Pain caused by a shoulder impingement often results when lifting your hands overhead where the pressure of your shoulder blades pushes against your rotator cuff therefore limiting your mobility, which is needed for for many yoga poses. With normal movement, the top of your shoulder bone (the humerus) lifts and rotates into the portion of the shoulder blade called the acromion on the scapula.
Too much compression and repeated lifting of the arms has been found to cause inflammation and pain that can become worse causing healing to take even longer if not addressed when the pain begins.
Healing Comes First
Before you begin to practice any activity that specifically targets your shoulder injury, I recommend that you consult with your doctor, physical therapist, or osteopath to make sure that your shoulder mobility issues are able to be rehabilitated through yoga. Furthermore, please ensure that you have given your shoulder enough time to heal itself before you start restrengthening to support it. As moving or putting too much activity before completely healed can worsen the injury. If you decide to being strengthening and feel any pain at all, I recommend you back off and let yourself be a patient to allow your body to rest and repair itself.
Poses to Avoid
My recommendation is that any asana that will cause sharp pain in your shoulder must be stopped until fully healed. Other sensations you need to be wary of while practising yoga are pinching, compression, burning, inflammation, and tearing pains.
One of the main poses I suggest you avoid in your yoga practice while healing from a shoulder injury is Chaturanga Dandasana, or Eight Angled Staff Pose. These asana require a lot of work from your shoulders to hold your body in the correct position. Unfortunately, many shoulder injuries in yoga happen as a result of too many Chaturangas while doing the Surya Namaskar vinyasa and allowing the shoulders to sink below the chest. Avoid this pose while recovering from shoulder injuries for the best chance of recovery.
How to Modify Poses for Shoulder Impingement
Be gentle and patient with your body as you continue your yoga practice while nursing a shoulder injury. Make sure you, listen to what your body is ready for before pushing or forcing yourself to perform any specific asana shape.
Poses that require you to move your arms in wide sweeping motions must be approached slowly, carefully, and mindfully. For instance, when transitioning in Surya Namaskar from Tadasana (Mountain Pose) and lifting the arms overhead before folding into Uttanasana (Forward Fold.)
Rather than raising your arms out to the sides in this, or any similar sequence, I recommend raising your arms up on the forward plane instead. This should help by reducing the pressure on the head of your humerus and shoulder joint, and still allow you to move through the vinyasa series with ease.
Asana for Elasticity and Range of Motion
Stretching ones arms will help increase blood flow to the muscles and joints in the shoulders, upper back, and upper arms, which will promote healing and even strengthening with time.
Garudasana though mostly practiced with both the arms and legs intertwined, can be used with a sole focus on the arms, as you can simply practice Eagle arms in either a seated or kneeling position.
Inhale and stretch your arms out wide to the side, and then on your exhale, bring your left elbow underneath your right elbow. Intertwining your forearms and bring your palms to face each other (or at least have the intention of one day being able to face each other). Keep your elbows in line with your shoulders and push your elbows forward to feel the stretch.
While in this pose either hold your head upright looking forward past your hands at a focus point, or close your eyes, you can also choose to rest your head into the cradle that has been created by your arms in front of you. Stay here in this pose for a few breaths before switching the cross of your arms for the same amount of time.
Gomukhasana or cow face pose is largely considered to be a hip opener where the knees are stacked over each other. The arm position of this asana though has been noted to be extremely good for stretching and opening up the shoulders as well. When you choose to use this pose as a healing method, that you should use a strap to help extend your reach in this pose so as to refrain from forcing or pulling your arm too much in any direction.
Whether you do this pose in full with the legs, or in a seated or kneeling position, it is still incredibly beneficial for your shoulders. Beginning by inhaling as you bring your right arm up overhead and on the exhale, bend your elbow so that the back of your palm is on the base of your skull or on your upper back behind your chest. Try to move your arm on the forward plane instead of out to the side if necessary.
