Ep 64: Sequencing for Students with Rotator Cuff Injuries

Your shoulder is one of the most mobile—and vulnerable—joints in your body, and the rotator cuff muscles play a crucial role in its stability. When a student is dealing with a rotator cuff injury, it can be challenging to know how to sequence a class that supports their healing while still offering a meaningful practice.

If you desire to understand and effectively address rotator cuff injuries, then a solid understanding of shoulder anatomy is essential. 

The rotator cuff is comprised of four muscles—the supraspinatus, infraspinatus, teres minor, and subscapularis—which work in concert to stabilize the shoulder joint and facilitate a wide range of motion.

In this episode, I’ll explain:

• the anatomy of the shoulder and rotator cuff,
• explore sequencing strategies to limit strain on these muscles, and 
• discuss how to incorporate strengthening and restorative elements into a vinyasa flow class. 

This conversation will give you the tools to confidently support your students with shoulder injuries. I'm excited for you to listen!

Transcript

Monica: 0:00

Your shoulder is one of the most mobile and vulnerable joints in your body, and the rotator cuff plays a crucial role in its stability. But when a student is dealing with a rotator cuff injury, it can be challenging to know how to sequence a class that supports their healing while still offering a meaningful practice. If you desire to understand. and effectively address rotator cuff injuries, then a solid understanding of shoulder anatomy is essential. The shoulder joint is a complex structure involving the articulation of the humerus, your upper arm bone, with the scapula, your shoulder blade. The rotator cuff is actually comprised of four muscles which work in concert to stabilize the shoulder joint and facilitate a wide range of motion. In this episode, I'll explain the anatomy of the shoulder and rotator cuff, explore sequencing strategies to limit strain on these muscles, and discuss how to incorporate strengthening and restorative elements into a vinyasa flow class. This conversation will give you the tools to confidently support your students with shoulder injuries. Welcome to the Essential Conversations for Yoga Teachers podcast with me. I'm Monica Bright, and I've been teaching yoga and running my yoga business for over a decade. This is the podcast for you. If you're a yoga teacher, you're looking for support. You love to be in conversation and you're a lifelong student. In this podcast, I'll share with you. My life as a yoga teacher, the lessons I've learned, my process for building my business and helpful ideas, tools, strategies, and systems I use, and you can use so that your business thrives. We'll cover a diverse range of topics that will help you whether you're just starting out or you've got years under your belt and you want to dive deep and set yourself up for success. I'm so glad you're here. Listen, I don't take myself too seriously, so expect to hear some laughs along the way. Now, let's do this. Together. Welcome back to the podcast. I'm Monica and while I can say I'm glad to be back in Chile, Chicago, I also miss. the fresh juices I had on retreat, as well as lounging by the pool and listening to the ocean crash on the shore all night. It made for some really wonderful sleeping conditions. While I was leading this last retreat, I had a student with a rotator cuff injury. Do you know how common rotator cuff tears are in yoga? It's one of the most common injuries you'll see in students that you teach. So, having a thorough understanding of what the injury is, the anatomy of the shoulder joint, and ways to sequence around the injury is what we'll dive into. Today, your shoulder is one of the most mobile and vulnerable joints in your body. And the rotator cuff muscles play a crucial role in its stability. But when a student is dealing with a rotator cuff injury, it can be challenging to know how to sequence your class and support their healing while still offering a meaningful practice. In this episode, I'll break down the anatomy of the shoulder and rotator cuff muscles, explore sequencing strategies to limit strain on these muscles, and discuss how to incorporate strengthening and restorative elements into a Vinyasa flow class. This conversation will give you the tools to competently support your students with shoulder injuries, namely rotator cuff injuries. Before we dive into sequencing, let's take a moment to understand the anatomy of the shoulder and the rotator cuff. The shoulder is a ball and socket joint made up of three bones, the humerus, the upper arm bone, the scapula, your shoulder blade, and the clavicle, your collarbone. What makes the shoulder so unique and so mobile is its shallow socket, which allows for a wide range of motion, but comes at a cost because the shoulder is also one of the most unstable joints in your body. That's where the rotator cuff muscles come in. The rotator cuff is a group of four muscles and their tendons that stabilize the shoulder joint. These muscles are the supraspinatus, the infraspinatus, the teres minor, and the subscapularis. These muscles work together to keep the head of the humerus centered in the socket, especially during overhead movements or weight bearing poses. When the