  5. 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
  6. Tissue damage is neither sufficient nor necessary for pain to be experienced
  7. Hurt and harm are not the same.

Assessment

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.

Treatment

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:

  1. Return to the breath
  2. Awareness of safety
  3. 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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