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DrRic Yoga for Shoulder Rehab Lecture for Bikram Yoga Naperville 2010 (slide share edition)



A presentation to the Bikram Studio in Naperville on how to utlize yoga for recovering from shoulder injuries.

A presentation to the Bikram Studio in Naperville on how to utlize yoga for recovering from shoulder injuries.



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    DrRic Yoga for Shoulder Rehab Lecture for Bikram Yoga Naperville 2010 (slide share edition) DrRic Yoga for Shoulder Rehab Lecture for Bikram Yoga Naperville 2010 (slide share edition) Presentation Transcript

    • Yoga for Shoulder Rehab
    • What’s in a shoulder? wikepedia
    • deltoids
    • Scapular Stabilizers “ The Middle Child”
    • rhomboids
    • Levator scapulea
    • Secondary stabilizers
      • Trapezius
      • Rhomboids
      • Latisimus dorsi
      • Pectoralis major and minor
      • Serratus anterior
      • Triceps
    • Skeletal structure scapula humerus clavicle ribs “ honorable mention”-the sternum?
    • The Shoulder Girdle R Party Pooper
    • The Joint
    • Anatomy of a Standard Joint
    • Cartilage Surfaces can last 80 years!
    • Side note for less “mortal injuries” These concepts go for any joint hip knee back
    • The Rotator Cuff
      • Supraspinatus
      • Infraspinatus
      • Teres minor
      • Subscapularis
    • R
    • RC L
    • Rotator Cuff Strain/Tear
      • The supraspinatus gets pinched (impinged)
      • The muscle through repetitive injury continues to break down and not get the chance to repair
      • Fibrous tissue instead of plump muscle
      • Tear, retraction, dysfunction, pain, more dysfunction, more tearing….
    • Reasons for strain/tear
      • Repetition
      • Poor anatomy
      • Scapular dyskinesis
      • Poor form at work or the gym
      • Fatigue
      • Poor protoplasm/health/healing
      • Accidents
      • Good note, muscle tissue heals!
    • Viva Viagra!!
      • The Capsule
      • The Bursa
      • The Nerves
      • The Labrum:
      • Soft parts heal but not great!
    • Glenolabral Tears The Season Ender
    • “ He’s got a lot of nerve!” R
    • Trigger points
      • Referred pain point
      • Chronically associated with FMS
      • Will cause contracture to the region the muscle traverses and pain above and below
      • Behaves like a pinched nerve
    • MRI Arthrogram with SLAP
    • Bankart Lesions
    • Bankart with Anchors IN
    • Arthroscopic repair
    • Adhesive Capsulitis Stage I - IV R
    • RSD “ Permanent fight or flight to the arm”
    • Rehab ???
    • Movement
      • Rotation (circumduction)
      • Abduction
      • Adduction
      • Extension
      • Flexion
    • Standard exercises
      • Overhead press
      • Lateral raise
      • Upright rows
      • Internal/External rotation therabands
      • Shoulder shrugs
      • Incline bench press
    • Standard therapy
      • Resistance bands
      • Weights
      • Isometric exercises
      • Manual therapy (only a select few therapists)
      • Iontophoresis, TENS Unit!!!!
      • Dr Saguil Doesn’t like handouts
    • Pump You Up! Note the amount of weight-good and pants-bad
    • No Pain No Gain! Weight and form-good, pants-doesn’t go with couch cover
    • Exercise with veggies!
    • Low Tech/High Intensity
    • Theraband!
    • Therabore! (For real: I love the concept but I expect you to do this for a very long time.)
    • External Rotator Stretches “ Effective Stretch”
    • Garudasana Eagle Now that’s a Stretch! Leslie Kaminoff
    • The toe hook is a killer!
    • Ardha Matsyendrasana Half Lord of the Fishes Stretch and work at the same time Leslie Kaminoff
    • Lord of the Fish
    • Parivrtta Baddha Parsvakonasana Revolved Side Angle Leslie Kaminoff
    • RSA
    • Bhujangasana Cobra 1 Side body up 2 Humeral heads back 3 Back bend Leslie Kaminoff
    • Cobra
    • Everybody Now!
      • Side body up, shoulders to the ears
      • Shoulder heads back, squeeze
      • Now hold it? Hold it? Hold it?
      • Takes energy, right?
      • We are used to a defensive posture as a society.
      • Fight or flight for life!?
    • Setu Bandhasana Bridge Leslie Kaminoff
    • Bridge
    • Salamba Sarvangasana Supported Shoulder Stand Leslie Kaminoff
    • Shoulder Stand
    • Easier than it looks –alignment! Leslie Kaminoff
    • Muscle strength important but alignment is key-FYI
    • Yoga’s concept
      • Engage
      • Align
      • Stretch
      Ah Grasshopper, when you can take the pebble from my hand -you can leave the temple.
      • Engage!
      • Align!
      • Stretch!
    • Secondary Gain
      • Other joint stretching, full body fitness
      • Breath control
      • Blood pressure, heart rate control
      • Heart fitness
      • Relative lack of exposure to injury
      • Dropping into the relaxation response
      • Controlling fight or flight
      • Improving function of every cell in the body
      • Digestion improvement
    • Circulatory benefits
