Ep 118: Teaching Yoga to Students with Bursitis

Bursitis, inflammation of the fluid-filled sacs that reduce friction in the shoulder, can make overhead movements and weight-bearing poses uncomfortable. But understanding how to work with students who have bursitis doesn't require a degree in physical therapy. It requires foundational knowledge of modern pain science, intelligent modification strategies, and language that reduces nervous system threat. This episode breaks down what yoga teachers actually need to know about teaching yoga to students with bursitis, from the initial conversation through specific pose modifications to knowing when to refer out.

What You'll Learn About Teaching Yoga to Students with Bursitis:

• What is Bursitis?
• Understanding Bursitis from a Modern Pain Science Perspective 
• The Initial Conversation That Sets You and Your Students Up for Success 
• Practical Modifications for Common Yoga Poses with Bursitis 
• Language That Reduces The Threat to the Nervous System
• Building Capacity Through Exposure, and
• When to Refer Students to Medical Professionals 

Teaching students with bursitis is absolutely within your scope when you understand the modern pain science behind their experience, offer intelligent modifications using language that reduces threat, and know when to refer for additional support.

Resources Mentioned:

Free: Rotator Cuff Injury Training  - Comprehensive shoulder anatomy and modification strategies

The First Step to Teaching Students with Pain ($34) - Foundational skills for working with any injured student

Teaching Students with Injuries Mentorship  - Ongoing support for real students in real time

 Related Episodes:

Ep 114: How to Teach Yoga to Students with Lower Back Pain

Ep 116: Students With Wrist Pain In Your Yoga Classes?

