Yoga for Shoulder RehabYoga for Shoulder Rehab
What’s in a shoulder?What’s in a shoulder?
wikepedia
deltoidsdeltoids
Scapular StabilizersScapular Stabilizers
“The Middle Child”
rhomboidsrhomboids
Levator scapuleaLevator scapulea
Secondary stabilizersSecondary stabilizers
TrapeziusTrapezius
RhomboidsRhomboids
Latisimus dorsiLatisimus dorsi
Pectoralis...
Skeletal structureSkeletal structure
scapula
humerus
clavicle
ribs
“honorable mention”-the sternum?
The Shoulder GirdleThe Shoulder Girdle
R
Party Pooper
The JointThe Joint
Anatomy of a Standard JointAnatomy of a Standard Joint
Cartilage Surfaces can last 80Cartilage Surfaces can last 80
years!years!
Side note for less “mortal injuries”Side note for less “mortal injuries”
These concepts go for any joint
hip
knee
back
The Rotator CuffThe Rotator Cuff
SupraspinatusSupraspinatus
InfraspinatusInfraspinatus
Teres minorTeres minor
Subscapulari...
R
RCRC
L
Rotator Cuff Strain/TearRotator Cuff Strain/Tear
The supraspinatus gets pinchedThe supraspinatus gets pinched
(impinged)(i...
Reasons for strain/tearReasons for strain/tear
RepetitionRepetition
Poor anatomyPoor anatomy
Scapular dyskinesisScapular d...
Viva Viagra!!Viva Viagra!!
The CapsuleThe Capsule
The BursaThe Bursa
The NervesThe Nerves
The Labrum:The Labrum:
Soft part...
Glenolabral TearsGlenolabral Tears
The Season Ender
““He’s got a lot ofHe’s got a lot of
nerve!”nerve!”
R
Trigger pointsTrigger points
Referred pain pointReferred pain point
Chronically associated with FMSChronically associated ...
MRI Arthrogram with SLAPMRI Arthrogram with SLAP
Bankart LesionsBankart Lesions
Bankart with Anchors INBankart with Anchors IN
Arthroscopic repairArthroscopic repair
Adhesive CapsulitisAdhesive Capsulitis
Stage I - IV
R
RSDRSD
“Permanent fight or flight to the arm”
RehabRehab ???
MovementMovement
Rotation (circumduction)Rotation (circumduction)
AbductionAbduction
AdductionAdduction
ExtensionExtension...
Standard exercisesStandard exercises
Overhead pressOverhead press
Lateral raiseLateral raise
Upright rowsUpright rows
Inte...
Standard therapyStandard therapy
Resistance bandsResistance bands
WeightsWeights
Isometric exercisesIsometric exercises
Ma...
Pump You Up!Pump You Up!
Note the amount of weight-good and pants-bad
No Pain No Gain!No Pain No Gain!
Weight and form-good, pants-doesn’t go with couch cover
Exercise with veggies!Exercise with veggies!
Low Tech/High IntensityLow Tech/High Intensity
Theraband!Theraband!
Therabore!Therabore!
(For real: I love the concept but I expect you to do this for a very long time.)
External Rotator StretchesExternal Rotator Stretches
“Effective Stretch”
GarudasanaGarudasana
EagleEagle Now that’s a Stretch!
Leslie Kaminoff
The toe hook is a killer!The toe hook is a killer!
Ardha MatsyendrasanaArdha Matsyendrasana
Half Lord of the FishesHalf Lord of the Fishes
Stretch and work at the same time
...
Lord of the FishLord of the Fish
Parivrtta Baddha ParsvakonasanaParivrtta Baddha Parsvakonasana
Revolved Side AngleRevolved Side Angle
Leslie Kaminoff
RSARSA
BhujangasanaBhujangasana
CobraCobra
1 Side body up 2 Humeral heads back 3 Back bend
Leslie Kaminoff
CobraCobra
Everybody Now!Everybody Now!
Side body up, shoulders to the earsSide body up, shoulders to the ears
Shoulder heads back, s...
