Tuesday, December 4, 2012
Arthritis of the Shoulder and Yoga
by Baxter
If you have been following our blog for any amount of time, you’ve become familiar with the wide variety of joints and areas of our boney spine that can be affected by osteoarthritis. From your hands to your toes, any movable joint is subject to this condition of wear and tear on the end surfaces of the bones and their slick, cushiony covering, the cartilage. The older we get, the more likely we are to develop osteoarthritis somewhere in our bodies, including the shoulder area. Seems the magic age is sometime after 50, but if you have sustained a traumatic injury to your shoulder or have the rarer form of arthritis, rheumatoid arthritis (RA), you could develop the tell-tail symptoms of arthritis-pain, swelling and reduced movement at the shoulder.
I’ve worked with many students and patients over the years with arthritis, and I will mention that the shoulder area is less commonly affected than say the knees, hips or spine. But it does show up now and again. Turns out there are actually two joints in the lateral shoulder area that can develop arthritis.
The first one is where a finger-like projection of the shoulder blade or scapula meets the far end of your collarbone or clavicle at what is technically referred to as the acromioclavicular joint (the AC joint). You can actually feel to the top connection of this joint if you trace your collarbone from your breastbone toward your shoulder area. You’ll note a sudden drop off as you move laterally. That’s where the two bones meet. Arthritis in this joint usually refers pain to the front of the shoulder area.
The second joint affected is where your arm bone, the humerus, meets the side of the scapula at something called the glenoid fossa (a shallow, cup-like area that is concave to fit the round end of the arm bone), forming the glenohumeral joint. Arthritis pain in this joint is usually referred to the back of the shoulder area. And like other forms of arthritis, a diagnosis is usually reached after a history and physical exam by your doc, possibly including X-rays to look for narrowing of the joint space or the development of bone spurs around the joint and, on rarer occasions, blood tests to rule out RA or drawing fluid from the joint to look for crystals or infection. Once diagnosed, usually with osteoarthritis, you’re likely to have rest, ice, anti-inflammatory meds and physical rherapy prescribed to help decrease swelling and pain, and increase your range of motion in the shoulder joints. On more rare occasions when these treatments are ineffective, injections or surgery may be recommended. Like the hip and knee joint, the surgeon may replace part of the joint with an artificial joint.
Where does yoga fit in? Well, since shoulder arthritis can result from chronic wear and tear action on the joints, it is possible that a yoga practice heavy on weight-bearing asana, such as Downward-Facing Dog pose, Push-Up pose, and arm balances, such as Crow or Heron, as well as vigorous repetitive practices that don’t vary much in their routine, could lead to this kind of shoulder problem. However, on average, yoga is more likely to be helpful as a tool for healing than the underlying cause of the problem. And if you suffer from shoulder arthritis, this is yet another setting in which working one-on-one with an experienced teacher could save you time in getting on the right course of practice to improving your symptoms.
Just as we discussed in arthritis of the hip, even with the abnormal changes to the joint that accompany arthritis, it is still essential to keep mobility in the affected joints. In the situation where symptoms are already present, you will want to proceed slowly and mindfully as you begin to experiment with yoga postures that are exclusively non-weight bearing (at least at first). Many of the standing poses, such as Triangle, Extended Side Angle (being cautious not to bear too much weight with the bottom arm for both of those), Warrior 1, 2 and 3 would all be reasonable choices.
Poses that involve more pressure around the shoulder joint, in which there are additional rotational forces, such as Prayer position behind the back, or Eagle arms, may not be appropriate, as they could more likely aggravate the joint than help it. However, working with a teacher, you may gradually be able to add in more complex arm movements if your symptoms stay quiet. Versions of poses you would be likely to encounter in class, such as the ubiquitous Downward-Facing Dog, may be added later if you are progressing, with wall versions, such as Half Downward-Facing Dog at the Wall (see here). And since it is not unusual for the muscles around the affected joint to be atrophied from lack of use when the joint is initially inflamed, holding the arm positions, like Warrior 2 arms, for 30-60 seconds can add strengthening of the muscles to the goal of maintaining mobility in the joint.
In addition, the pain-diminishing effects of pranayama and meditation practices could be very helpful along with your physical poses, and could be substituted for asana during times when your shoulder symptoms flare up and resting your body makes more sense for a while. And, as always, we welcome your comments and experiences with the topics we share with you. So if you have some yoga insights on arthritis of the shoulders, we are all ears (and shoulders, of course!).
If you have been following our blog for any amount of time, you’ve become familiar with the wide variety of joints and areas of our boney spine that can be affected by osteoarthritis. From your hands to your toes, any movable joint is subject to this condition of wear and tear on the end surfaces of the bones and their slick, cushiony covering, the cartilage. The older we get, the more likely we are to develop osteoarthritis somewhere in our bodies, including the shoulder area. Seems the magic age is sometime after 50, but if you have sustained a traumatic injury to your shoulder or have the rarer form of arthritis, rheumatoid arthritis (RA), you could develop the tell-tail symptoms of arthritis-pain, swelling and reduced movement at the shoulder.
