Download - DrRic Yoga for Shoulder Rehab Lecture for Bikram Yoga Naperville 2010 (slide share edition)
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
TrapeziusTrapeziusRhomboidsRhomboidsLatisimus dorsiLatisimus dorsiPectoralis major and minorPectoralis major and minorSerratus anteriorSerratus anteriorTriceps Triceps
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 80 Cartilage 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
kneeback
The Rotator CuffThe Rotator Cuff
SupraspinatusSupraspinatusInfraspinatusInfraspinatusTeres minorTeres minorSubscapularisSubscapularis
R
RCRC
L
Rotator Cuff Strain/TearRotator Cuff Strain/Tear
The supraspinatus gets pinched The supraspinatus gets pinched (impinged)(impinged)The muscle through repetitive injury The muscle through repetitive injury continues to break down and not get the continues to break down and not get the chance to repairchance to repairFibrous tissue instead of plump muscleFibrous tissue instead of plump muscleTear, retraction, dysfunction, pain, more Tear, retraction, dysfunction, pain, more dysfunction, more tearing….dysfunction, more tearing….
Reasons for strain/tearReasons for strain/tear
RepetitionRepetitionPoor anatomyPoor anatomyScapular dyskinesisScapular dyskinesisPoor form at work or the gymPoor form at work or the gymFatigueFatiguePoor protoplasm/health/healingPoor protoplasm/health/healingAccidentsAccidents
Good note, muscle tissue heals!Good note, muscle tissue heals!
Viva Viagra!!Viva Viagra!!
The CapsuleThe CapsuleThe BursaThe BursaThe NervesThe NervesThe Labrum:The Labrum:
Soft parts heal but not great!Soft parts heal but not great!
Glenolabral TearsGlenolabral Tears
The Season Ender
““He’s got a lot of He’s got a lot of nerve!”nerve!”
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Trigger pointsTrigger points
Referred pain point Referred pain point Chronically associated with FMSChronically associated with FMSWill cause contracture to the region the Will cause contracture to the region the muscle traverses and pain above and muscle traverses and pain above and belowbelowBehaves like a pinched nerveBehaves like a pinched nerve
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
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RSDRSD
“Permanent fight or flight to the arm”
RehabRehab???
MovementMovement
Rotation (circumduction)Rotation (circumduction)AbductionAbductionAdductionAdductionExtensionExtensionFlexion Flexion
Standard exercisesStandard exercises
Overhead pressOverhead pressLateral raiseLateral raiseUpright rowsUpright rowsInternal/External rotation therabandsInternal/External rotation therabandsShoulder shrugsShoulder shrugsIncline bench pressIncline bench press
Standard therapyStandard therapy
Resistance bandsResistance bandsWeightsWeightsIsometric exercisesIsometric exercisesManual therapy (only a select few Manual therapy (only a select few therapists)therapists)Iontophoresis, TENS Unit!!!!Iontophoresis, TENS Unit!!!!
Dr Saguil Doesn’t like handoutsDr Saguil Doesn’t like handouts
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”
GarudasanaGarudasanaEagle Eagle Now that’s a Stretch!
Leslie Kaminoff
The toe hook is a killer!The toe hook is a killer!
Ardha MatsyendrasanaArdha MatsyendrasanaHalf Lord of the FishesHalf Lord of the Fishes
Stretch and work at the same time
Leslie Kaminoff
Lord of the FishLord of the Fish
Parivrtta Baddha ParsvakonasanaParivrtta Baddha ParsvakonasanaRevolved Side Angle Revolved Side Angle
Leslie Kaminoff
RSARSA
BhujangasanaBhujangasanaCobraCobra
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 earsShoulder heads back, squeeze Shoulder 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 a We are used to a defensive posture as a society.society.Fight or flight for life!?Fight or flight for life!?