Setu BandhasanaSetu Bandhasana
BridgeBridge
Leslie Kaminoff
BridgeBridge
Salamba SarvangasanaSalamba Sarvangasana
Supported Shoulder StandSupported Shoulder Stand
Leslie Kaminoff
Shoulder StandShoulder Stand
Easier than it looks –alignment!Easier than it looks –alignment!
Leslie Kaminoff
Muscle strength important butMuscle strength important but
alignment is key-FYIalignment is key-FYI
Yoga’s conceptYoga’s concept
EngageEngage
AlignAlign
StretchStretch
Ah Grasshopper, when you can take the pebble from my h...
Engage!Engage!
Align!Align!
Stretch!Stretch!
Secondary GainSecondary Gain
Other joint stretching, full body fitnessOther joint stretching, full body fitness
Breath con...
Circulatory benefitsCirculatory benefits
Lymphatic movementLymphatic movement
Synovial wringingSynovial wringing
Muscle pe...
Other cells (controversial inOther cells (controversial in
western medicine):western medicine):
FibroblastsFibroblasts
Cho...
Honorable mention to the RRHonorable mention to the RR
Herb BensonHerb Benson
John Kabat ZinnJohn Kabat Zinn
Ekhart TolleE...
Pointers for injured shoulderPointers for injured shoulder
Work first to mobilize the shoulder girdleWork first to mobiliz...
A home exercise program by EricA home exercise program by Eric
SchiffmannSchiffmann
The Spirit and Practice ofThe Spirit and Practice of
Moving into StillnessMoving into Stillness
-Eric Schiffmann-Eric Schi...
Understand your pathologyUnderstand your pathology
Most common injury is rotator cuff overuse andMost common injury is rot...
Surgical pathology?Surgical pathology?
Once the movement of the scapula isOnce the movement of the scapula is
impaired, th...
……if needed, call in the Calvary!if needed, call in the Calvary!
Too painful (narcotics)
Too disabling (no can work)
Too l...
Surgery or not get a goodSurgery or not get a good
physical therapist!physical therapist!
Naperville PT (630) 369-1015Nape...
Alternative HealingAlternative Healing
With poor healing comes the introductionWith poor healing comes the introduction
of...
Hands on HealersHands on Healers
Reiki therapistReiki therapist
Massage therapist (oil knowledge)Massage therapist (oil kn...
ReflexologistReflexologist
Jennifer Adams in Aurora (630) 710 0304
AcupuncturistAcupuncturist
Frank GrillFrank Grill
Naperville Acupuncture CenterNaperville Acupuncture Center
1324 e ogden ave1324 e ogden ave
suite 1...
Yoga “Therapist”Yoga “Therapist”
Bikram YogaBikram Yoga
Living Yoga AuroraLiving Yoga Aurora
Total Body Yoga MundeleinTota...
Ayurvedic MedicineAyurvedic Medicine
The antiinflammatory diet for the long runThe antiinflammatory diet for the long run
...
Control InflammationControl Inflammation
The Antiinflammatory DietThe Antiinflammatory Diet
TurmericTurmeric
Vitamin D3Vit...
““Food as Medicine”Food as Medicine”
SupplementsSupplements
TumericTumeric
Vitamin D3Vitamin D3
Omega 3 fish oilOmega 3 fish oil
White willow bark, shark carti...
My favoritesMy favorites
My favesMy faves
Traumeel by Heel (homeopathic cream)Traumeel by Heel (homeopathic cream)
PanAway by Young Living (essen o...
……Call them out!Call them out!
Call the 800 numberCall the 800 number
Ask for R&D departmentAsk for R&D department
Ask if ...
The Saguil ApproachThe Saguil Approach
Do no further harmDo no further harm
Stop inflammation (ice therapy)Stop inflammati...
Engage!Engage!
Align!Align!
Stretch!Stretch!
Thanks and NamasteThanks and Namaste
Q&A time!Q&A time!
www.herbal411.comwww.herbal411.com
Enrique Saguil, MDEnrique Sagui...