      • Lymphatic movement
      • Synovial wringing
      • Muscle perfusion
      • Brain perfusion (inversions)
    • Other cells (controversial in western medicine):
      • Fibroblasts
      • Chondroblasts
      • Lymphocytes
      • Neuroblasts
      • Myoblasts
      • Killer T Cells
      • Ribosomes? Genetic Expression?
    • Honorable mention to the RR
      • Herb Benson
      • John Kabat Zinn
      • Ekhart Tolle
      • Deepak Chopra
      • Wayne Dyer
      • Fr Gabe
      • Terri (Bikram)
    • Pointers for injured shoulder
      • Work first to mobilize the shoulder girdle
      • Control pain (spasm) flare up with usual measures
      • After flexibility is gained, work on muscle “tone” and continued flexibility (exhale and push)
      • Once accustomed to movement, advance to shoulder challenging poses
      Chronic or acute!
    • A home exercise program by Eric Schiffmann
    • The Spirit and Practice of Moving into Stillness -Eric Schiffmann
    • Understand your pathology
      • Most common injury is rotator cuff overuse and inflammation/tear
      • The space between the humerus and the acromial arch is narrow thus creating a “guillotine” especially if the scapula moves poorly (as in fatigue or sloppy movment)
      • Once injured, the shoulder joint collects more fluid than it is used to holding (bursa)
      • Frozen shoulder ensues causing smaller space and poor perfusion of muscle and tighter shoulder space etc etc
    • Surgical pathology?
      • Once the movement of the scapula is impaired, the humeral head will not sit correctly in the glenoid fossa and it will start to clunk out of space tearing labrum (cartilage) or muscle (supraspinatus)
      • Attempt physical therapy with a ‘shoulder trained therapist’
      • Time for surgeon or injection with conventional medicine …….or…….
      Don’t feel bad…..
    • …if needed, call in the Calvary!
      • Too painful (narcotics)
      • Too disabling (no can work)
      • Too long to wait (got a world competition)
      • Too many issues getting out of control
    • Surgery or not get a good physical therapist!
      • Naperville PT (630) 369-1015 http://www.napervillept.com
      • Personal Best Performance Downers Grove (630) 435-1800
      • Hand/Shoulder Therapy Plainfield/ Lombard (630) 393-0968
    • Alternative Healing
      • With poor healing comes the introduction of ‘stagnation of energy’
      • Meridia’s in TCM or Nadi’s in Ayurveda
      • Acupuncture or Marma therapy
      • Less invasive would be Qi Gong or Yoga
      • (with massage to both arts)
      • remember- this is the long cut!
    • Hands on Healers
      • Reiki therapist
      • Massage therapist (oil knowledge)
      • Physical therapist (Manual therapy, shoulder training, kinesio taping)
      • Reflexologist
      • Acupuncturist
      • Chiropractor
      • Marma practioner, Thai Massage, Yoga Therapist
    • Reflexologist Jennifer Adams in Aurora (630) 710 0304
    • Acupuncturist
      • Frank Grill
      • Naperville Acupuncture Center
      • 1324 e ogden ave
      • suite 102
      • naperville, il 60563
      • (630) 369-3237
    • Yoga “Therapist”
      • Bikram Yoga
      • Living Yoga Aurora
      • Total Body Yoga Mundelein
      • The Chopra Center California SSLY
    • Ayurvedic Medicine
      • The antiinflammatory diet for the long run
      • Specific supplements for the short run
      • Topical oils
      • Homeopathy
      • Energy healing
      • Massage (thai, deep tissue, hot stone, lymphatic)
    • Control Inflammation
      • The Antiinflammatory Diet
      • Turmeric
      • Vitamin D3
      • Omega 3 fish oil
      • Water
      • Abstinence from damaging intake
      • (etoh, high GI foods, tobacco,dairy)
      • - Nutritionist Andrea Klouda (630) 855-7907
    • “Food as Medicine”
    • Supplements
      • Tumeric
      • Vitamin D3
      • Omega 3 fish oil
      • White willow bark, shark cartilage, oregano, ginger, holy basil
      • Helicrysium, tea tree, traumeel, frankinsence. menthol, marjoram
    • My favorites
    • My faves
      • Traumeel by Heel (homeopathic cream)
      • PanAway by Young Living (essen oil)
      • Turmeric FSE by New Mark (cap)
      • Vitamin D3 by NaturesSunshine (tab)
      • Super Omega 3 EPA by NS (cap)
      • Challenge the company…..
    • …Call them out!
      • Call the 800 number
      • Ask for R&D department
      • Ask if the supplement has been tested for level of “bioavailability”
      • Ask if the supplement has been tested for mercury content
      • Ask if you can get a copy of the study
    • The Saguil Approach
      • Do no further harm
      • Stop inflammation (ice therapy)
      • Relative rest
      • Sling at night (8 hours)
      • Gentle movement at day
      • Job alteration
      • Watch for secondary spasm
      • Develop the Relaxation Response
      • Engage!
      • Align!
      • Stretch!
    • Thanks and Namaste
      • Q&A time!
      • www.herbal411.com
      • Enrique Saguil, MD
      • (630) 689-7986