Shoulders

[muck_a_luck]

My mom has developed terrible arthritis in her shoulders, as well as debilitating limited mobility in one hip. Being the born-again yogini that I am, I picked up Yoga for Arthritis, by Loren Fishman, MD and Ellen Saltonstall, at the library.

This book has some really interesting stuff in it, even if you aren't so concerned about arthritis, and are more just interested in how the body works. I don't really have a review of the book, but in particular, I am fascinated by and wanted to share the explanation of how the shoulders work and how they can deteriorate.

The system of muscles, tendons, ligaments, and bones that make up the shoulder joint is unique. Although most bones con¬nect to specific places—usually the ends of other bones—the scapulae, or shoulder blades, are different. They hang loosely and slide over a large region of the backs of the ribs. They are capable of rising, lowering, moving to the midline and considerably out toward the sides, and tilting in all three dimensions. The scapulae are not held in place by inelastic ligaments, as are the knees, hips, ankles, elbows, and vertebrae. Rather, a large group of muscles, each flexible and independently contractile, moves the shoulder blades or holds them in place each time the arms move. These muscles span an enor¬mous spatial range in the body; they include the omohyoid and pec-toralis muscles arising from the jaw and sternum, to the latissimus dorsi muscles that originate at the back of the pelvis. When you consider how moving the arms and shoulders changes your center of gravity, the activity at the shoulders is practically the whole body's business.

The shoulder's function is mostly related to supporting the arm and helping us do things with our hands, such as reaching and turning, twisting and carrying, and operating devices as various as a tennis racquet, a button, an automobile, and a scalpel. Sometimes the job of the shoulder is to hold things steady, as when you are taking a photograph, brushing your teeth, or performing tasks that utilize the fine muscles of the hand, such as typing. At other times, the shoulder does the lion's share of work, for example, when you are throwing a ball, where the hand only controls the release of the ball.

As osteoarthritis degrades the actual structure of the joint, encroaching at the edges of the glenoid fossa (the socket of the shoulder joint) or distorting the smooth spherical perfection of the head of the humerus (upper arm bone), the range of motion of the joint itself decreases. At first there is ample room for adaptation: the shoulder blade tilts farther forward or back, shifts up or down, angles right or left. This increased movement of the shoulder blade makes up for stiffness in the shoulder joint. The muscles that govern the scapula's position and orientation "give" enough so that the joint motions in question, those of the humerus in the shoulder socket, are not really challenged. But as the degenerative process continues, the ligaments and joint cap¬sule begin to tighten, exactly because adaptation is so effective. A vicious cycle develops—the less the joint moves, the less it is able to move. There is no straining at the new limits on joint range; therefore, that range quickly decreases. And soon the easy adaptation stage is over, and the arm simply will not go up high enough to reach the top shelf in the garage, or will not twist far enough to hook on a brassiere.

The idea with yoga is to challenge these limitations before they outstrip your shoulder's built-in capacity to adapt to them. But this is not easy, precisely because of the joint's inherent adaptability! When you try to stretch the knee joint, you stretch whatever is stopping you, but when you do the same thing with the acromioclavicular joint, the shoulder will just slide along the back of the ribs to accommodate your limitation. So the exercises have to be more sophisticated, and have to fix the shoulder blade in place on the back of the chest before any of the shoulder's motions are extended. At times the poses cunningly do the opposite: hold the humerus in place and move the glenoid fossa around it!

The instructions in this chapter are drawn from Anusara Yoga as well as the teachings of Mr. Iyengar. What we have learned from Mr. Iyengar is implicit in what follows. Anusara Yoga explicitly offers four principles of particular value for the shoulder:


Inner Body Bright— In preparing for any action, open to the breath, to your intention, and to a deep energetic expansion. Avoid beginning from a collapsed posture, both physically and mentally.

Muscular Energy—The muscles of the arms activate, hugging the bones and connecting the upper arm bones securely into the shoulder sockets, which provides stability.

Shoulder Loop—The shoulder blades pull in toward the spine and move slightly down, which causes a lift in the front of the chest. The tops of the ears tilt slightly back to maintain the normal curve of the cervical spine. This action brings the shoulder girdle and neck into an alignment that will provide both stability and freedom. Consult the diagram and explanation of the Loops in Appendix III.

Organic Energy—While maintaining the previous actions, extend out from the center of the chest, out through the arms, creating space in the joints and balancing the compressive effects of Muscular Energy. With Organic Energy the practice becomes less mechanical and more expressive, fluid, and expansive.
(pp. 96-99)