My new peace flags from Civilian!

http://civilianbasics.com/blog/

http://www.civilianbasics.com/

"May We All Remain Civilian"

: )

Looking into Mya-Lisa's shoulder troubles.

Well of course this story would have to begin with an airborne flight from a mountain bike, now wouldn’t it? ; ) It seems very likely, Mya-Lisa, that your rainy day aches are secondary to good old fashioned post-traumatic arthritis, a thing that takes about ten years after an injury to sneak up on ya. With arthritis comes inflammation, and inflammation itself can have degenerative effects on a joint. This makes your shoulder a little more vulnerable to another issue known as impingement syndrome (I’ll come back to this).



Okay, so ten years ago we have your aerodynamic journey, and today we have your other great adventure in life – writing. I believe you have correctly surmised that this passionate endeavor of yours has become your overuse syndrome. Any action (or stress) that we repeat over and over again, even if it is only the quiet work of constant shoulder stabilization for the allowance of the perpetual fine motor task of typing, can easily fit the bill. The tendons that are overused become inflamed. They also thicken, taking up a lot of space, and in the shoulder, there just isn’t enough room for that.

Impingement syndrome occurs when there is inflammation between the top of the humerus (arm bone) and the acromion (tip of the shoulder blade), and that is where you will find the tendons of the rotator cuff muscles, as well as the bursa that protects them. What you described over the phone to me (when I went hunting for more details) was pain in exactly this area. The movements that you performed, which elicited pain, are controlled by the rotator cuff muscles (the most likely culprit of these right now being the supraspinatus). The impingement test I had you self-administer was somewhat painful (sorry), and the gomukasana pose with your right arm down was even more so (sorry again!). The rule for now on is to NEVER do anything that creates that pain.

The good news is that you are able to do warrior two, down dog, plank, and even wheel. If this IS an impingement syndrome, then it is in very early stages. The less good news is that there is some loss of motion in your right shoulder, and loss of motion generally leads to atrophy or weakening, and that's something we ought to address.

We need to rebuild strength in your rotator cuff muscles, Mya-Lisa. Yoga will be useful for that. Any pose where you find yourself elevating your arms (like in the warrior poses) is going to strengthen your supraspinatus. My recommendation at this time is to not go higher than 90 degrees in any pose until you have pain free movement at your computer. Typing can be your litmus test for recovery.

Though I am not in favor of too many sun salutations at this point (too much of anything is just not going to feel good I believe), what I do have in mind is an exploration of plank, chaturanga, and down dog with lots of gravity removed.

Plank, chaturanga, and down dog against the wall:



Progressing towards a table:



And on to a chair:



Hey - no making fun of my stick figures (or shoddy photography). Like your ponytail?

In all of these asanas, you must place your effort into maintaining external rotation of your shoulders by drawing the outside folds of your armpits (these are your lats) around toward the front of your body. This will strengthen your supraspinatus, infraspinatus and teres minor.

There is only one more rotator cuff muscle, the subscapularis, and there is no great way at this time to incorporate this muscle into your yoga. So, I suggest lying on your back with your palms facing up. Bend your right elbow 90 degrees by sliding your forearm along the ground. Now keep your humerus (upper arm bone) on the ground, and lift your forearm to vertical (internally rotating at your shoulder). If this is pain-free, you can introduce a can of corn or something to your hand to use as a weight and build up from there.

For some really nice mobility work, M-L, I'd like to introduce you to the work of Moshe Feldenkrais (a very big part of my education in physical therapy). This exercise is called the Shoulder Clock ATM Lesson.
http://www.feldenkrais.com/method/article/shoulder_clock_atm_lesson/
It is very quiet, mindful and juicy work. Let it be your indulgence.

I really recommend typing as little as possible right now (are you laughing at me?!!), because causing any pain at all can really worsen the situation (I will not be policing this activity by the way, should I happen to find you on the internet – wink, wink). When you are typing, please remember to “align your heart” with your shoulders drawn back and your shoulder blades gliding back and down, tucking your lower front ribs into your body.

A cold pack to that painful (subacromial) area should feel pretty good (5 to 10 minutes is enough).

And now for my disclaimer: As you know, my cyber assessment is far from the real thing. A visit to a physical therapist in your area would be ideal. (Or a quick look at Travelocity for cheap flights to NJ?)

Final advice: be mindful, be protective, breathe.


~~~~~~~~~~ positive healing vibes ~~~~~~~~~~

Lets talk physical issues.

I happen to know that Mya-Lisa has a shoulder issue she would like to discuss, so I thought I'd start a thread.

My question is - what bothers you?
When does it bother you, how does it bother you, does anything alleviate this, does anything make it worse, and how long has this been going on? Details please.

Aligning your heart.

On an inhale, lift your sternum (breastbone)and open your chest. This open-hearted posture is the one we take, when we are feeling very brave. It becomes part of our yoga, part of our meditation, part of our way of looking out at the world - or so we may aspire. This stance says I am making myself open to you. I am not shutting down. I am here to connect. Fill all of your chest - your entire rib cage - with breath and simply observe how it fills and empties this space.

Next step:

Begin to drop your chin towards your chest. At some point, the muscles at the back of your neck or somewhere down your back will stop you from getting any closer to your chest. Take a gentle hold of your lower ribs, where they come to meet the top of your abdomen, so that your hands are resting halfway on the ribs and halfway on the soft tissue of your abdomen. The lightest touch will register the most feedback. Now allow your chin to drop a little bit more - not by forcing more stretch from your neck/back muscles, but by allowing your lower ribs to sneak inward, just ever so slightly. You may notice some tone in your abdominal muscles switch on. It is subtle. And it's just good old, plain vanilla, postural tone - there to help us support our backs - to offer some core stability. Maintaining this slightly tucked position of the lower ribs, return your neck to an upright posture. Check in with your shoulders to see if they have moved forward and bring them back to center. Check in with your shoulder blades and draw them down the back if it feels necessary. And again, fill and empty all of this space with breath. Has anything changed?

Anatomically and perhaps emotionally aligned:

This fresh alignment creates ease and stability, once the surrounding muscles have adjusted their lengths to accommodate the new position (give them some time - they like their old habits). And it's a wake up call to our abdominal muscles, which I feel can be such an emotionally loaded area for many of us. We are either crunching our lower abs in an effort to look...how we think we should look, or we are practicing letting go, letting go, letting go of the ego that lives in our bellies. Both strategies have the potential to screw up our posture and cause dire consequences for our backs. But this simple act of opening the chest, while keeping some ribs for self, lets the abdominal muscles do their involuntary, postural job all on their own, removing our brains from them entirely. What a fricking relief!

What I like even more about this alignment is the metaphor it offers me for life. I open up to the world from a place that supports me. I take care of me to take care of you. For this I am grateful to my abdominal muscles!

No Class Tuesday, November 6th

That's the bad news.

But the good news is that I will be taking a course at The Institute of Physical Art, advancing my skills in functional orthopedics and soft tissue mobilization. I can't wait to see how much of this I can take to the mat! One of the most exciting aspects of my work as a yoga teacher is incorporating my knowledge as a physical therapist - an ever evolving endeavor and source of inspiration for me.

Classes will continue to be on Tuesdays and Thursday from 1:00 to 2:30.

I would really appreciate any feedback anyone has on what the most convenient times are to come to class, so that I can set up the most optimal schedule. Please feel free to comment here or email me privately at thekarmagarage@yahoo.com.

Hope to see you soon!