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DrRic Yoga for Shoulder Rehab Lecture for Bikram Yoga Naperville 2010 (slide share edition)

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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)

  1. 1. Yoga for Shoulder RehabYoga for Shoulder Rehab
  2. 2. What’s in a shoulder?What’s in a shoulder? wikepedia
  3. 3. deltoidsdeltoids
  4. 4. Scapular StabilizersScapular Stabilizers “The Middle Child”
  5. 5. rhomboidsrhomboids
  6. 6. Levator scapuleaLevator scapulea
  7. 7. Secondary stabilizersSecondary stabilizers TrapeziusTrapezius RhomboidsRhomboids Latisimus dorsiLatisimus dorsi Pectoralis major and minorPectoralis major and minor Serratus anteriorSerratus anterior TricepsTriceps
  8. 8. Skeletal structureSkeletal structure scapula humerus clavicle ribs “honorable mention”-the sternum?
  9. 9. The Shoulder GirdleThe Shoulder Girdle R Party Pooper
  10. 10. The JointThe Joint
  11. 11. Anatomy of a Standard JointAnatomy of a Standard Joint
  12. 12. Cartilage Surfaces can last 80Cartilage Surfaces can last 80 years!years!
  13. 13. Side note for less “mortal injuries”Side note for less “mortal injuries” These concepts go for any joint hip knee back
  14. 14. The Rotator CuffThe Rotator Cuff SupraspinatusSupraspinatus InfraspinatusInfraspinatus Teres minorTeres minor SubscapularisSubscapularis
  15. 15. R
  16. 16. RCRC L
  17. 17. Rotator Cuff Strain/TearRotator Cuff Strain/Tear The supraspinatus gets pinchedThe supraspinatus gets pinched (impinged)(impinged) The muscle through repetitive injuryThe muscle through repetitive injury continues to break down and not get thecontinues to break down and not get the chance to repairchance to repair Fibrous tissue instead of plump muscleFibrous tissue instead of plump muscle Tear, retraction, dysfunction, pain, moreTear, retraction, dysfunction, pain, more dysfunction, more tearing….dysfunction, more tearing….
  18. 18. Reasons for strain/tearReasons for strain/tear RepetitionRepetition Poor anatomyPoor anatomy Scapular dyskinesisScapular dyskinesis Poor form at work or the gymPoor form at work or the gym FatigueFatigue Poor protoplasm/health/healingPoor protoplasm/health/healing AccidentsAccidents Good note, muscle tissue heals!Good note, muscle tissue heals!
  19. 19. Viva Viagra!!Viva Viagra!! The CapsuleThe Capsule The BursaThe Bursa The NervesThe Nerves The Labrum:The Labrum: Soft parts heal but not great!Soft parts heal but not great!
  20. 20. Glenolabral TearsGlenolabral Tears The Season Ender
  21. 21. ““He’s got a lot ofHe’s got a lot of nerve!”nerve!” R
  22. 22. Trigger pointsTrigger points Referred pain pointReferred pain point Chronically associated with FMSChronically associated with FMS Will cause contracture to the region theWill cause contracture to the region the muscle traverses and pain above andmuscle traverses and pain above and belowbelow Behaves like a pinched nerveBehaves like a pinched nerve
  23. 23. MRI Arthrogram with SLAPMRI Arthrogram with SLAP
  24. 24. Bankart LesionsBankart Lesions
  25. 25. Bankart with Anchors INBankart with Anchors IN
  26. 26. Arthroscopic repairArthroscopic repair
  27. 27. Adhesive CapsulitisAdhesive Capsulitis Stage I - IV R
  28. 28. RSDRSD “Permanent fight or flight to the arm”
  29. 29. RehabRehab ???