On your next inhale, extend your left arm to the side and bend the elbow behind your back with the palm facing out. Either hold on to your right hand or a yoga strap. Maintaining a good grip without forcing your arms either upward or downward. To reap the true benefits of this pose try to stay in this pose for a few breaths and before slowly coming out of the pose to switch sides.
Strength building through Asana
A flexible body is a stronger body so it’s important to incorporate gentle ways in which you are able to strengthen a muscle that is rehabilitating after stretching it.
Marjaryasana — Cat/Cow Pose
Come to your hands and knees to form a table top position, now moving with your breath, create a arch with you spine as you inhale and a convex arch with your spine on your exhales. Involve your shoulders by drawing them back and together on each of your inhales, and rounding them to hug in toward the front of your body when you exhale. If your find this to comfortable for your shoulders and not too painful, experiment further with your mobility by carefully incorporating forward and backward rocking motions and even side to side motions.
Adho Mukha Svanasana
Downward Facing Dog or Ardha Mukha Svanasana, is an excellent pose to work on building strength in ones rotator cuff muscles. Work on rehabilitating your shoulder muscles by either practicing it the regular way with palms on the floor, or modify the pose with your palms on a wall instead. To do this half Downward Facing Dog variation, stand facing the wall around the distance of your own leg length away from the wall. Keep your hips over your heels as you fold forward. Keep your spine straight and parallel with the floor.
Ensure that you keep your palms firmly pressed against the wall, just as you would if they were pushing against the floor in a normal Down Dog. Keep a slight bend in your elbows, turn your lower arms inwards while your upper arms spiral outwards to the heads of your arms engage into your shoulder sockets and do not over rotate inwards.
Rest and Rejuvenation
It is very important to stress just how important it is for us to allow ourselves enough time our body to rest and recover while it is healing from injuries, especially shoulder impingements and any rotator cuffs strains. To ensure that an adequate amount of rest is achieved I stress that you included the practice of restorative and resting yoga poses often and for greater periods of time than you might normally use in order for your body to really get into a proper healing rest and digest mode.
Balasana — Child’s Pose (Embryo Pose Variation)
Balasana, commonly referred to as Child’s pose, is often recommended for anyone to practice during class when a certain pose or vinyasa sequence gets too tiring for them or when they loose control of their mind - body - breath connection or simply when they feel dizzy during practice. Full Child’s Pose however where your arms are stretched out over your head may trigger your shoulder impingement. So to put less compression and stress on your rotator cuff modify the pose by practicing the version of Child’s Pose where your arms are relaxed by your sides.
Savasana — Corpse Pose
When it comes to rest and rejuvenation, there is nothing that can beat Savasana, or Corpse Pose. When practiced at the start and end of your practice, and even as a transition between poses, can help you to really take notice of your body and aid you in finding out what is really needed for your rehabilitation. Savasana is often considered to be one of the most difficult of yoga asanas for one to master. This is similar for the fact that it is a pose that encourages you to let go of everything that no longer serves you at the present moment. It is therefore much more than laying down on your mat with your eyes closed. It’s purpose is more about feeling your body and the space in and around it and how your energy is able to move freely through that space — that’s the ultimate practice of yoga.
Lastly, it is very important that one sticks to a regular yoga practice even though with an injury like a shoulder impingement or pinched rotator cuffs this can be overly frustrating and even tend to make you feel like you are moving backwards in your practice rather than progressing. However having a limited range of motion in your shoulders is able to actually help make you look deeper into your own mobility and the ways in which you practice yoga. A mindful yoga practice, that allows for enough rest and proper modifications, is a ultimately a better practice than one that forces your body into specific shapes that might worsen your injuries.
Sadly at on occasion only time and rest can truly heal your rotator cuffs, but when your body is truly ready, a few slight adjustments to asanas that you already know and a few modifications to suit your anatomy when flowing through a vinyasa sequence can make your yoga practice more sustainable and pain-free.