When it comes to avoiding shoulder injury, yoga practitioners – yogis — might well heed the words of Roman lyric poet, Horace: “Think carefully about what your shoulders may refuse and what they are capable of bearing.” That is the warning from noted hand and upper limb orthopedic surgeon Alejandro Badia MD, referring to the more advanced, intense yoga poses – like the downward dog or the low plank – which put significant stress on shoulders and other upper-limb joints and muscles.
Research indicates yoga can relieve stress and anxiety; lower blood pressure; improve sleep; increase balance, flexibility, and strength; even enhance brain function and energy levels. But if the discipline’s more challenging poses are performed incorrectly or too quickly, are beyond the strength of the practitioner, or attempted without adequate preparation, the result can be shoulder strains, sprains and pain, including damage to the rotator cuff and the joint cartilage, says Dr. Badia, an expert in the treatment of disorders of the upper limb.
The rotator cuff is composed of a group of muscles and tendons that power the shoulder joint, allowing it to move and function properly.
Dr. Badia points to the 2018 published study, Musculoskeletal Injuries in Yoga, in which doctors report that the “rotator cuff is particularly vulnerable in [yoga] positions” and sequences of positions “that put weight on the hands, such as the four-limbed staff pose, downward-facing dog, side plank and upward-facing bow.” These poses, the researchers contend “can lead to impingement of the rotator cuff,” with the supraspinatus – the tendon which is directly attached to the arm’s humerus bone in the shoulder and helps lift the arm overhead – being most susceptible to damage.
A more than 3,000-year-old East Indian discipline for integrating mind, body and breathing, yoga has evolved to become more westernized, with increased focus on physical movement rather than meditation. Estimates put the number of yoga practitioners in the United States as high as 36 million, including a significant percentage of Americans age 50 and above. “Many of these older individuals lack the strength and flexibility that they once had in their muscles and joints and may suffer some level of bursitis, tendonitis, even osteoporosis or other underlying condition,” Dr. Badia says.
Experts, like those writing in a 2018 edition of Journal of Science and Medicine in Sport, contend that a majority of yoga-related injuries tend to be relatively “mild and transient.” Even representatives of the American Academy of Orthopaedic Surgeons (AAOS) write that the “rewards of basic yoga outweigh the potential physical risks, as long as [the participant] takes caution and performs the exercises in moderation, according to individual flexibility level.”
Dr. Badia concurs, but says yogis, especially those who are self-taught or participate in large classes, are oftentimes engaging in movements without sufficient instruction in proper technique or attempting poses, such as shoulder- or headstands, that put excessive force on the shoulder and wrist and are beyond their capabilities.
Dr. Badia adds that yoga is particularly stressful on the wrist, often because there may be some underlying conditions that yogis are not aware they have. They may have minor cartilage tears in the TFCC (triangular fibrocartilage) of the wrist which can be aggravated by twisting movements. Furthermore, it is not uncommon that thin, hyperlax (loose jointed) women suffer from painful ganglion cysts, small synovial cysts on the top of the wrist where pain is aggravated when the wrist is in full extension as in doing a downward dog or handstand. There are also types of tendonitis, also seen more in women, such as de quervain’s tendonitis which can be aggravated by yoga maneuvers.
To help yogis reap the benefits of yoga while minimizing risk for adverse effects, especially in the shoulder and wrist, Dr. Badia advises:
- Learn proper technique; work with a qualified instructor.
- Stick to easier poses and movement flows if a beginner or older in age. Do not register for advanced classes unless you are at an advanced level.
- Warm up muscles, tendons, and ligaments before starting a yoga session. “Yoga is a sport and requires appropriate preparation time like any other sporting activity,” Dr. Badia says.
- In-between yoga sessions, perform exercises that can help maintain and increase shoulder strength and flexibility.
If you have an underlying medical condition, including musculoskeletal pain, talk to your physician before doing yoga. See an orthopedic specialist, especially an upper-limb expert, if you begin experiencing shoulder pain following yoga practices. Delaying medical treatment can lead to more serious joint damage.
Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member of the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons and an honorary member of many international professional hand societies. Dr. Badia specializes in treating all problems related to the hand and upper extremities, including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. Dr. Badia has a particular interest in sports and fitness related upper limb problems having served as past worldwide president of the International Society of Sport Traumatology of the Hand (ISSPORTH) founded in Europe in 2011. http://www.OrthoNOWcare.com and http://www.drbadia.com.