  30. 30. MovementMovement Rotation (circumduction)Rotation (circumduction) AbductionAbduction AdductionAdduction ExtensionExtension FlexionFlexion
  31. 31. Standard exercisesStandard exercises Overhead pressOverhead press Lateral raiseLateral raise Upright rowsUpright rows Internal/External rotation therabandsInternal/External rotation therabands Shoulder shrugsShoulder shrugs Incline bench pressIncline bench press
  32. 32. Standard therapyStandard therapy Resistance bandsResistance bands WeightsWeights Isometric exercisesIsometric exercises Manual therapy (only a select fewManual therapy (only a select few therapists)therapists) Iontophoresis, TENS Unit!!!!Iontophoresis, TENS Unit!!!! Dr Saguil Doesn’t like handoutsDr Saguil Doesn’t like handouts
  33. 33. Pump You Up!Pump You Up! Note the amount of weight-good and pants-bad
  34. 34. No Pain No Gain!No Pain No Gain! Weight and form-good, pants-doesn’t go with couch cover
  35. 35. Exercise with veggies!Exercise with veggies!
  36. 36. Low Tech/High IntensityLow Tech/High Intensity
  37. 37. Theraband!Theraband!
  38. 38. Therabore!Therabore! (For real: I love the concept but I expect you to do this for a very long time.)
  39. 39. External Rotator StretchesExternal Rotator Stretches “Effective Stretch”
  40. 40. GarudasanaGarudasana EagleEagle Now that’s a Stretch! Leslie Kaminoff
  41. 41. The toe hook is a killer!The toe hook is a killer!
  42. 42. Ardha MatsyendrasanaArdha Matsyendrasana Half Lord of the FishesHalf Lord of the Fishes Stretch and work at the same time Leslie Kaminoff
  43. 43. Lord of the FishLord of the Fish
  44. 44. Parivrtta Baddha ParsvakonasanaParivrtta Baddha Parsvakonasana Revolved Side AngleRevolved Side Angle Leslie Kaminoff
  45. 45. RSARSA
  46. 46. BhujangasanaBhujangasana CobraCobra 1 Side body up 2 Humeral heads back 3 Back bend Leslie Kaminoff
  47. 47. CobraCobra
  48. 48. Everybody Now!Everybody Now! Side body up, shoulders to the earsSide body up, shoulders to the ears Shoulder heads back, squeezeShoulder heads back, squeeze Now hold it? Hold it? Hold it?Now hold it? Hold it? Hold it? Takes energy, right?Takes energy, right? We are used to a defensive posture as aWe are used to a defensive posture as a society.society. Fight or flight for life!?Fight or flight for life!?
  49. 49. Setu BandhasanaSetu Bandhasana BridgeBridge Leslie Kaminoff
  50. 50. BridgeBridge
  51. 51. Salamba SarvangasanaSalamba Sarvangasana Supported Shoulder StandSupported Shoulder Stand Leslie Kaminoff
  52. 52. Shoulder StandShoulder Stand
  53. 53. Easier than it looks –alignment!Easier than it looks –alignment! Leslie Kaminoff
  54. 54. Muscle strength important butMuscle strength important but alignment is key-FYIalignment is key-FYI
  55. 55. Yoga’s conceptYoga’s concept EngageEngage AlignAlign StretchStretch Ah Grasshopper, when you can take the pebble from my hand -you can leave the temple.
  56. 56. Engage!Engage! Align!Align! Stretch!Stretch!
  57. 57. Secondary GainSecondary Gain Other joint stretching, full body fitnessOther joint stretching, full body fitness Breath controlBreath control Blood pressure, heart rate controlBlood pressure, heart rate control Heart fitnessHeart fitness Relative lack of exposure to injuryRelative lack of exposure to injury Dropping into the relaxation responseDropping into the relaxation response Controlling fight or flightControlling fight or flight Improving function of every cell in the bodyImproving function of every cell in the body Digestion improvementDigestion improvement
  58. 58. Circulatory benefitsCirculatory benefits Lymphatic movementLymphatic movement Synovial wringingSynovial wringing Muscle perfusionMuscle perfusion Brain perfusion (inversions)Brain perfusion (inversions)
  59. 59. Other cells (controversial inOther cells (controversial in western medicine):western medicine): FibroblastsFibroblasts ChondroblastsChondroblasts LymphocytesLymphocytes NeuroblastsNeuroblasts MyoblastsMyoblasts Killer T CellsKiller T Cells Ribosomes? Genetic Expression?Ribosomes? Genetic Expression?