Ep 72: When to Refer Out: Recognizing the Limits of Your Scope

Transcript

Monica 4:00

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 are 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 wanna dive deep and set yourself up for success. I am 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 I'm so glad you're here. Here we talk about the anatomy, the injuries, the nervous system insights, plus all the real life knowledge you wish had been included in your yoga teacher training. If you've been listening to the podcast for a while, you know that I'm a yoga teacher who specializes in teaching other teachers how to work confidently with students who have pain and injuries. I've focused my continuing education in biomechanics, human movement, and modern pain science. We're going to cover what bursitis actually is from a modern pain science perspective. How to have the initial conversation with a student who has it what modifications to consider for common poses, and when you might want to refer them out to work with someone else. By the end of this episode, you're going to feel more confident the next time a student tells you that they have bursitis. Before we get into it, I wanna say this bursitis is one of those diagnoses that sounds really medical and intimidating, but once you understand what's happening and how the nervous system is involved, you'll realize you absolutely can work with these students else. You don't need to be a physical therapist. You don't need to know every detail of shoulder anatomy. You just need to understand enough to offer intelligent modifications and create environments where their nervous system feels safe. So let's begin to break it down. Let's start with what bursitis actually is. A bursa is a small, fluid-filled sack that sits between bones and soft tissues, like tendons or muscles. Its job is to reduce friction. You have bursa all over your body, but in the shoulder, the most commonly affected one is the sub acromial bursa, which sits between the top of the shoulder blade and the rotator cuff tendons. Bursitis means inflammation of the bursa. When a bursa becomes irritated or inflamed, it can swell and become painful. Especially with certain movements in the shoulder. This typically happens with overhead movements or when the arm is lifted away from the body. Now, here's where modern pain science comes in. Yes, there is often actual inflammation happening in the tissue, but the pain someone experiences isn't about that inflammation. Pain is a protective output from the brain. It's the brain's way of saying, I'm perceiving a threat to this area and I want you to move differently or stop moving altogether. The amount of inflammation doesn't always match the amount of pain someone feels someone can have. Significant inflammation and minimal pain, or minimal inflammation, and a lot of pain. Context matters. Stress, sleep, how safe the nervous system feels previous experiences with shoulder pain, all of these things influence the pain experience. So when you're working with a student with bursitis, you're not just thinking about the inflamed bursa. You're thinking about how to create an environment where their nervous system feels safe enough to explore movement without triggering that protective pain response. So if you're thinking, well, if there's inflammation, shouldn't they just go to a physical therapist and come back to yoga class when it's healed? And this is where I wanna challenge that thinking a little bit. First bursitis often doesn't have a clear timeline for healing. It's not like a fracture where you can say, in six weeks this will be healed. Inflammation can calm down relatively quickly with rest and sometimes anti-inflammatory medication, but the nervous system sensitivity can linger. Someone might be cleared by their doctor to resume activity, but they're still nervous about certain movements. They're still holding tension in that shoulder. They're still moving in ways that protect that area, and that's where you come in as their yoga teacher. Second, yoga offers something that physical therapy often doesn't, which is ongoing practice in a supportive environment. Physical therapy is typically short term. You go for six to eight weeks, you do your exercises, you graduate, but then what yoga gives people a place to continue building capacity to practice moving their shoulder in different ways, to rebuild confidence in movement that's valuable, and that's exactly what they need. Third, many students with bursitis are going to show up to your classes whether you feel ready or not. They're not gonna wait until they are completely pain free to come back to yoga. So the question isn't whether you should teach them. The question is how you can work with them. Thoughtfully. Now, there are absolutely times when you should refer someone out, and we'll talk about that in a few minutes, but in many cases, you can be a valuable part of their recovery process. So let's talk about what to say when a student tells you that they have bursitis. This conversation is really important because it's. Sets the tone for everything that comes after. The first thing I always do is thank them for telling me. I say something like, thank you for letting me know. That's really helpful information.. This acknowledges that they trusted you enough to share and it reinforces that you wanna know about their injuries. Then I ask when it started, and if they're currently working with anyone. This gives you context about whether this is acute or chronic and whether they have other support outside of yoga. Next, and this is critical, I ask if they are noticing specific movements that increase their pain. I say something like, have you noticed specific movements or positions that tend to aggravate it? And this is where you're gathering information about what might need to be modified in your sequence for bursitis. Students will often tell you that lifting their arm overhead or out to the side is uncomfortable. Sometimes they'll say that lying on that shoulder at night is painful, and this is useful information. It tells you a lot. And then I confirm that I'll offer modifications as we go through class. I'll say, great. I'll offer some different options throughout class for movements that might not feel good for your shoulder right now. So please feel free to take any of those options or let me know if you need something else. You notice what I'm doing here. I'm not diagnosing, I'm not telling them what caused it or what will fix it. I'm not promising that yoga will heal their bursitis either. I'm just gathering information and confirming with them that I'll modify some movements and they're welcome to take them as needed. I wanna stress that as a movement educator, this is your job. Now let's get practical. What do you actually modify for someone with shoulder bursitis? The main thing you're thinking about is reducing overhead and abducted arm positions, especially with weightbearing, so let's walk through some common poses. Downward facing dog is often problematic because the arms are overhead and weightbearing. For students with bursitis, you might invite them to take extended puppy dog pose instead, which keeps the arms extended, but removes some of the weightbearing component. You could also invite them to try downward facing dog with their hands on blocks, which can reduce the angle of shoulder flexion, and it can help reduce the amount of load in the shoulders and the wrist. Or they might wanna try dolphin pose on their forearms, though for some people this is still a little bit too much. The key is offering options and letting them explore what feels okay for them on that given day Plank and Chaturanga can also be challenging because of the weightbearing component, even though the arms aren't overhead for these, you might invite the student to take a forearm plank instead of a high plank and hold it. Or they could take their knees down in both plank and in Chiang, or they might choose to skip Chaturanga entirely and just step straight back to downward facing dog from a forward fold for poses that involve the arms reaching overhead, like Warrior one or Ano, or think about Warrior two with the arms extended out, you also have options. The simplest is to invite them to keep their arms lower in Warrior One, instead of reaching up, they could bring their hands together to touch in front of their heart, or they could keep their arms alongside their body in Warrior two. Instead of extending the arms out to the sides at shoulder height, they could rest their hands on their hips. The point is that the leg work and the hip work can still happen without adding in arm positioning. Side plank can be particularly challenging for shoulder bursitis because the students are weightbearing on one arm with the shoulder abducted. For this, you might invite the student to take a forearm side plank instead and just kind of see how that feels. Or to drop the bottom knee down to the mat. For more support, they might choose to skip SI plank. All together and just take a different core strengthening option that you offer. Think