Shoulder Surgery

One of the students that just started coming to my class has had shoulder surgery six months ago. The Doctors have told her that is ok for her to order to strengthen her shoulder. Can anyone advise me on what asanas she should avoid and which ones she should do? She told me her surgery consisted of reattachment of her shoulder and it involved the shoulder cuff.

Thank you

ANSWERS:

From Tina Taylor:

Jorge, I've had trouble recently with my own shoulder, and my chiropractor pointed out that any lifting of my arm with the hand pronated (palm down) pushes the ball of the shoulder forward, into the weakest area of the rotator cuff. Therefore, it's best to keep the hand supinated (palm up), and the shoulder rolled back into its stronger position. Good Luck!!

From Ann Frances, grad. 2002

Jorge,

I'm not a doctor but my mother has had both rotator cuff surgery and recently had a partial shoulder replacement (different operations). She's currently in physical therapy on the partial shoulder replacement and does "exercises" designed to gradually increase her range of movement - really simple stuff like lifting her arm and circles. You're probably inquiring what to do for a person who is farther along on the road to recovery. May I suggest you talk to a physical therapist directly, in addition to, any advice you get from fellow yoga teachers. If you find out from them what you should consider in deciding upon appropriate poses, it will help direct your thinking about what to do. Once you think about it and come up with poses, perhaps a kind PT would allow you to show them or describe the movement (or fax a picture if they don't have time) to see if it's appropriate.

Just some ideas......hope this helps.

From Kyle Forman, CMT, AYTT grad

Jorge,

The rotator cuff muscles involve the subscapularis, infraspinatus, teres minor and supraspinatus to a lesser degree. The subscapularis medially rotates the shoulder and the infraspinatus and teres minor laterally rotate the shoulder; all stabilizing the humerus in the glenoid (shoulder) cavity. I think I would want to confer with her doctor with the client’s permission as to any contraindications and to the degree of her healing.

Strengthening these muscles would probably be done gradually. There is a great Cybex weight machine ( available in most health clubs) that work the subscapularis and infraspinatus and teres major. The elbow is bent at a ninety degree angle and the lower arm rests in an extension arm and the hand gripping a handle. You laterally rotate the lower arm away from the body for a set number of times and also internally rotate the lower arm, all with weights. I imagine you could do this with free weights if you are very conscious of keeping the upper arm close to the body.

As for stretches, which are best followed by strengthening there are several for these muscles in Julie Websters "Regaining Good Poster" available from Julie Webster, PO Box 19853, Boulder, CO 80308.

I would just have your client be very conscious of any yoga poses that brought on any pain and go slowly. All of the yoga poses that emphasize shoulder strength and stretching would be helpful provided she is well healed. And making sure that she is working for balance of all the muscles in the shoulder. Hope this helps.

From Nicole DeAvilla, Kentfield, Ca., grad. 1984

Dear Jorge,

Your student most likely will have had physical therapy after her surgery. If so, ask her to show you what exercises they had her do. This will give you an idea of what her current range of motion is and the type of strength building she has been doing already. Also if the rest of the class is doing something that would not be appropriate for her and you do not know of an appropriate variation, you could ask her if she would like to do one of her P. T. (physical therapy) exercises. Students usually are happy to have time to practice their P. T. exercises in class.

Initially I would recommend that she not bear weight on her arms unless she has already been doing that successfully. The arm positions in the standing poses will begin the strengthening process. Positions like the table pose where the shoulder and wrist are lined up perpendicular to the floor will be better to start with than when they are out stretched as in downward facing dog

Go very gently and slowly on stretching poses. While range of motion and flexibility are important, there must be enough strength to support the joint. It takes more muscle strength to support a joint that has been injured and especially one that has had surgery, than a normal joint that has not suffered any trauma.

One of the main points to remember in rehabilitation is to go slowly and steadily. Too much too soon can cause a relapse. This caution is best remembered down the road a bit when everything has been going well, and there is a tendency to start to move too fast.

Remind your student to not do anything that places stress or discomfort of any kind in the joint itself. The muscles around the joint may feel gentle stretching and strengthening sensations. Help her distinguish the difference. The more feed back you get from her, the easier it will be to assess how to pace her progress and what is working and what is not working.

Let me know if you have questions about any specific asanas.

Best wishes.

From Allyson Cannata. PT, grad. 1996

Hard to generalize this one since I don't know her baseline strength, approximate age or previous/present exercise history. Also, with this extensive surgery, I would think she has seen a P.T. Is she still seeing one?

I would love to help address this question, but would need this info first to answer without lots of if's and maybe's. If you want to give that info and then call me or email again, I would be happy to help.

From Terry Cramer:

I try to do the eagle and breath of life