  60. 60. Honorable mention to the RRHonorable mention to the RR Herb BensonHerb Benson John Kabat ZinnJohn Kabat Zinn Ekhart TolleEkhart Tolle Deepak ChopraDeepak Chopra Wayne DyerWayne Dyer Fr GabeFr Gabe Terri (Bikram)Terri (Bikram)
  61. 61. Pointers for injured shoulderPointers for injured shoulder Work first to mobilize the shoulder girdleWork first to mobilize the shoulder girdle Control pain (spasm) flare up with usualControl pain (spasm) flare up with usual measuresmeasures After flexibility is gained, work on muscleAfter flexibility is gained, work on muscle “tone” and continued flexibility (exhale and“tone” and continued flexibility (exhale and push)push) Once accustomed to movement, advanceOnce accustomed to movement, advance to shoulder challenging posesto shoulder challenging poses Chronic or acute!
  62. 62. A home exercise program by EricA home exercise program by Eric SchiffmannSchiffmann
  63. 63. The Spirit and Practice ofThe Spirit and Practice of Moving into StillnessMoving into Stillness -Eric Schiffmann-Eric Schiffmann
  64. 64. Understand your pathologyUnderstand your pathology Most common injury is rotator cuff overuse andMost common injury is rotator cuff overuse and inflammation/tearinflammation/tear The space between the humerus and theThe space between the humerus and the acromial arch is narrow thus creating aacromial arch is narrow thus creating a “guillotine” especially if the scapula moves“guillotine” especially if the scapula moves poorly (as in fatigue or sloppy movment)poorly (as in fatigue or sloppy movment) Once injured, the shoulder joint collects moreOnce injured, the shoulder joint collects more fluid than it is used to holding (bursa)fluid than it is used to holding (bursa) Frozen shoulder ensues causing smaller spaceFrozen shoulder ensues causing smaller space and poor perfusion of muscle and tighterand poor perfusion of muscle and tighter shoulder space etc etcshoulder space etc etc
  65. 65. Surgical pathology?Surgical pathology? Once the movement of the scapula isOnce the movement of the scapula is impaired, the humeral head will not sitimpaired, the humeral head will not sit correctly in the glenoid fossa and it willcorrectly in the glenoid fossa and it will start to clunk out of space tearing labrumstart to clunk out of space tearing labrum (cartilage) or muscle (supraspinatus)(cartilage) or muscle (supraspinatus) Attempt physical therapy with a ‘shoulderAttempt physical therapy with a ‘shoulder trained therapist’trained therapist’ Time for surgeon or injection withTime for surgeon or injection with conventional medicine …….or…….conventional medicine …….or……. Don’t feel bad…..
  66. 66. ……if needed, call in the Calvary!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
  67. 67. Surgery or not get a goodSurgery or not get a good physical therapist!physical therapist! Naperville PT (630) 369-1015Naperville PT (630) 369-1015 http://www.napervillept.comhttp://www.napervillept.com Personal Best Performance DownersPersonal Best Performance Downers Grove (630) 435-1800Grove (630) 435-1800 Hand/Shoulder Therapy Plainfield/Hand/Shoulder Therapy Plainfield/ Lombard (630) 393-0968Lombard (630) 393-0968
  68. 68. Alternative HealingAlternative Healing With poor healing comes the introductionWith poor healing comes the introduction of ‘stagnation of energy’of ‘stagnation of energy’ Meridia’s in TCM or Nadi’s in AyurvedaMeridia’s in TCM or Nadi’s in Ayurveda Acupuncture or Marma therapyAcupuncture or Marma therapy Less invasive would be Qi Gong or YogaLess invasive would be Qi Gong or Yoga (with massage to both arts)(with massage to both arts) remember- this is the long cut!remember- this is the long cut!
