Modifying downward facing down when you have shoulder pain
Sanskrit for Downward Dog pose is Adho Mukha Svanasana
It can be difficult to participate in your daily routine when you have shoulder pain. Especially when the pain is in your dominant arm! Working with people who have shoulder pain, I observe difficulty reaching forward, reaching overhead, reaching out to the side, behind the head and behind the back! Maybe not all of these motions at one time, but I have seen people have pain with all of those! Doing basic activities of daily living, like brushing your teeth, washing/shaving your face, and completing toileting hygiene becomes painful and difficult. Sometimes, when the shoulder is painful, we are unable to even complete these tasks without help. If you don’t know why your shoulder is painful, or if you have sustained an injury, I would ask you to discuss your pain with your medical provider before trying these suggestions for downward-facing dog. You would want to get some medical advice before starting a new exercise practice.
If you like to practice yoga, how would you complete your asana practice with Downward-facing dog if your shoulder is painful? Let’s talk about this.
First, I would look at mobility of the shoulder, shoulder blade, collar bones and rib cage. Since downward dog is an inversion pose, meaning the head is in a lowered position related to the pelvis, the arms are required to be in an overhead position. If reaching overhead is painful, let’s look at your range of motion. When you are laying down on your back with your palms facing up, do you feel tension in the arm, neck or back? Now, reach overhead with what range is accessible to you while keeping the palm facing up. Try one arm at a time and try both arms moving together. Notice if your palm wants to turn. Notice tension. Notice what happens to your rib cage. Notice what happens to your lower back. These observations can give you insight into where you may have some loss of mobility or too much mobility. Limitations with reaching in the initial 1/3 of the range can indicate tightness in the pectorals and/or the upper thoracic area may be limited. In the middle 1/3 of the range, limitations here may indicate limited mobility around the shoulder blades and/or middle thoracic area. With limitations reaching in the last third, the joints at each end of the collar bones may be limited. They need to rotate and spin to allow the arms to lift overhead from 120 degrees up to 180 degrees. The lower thoracic area needs to be mobile in order to allow for full overhead mobility.
In sitting, cross your arms over your chest and try to rotate to each side looking over the shoulder. Is there stiffness or ease with the motion? Is there more movement to one side versus the other? Do you arch or extend your back to initiate the rotation? Do you grip the front body to pull one shoulder forward to initiate the rotation? Again, your observations can provide insight into how your body is moving. This can give you clues about how your ribs and spine move.
Next, while still sitting, try to reach one arm behind your back. How far up the back will your hand reach? Try each side. Do you lean back and flare the ribs or arch the back to reach? Do you lean to the side to help reach? Limited reach behind the back can indicate stiffness and tightness in the pectorals/chest.
When you are inverted and have your hands on the ground in downward dog, the arms travel up toward your head as your pelvis rises. Sometimes, we sink into the arm socket and can rest on the passive stability structures in the shoulder joint like the ligaments or labrum. Instead, we need to practice pushing with the arms to press our body away from the Earth. We want to engage the muscles that support the shoulder blade, the shoulder joint and the spine and keep a space between the shoulders and the ears.
Being mindful of the rotation of humerus in the shoulder socket is also something to be notice when in Adha Mukhva Svanasana. By turning the elbow creases up, you create external rotation in the shoulder. This allows for greater space in the glenohumeral joint and reduces the risk of shoulder impingement.
If your shoulder is painful with Downward Dog, try these suggestions, and let me know how they work for you!
Do the assessments mentioned above and notice where you may have stiffness or tightness. Work on mobility in these stiff areas
Modify Downward Dog by using the wall instead of the floor. Place your hands on the wall, feet on the floor and practice bending at your hips. You can do this while sitting on a chair or standing.
Practice varied widths between your hands and your feet. Sometimes, a wider stance can offer more support.
Practice varied distances between your hands and your feet. With the hands and feet farther apart, there may be less pressure in the shoulder and this could help reduce pain when weight bearing through the arm.
Use props. Place your hands on yoga blocks which lowers the amount of weight coming through the arms. Use a chair to support your body which will take pressure off your arms and shoulders. Use bolsters or pillows to support you if a chair is not comfortable.
Practice a V-sit or boat pose. This is not an inverted pose, but it does replicate the posture of Downward Dog without the weight bearing through the arms.
Sit with your legs out straight and practice reaching overhead with both arms, keeping the spine neutral, and keeping the ribs from flaring out. Use a wand in your hands to help achieve equal mobility of the shoulders if needed.
Work on stability of the should joint by practicing weight shifting the body over the shoulder when standing with the hand on a wall. Progress to a 45-degree angle with the hands on a tabletop. Work in sitting with hand on the wall or tabletop. Lastly, practice on your hands and knees, in a plank with the knees down, on your forearms, or with a large therapy ball.
I hope you give some of theses a try and let me know what you think!
Take good care,
Sharon