A number of my yoga students present with shoulder injuries: dislocation; rotator cuff; bicep tendonitis; stiffness; frozen shoulder; and impingement. The shoulder gains its high degree of mobility from being a ball and socket joint however, this brings with it a propensity for vulnerability and instability.
Moreover, the forward position of modern lives contributes to rounded shoulders: pushing the head of the upper arm bone, the humerus, forward; weakening the muscles of the upper back; and tightening the chest. This coupled with insufficient activity leaves the shoulder with little protection against injury. Once a student has consulted their healthcare provider, there is much we can do in yoga therapy to co-activate muscles to strengthen and support this area.
However, there is more to shoulder therapy than biomechanics. The nerves of the brachial plexus run between the neck and the upper back, affecting and affected by the shoulder joint. In yogic tradition, reducing blood flow to the left arm can invoke the sympathetic nervous system, the ‘fight or flight’ stress response, and reducing blood flow to the right arm can invoke the parasympathetic nervous system, the ‘rest and digest’ calming response.  Therefore, depending on the shoulder injury and related conditions, the nervous system can also be affected in different ways.
In addition, the shoulder lies between the fourth and fifth major Chakras: Anahata at the heart; and Vishuddi at the throat. This proximity suggests that shoulder injuries may correlate with energetic blockages related to either of these chakras. There can be a sense of burden, restricted emotions or communication and a lack of freedom or joy.
I have one student, in particular, who has a sound yoga practice yet experiences shoulder discomfort in Downward Dog. She experiences moderate levels of pain if the pose is attempted with a strap and I can observe difficulties in keeping the head of the humerus out and back. After sending her to seek advice from a physiotherapist, we have started work on modifying her practice to reduce discomfort while strengthening her shoulder.
This student specifically presents with mechanical rotator cuff issues, specifically the weakness in the Supraspinatus, combined with insufficiency in Rhomboids and Latissimus Dorsi. There is no visible inflammation and the discomfort generally worsens with use suggesting mechanical contribution.
To ensure her shoulder joint has adequate support, we need to practice co-activation of all of the muscles around the joint, creating Shoulder Co-Activation or Amsa Bandha.
All shoulders, all bodies, are unique. My yoga therapy approach in this case is to work on nerve tensioning, gentle shoulder openers and binds, before safe inversions. We drop Downward Dog to the forearms in Dolphin Pose and work with Plank or Forearm Plank (all sides). Then Scales Pose Tolasana, Headstand and Forearm balance, Pincha Mayurasana, preparation are included as appropriate.
I also encourage daily practice but it’s important to emphasise that it is not all shoulder-specific work. The biggest challenge as with most rehabilitation cases is frequency and persistence. Many scientific studies I read on the effectiveness of yoga, demonstrate results with a gentle daily practice five to six days per week. However, practice should always be balanced. It needs to cater to anything else that is going on in the body, include passive opening as well as dynamic work, relaxation (savasana) and breathwork (pranayama).
One thing I do introduce that I find makes a big difference is work with a bolster. Gentle backbends using a bolster or blocks are a comforting way to open the chest and give the autonomic nervous system a bit of a rest. Passive poses are not sufficient alone, but they are a good counterbalance to dynamic Shoulder Co-Activation, Amsa Bandha, work.
The other tools from my yogic toolkit that I use where possible in these situations are Yoga Nidra Guided Relaxation and Meditation with or without mantra or affirmations. These can be used to direct the mind to the area of injury or the corresponding Chakra with healing intention. The practices are particularly useful to do after physical practice, asana, if time permits. However, it can also be done separately as preparation for sleep or similar.
I also offer mantras or affirmations to help change patterns of thinking that may be contributing to the injury and no longer be serving the student. Much yoga therapy work can remain symptomatic unless we focus attention on the energetic and psychological beliefs, information, and programming that may be contributing to the condition.
In my experience, we don’t always need to determine whether an emotional event or particular pattern of thinking came before an injury or condition. Significant psychological issues can be referred to other healthcare providers but often it is not material to analyse or diagnose. It can be enough to acknowledge the link between our bodies and our minds and choose our thoughts more carefully.
- Affirmations for shoulder conditions might include: 
- I release any burden. I stand tall and free.
- I express myself with joy.
- I am loved and loving. I am heard.
If using an affirmation is not comfortable, then I encourage simple, silent SOHUM meditation. This is a perfect place to start.
 Borg-Olivier, S & Machliss, B, The Anatomy & Physiology of Yoga, Yoga Synergy, 2009, p95.
 Long, R, The Key Muscles of Yoga, Bandha Yoga Publications LLC, 2006, p176.
 Borg-Olivier, S & Machliss, B, op. cit, p 97.
 Hay, L, You Can Heal Your Life, Specialist Publications, 1988, pp181-182