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.
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| Shoulder Joint |
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.
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| Humerous and Scapula |
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!).
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Yoga comprises of eight-fold path: Yama,Niyama,Asana,Pranayama,Pratyahara,Dhyana,Dharana and Samadhi.Restriction of Yoga only to asanaa and breathing has been a major deviation for the convenience of the western Yoga students.I request the bloggers to evaluate the shoulder health of the persons practicing integral Yoga for years vs those who merely follow some asanas for years.Ayurveda has certain dietary advice that helps immensely in arthritis.If Yoga and Ayurveda are combined, we may get very significant relief in arthritis of the shoulder.Ashok Vaidya MD, PhD FAIM
Baxter, thanks for your article and great blog.
Ashok,thanks for your comment. It is true we have to take into account all the petals of the yoga flower to better help our students. Combining Yoga and Ayurveda is definitely the way to go. What are the ayurvedic tips you'd like to share on the topic of artheritis. Many thanks. OM
I just reread the post "Arthritis of the Shoulder and Yoga", from Dec 2012. I have been struggling with the same issue of arthritis of the AC joint. It has been steadily getting worse so I finally saw a doctor and will be starting physical therapy next week.
I wanted to add some other poses that I have temporarily dropped from my practice.
Shoulder stand because it has been making the problem worse as my pose go closer to vertical.
Head stand – my right shoulder is lower than my left shoulder from carrying a heavy tool bag for 17 years early in my career. This caused my right "leg" (upper arm) to be almost 2" shorter when I was in Head stand. I think this caused enormous problems in alignment, weight distribution, and compression of the AC joint.
Stopping anything that compresses the AC joint, like, Garudasana arms, the classic upper arm position in Gomukhasana arms, Urdhva Hastasana, Urdhva Baddhangullyasana, Urdhva Namaskarasana, classic position of the arms in Adho Mukha Virasana.
I'm still building my list.
I found this post whilst searching for guidelines for movement as I begin the road to recovery after falling out of a hammock (don't ask) resulting in a clean break of my left clavicle 3 days ago. I teach yoga in the UK, and am 59 years old. Since the fracture, my personal practice has obviously shifted focus to maintaining and building lower body strength, balance, retaining mobility and alignment of thoracic and cervical spine, pranayama, etc, but as time goes on I will want to begin to bring movement to affected arm and shoulder, don't want to over-do, but don't want to under-do either. Obviously hoping for best outcome and future ROM. Any enlightenment would be much appreciated. Thank you!