One can hardly imagine a yoga class without at least one round of Surya Namaskar, or Sun Salutations, which is a composition of a variety of different asanas, allowing your body to move in all directions. However healthy the intention behind this practice, it can certainly also bear risks such as shoulder impingement syndrome.
This article will provide answers to the following questions:
1. What Is Shoulder Impingement?
To better understand what shoulder impingement is, let's take a closer look at the structure of your shoulder joint. The shoulder is a complex construct and is actually composed of three joints:
- the glenohumeral joint, which is the ball-and-socket joint between the upper arm bone (humerus) and the shoulder blade (scapula),
- the acromioclavicular joint, a synovial joint that connects the clavicle and the acromion (the part of the scapula that forms the highest point of the shoulder), and
- the sternoclavicular joint, which basically connects the shoulder to the rest of the skeleton. It is also a synovial joint and is composed of the clavicle and the sternum.
All these bones and joints in the shoulder are guided and supported by the surrounding muscles and tendons, which are jointly referred to as the rotator cuff.
Shoulder impingement is an inflammation of the tendons (tendonitis) of the rotator cuff muscles that pass through the passage beneath the acromion (i.e. the subacromial space). The main muscle affected is the supraspinatus, which is the smallest muscle of the rotator cuff muscles and connects the upper part of the scapula with the head of the humerus. Its tendon travels through the subacromial space and is protected by a small sac of fluid (bursa) between the tendon and the acromion process.
Shoulder impingement is the result of compression of the bursa sac when the humerus and the scapula collide into each other, causing pain and weakness in the shoulder. The consequences are limited range of motion and reduced movement at the shoulder.
According to the medical website healthline, shoulder impingement is also called swimmer’s shoulder, since it’s common in swimmers. But other athletes who use their shoulders a lot are also highly perceptible to shoulder impingement, such as baseball or softball players and, as we will see in this article, yoga practitioners.
If you're already suffering from shoulder impingement or any other kind of shoulder pain, try Yoga for Neck & Shoulders with Young Ho Kim on TINT.
2. How Can One Single Cue Cause Shoulder Impingement?
To be clear: It is not the Surya Namaskar itself that can involve risks and injury. It rather is one single cue that may – in the long term – cause shoulder impingement or similar shoulder injuries such as frozen shoulder and arthritis.
The culprit is one of the most common cues in yoga classes: "pull your shoulders away from the ears" or "draw your shoulders down". While this may be helpful to make students aware of unconscious shrugging of the shoulders due to stress or postural habits, this cue is not helpful in poses where you reach your arms overhead and it can even cause pain and injury in the shoulder joint.
Apart from that, drawing the shoulders away from the ears in asanas where the arms are above the head also limits the range of motion and decreases stability in the shoulder joint. Let us explore why:
Reaching your arms overhead is a complex movement, requiring multiple parts of your shoulder working together in a synchronized way. This coordinated movement pattern is called the scapulohumeral rhythm: the interaction between the shoulder blade (scapula) and the upper arm bone (humerus). This means that, when you bring the arms overhead, the shoulder blade moves upward with the upper arm bone.
Any change of the normal position of the scapula in relation to the humerus can cause dysfunction of the scapulohumeral rhythm, which is also called scapular dyskinesis or scapular dysfunction. So, if you pull the shoulders down in this movement, the scapula and the humerus collide into each other. Doing this repeatedly or forcefully can cause compression of the bursa sacs in the shoulder as well as pinching or friction in the rotator cuff muscles, eventually leading to inflammation and wear and tear of the shoulder.
This is why the common cue to pull down the shoulder blades when lifting the arms overhead will block the movement of the arms. As a result, the action will not only become more difficult, but it will also cause compression in your shoulder joint and may eventually lead to shoulder impingement syndrome.
We have summarized this issue – and other common alignment questions in yoga – in a free yoga alignment ebook. This will give you a basic understanding of alignment principles that can be applied to any pose and will make a huge difference to your yoga practice.
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3. What Happens in Surya Namaskar?
While lifting your arms is a very common movement from washing your hair to reaching for a can on a high shelf or climbing up a ladder, what does this have to do with Surya Namaskar?
Note that in your yoga practice, the first movement of the Sun Salutation is raising up the arms overhead in Mountain pose. The same happens when you step the foot back into Warrior I or Crescent Lunge or proceed to Chair pose: the arms reach up in the air. Even in Downward-Facing Dog, the arms are above your head. Although it may not be immediately obvious since the hands are fixed on the ground, the principles are exactly the same as for poses where the hands are up in the air.
So, to sum up, there are various poses in Surya Namaskar where it is of particular importance to pay attention to shoulder alignment in order to avoid shoulder impingement:
- Mountain pose with raised arms (Urdhva Hastasana)
- in Surya Namaskar B: Chair pose (Utkatasana)
- Warrior I (Virabhadrasana I) or its variation Crescent Lunge
- Downward-Facing Dog (Adho Mukha Svanasana).
4. What Can You Do in Surya Namaskar to Avoid Shoulder Impingement?
So, does this mean you should stop practicing Surya Namaskar once and for all? Don't worry! Once you're aware of the potential for shoulder impingement, there are various alignment techniques to apply to your yoga practice that help to avoid the problem. However, these may involve rethinking familiar alignment cues.
Let's take a look at the first movement in Surya Namaskar: raising the arms up from Mountain pose (Tadasana) to Urdhva Hastasana. This asana is perfect for explaining the basic principles of the scapulohumeral rhythm since it does not vary too much from the usual standing posture and we can focus entirely on the movement of the shoulders.