I’ve worked with many students and patients over the years with arthritis, and I will mention that the shoulder area is less commonly affected than say the knees, hips or spine. But it does show up now and again. Turns out there are actually two joints in the lateral shoulder area that can develop arthritis.
The first one is where a finger-like projection of the shoulder blade or scapula meets the far end of your collarbone or clavicle at what is technically referred to as the acromioclavicular joint (the AC joint). You can actually feel to the top connection of this joint if you trace your collarbone from your breastbone toward your shoulder area. You’ll note a sudden drop off as you move laterally. That’s where the two bones meet. Arthritis in this joint usually refers pain to the front of the shoulder area.
 |
| Shoulder Joint from Gray's Anatomy |
 |
| Humerous and Scapula from Gray's Anatomy |
Just as we discussed in arthritis of the hip, even with the abnormal changes to the joint that accompany arthritis, it is still essential to keep mobility in the affected joints. In the situation where symptoms are already present, you will want to proceed slowly and mindfully as you begin to experiment with yoga postures that are exclusively non-weight bearing (at least at first). Many of the standing poses, such as Triangle, Extended Side Angle (being cautious not to bear too much weight with the bottom arm for both of those), Warrior 1, 2 and 3 would all be reasonable choices.
Poses that involve more pressure around the shoulder joint, in which there are additional rotational forces, such as Prayer position behind the back, or Eagle arms, may not be appropriate, as they could more likely aggravate the joint than help it. However, working with a teacher, you may gradually be able to add in more complex arm movements if your symptoms stay quiet. Versions of poses you would be likely to encounter in class, such as the ubiquitous Downward-Facing Dog, may be added later if you are progressing, with wall versions, such as Half Downward-Facing Dog at the Wall (see here). And since it is not unusual for the muscles around the affected joint to be atrophied from lack of use when the joint is initially inflamed, holding the arm positions, like Warrior 2 arms, for 30-60 seconds can add strengthening of the muscles to the goal of maintaining mobility in the joint.
In addition, the pain-diminishing effects of pranayama and meditation practices could be very helpful along with your physical poses, and could be substituted for asana during times when your shoulder symptoms flare up and resting your body makes more sense for a while. And, as always, we welcome your comments and experiences with the topics we share with you. So if you have some yoga insights on arthritis of the shoulders, we are all ears (and shoulders, of course!).
Monday, December 3, 2012
Practice As Many As You Can: T. Krishnamacharya's Yoga
 |
| T. Krishnamachrya in a "New" Pose |
In my post last week Authentic Yoga, I mentioned that most of the yoga asana we do these days were invented in the early 20th century. In his book on the origins of modern posture practice Yoga Body, Mark Singleton focuses in particular on the innovations of T. Krishnamacharya, the teacher of three very influential 20th century yoga teachers who had a tremendous impact on yoga in the western word, Iyengar, Jois, and Desikachar. Krishnamacharya was clearly a genius, whose system, as Singleton puts it:
"can be fruitfully considered a synthetic revival of indigenous exercise (comprising yogasana alongside other types) within the context of Westernized curricular physical education in late colonial India."
Because so many people are reluctant to practice yoga at home due to concerns that they might not be doing it “right” or don’t have time to do what they would do in one of their full-length classes, it’s worth taking a little time to look at what Krishnamacharya (who was, for many of us, the original teacher of our teacher, or our teacher’s teacher) was doing in the late 19th and early 20th centuries. Dear readers, he was making stuff up! For details you can see the wonderful book The Yoga Tradition of the Mysore Palace by N.E. Sjoman. But for now let’s just look at this quote in Yoga Body from T.R.S. Sharma, one of a group of students at the yogasala in Mysyore, which confirms that Krishnamacharya’s teaching was intended to be, and in practice was, experimental:
"was innovating all the time in response to his students. He would make up variations of the postures when he saw that some of his students could do them easily. “Try this, putting this here, and here.” He was inventing and innovating. Krishnmachrya never emphasized a particular order of poses, there was nothing sacrosanct about observing order with him. He would tell me “practice as many as you can.”
The quote as whole really brings home the idea that, regardless of what we may have been told by certain teachers, the practice of yoga asana traditionally was not a rigid system that you have to follow or else it won’t be effective. And it seems to me, if you’ve been reluctant to practice at home due to time restrictions or concerns about doing something wrong, this quote contains a great motto for home practice in general:
Practice as many as you can.
Since it is December already and you may be thinking about New Year’s resolutions, “practice as many as you can” also seems like an excellent resolution for starting or deepening a home practice next year.
P.S. Hey, Krishnamacharya's alignment in Utthita Parsvokasana (Extended Side Angle pose) in the photo above doesn't look the same as what I've been taught is "correct," so that must mean....
Subscribe to:
Posts (Atom)
