Friday Practical Pointers: Who Should Avoid Certain Shoulder Movements?

by Baxter

Judith Valerie, Age 63

Today let�s look at who should avoid certain movements at the shoulder, specifically the movement of the upper arm bone at the shoulder joint (the glenohumeral joint). This is where the upper arm bone meets the shoulder blade (the scapula). 

The movement of your shoulder is actually quite complex; it's not just those two bones moving relative to one another. Instead, when your arm bone moves in different directions, the shoulder blade slides and glides around on your back and side rib cage, too. Although this makes the shoulder joint�s movements more complex than the hip joint, the shoulder has the same six basic movements, which can be combined in various ways as you do yoga poses, sports, or movement arts, or simply move about the world:

1. Flexion: Reaching your arm forward of your body, whether parallel to the ground or up overhead as far as it can go, for example, bringing the arms forward and up in Tree pose (Vrksasana). As the upper arm bone moves in flexion, the shoulder blade slides around and up the side of the rib cage. You also move in flexion when you release from extension, for example, releasing arms from Locust pose (Salabasana). 

2. Extension: Reaching your arm back behind your body, for example, in Locust pose (Salabasana). As you make this movement, your shoulder blade slides down and back towards the spine on the back of the rib cage. You also move in extension when you release from flexion, for example, releasing arms from Tree pose (Vrksasana). 

3. Abduction: Taking your arm from alongside your body either out to your side, for example, for Warrior 2 pose (Virabradrasana 1), or continuing through an out-to-the side position all the way up to alongside your head, for example, in Arms Overhead pose (Urdva Hastasana). Interestingly, the shoulder blade action is the same as in flexion. 

4. Adduction: Returning your arm back alongside your body, either from an out-to-the side position, for example, from Warrior 2 pose (Virabradrasana 2) or from an arms overhead position, for example, from Arms Overhead pose (Urdva Hastasana). If you add in a little flexion, you can continue the adduction across the front of the body, for example, in Eagle pose arms (Garudasana. If you add in a little extension, you can continue adduction across the back of your body, for example, in Reverse Prayer pose (Paschima Namaskarana). The shoulder blade action is the same as with extension.

5. External Rotation: Rolling the upper arm bone out away from the midline of your body (the lower arm bones follow). For example, you use this action in Savasana when you turn your elbow creases and palms towards the ceiling.

6. Internal Rotation: Rolling the upper arm bone in towards the midline of your body (the lower arm bones follow). For example, you use this action when bringing the bottom arm of Cow Face pose (Gomukasana) into position. 

Cautions

Now let�s look at who should avoid or minimize certain shoulder movements. Keep in mind, however, that we want to maintain as much of our full range of movement of the shoulder joint as possible. So, in many instances, my caution will not mean �don�t� or �never,� but rather approach cautiously and stop if the movement worsens pain. In general, you should avoid or minimize any shoulder movement if you have: 

1. Acute painful injury to the shoulder area that gets worse with that movement. 
2. Chronic issues that flare with that movement, such as those with shoulder joint arthritis, rotator cuff injuries that have not been repaired, painful bone spurs, chronic bursitis, and those at risk of dislocation of the shoulder joint (much more common that in the hip, for instance). 

Note: Those with a diagnosis of frozen shoulder will actually have to move into the range of motion that starts to be painful, and gradually increase the range of motion over time, even if it hurts. In contrast, this would not be the case, for those with a rotator cuff tear that has not been fixed. This means you really need to get your shoulder issues fully checked out by a good orthopedic doctor before you can know what to avoid!

Now for the specific movements. Who should avoid or minimize the following movements?

Flexion

1. Those with shoulder impingement issues, such as rotator cuff tears or bursitis, that your doctor says warrants avoiding this movement. 
2. Those prone to shoulder dislocation (check with your doctor) when this action occurs in weight-bearing poses, such as moving into Downward-Facing Dog pose (Adho Mukha Svanasana) from an all-fours position or kicking up into Handstand, where the stress on the joint increases. 
3. Those with thoracic outlet syndrome may only be able to take their arms briefly into full flexion, and should lower them down if symptoms arise. 

Extension

1. Those with shoulder impingement issues, such as rotator cuff tears or bursitis, that your doctor says warrants avoiding this movement. 
2. Those prone to shoulder dislocation (check with your doctor) when extension occurs in a weight-bearing pose, for example, coming into Upward Plank pose (Purvottanasana) from Staff pose (Dandasana), or when it occurs in non-weight bearing poses, for example, when you clasp your hands behind your back in Standing Forward Bend (Uttanasana) and lift your hands away from your lower back. 

Abduction

1. Those with acute strain of the muscles that get stretched via abduction, such as the latissimus dorsi and certain parts of the trapezius and pectoralis muscles. 
2. Those with certain types of shoulder impingement issues, such as rotator cuff and bursitis. 
3. Those with risk of certain types of shoulder dislocation (check with you doctor) when the arm is taking to the extreme of abduction overhead, such as the top arm in Revolved Janu Sirsana when clasping the big toe of the straight leg. 
4. Those with thoracic outlet syndrome may only be able to take their arms briefly into full abduction, and should lower them down if symptoms arise. 

Adduction

1. Those with acute strain of the muscles that get stretched with adduction, such as the deltoids, and certain parts of the trapezius and pectoralis muscles. 
2. Those with certain types of shoulder impingement issues, such as rotator cuff and bursitis. 
3. Those with risk of certain types of shoulder dislocation (check with your doctor) when the arm is taking to the extreme of adduction behind the back, such as the bottom arm in Cow Face pose or in Reverse Prayer position and in many binding poses when the arm comes behind the back. 

External Rotation

1. Those for whom the movement creates a pinching or painful sensation at the shoulder joint area. 

Internal Rotation

1. Those for whom the movement creates a pinching or painful sensation at the shoulder joint area. This can often be the case with issues of the subscapularis muscle, one of the four rotator cuff muscles. 

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