Friday Q&A: Rotator Cuff Pain

Q: I've been trying unsuccessfully to resolve a very long term (perhaps a year) of rotator cuff pain. I've modified my yoga practice, but it still hurts. I've tried acupuncture and massage. Neither worked. I'm doing PT, and I think it's addressing the underlying muscular problem but I want to keep my whole body moving and stretching.

A: Thanks for writing in about your journey toward healing!  If you have not do so, I’d definitely get the shoulder looked at, and consider requesting an MRI to more clearly identify what is really going on in the joint. Having said that, I would also encourage you to seek the assistance of a local yoga teacher with lots of experience working with shoulder issues. In addition, you may have to consider a longer term modification of how you approach your yoga. You can certainly continue to practice many yoga asana to keep other parts of the body strong and flexible, but use your arms in a more neutral way. This might mean not doing certain poses, such as Downward-Facing Dog, if they continue to cause pain and provoke inflammation of your injured area.

You can also look at several articles in Yoga Journal online, particularly ones written by Julie Gudmestad, Roger Cole and Judith Lasater on the topic. Judith also has an interesting section in her book Yoga Body, a yoga anatomy text, on the “Gleno-humeral Rhythm,” which could prove helpful in deepening your understanding of normal movement patterns in the shoulder. And several years back, Loren Fishman, MD, did a small study on rotator cuff tears and modified Headstand, and found some very encouraging results. I am not suggesting you start doing Headstand today, but would recommend you review the study, which you can find in the International Journal of Yoga Therapy, and then discuss with your teacher if this approach is good for you. For now, all the best on your healing journey!

—Baxter

A: I urge you to continue with physical therapy but ask that the physical therapist look at you in a more holistic way, for example, considering how you use your neck in poses that may be problematic and whether you hold your breath either in the anticipation of pain or when in pain. I also suggest that less is definitely better, such as going into problem poses half way and only staying in a pose if it can be done without pain. To practice asana in the midst of pain is not asana. Trying to understand the root of the pain is often the hardest because it may be coming because you are trying to protect another body part from pain (like the low back area). Finally taking a break from active asana and maybe doing more restorative poses with breathing might help progress the healing.

—Shari