Setu BandhasanaSetu BandhasanaBridgeBridge
Leslie Kaminoff
Bridge Bridge
Salamba SarvangasanaSalamba SarvangasanaSupported Shoulder StandSupported Shoulder Stand
Leslie Kaminoff
Shoulder StandShoulder Stand
Easier than it looks –alignment!Easier than it looks –alignment!
Leslie Kaminoff
Muscle strength important but Muscle strength important but alignment is key-FYIalignment is key-FYI
Yoga’s conceptYoga’s concept
EngageEngageAlignAlignStretchStretch
Ah Grasshopper, when you can take the pebble from my hand -you can leave the temple.
Engage! Engage! Align!Align!Stretch!Stretch!
Secondary GainSecondary Gain
Other joint stretching, full body fitnessOther joint stretching, full body fitnessBreath controlBreath controlBlood pressure, heart rate controlBlood pressure, heart rate controlHeart fitnessHeart fitnessRelative lack of exposure to injuryRelative lack of exposure to injuryDropping into the relaxation responseDropping into the relaxation responseControlling fight or flightControlling fight or flightImproving function of every cell in the bodyImproving function of every cell in the bodyDigestion improvementDigestion improvement
Circulatory benefitsCirculatory benefits
Lymphatic movementLymphatic movementSynovial wringingSynovial wringingMuscle perfusionMuscle perfusionBrain perfusion (inversions)Brain perfusion (inversions)
Other cells (controversial in Other cells (controversial in western medicine):western medicine):
FibroblastsFibroblastsChondroblastsChondroblastsLymphocytesLymphocytesNeuroblastsNeuroblastsMyoblastsMyoblastsKiller T CellsKiller T CellsRibosomes? Genetic Expression?Ribosomes? Genetic Expression?
Honorable mention to the RRHonorable mention to the RR
Herb BensonHerb BensonJohn Kabat ZinnJohn Kabat ZinnEkhart TolleEkhart TolleDeepak ChopraDeepak ChopraWayne DyerWayne DyerFr GabeFr GabeTerri (Bikram)Terri (Bikram)
Pointers for injured shoulderPointers for injured shoulder
Work first to mobilize the shoulder girdleWork first to mobilize the shoulder girdleControl pain (spasm) flare up with usual Control pain (spasm) flare up with usual measuresmeasuresAfter flexibility is gained, work on muscle After flexibility is gained, work on muscle “tone” and continued flexibility (exhale and “tone” and continued flexibility (exhale and push)push)Once accustomed to movement, advance Once accustomed to movement, advance to shoulder challenging posesto shoulder challenging poses
Chronic or acute!
A home exercise program by Eric A home exercise program by Eric SchiffmannSchiffmann
The Spirit and Practice of The Spirit and Practice of Moving into StillnessMoving into Stillness
-Eric Schiffmann-Eric Schiffmann
Understand your pathologyUnderstand your pathologyMost common injury is rotator cuff overuse and Most common injury is rotator cuff overuse and inflammation/tearinflammation/tearThe space between the humerus and the The space between the humerus and the acromial arch is narrow thus creating a acromial 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 more Once 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 space Frozen shoulder ensues causing smaller space and poor perfusion of muscle and tighter and poor perfusion of muscle and tighter shoulder space etc etcshoulder space etc etc
Surgical pathology?Surgical pathology?
Once the movement of the scapula is Once the movement of the scapula is impaired, the humeral head will not sit impaired, the humeral head will not sit correctly in the glenoid fossa and it will correctly in the glenoid fossa and it will start to clunk out of space tearing labrum start to clunk out of space tearing labrum (cartilage) or muscle (supraspinatus)(cartilage) or muscle (supraspinatus)Attempt physical therapy with a ‘shoulder Attempt physical therapy with a ‘shoulder trained therapist’trained therapist’Time for surgeon or injection with Time for surgeon or injection with conventional medicine …….or…….conventional medicine …….or…….
Don’t feel bad…..
……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
Surgery or not get a goodSurgery or not get a good physical therapist! physical therapist!