rotator cuff is injured, whether from overuse, trauma, or degeneration, it can lead to pain, weakness, and limited range of motion. As movement teachers, it's our job to have the anatomy understanding to either create sequences or modify them so that we offer a practice that will protect these vulnerable muscles while still teaching a balanced practice. Students can either have a muscle tear or a tear in the tendon. So it's important that you ask them if they've been diagnosed because recovery from tears in each of those types of tissues is different and varies in length of time it takes to recover. Now that we understand the anatomy, let's talk about sequencing strategies you can use that can limit strain on the rotator cuff for your injured student. First, try to avoid overhead movements. Poses like downward facing dog and chair pose with arms overhead will likely not feel good for students with rotator cuff injuries. You can easily offer arm variations or pose modification. Chaturanga can place significant strain on the rotator cuff, especially if the student lacks strength or stability and races through the transition to upward facing dog and downward facing dog. This transition can be problematic and potentially cause further injury. Modify the amount of load bearing in these poses by cueing students to lower their knees in both plank and Chaturanga. Limit weight bearing on the arms. So poses like Plank, crow pose, or side plank can be too intense for an injured rotator cuff. Offer alternatives like tabletop or a squat balance with hands on the thighs. This way students can still practice balancing while they're caring for their shoulder and not bearing weight on it. Focus on neutral shoulder positions. Encourage students to keep their shoulders in a neutral position instead of rounded forward or shrugged up. Discuss shoulder shrugging in classes while you teach poses like Warrior II, Tadasana, Triangle, or even in seated poses. One of my favorite ways to teach students more awareness about their bodies is to bring them forward. out of alignment and then cue them back into alignment. I use the word alignment very loosely here because you should believe that it's different for everyone, even shoulder positioning. I would cue students to round their shoulders forward and breathe and notice the quality of their breath and then draw their shoulders back, lift the ribcage and notice the difference in the quality of their breath. You see how I cued to sit more upright without cuing them to broaden their collarbones or draw their scapula, their shoulder blades, down their back, which can be confusing for some students to do. This also allows each student to come into their own alignment for their bodies as opposed to trying to fit in with the norm or what a picture of the pose looks like. Even if you're teaching a vinyasa flow style class, you can incorporate restorative elements. Use props like bolsters, blankets, and blocks to support the shoulders or the arms in restorative poses like Supported child's pose or reclined bound angle pose with props underneath the arms for support. These poses with added support will help allow the student's shoulders to relax while they're still practicing and offer a sense of grounding and You can offer alternatives for common poses as well. Instead of Upward Facing Dog, suggest Cobra Pose with the elbows bent to reduce shoulder strain. Or Salambasana or Locust Pose, which is a prone backbend without the use of the arms or shoulders. Cue students to place their arms down by the sides of their body and lift their face, chest, and legs from their mat. This active backbend can be practiced with the backs of the hands connected to the mat or with arms lifted if it doesn't bother their shoulders. Instead of wheel pose, offer bridge pose for a gentle backbend or supported bridge pose with a block under the sacrum for a supported backbend. We've discussed modifying your sequence, alleviating poses that might be further damaging to the rotator cuff injury, and utilizing different styles of yoga, such as restorative poses, to teach around the injury. But what if you want to offer something more? Something in class to help treat the injury because you understand the injury and what exercises will have a positive effect on the tissues. While it's important to limit strain on the rotator cuff, it's also helpful to incorporate strengthening exercises that support shoulder stability and healing. Here are a few ways to add them to a vinyasa class. And by the way, I've taught all of these. The first is isometric holds. Have students hold tabletop position with their hands either on blocks or on their mats and press firmly into the surface to engage the rotator cuff muscles without moving the shoulders. The second is external rotation exercises. In a seated or standing position, have your students hold a strap and gently pull it apart while keeping their elbows bent at 90 degrees. This strengthens the infraspinatus and teres minor. You can feel the difference in engagement in the shoulder girdle when you practice this. You should try it out for yourself so you can feel it. The third is scapular stabilization. In cat cow pose, cue students to draw their shoulder blades together on the inhale in cow pose, or this back bend, and round them apart