Shoulder Stabilization in Posture and Movement
In Yoga and many times in athletics/sports, we are often looking at physical flexibility. This is great in the proper context. Flexibility which is certainly stressed in yoga asanas has it’s compliment in stability. We often talk a good line about balancing the body. Often in practice we don’t notice what kind of balance we are creating or have created. Since I often hear instructors in yoga class repetitively encouraging a student to go farther into the asana, I wish to focus on this incomplete perspective.
We will look at a case example from my Physical Therapy clinic. Before moving into looking at this specific example of shoulder instability, let’s speak more of this flexibility vs instability issue. Is it that one is better than another. (of course it is and of course it is not)
Posture or Asana Guidelines
This is old material for many who know it, but a brief review will be stated. The first of the three Yoga Sutras of Patanjali on asana starts out as:
Asana or posture is steady/stable and easeful/comfortable. I don’t know how many teachers and students who can recite this and more, still persist in having someone focus over and over again in trying to stretch further. Many people will look at a picture of someone who has tremendous physical flexibility, and they will effort to accomplish more range of movement. (Just like in the picture of their mind)
This perspective of overdoing the flexibility aspect of asana is not being balanced out by proper training of the needed stability. There must be good reasons why such an authoritative text like the Yoga Sutras has started out with stability and not about flexibility per se. (I know the context is stability of the mind–but we are starting with the body part of the mind here)
When babies start to move around, what is the first thing they do? In one way they start just moving. They seem to come equipped with great flexibility, right? (Wouldn’t some of us love to have that now days.) Well they don’t get very far until they develop significant stability. They do a ton of core work on their backs while seemingly flaying around their limbs for example. I will not get into the large amount of work they do sucking and orienting their eyes and head, etc. I just want to focus on this idea and observation–they don’t get up and get around until they develop their stability.
So if someone has the proper mobility then stability comes in conjunction to complete many of the functional movement patterns or exercise/sport patterns that we are involved in. What if we don’t have the flexibility, let’s say for the a particular asana.
We need to have movement. What is the relationship with movement and stability? Does one come before another? Well—it depends. (great words of wisdom : ))
Flexibility Problems and Of Course Stability Problems
Flexibility and Stability are both needed. It is the prescription of how, when, and where–including dosage amounts and timings.
For the past several weeks I have been seeing a client for shoulder and neck pain. Basically when he raised his arm above shoulder level in abduction, he has a painful arc of movement from about 110-150 degrees. Also this is his limit of movement on first examination. He can stretch it farther into the ends of range to 160, but it is just more painful in this case (not a true painful arc, per se). His neck movements were slightly limited in rotation and side bending away from the affected side. Mainly stiff lower cervical segments as a group. Also his thoracic spine rotation was markedly restricted bilaterally.
All his movements demonstrated poor sequencing of the scapular component. He was very weak in scapular retraction against resisted rowing movements, especially on his affected side. (The gleno-humeral joint was also anteriorly subluxed slightly) He was unable to retract or move his scapula’s together with resisted pulling movements when his forearms were more vertical.
I often use a mini band at this point to see if they can maintain their forearms in more of a vertical position as they pull the band apart and try to retract the shoulders.
Often they are grabbing this mini-band with their hands vs just wrapped around their wrists. You can see here that the band is at the top of the chest level. If you try to have them start at their nose level and then try to pull it apart–you will often see them only able to pull it while allowing it to come to their chest level again. Their scapular stabilizers with abduction of the arms are quite weak. The classic testing of shoulder stability with the elbows at the sides of the trunk are for very weak folks. Much of compromised work is with the hands/arms raised over his head.
Flexibility and Stability Retesting
Once I found both a flexibility and a stability problem, I will start to stimulate one area like the above scapular retraction with the mini bands. (As this scapular component could be at the base of his flexibility problem–as the shoulder blade is literally the base of the arm AND it was the most asymmetrical problem). Then I will retest their original complaint. In this case, he had pain with limited shoulder abduction. He immediately showed improvement. So then just for an experiment in his case, I tried doing some gleno-humeral (shoulder ball and socket) mobilization and mobility exercises. He didn’t respond as well upon retesting. I also tried improving his thoracic rotation. We used combined active movements of rotation and side bending of his trunk in sitting. He improved in shoulder abduction a few degrees, but not nearly the improvement as seen with the direct scapular resistance.
This particular fellow is rock climber and surfer, etc. He is very active and very strong in other ways. In other words, when I asked him to do a push up, he just dropped to the floor and pushed away with no problem. Please note that in this push up position, he locked his upper arms in close to his side. His scapula’s were quite stable, with no winging or instability. Very impressive.
Note that his instability (and seemingly inflexibility) is when his arm and hand are above his head.
This client case is just to emphasize that some people will have a lack of movement. Their lack of movement does not always respond to stretching. In this particular case it made no difference, except it was actually more uncomfortable with end range stretching.
He has responded well to starting with side plank positions. He is fairly unstable and has very weak endurance in this side plank position. The forward plank did not demonstrate enough change. The bulk of his program that has proved most helpful has been with these pulling movements at different angles. We often focus on holding the pulling movement and then working on eccentric/concentric contractions of this movement pattern. We change the angles over time, trying to find the weakest and most unstable position. We back away from it slightly and work before that place and after that place and then through that place that is difficult. He still uses thoracic mobility exercise to his advantage too.
Limitation of Yoga Asana
He has done very well. It is interesting to note that in traditional Yoga Asanas:
…most asanas develop forward pressure movements involving the upper body
He was originally trying stretch it out for weeks and weeks. There wasn’t much change. All forward pressure movements did not significantly help him either.
Realize this is a case example–speaking to the importance of assessing both mobility and stability. Certain protocols/sports/movement paradigms are biased in direction of movements and particular activities. These are constraints that can lead to significant imbalances. It is not that something is bad or good for you directly. There has to be an evaluation of what are your weaknesses and strengths. Often we are involved in activities that strengthen our strengths and do not do much for our weaknesses.
I know that in other people, they have more of a mobility restriction in their particular case. Therefore work more on mobility. Remember it is identifying the problem(s) and then a key is to RETEST. This retest provides the feedback. It isn’t this paradigm vs that paradigm. These topics of controversy, if they truly are, only should lead to examination not to reverential following.
Strengthening your ability to observe is paramount. Also you must ask a lot of questions. Be systematic in your focus of questions and answers–(most really are not–their mind immediately jumps away to a more familiar aspect of their inquiry–more to say about this in another post)
OK, make some comments. Share what you find works. Let’s build a community together.
Strong Mind and Body–Peter