Did you read our last episode, where we discussed Frozen Shoulder, and how it can benefit from a gentle yoga regime?
In the fifth instalment of our Samadhi Anatomy with Greg Walsh article we are going to look at Shoulder Arthritis, what is is, and some conventional treatments. We will also discuss at how to execute some poses which can help to regain mobility and ease discomfort in your shoulders through yoga.
Please be aware we always advise that you get the opinion of a medical professional, be it your GP or a physiotherapist, before you embark on any treatment or exercise regime. To take up yoga, we always recommend you find a good teacher who can guide you through the practice, modifying for your particular needs.
Episode 5: Shoulder Arthritis, and how yoga can help
Osteoarthritis in is a debilitating condition is where the cartilage inside a joint wears down or becomes damaged with time, or through injury. Shoulder Osteoarthritis usually occurs in the Glenohumeral Joint 1. Lets explore the anatomy of the shoulder joints, with reference to arthritis.
What is cartilage?
Cartilage is a strong and smooth type of tissue, with a firm rubbery consistency. It is made up of approximately 70% water and a 30% matrix of collagen and proteins. With age and wear the water content in cartilage declines, leaving it more vulnerable to damage and injury.
What is a joint?
A joint is the place here two (or more) bones connect and usually articulate or move. There are different types of joints, but most mobile joints are called synovial joints. This is because the joint is encased in a synovial capsule or sac, filled with synovial fluid. The ends of the bones inside the synovial joint are usually covered with hyaline cartilage. This particular cartilage has a very low level of friction so that the two bone ends slide on or over each other without any irritation. As mentioned above, with age, injury and wear and tear, this cartilage can wear away, tear, or become frayed or scuffed. Without this smooth cartilaginous buffer, bone and rub against each other causing pain and inflammation.
What is synovial fluid?
Synovial fluid has been compared to an egg white in appearance and consistency. It acts as a lubricant inside the joint capsule to reduce friction. By filling the synovial capsule it aids in shock absorption, and it also helps to distribute nutrients to the joint cartridge. A curious fact, synovial fluid is classed as non-Newtonian. Its viscosity increases under pressure. This action may help with the aforementioned shock absorption.
Shoulder Arthritis (Shoulder Osteoarthritis)
Diagnosis and Symptoms of Shoulder Arthritis
The main symptom of shoulder arthritis is pain. The condition is irritated by activity. Range of motion will most likely be reduced, possibly with a feeling of grinding inside the joint. Movement may create popping or clicking sounds. Please note, popping sounds are not unusual in joints, and do not necessarily mean arthritis. Pain is the symptom to look out for.
Pain often increases at night. This is due to the lack of mobility and to the simple fact that you may for a long period be lying on the shoulder, pushing weight into the injured area.
Affected areas of the Shoulder
There are two joints where are you may experience shoulder arthritis.
The first is the joint between the clavicle and the acromion. The clavicle is your collarbone. The acromion is a finger like protrusion at the front of the scapula or shoulder blade. Together they form the acromio-clavicular joint. Arthritis in this area would be felt as pain and irritation in the front shoulder.
The second is where the humeral head connects with the glenoid fossa. The humeral head is the ball at the end of your humorous, or upper arm bone. The glenoid fossa is the socket which your upper arm bone plugs into. This form is one of the two ball and socket joints in the body, the other being your hip. This area is the most common area to develop shoulder arthritis, and is the one which we will discuss.
Conventional Shoulder Arthritis Treatment Options
On diagnosis your doctor may recommend firstly rest to allow irritation to recede. Then medication , physical therapy, and possibly steroid injections are all non-surgical options. Inflammation is always present with arthritis, and if you have arthritis or any inflammation it is worth looking at your diet, habits and lifestyle. You may find ways to reduce inflammation in your body through making lifestyle changes.
If non-surgical treatments do not reduce pain sufficiently your doctor may refer you on for surgery. Within surgery there are a few options:
Shoulder arthroscopy is classed as key hole surgery. The surgeon inserts a small camera through hey small incision to examine inside the shoulder and joint capsule. The surgeon is looking to see what is causing the pain. It could be adhesions, see episode four about frozen shoulder for more information. It could be torn cartilage. The cartilage could be frayed and folding back on itself, or a floating piece of cartilage could be getting jammed in between the two bone surfaces. This can be trimmed back and smoothed out.
Shoulder arthroplasty is what we refer to as shoulder replacement. There is a wealth of variety in shoulder replacement surgery, depending on what level of arthritic damage is present. It might simply be that the head of the humerus and the glenoid fossa are resurfaced. At the other end of the scale the whole of the ball of the humerus and the glenoid fossa and accompanying bone may be removed, and replaced with a titanium prosthesis .
Can yoga help with Shoulder Arthritis:
Much of yoga is weight-bearing, which is going to compress a joint. This is beneficial for healthy joints, as a controlled level of weight-bearing will build bone density and maintain cartilage shock absorption. However such yoga poses may need to be avoided or modified when dealing with arthritis. It is important to remember that extreme mobility exercises may also irritate arthritis, so I recommend keeping all movements within a realistic and achievable level of flexibility.