on the exhale, or in a full cat stretch. This helps strengthen and move the muscles around the shoulder blades, including the rotator cuff muscles and the rhomboids. And finally, you could add in gentle arm movements. In mountain pose, have students slowly lift their arms to shoulder height, Then lower them back down. This strengthens the supraspinatus without overloading the shoulder by practicing weight bearing poses. These exercises can be woven into the flow or offered as part of a warm up or a cool down at the end of your sequence. Finally, let's talk a little bit more about how to incorporate restorative and additional yoga practices into your vinyasa flow class for students with rotator cuff injuries. We briefly talked about supported child's pose. So place a bolster under the chest and the forehead and allow the shoulders to relax completely. You might have students rest their arms on blocks or blankets depending on their body proportions and whether their forearms can reach their mat or not. In reclined bound angle pose use a bolster under the spine and blankets under the knees to create a sense of openness in the chest without straining the shoulders. Also with arms supported by props so students can relax and not feel any type of straining in the arms or shoulders. The third, and I love this option, is side lying shavasana. Have students lie on their unaffected side with a pillow under their head or a blanket under their head and another blanket between their arms. This allows the injured shoulder to rest comfortably on a supported surface. This was one of my most favorite positions when I had frozen shoulder. Finally, add breathwork and meditation. In your class, with a short guided meditation or breathwork practice to help students connect with their bodies and cultivate a sense of calm, these restorative elements provide a gentle counterbalance to the more active parts of the practice, supporting both physical and emotional healing. Teaching students with rotator cuff injuries requires a thoughtful and compassionate By understanding the anatomy of the shoulder, modifying poses to limit strain, and incorporating strengthening and restorative elements, you can create a practice that supports their healing journey and work in unison with their doctors or physical therapists. Remember, Every student is unique and it's okay to ask questions, offer alternatives, and adapt as needed. The most important reminder is to keep learning and incorporate practices that create a safe and supportive space students will feel seen and cared for. Here's my question for you. Have you ever had a student tell you they have a rotator cuff injury? What was your initial reaction? Did you alter or modify your sequence in any way to accommodate this student? It's okay if you didn't. My hope and the reason why I made this episode is so that you realize you can actually do more than say, do what feels right with you. With a ton of feedback from your injured students, you can become more and more confident with working with students with injuries. Remember, it's all a process, and there is no right time, just the timing that feels right. for you. If you can't tell already, this is one of the subjects that lights me up. And I want all teachers of movement to understand how a working knowledge of the human body affects your teaching. I don't think we talk about the importance of injury awareness and education enough. And if this conversation feels slightly uncomfortable, don't worry, this is exactly where change happens for you. Pick up an anatomy book, watch a video series, follow accounts on social media that will teach you. Just keep taking steps to be more informed. I hope that this episode sparked some deeper thought around getting more comfortable and confident with your knowledge of anatomy and injuries. is so important as a movement educator. If you're looking for more resources on teaching students with injuries, check out the ebook sequencing for different injuries. The link is in the show notes below, and I promise you it will help you form a foundation for teaching students with injuries, and it'll be a great resource for you to return to again and again. When you download the ebook, you'll be joining my newsletter. That's just for yoga teachers, but I've got more exciting teachings coming soon. So I'll want to tell you all about them. The link is in the show notes below, and I would love for you to join it so we can always stay connected. I've also added a link in the show notes for you to send me a quick message about your thoughts on this episode. I won't know your phone number. It's just a neat addition to the platform I use that allows for this new and really easy way for you to communicate with me. Once you click on it, it will take you to your messages. Don't delete the code. That's how your message will get to me. And I would love to know your thoughts. Subscribe to the podcast. So you're always in the know when a new episode drops and share it with another yoga teacher who you think would love to be in on these conversations. Thank you for helping to spread the word about this podcast. And if you've been taking notes in your journal, as you listen to these episodes, I'm so glad you are. And I would love to hear about it. All right, that's it for now. Bye! Mhm.