Naperville PT (630) 369-1015 Naperville PT (630) 369-1015 http://www.napervillept.comhttp://www.napervillept.comPersonal Best Performance Downers Personal Best Performance Downers Grove (630) 435-1800 Grove (630) 435-1800 Hand/Shoulder Therapy Plainfield/ Hand/Shoulder Therapy Plainfield/ Lombard (630) 393-0968Lombard (630) 393-0968
Alternative HealingAlternative Healing
With poor healing comes the introduction With 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 AyurvedaAcupuncture or Marma therapyAcupuncture or Marma therapyLess 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!
Hands on HealersHands on Healers
Reiki therapistReiki therapistMassage therapist (oil knowledge)Massage therapist (oil knowledge)Physical therapist (Manual therapy, shoulder Physical therapist (Manual therapy, shoulder training, kinesio taping)training, kinesio taping)ReflexologistReflexologistAcupuncturistAcupuncturistChiropractorChiropractorMarma practioner, Thai Massage, Yoga Marma practioner, Thai Massage, Yoga TherapistTherapist
ReflexologistReflexologist
Jennifer Adams in Aurora (630) 710 0304
Acupuncturist Acupuncturist
Frank Grill Frank 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
Yoga “Therapist”Yoga “Therapist”
Bikram YogaBikram YogaLiving Yoga AuroraLiving Yoga AuroraTotal Body Yoga MundeleinTotal Body Yoga MundeleinThe Chopra Center California SSLYThe Chopra Center California SSLY
Ayurvedic MedicineAyurvedic Medicine
The antiinflammatory diet for the long runThe antiinflammatory diet for the long runSpecific supplements for the short runSpecific supplements for the short runTopical oilsTopical oilsHomeopathyHomeopathyEnergy healingEnergy healingMassage (thai, deep tissue, hot stone, Massage (thai, deep tissue, hot stone, lymphatic)lymphatic)
Control InflammationControl Inflammation
The Antiinflammatory DietThe Antiinflammatory DietTurmericTurmericVitamin D3Vitamin D3Omega 3 fish oilOmega 3 fish oilWaterWaterAbstinence from damaging intakeAbstinence from damaging intake
(etoh, high GI foods, tobacco,dairy)(etoh, high GI foods, tobacco,dairy) --Nutritionist Andrea Klouda (630) 855-7907Nutritionist Andrea Klouda (630) 855-7907
““Food as Medicine”Food as Medicine”
SupplementsSupplements
TumericTumericVitamin D3Vitamin D3Omega 3 fish oilOmega 3 fish oilWhite willow bark, shark cartilage, White willow bark, shark cartilage, oregano, ginger, holy basiloregano, ginger, holy basilHelicrysium, tea tree, traumeel, Helicrysium, tea tree, traumeel, frankinsence. menthol, marjoramfrankinsence. menthol, marjoram
My favoritesMy favorites
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…..
……Call them out!Call them out!
Call the 800 numberCall the 800 numberAsk for R&D departmentAsk for R&D departmentAsk if the supplement has been tested for Ask if the supplement has been tested for level of “bioavailability”level of “bioavailability”Ask if the supplement has been tested for Ask if the supplement has been tested for mercury contentmercury contentAsk if you can get a copy of the studyAsk if you can get a copy of the study
The Saguil ApproachThe Saguil Approach
Do no further harmDo no further harmStop inflammation (ice therapy)Stop inflammation (ice therapy)Relative restRelative restSling at night (8 hours)Sling at night (8 hours)Gentle movement at dayGentle movement at dayJob alterationJob alterationWatch for secondary spasmWatch for secondary spasmDevelop the Relaxation ResponseDevelop the Relaxation Response
Engage! Engage! Align!Align!Stretch!Stretch!
Thanks and NamasteThanks and Namaste
Q&A time!Q&A time!
www.herbal411.comwww.herbal411.comEnrique Saguil, MDEnrique Saguil, MD
(630) 689-7986(630) 689-7986