1. Tadasana Variations
Tadasana is a wonderful diagnostic pose. Because in shoulder terms it is not weight bearing, and because the spine is in a neutral position, it allows us to play with shoulder mobility, and explore where pain begins in various arm positions.
a. I recommend exploring arms out to the sides, reaching out like in Virabhadrasana 2, and exploring internal and external rotation (palms down, palms up). If your arms feel too heavy, you can bring your fingertips onto your shoulders, which effectively makes the arms lighter.
You can try the arm variations described below, using a brick or belt, as these props help to create space inside the glenohumeral joint of the shoulder.
b. Hold a brick behind the back, and grip it with the palms, not the fingers. Squeeze the brick, straighten the arms, draw the shoulder blades back and down, and and see if you can push the brick down.
c. Hold a brick between the palms, and attempt to lift it above the head. Grip it with the palms, not the fingers. Squeeze the brick, straighten the arms, and lift the brick. Also lift the armpits, and spread the shoulder blades. You may find you cannot lift the brick as high as shown in the picture. No problem, lift to your comfortable limit.
d. Put a looped belt around the wrists, behind the back, and hit out into it. Straighten the arms, and extend the hands downward.
e. Put a looped belt around the wrists, straight out in front, and hit out into it. Straighten the arms, and extend the hands forward and upward. As the arms rise you will get to a stiff point, where you will want to poke out the chest and sway the back. Resist, take the lower front ribs in, and keep the abdomen engaged. Also lift the armpits, draw the elbows in and spread the shoulder blades.
2. The Pendulum
This a wonderful way to release pressure in the shoulder. Bend over a chair, and put your knee and hand on the seat of the chair. Let the arm of your arthritic shoulder hang, and allow the weight to create space in the shoulder socket. You can then let your arm swing gently, which will decompress the joint.
3. The Swing
In Tadasana hold a a stick or broom handle behind you, and swing it from side to side. This will gently limber up the shoulders without strain. You can play with an overhand or underhand grip, and how wide you place your hands also. I recommend having the feet apart for this one. It will help you to stay rooted as you mobilise the shoulders.
Remember, taking the arms above shoulder height may be painful. Remember: try taking the arms behind the back before taking them forward, as this will help with mobility.
You can then do the same action with the stick or broom handle in front of you, and explore your range of mobility by swinging it from side to side in front of you.
4. Trikonasana, Virabhadrasana 2
Standing poses which put no weight into the shoulders or arms are really useful when managing shoulder arthritis. Both Utthita Trikonasana and Virabhadrasana 2 are primarily leg and pelvic poses, but they also have great potential as a gentle shoulder mobilising and strengthening pose. You may find that you cannot hold your arms at shoulder height, so you can just release them onto the hips. Once you feel that you are strong enough to go a little further, why don’t you try doing the pose with a stick or broom handle?
In Utthita Trikonasana vertical arms may be too challenging due to shoulder pain, but you can use your strong shoulder to support your immobile shoulder using a staff or stick.
As you hold the poses, feel the shoulder blades spread and reach out into the fingertips, to create space in the glenohumeral joints.
I recommend playing with the shoulders in the pose. If you can take the arms out to the sides, explore how the shoulders feel as you externally rotate the upper arms. Try turning the palms upward. Compare how the shoulders feel when you broaden the shoulder blades vs. the collarbones. Get to know your comfortable range of motion in the pose!
You can also explore the range of comfortable motion in your shoulders in any other standing poses, as they bear no shoulder weight.
Bharmanasana is commonly known as tabletop pose. It can gently strengthen the arms and shoulders, without irritating shoulder arthritis. Try grounding into the finger bases, particularly the index fingers (as they tend to lift). then push the floor away, and grip into the upper arms. As you push the floor away let your shoulder blades spread. Once again try to bring space into the shoulders by lifting out of the hands, rather than sinking down into the hands (and shoulders).
6. Bharmanasana into Adhomukha Virsasana
From Bharmanasana you can sit back onto your heels into Adhomukha Virasana, keeping the hands on the floor in front of you. feel the armpits open and the shoulders stretch out. The more you can sit back the more you will create space in the glenohumeral joints.
7. Ardha Adhomukha Svanasana
If you can do all of the above poses without pain, you could think of bringing Dog back into your yoga practice. Adhomukha Svanasana is a weight bearing pose, so if you are rehabilitating a dislocated shoulder or working to stabilise shoulder instability, I recommend doing Adhomukha Svanasana with your hands on a height. It can be the seat of a chair, or the wall. If you know Samadhi yoga studios, the upstairs window ledges are perfect for this. Having the hands on a height takes much of the weight out of the shoulders, allowing you to control the amount of effort and stretch, and to focus more directly on spreading and drawing down the scapulae, and drawing the humeral heads into the glenohumeral sockets.
As I say each month:
Recovery takes time, and requires patience. Always practice with care and carefully observe each movement. That way you can feel any unhealthy movement as it occurs, and you can pull back from it, which will aid your recovery and reduce the risk of re-injury. I suggest you find a really good teacher who can work with you personally, and you should start to see improvement.
Next episode, we move down the arm, to cover both:
Tennis Elbow & Cubital Tunnel Syndrome