What is Shoulder Impingement?

Feel pain in your shoulder especially during downward dog, wheel or king pigeon? You might have shoulder impingement.

Shoulder impingement is when you lift your arms, bones in your shoulder rub against soft tissue such as ligaments repeatedly, resulting in inflammation and hence pain.

Where is the pain?
When people say they have painful shoulders, they could be referring to many different regions. Pain due to shoulder impingement can be rather easily pinpointed. It lies just between the acromion and humerus:

And the pain aggravates when you lift your arm, because that is when the space between the humerus and acromion narrows, causing impingement.

What increases the risk of nerve impingement?

  1. Anatomical differences
    There are three main types of acromions – flat, curved and hooked. Hooked acromions are sometimes believed to be acquired rather than being born with, due to the growth of a bone spur. People with curved or hooked acromions tend to have less space between the acromion and humerus, increasing the risk of impingement.
  2. Inflammation in the body
    People with autoimmune disease or other chronic diseases tend to have more inflammation in their body. This could prevent the body from recovering quickly from wear and tears or injuries, resulting in chronic inflammation in areas such as the shoulder.
  3. Wear and tear, and improper technique
    Sometimes it’s just a matter of overuse and improper technique. Are you rolling your shoulders outwards in downward dog to prevent injuries?
  4. Poor posture and weak tendons
    Sitting at the desk for prolonged periods, or looking down at our phones too frequently causes our necks to fold forward, which in turn causes our backs to hunch and our shoulders to roll forward. This hunched over posture causes tightness in the front and weakness at the back. As such, the tendons holding the humerus in neutral position weakens, leading to the humerus shifting upwards and narrowing the space between the acromion and humerus (subacromion space). Hence this increases the risk of impingement.
  5. Or it could be a combination of any of the above factors!

How can we modify poses?
People with shoulder pain can reduce stress on the shoulders by modifying the downward dog pose as follows:

If your shoulders are able to make a 180-degree angle, you can shift your weight to your legs by bending your knees.

If your shoulders aren’t able to open all the way (you feel bone against bone, perhaps due to bone spurs or a curved/ hooked acromion), your downward dog variation would look like this, and that’s absolutely fine:

If you still feel pain in your shoulders, you can shift your weight even further on your feet with the aid of blocks:

It is important to rotate your shoulders outwards while keeping your palms still flat. Practise chest opening and upper back bending exercises as well to open the front part of the shoulders.

Let us know what variations you can think of for other poses that involve the shoulders!

ELEMIT YOGA

Learn the art and science of yoga with heart and wisdom

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