How to treat yoga-related shoulder injuries?

Treatment of Yoga-Related Shoulder Injuries

The treatment of yoga-related shoulder injuries should begin with gentle stretching and mobilization techniques, focusing on increasing external rotation and abduction, while gradually restoring alignment and strengthening weak muscles in the shoulder girdle. 1

Initial Assessment

When evaluating yoga-related shoulder injuries, consider:

• Assess for neurovascular compromise by checking axillary nerve function and distal pulses 2
• Evaluate tone, strength, changes in soft tissue length, and alignment of joints in the shoulder girdle 1
• Determine pain levels and any orthopedic changes in the shoulder 1
• Use appropriate imaging if needed:
  • Plain radiographs as first-line imaging to rule out fractures 2
  • MRI without contrast for soft tissue injuries when radiographs are negative 1

Treatment Algorithm

1. Pain Management

• If no contraindications exist, use analgesics such as acetaminophen or ibuprofen for pain relief 1
• Consider subacromial corticosteroid injections if pain is related to injury or inflammation of the subacromial region (rotator cuff or bursa) 1
• Apply ice for acute injuries to reduce swelling 2

2. Rehabilitation Exercises

• Active Range of Motion

  • Begin with gentle stretching and mobilization techniques
  • Focus on gradually increasing external rotation and abduction 1
  • Perform exercises in all planes including forward flexion, external and internal rotation 2
  • Avoid aggressive overhead movements that could stress healing structures 2

• Strengthening

  • Target weak muscles in the shoulder girdle 1
  • Include rotator cuff strengthening exercises, particularly external rotators 2
  • Add scapular stabilization exercises to improve shoulder mechanics 2

3. Self-Management Strategies

• Implement self-efficacy and self-management programs 1
• Educate on proper positioning and handling of the affected arm 2
• Avoid above chest level activities until healing is evident 2

4. Complementary Approaches

• Consider mind-body practices such as tai chi, which has shown efficacy for shoulder conditions 1
• Cognitive behavioral therapy may be beneficial for managing chronic pain 1

Special Considerations

For Specific Injury Types

• Rotator Cuff Injuries: Common in yoga, particularly during weight-bearing poses. Focus on progressive strengthening of the rotator cuff muscles 3, 4
• Impingement Syndrome: A rehabilitation program including stretching, ice packs, and strengthening exercises has shown large effect size in reducing pain and disability 5
• Supraspinatus Tendinopathy: Consider hyperthermia treatment (heating the skin to 38°C-40°C) which has shown large effect in reducing pain and disability 5

Prevention of Recurrence

• Proper warm-up before yoga practice 2
• Strengthening of scapular stabilizing muscles 2
• Proper technique during poses, especially those involving weight-bearing on the arms 4
• Gradual progression of practice intensity 2
• Supervised practice shows better outcomes than unsupervised 2

Follow-up Recommendations

• Initial evaluation at 1-2 weeks 2
• Clinical assessment at 6 weeks 2
• Assessment for progress of rehabilitation at 3 months 2
• Long-term follow-up at 6-12 months to evaluate for complications 2

Common Pitfalls to Avoid

• Returning to full yoga practice too quickly before adequate healing
• Neglecting scapular stabilization in the rehabilitation process
• Focusing only on pain management without addressing underlying biomechanical issues
• Failing to modify yoga practice to accommodate the healing shoulder

The evidence suggests that yoga-related shoulder injuries are generally mild to moderate in severity, with only about 4% of practitioners experiencing severe injuries 4. With appropriate treatment and rehabilitation, most practitioners can return to yoga safely with modifications to prevent recurrence.