There are basically three alignment principles you should have in mind to avoid shoulder impingement:
- external rotation of the upper arms,
- upward rotation of the scapulae, and
- pronation of the forearms.
To better understand what is happening in these movement patterns, it's best to examine each of the actions separately. If you want to take a shortcut, simply download our free ebook on yoga alignment secrets and read the summarized version of this, and other, alignment issues.
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External Rotation of the Upper Arms
The first action to avoid impingement of the shoulder in Surya Namaskar is rotating the humerus externally when the arm reaches overhead. As already mentioned, the supraspinatus, one of the rotator cuff muscles, runs through the subacromial space (under the acromion and above the head of the humerus). This muscle is involved in the action of lifting the arms up when you transition from Tadasana into Urdhva Hastasana, for example.
Raising the arms actually means abducting the shoulder. Abduction of the shoulder usually involves internal rotation of the humerus, which consequently moves more closely into the subacromial space, increasing the potential for impingement. Due to its location, the supraspinatus is easily pinched in this movement if the arms reach overhead but the shoulder blades don’t follow the movement.
In order to externally rotate the upper arms, turn the triceps toward the face and the armpits forward. As a result, you will maintain more space in the subacromial space and reduce the pressure the head of the humerus puts on the acromion and thus decrease the potential for impingement.
Upward Rotation of the Scapulae
To bypass compression between the scapula and the humerus, you need to upwardly rotate your shoulder blade. This is a quite complex scapular movement: While the inner edge of the scapula moves down, the outer edge moves up. If you look at your shoulder blade from the back, it turns either clockwise (left scapula) or counterclockwise (right scapula).
But why is this relevant to arm elevation? Here, the scapulohumeral rhythm comes into play: Bringing up the arms from straight down at the side overhead requires the arm to move through an arc of 180 degrees. However, the shoulder joint only allows for an arc of about 120 degrees. This means that the remaining 60 degrees have to come from the upward rotation of the scapula.
This is why it is important to turn the humerus outward when lifting the arm upward to prevent compression on the rotator cuff. Reach up through the outer line of the arms as if climbing up a ladder. This will put the scapula in an angle that allows the humerus to be vertical without the two bones colliding into each other.
In Surya Namaskar, these two alignment principles basically also apply to Chair pose and the Warrior I variations, as you raise your arms up in the air in all of these poses. So make sure you keep them in mind during these poses as well.
It may be a good idea to pause and feel into your body every time you want to bring your arms up, revising the correct alignment principles first. Awareness is the key to good and safe posture.
So, understanding correct alignment in one single pose can make a big difference to almost all poses in your Surya Namaskar. There is one asana which is worth examining separately, though: Downward-Facing Dog.
Pronation of the Forearms
In Adho Mukha Svanasana, the situation is slightly different since the hands are on the ground. However, the arms are above the head just like they are in Urdhva Hastasana or Utkatasana so that the first two steps to correctly align the shoulders are the same.
In addition to the external rotation of the upper arms and the upward rotation of the shoulder blades, the third alignment principle comes into play here: pronation of the forearms.
Due to the external rotation of the upper arm, the forearm will rotate together with the humerus. This can lead to increased pressure in the outside of the hand and wrist. You can avoid this by pronating your forearm, which means pressing the index finger firmly into the ground, to evenly distribute the weight over the whole hand.
However, some practitioners may not have the range of motion in the radioulnar joint to press the index finger down. In this case, turning the hands slightly outward helps to maintain external rotation of the shoulder.
5. How Will Your Practice Improve?
With these three alignment principles in mind, raising the arms during your Surya Namaskar becomes a safe and stable movement for the shoulder without causing any compression in the subacromial space, and, thus, giving you the full range of motion. Surya Namaskar should no longer carry any risk of causing shoulder impingement syndrome – at least not due to the action of bringing your arms overhead.
These principles will also significantly improve your experience in other asanas such as Tree pose (Vrksasana), Half Moon (Ardha Chandrasana) or any up-reaching side bends. Our yogi friend Matt Giordano provides a great visual explanation of this issue on his website. Being a dedicated teacher, Matt also provided several free classes to our platform, such as Yoga for Non-Yogis.
If you want to learn even more about this and similar alignment issues, check out our Inside Yoga Alignment program, which takes you step by step through the most common yoga poses, clarifying some of the most widespread misconceptions about yoga alignment. There are sequences on Chair pose, Mini Warrior and Downward-Facing Dog, for example, so you can revisit what you've just learned in this article and will certainly experience more than just one eureka moment.
Next time you hop on your mat, play with the different movements in the shoulder area. If you're a teacher, preferably try to explore these actions yourself in your own practice before passing them on to your students.
However, keep in mind that everybody has a different bone structure, which is why not all students will benefit from these alignment principles to the same extent. It is also worth examining how they affect the rest of the body, especially the other joints involved in the same kinetic chain such as the elbows and wrists.
Bear in mind that the body is a holistic system of interconnected bones, muscles, and tissues. This means that one movement rarely has an isolated effect on one single joint region but rather involves a whole chain of reactions. This is why the application of these alignment principles may not only result in increased range of motion in the shoulder or improved mobility throughout your Surya Namaskar but in a whole new experience throughout your entire yoga practice.
If you want to go even another step further and learn 3 yoga alignment secrets that will boost your yoga practice and make it healthier, safer and more effective, download our free ebook where we have summarized basic principles that you can apply to all yoga poses.
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