—Max 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 bone—external rotation—can reduce aggravating your condition. Experiment by taking your arm out to the side until it’s parallel to the floor, with the palm facing the floor. Bring the arm back to your side. Rotate the palm so that it’s 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 it’s 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, it’s 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 can’t 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).
It’s 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, it’s 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.