  69. 69. Hands on HealersHands on Healers Reiki therapistReiki therapist Massage therapist (oil knowledge)Massage therapist (oil knowledge) Physical therapist (Manual therapy, shoulderPhysical therapist (Manual therapy, shoulder training, kinesio taping)training, kinesio taping) ReflexologistReflexologist AcupuncturistAcupuncturist ChiropractorChiropractor Marma practioner, Thai Massage, YogaMarma practioner, Thai Massage, Yoga TherapistTherapist
  70. 70. ReflexologistReflexologist Jennifer Adams in Aurora (630) 710 0304
  71. 71. AcupuncturistAcupuncturist
  72. 72. Frank GrillFrank Grill Naperville Acupuncture CenterNaperville Acupuncture Center 1324 e ogden ave1324 e ogden ave suite 102suite 102 naperville, il 60563naperville, il 60563 (630) 369-3237(630) 369-3237
  73. 73. Yoga “Therapist”Yoga “Therapist” Bikram YogaBikram Yoga Living Yoga AuroraLiving Yoga Aurora Total Body Yoga MundeleinTotal Body Yoga Mundelein The Chopra Center California SSLYThe Chopra Center California SSLY
  74. 74. Ayurvedic MedicineAyurvedic Medicine The antiinflammatory diet for the long runThe antiinflammatory diet for the long run Specific supplements for the short runSpecific supplements for the short run Topical oilsTopical oils HomeopathyHomeopathy Energy healingEnergy healing Massage (thai, deep tissue, hot stone,Massage (thai, deep tissue, hot stone, lymphatic)lymphatic)
  75. 75. Control InflammationControl Inflammation The Antiinflammatory DietThe Antiinflammatory Diet TurmericTurmeric Vitamin D3Vitamin D3 Omega 3 fish oilOmega 3 fish oil WaterWater Abstinence from damaging intakeAbstinence from damaging intake (etoh, high GI foods,(etoh, high GI foods, tobacco,dairy)tobacco,dairy) --Nutritionist Andrea Klouda (630) 855-7907Nutritionist Andrea Klouda (630) 855-7907
  76. 76. ““Food as Medicine”Food as Medicine”
  77. 77. SupplementsSupplements TumericTumeric Vitamin D3Vitamin D3 Omega 3 fish oilOmega 3 fish oil White willow bark, shark cartilage,White willow bark, shark cartilage, oregano, ginger, holy basiloregano, ginger, holy basil Helicrysium, tea tree, traumeel,Helicrysium, tea tree, traumeel, frankinsence. menthol, marjoramfrankinsence. menthol, marjoram
  78. 78. My favoritesMy favorites
  79. 79. My favesMy faves Traumeel by Heel (homeopathic cream)Traumeel by Heel (homeopathic cream) PanAway by Young Living (essen oil)PanAway by Young Living (essen oil) Turmeric FSE by New Mark (cap)Turmeric FSE by New Mark (cap) Vitamin D3 by NaturesSunshine (tab)Vitamin D3 by NaturesSunshine (tab) Super Omega 3 EPA by NS (cap)Super Omega 3 EPA by NS (cap) Challenge the company…..Challenge the company…..
  80. 80. ……Call them out!Call them out! Call the 800 numberCall the 800 number Ask for R&D departmentAsk for R&D department Ask if the supplement has been tested forAsk if the supplement has been tested for level of “bioavailability”level of “bioavailability” Ask if the supplement has been tested forAsk if the supplement has been tested for mercury contentmercury content Ask if you can get a copy of the studyAsk if you can get a copy of the study
  81. 81. The Saguil ApproachThe Saguil Approach Do no further harmDo no further harm Stop inflammation (ice therapy)Stop inflammation (ice therapy) Relative restRelative rest Sling at night (8 hours)Sling at night (8 hours) Gentle movement at dayGentle movement at day Job alterationJob alteration Watch for secondary spasmWatch for secondary spasm Develop the Relaxation ResponseDevelop the Relaxation Response
  82. 82. Engage!Engage! Align!Align! Stretch!Stretch!
  83. 83. Thanks and NamasteThanks and Namaste Q&A time!Q&A time! www.herbal411.comwww.herbal411.com Enrique Saguil, MDEnrique Saguil, MD (630) 689-7986(630) 689-7986

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