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Dealing with Common Yoga Teaching Challenges: Keys to Healthy Shoulders
Why is the shoulder joint particularly vulnerable to injury in yoga? In this interview, Iyengar yoga teacher Julie Gudmestad talks about common teaching challenges facing yoga teachers today with special focus on the many issues linked to weakness in the shoulder joint.
YogaUOnline: You have been teaching yoga for more than three decades. During this time yoga has gone from a relatively obscure practice to mainstream. But with this has come a number of challenges! As you travel to teach your workshops, what do you find are the main challenges that the yoga teaching profession faces today?
Julie Gudmestad: One of the biggest challenges I see yoga teachers face is navigating new students with fairly serious health problems. What should a yoga teacher do if a student arrives at their class with a herniated disc in their back, a new knee replacement, or recent open heart surgery? These students come into class wanting and expecting the teacher to tell them what their limits are. This is very concerning for both patients and yoga teachers who are being put in this almost impossible situation.
As a physical therapist who’s been practicing for forty years, I would not want somebody with a recent hip surgery to arrive at my class, expecting me to give them a personalized program. In order to do that, I would need an extensive individual session to take their medical history, evaluate their condition, check their range of motion, and read their surgery report. This simply isn’t something that can be done in a group class setting.
To a large degree, I believe the blame lies with the medical profession and the insurance industry. Ideally, after a patient has had a major injury or surgery, they need to be referred to professional physical therapy or rehab to help them understand what they should and shouldn’t do to best facilitate their body healing. Unfortunately, many people are not receiving that extensive care, and desperate for help, start seeking yoga classes. Yoga teachers are put in a challenging situation because they want to help the student, but often don’t have the necessary training, experience, or time when teaching a group class to do so.
YogaUOnline: Many of these people are drawn to yoga because they hear about its health benefits. However, incorrectly practiced yoga can also lead to muscle strain or injuries. As yoga is becoming more mainstream, is the number of yoga injuries also on the rise?
Julie Gudmestad: I can’t speak for numbers but I do believe there is an injury problem, often because the student does not know when they should back off. Beginners often push themselves inappropriately to be able to go into an intermediate class before they are sufficiently flexible or strong.
Alternatively, some injuries are the result of a mixed level class, in which a beginner attempts to do a pose beyond his or her ability to do it safely. I believe it is crucial that beginners seek out an appropriate beginning class with a teacher who has experience working with beginners.
YogaUOnline: Many yoga beginners complain about wrist pain when they go into Downward Dog or that their shoulders and arms are weak. Are these students more predisposed to shoulder injuries? Should yoga teachers be particularly vigilant to this?
Julie Gudmestad: Yes. A perennial concern of mine is women who come to yoga with very little history of upper body strength. Often people don’t understand that the shoulder is very mobile. This mobility allows us to do a variety of yoga poses with our arms in a variety of positions, but because it’s so mobile, it sacrifices stability. Therefore, the shoulder is very dependent on soft tissue to stabilize the ball in the socket and to stabilize the shoulder blade, which forms the socket.
If you begin yoga with no recent strength work, then all of the soft tissues and muscles are likely to be weak. If a student wants to do the iconic, weight bearing poses on their arms, but the muscles are not strong enough to stabilize the joint, either the joint gets injured or the muscles and tendons become strained. Strained muscles and tendinitis are common. Shoulders are also prone to bursitis.
Many of these injuries could be avoided with what I think of as a ramp style of conditioning. Take the person at the condition that they are in, which is possibly very weak in the upper body, and then gradually build up their strength. It takes months to build up the strength to be able to do some of the advanced, weight bearing poses that we do on our arms.
YogaUOnline: Yes. One additional important benefit of building that strength is preventing injuries from falling as we age. As we age, we are more prone to falls, and our arms are what we use to catch ourselves. Do you find that your students appreciate that arm and wrist strength outside of their yoga practice?
