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Yoga for Bursitis

I have bursitis of the shoulder. I know that rest is the usual recommendation for bursitis, but so are strengthening and stretching. Which asanas would be beneficial and which should I avoid?

By Baxter Bell

óMax Isles, California

Baxter Bell's reply:
This is an excellent question, Max, because bursitis of the shoulder, as well as bursitis of the elbow, hip, and knee, are problems that many people experience. A bursa is a fluid-filled sac (a connective-tissue shell filled with fluid, not unlike a water-filled balloon) that usually lies between a bone and a muscle tendon, providing cushion and ease of movement between the two structures. Most of the time, the relationship between bursa, tendon, and bone is a happy, efficient, and painless one. But with repetitive use or overuse, or with direct pressure on a bursa (more commonly seen in the elbow joint), the bursa itself can often swell in size, reducing the normal amount of space within the joint in question. This inflammation and pressure results in a gradual increase in pain in and around the joint.

The typical symptoms of shoulder bursitis are a slow onset of pain, specifically when lifting the arm away from the body and when reaching the arm overhead. The pain is located in the upper shoulder or upper third of the arm and may feel worse if you're accustomed to lying on that arm while sleeping.

When you have acute swelling and inflammation of the olecranon bursa (the specific sac in the shoulder joint that most often causes pain there), you can practice yoga, but with very specific modifications. Because specific movements could prolong recovery times, avoid taking the arms above parallel to the floor for a while. Poses such as Virabhadrasana II (Warrior Pose II) are probably fine, whereas you should modify Virabhadrasana I (Warrior Pose I), Utthita Parsvakonasana (Extended Side Angle Pose), or Urdhva Hastasana (Upward Salute) to honor the injury.

When you are ready to take your arms overhead again, one specific movement of the upper arm boneóexternal rotationócan reduce aggravating your condition. Experiment by taking your arm out to the side until itís parallel to the floor, with the palm facing the floor. Bring the arm back to your side. Rotate the palm so that itís facing up with the thumb pointing behind you, and lift the arm from the side of the body. Do you feel a noticeable difference in the amount of pain between the first and second methods? Keep this in mind as your condition improves and your painless range of motion increases.

Obviously, you may need to avoid poses such as Adho Mukha Svanasana (Downward-Facing Dog Pose) and all of itís myriad variations,Adho Mukha Vrksasana (Handstand), Pincha Mayurasana (Forearm Balance), and Salamba Sirsasana (Supported Headstand) until reaching the arms overhead is no longer painful. And even then, itís important to know that when you invert, you will likely experience more compression in the shoulder joint, and possibly some recurrence of pain, due to the weight of the body dropping toward the floor.

Remember also that the bursa is simply a cushion between two places, and as such it canít be stretched or strengthened. It needs to quiet and return to its original shape and size. Monitor your shoulder closely to determine which movements seem to aggravate the situation. In the acute, early phase, you may find that rest, ice, and over-the-counter anti-inflammatory meds or natural alternatives (such as curcumen) are often helpful in reducing swelling. An excellent book to look at to understand rhythm of this joint, the glenohumeral rhythm, is The 7-Minute Rotator Cuff Solution (Health for Life, 1990).

Itís also interesting to note that we tend to compensate when bursitis occurs by raising the affected shoulder toward the ear, which shortens the upper trapezius muscle and other muscles in the neck region and can lead to a whole new problem. You can counteract this with your yoga practice. When you are well enough to lift the arms overhead, begin the movement by consciously moving the shoulder blades down and away from the ears as you lift the arms. As the arms continue to move overhead, feel the shoulder blades spread away from each other (in protraction), creating width across the upper back. If you have trouble feeling this on your own, itís helpful to work with a partner. Have someone place his hands over your shoulder blades as you reach the arms overhead to give a clear tactile experience of this scapular action. Also, do this for someone else, so you can visualize it better.

One of the muscles often implicated in shoulder bursitis is the supraspinatus, which begins in the upper part of the scapula and attaches to the head of the arm bone. Gomukhasana (Cow Face Pose) and Garudasana (Eagle Pose) arms both seem to help lengthen this muscle, so you may want to add them to your tool kit. Finally, consider looking for a physical therapist with additional training as a yoga instructor. There are now many cross-trained professionals available throughout the country. And never underestimate the power of a good bodyworker!

Baxter Bell, M.D., teaches public, corporate, and specialty back-care yoga classes in Northern California, and lectures to health care professionals around the country. A graduate of Piedmont Yoga Studio's Advanced Studies Program, he integrates the therapeutic applications of yoga with Western medicine.


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Reader Comments

Sara

Thanks Christine for the information on trochanteric bursitis! I am suffering from this currently and was having trouble finding a specific list of things to be wary of.

Christine Balkwill

Hello to all of those who are asking about trochanteric bursitis. I am a physiotherapist in Vancouver and also a yoga instructor, and I also HAVE trochanteric bursitis! Without getting long-winded I would like to make a few comments.

Trochanteric bursitis is actually a combination of two conditions - bursitis and tendinopathy. It presents as pain on the outside of the hip which is aggravated by running, climbing hills, lying on that side, standing on one leg, or similar. The bursa is a thin membranous sac that sits under the tendon of gluteus maximus and medius and so when these muscles contract or stretch the bursa is squished/sheared. Usually painless, when it is subject to too much of this stress it becomes inflamed and painful. Research shows that in most of these cases there is also micro-damage or even small tears to the tendons themselves.

When it is acute any but the most gentle yoga practice should be avoided. When it has settled or is a chronic (>3 mos) condition yoga can be practiced with a strict attention to avoiding pain. Forward bends and back bends are usually fine as are all elements of the sun salutations.

Things to be careful for -

External rotation poses - external rotation, at its limit, squishes the bursa and tendons and can aggravate the condition so in Warrior II, reclined butterfly, tree it is important not to feel any discomfort on the outside of the hip.

Hip openers - such as pigeon, square, 90/90 are intended to stretch these tendons and if they stretched intensely it will aggravate the condition. I prefer to choose a gentle ankle to knee stretch in order to release tension in the muscle without aggravating the tendons.

Single leg balances - prolonged single leg standing will put sustained stress on these injured tissues - whether this can be tolerated will depend on the individual. Remember that it might feel like a mild stress during the practice and lead to substantial pain after. Best to avoid any discomfort at all.

Hope this is helpful!

Reeb

Thanks for this article. I've been doing yoga for years with bursitis in both shoulders and I routinely blow out each shoulder and then stop doing yoga. Finally I'm starting to understand how damaging yoga can be when done incorrectly. Thank you for this advice.

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