Julie Gudmestad: Yes. When we hold weight bearing yoga poses, we are doing more than building up muscle strength. The theory is that putting stress on a bone helps to remind your body that it needs to keep the calcium mineral in the bone. When you stress the bone, your body maintains the mineral, and by doing the weight bearing poses, ideally we are both building muscle strength and also helping to maintain the bones so those arm bones, wrists, and shoulders are less likely to fracture when you fall.
YogaUOnline: The shoulder can be an unpredictable joint with problems like frozen shoulder, which can seemingly appear out of nowhere. What is your experience with this pervasive issue?
Julie Gudmestad: I am often approached by yoga teachers asking what they should do if someone comes to their class with a frozen shoulder. Unfortunately, it is a complicated problem that doesn’t have a short easy answer. Sometimes it is caused by a minor injury that the body reacts to with a big inflammatory response. Other times, the cause is unknown. I personally am suspicious of hormonal changes, but we don’t always know. The end result is that if we have a big problem, it’s painful and the arm loses mobility. People don’t want to use the arm, which results in losing even more strength and mobility. It requires a very thorough and persistent approach to work your way out of a frozen shoulder.
YogaUOnline: Another common injury is the rotator cuff. Can you share some wisdom about that?
Julie Gudmestad: Rotator cuff injuries are very common. I believe the root of the problem is that people are weak there. This is particularly true for women because historically, they have done less upper body strengthening. The rotator cuff is the main muscle group that stabilizes the ball and the socket. Often, when these injuries occur, it seems out of the blue: throwing a frisbee for the dog, washing windows, or falling and landing on their arm.
I feel passionately that the best thing one can do for rotator cuffs is prevention. This means keeping the rotator cuff strong, whatever your age. Maintaining strong rotator cuff requires regular practice of strengthening, but as the decades go by, it means being less vulnerable to injuries from seemingly innocuous activities. Fortunately, that’s where yoga has much to offer. Certain poses in the right alignment can do an excellent job of working the rotator cuff.
YogaUOnline: Anatomically, how does strengthening the rotator cuff help prevent injuries?
Julie Gudmestad: There are four muscles that are deep around the ball and socket; they help hold the ball in its normal and ideal position. When the body is still, they are helping to hold it in position. As we do yoga poses with the arms forward, such as Plank Pose, or with the arms overhead, such as Down Dog, Handstand or Tree Pose, those four muscles help position the ball in optimal alignment in the socket.
The word rotator most likely refers to the fact that three of the four muscles are powerful rotators: two external rotators, one internal rotator. Together, they form a cusp that helps stabilize the ball and socket both at rest and during movement. Dislocation, when the ball is partially out of the socket, occurs when one of the muscles, often the supraspinatus, is paralyzed. The first time a shoulder is dislocated, there’s typically been a trauma or unnatural position involved. However, once it has happened, strengthening the rotator cuff helps prevent the dislocation from occurring again.
YogaUOnline: You have a course on YogaU concerning shoulder health, with special focus on the rotator cuff. Could you tell us more about the course and what you cover?
Julie Gudmestad: It’s important for teachers to understand basic shoulder anatomy if they really want to know more about healthy shoulder function. So the first part of the course will be focused on anatomy. The rotator cuff is fairly mysterious, and many people wouldn’t be able to locate it or explain what it does. It consists of four muscles, and I will look at each of them to help you understand exactly where they are in the body and what they do and why they’re important to the function of the bone socket joint.
The course will then focus on basic strengthening for the rotator cuff. If weak, those muscles are too vulnerable to immediately start yoga poses such as Sun Salutation, so the strengthening exercises will begin with traditional strength training and therapeutic strength training to ensure that the muscles are strong enough to stabilize the ball and socket. Building up strength, we will then apply it to alignment and awareness in simple poses, and eventually the more challenging, weight bearing positions as well.
Julie Gudmestad is an Iyengar yoga teacher, yoga therapist, and physical therapist. She is the founder of Gudmestad Yoga in Portland, Oregon, and frequent contributor to "Yoga Journal" and presenter at yoga conferences and workshops worldwide.