about Cobra and upward facing dog. Those poses can go either way. Some students with bursitis find these, okay, because the shoulder isn't as flexed. It's not as overhead as it is in downward facing dog, but others find the positioning uncomfortable still. I usually will cue these and say something like, if this feels okay for your shoulders, you are welcome to take Cobra or Upward Facing Dog. Otherwise, you might stay in Sphinx pose or just rest in child's pose, and then we'll all meet in either downward facing dog or maybe tabletop. Here's what I want you to know about all of these modifications. I'm not telling the student what they should or should not do. I am offering options using invitational language. I'm saying you might, you could, you're welcome to, if this feels okay. I'm giving them agency to decide what works for their body. This is really important because they're experiencing their pain in their body and you can't feel it. So your job is to offer intelligent options and their job. Is to choose. Now, the language you use when queuing these modification matters a lot. If you say something like, if you have a bad shoulder, don't do this. Then you've just reinforced in that student's mind that their shoulder is bad, that it's less than that, it can't do certain things, and that increases the protective response from the nervous system. Instead, say things like. If your shoulder is sensitive right now or if overhead movements don't feel good for your shoulder today, notice the difference in that language sensitive, and right now and today are all temporary descriptors. They don't make the shoulder sound damaged or less than they acknowledge that something is tender or reactive, but not permanently. I also avoid saying things like, this will protect your shoulder because that implies the shoulder needs protecting, which again, reinforces vulnerability. Instead, I might say, this will offer your shoulder a break. Or this is a way to explore the pose with less demand on your shoulder. These might seem like small language shifts, but they make a difference in how students perceive their bodies and their injuries. Something really important to understand about working with students who have bursitis is that the goal isn't to avoid all shoulder movement forever. The goal is to reduce demand while their nervous system calms down and then gradually rebuild capacity. This is where gradual exposure comes in. This is a principle that says. We want to progressively introduce movements or loads that the nervous system currently perceives as threatening, But in doses that don't trigger the pain response over time, this helps the nervous system learn that these movements are safe. So for a student with bursitis, you might start by having them avoid overhead, weight bearing and downward facing dog for a few weeks. As their shoulder starts to feel better, you might invite them to try downward facing dog with their hands on blocks for just a breath, and then maybe for a few breaths, and then maybe without blocks, but with the option to come down anytime. This way, you're gradually increasing the demand. In a way that lets their nervous system adapt. I wanna be clear that this isn't something you're prescribing to them. You're not a physical therapist, but you can create opportunities for them to explore more challenging variations as they're ready. And you can use language like if you're feeling ready to try a little bit more today, downward Facing dog is available otherwise. Extended puppy dog pose is always here for you. This approach helps students rebuild confidence and capacity over time, which is one of the most valuable things you can offer. Now, if a student tells you they have bursitis, but they haven't been diagnosed by a medical professional, I would encourage you to encourage them to get it checked out, especially if the pain is new or severe. Shoulder pain can come from a lot of different things, and having a clear diagnosis helps everyone make better decisions. So if a student's pain is getting worse despite modifications, that's a sign that they need more support. Then you can offer in a group class, you might say something like, I've noticed you're still experiencing a lot of discomfort. Even with the modifications we've been trying, have you considered working with a physical therapist who specializes in shoulders? They might be able to give you some specific exercises that could help you If a student is in acute, severe pain, meaning they can barely lift their arm at all and. And even small movements cause significant pain. They probably need rest and possibly medical intervention before they're ready for group yoga classes. You can be honest about this and say, it sounds like your shoulder is really reactive right now, and I think it might be helpful to let it calm down a little bit and maybe get some guidance from a physical therapist before jumping back into class. Class will always be here whenever you're ready. And if a student asks you questions that are outside your scope, like, do you think I should get a cortisone injection? Or should I stop taking my anti-inflammatory medication? You can say, that's a great question for your doctor. I'm not qualified to give medical advice, but I'm happy to continue offering modifications for movements in class. Plus other yoga specific tools that will help you and your nervous system. The point is you don't need to have all the answers. You just need to know when something is beyond. What you can support in a yoga class. I know that thinking through all of these modifications on the spot can feel overwhelming, especially when you have like say, 15 other students in class who all have different needs. And honestly, that's one of the reasons I'm working on something right now that I think is gonna be really helpful for teachers. I'm developing a resource. That will help you think through sequencing and modifications for students with specific injuries. It's designed to take what you already know about yoga. And about bodies and help you apply it more quickly when you're actually teaching. Right now, teachers in my mentorship program are testing it out and giving me feedback, and I'm really excited about how it's shaping up. I'm not ready to share all of the details about it just yet, But know that it'll be a resource that you can go to and ask questions and learn from. but I wanted to mention it because if you're someone who sometimes feels overwhelmed trying to modify on the spot for students with injuries or understanding what's actually going on in their bodies or some tools that you can weave into your sequencing, then this resource is going to help. I'll share more in the coming months, but for now, just know that I'm working on tools to make this easier for you. In the meantime, if you wanna dive deeper into working with shoulder injuries, I have a free training called the Rotator Cuff Injury Training. It walks you through the anatomy of the shoulder, common rotator cuff injuries, including bursitis, and how to think about modifications. It's completely free, and you can grab it at the link that I'll add to my show notes. And if you're realizing. That you want more comprehensive support in learning how to work with injured students, not just shoulders, but all types of injuries. I have a workshop called The First Step to Teaching Students With Pain. It's$34 and it walks you through the foundational skills you need to feel confident. Working with any injured student, you can find that, again, linked in the show notes below. And if you're ready for ongoing support, where you bring your actual students and we work through modifications together in real time. My teaching students with injuries, mentorship might be a good fit for you. The teachers that I'm working with now, We're working with real life student scenarios and building case studies as we move throughout the mentorship. You can learn more@enhanced-body.com. Back slash teaching students with injuries. I'll link that in the show notes below. So to recap, bursitis is inflammation of a bursa, but the pain experience is influenced by the nervous system, not just the tissue state. You can absolutely work with students who have bursitis by offering intelligent modifications for overhead and weight-bearing shoulder movements using language that reduces. Threat and helping them gradually rebuild capacity over time. And you should refer them out if they have not been diagnosed, if their pain is getting worse, or if they're asking questions outside of your scope of practice, the next time a student tells you they have bursitis, you're going to feel more prepared. I promise. You're going to know what questions to ask, what to modify, and how to support them. So you've got this. Thank you for being here and caring enough about your teaching to work through the questions you have. If this episode helped you, I would be so grateful if you shared it with another teacher who might be having the same kinds of questions, and if you want more support on your journey. If you could send me a message on Instagram at Monica C Bright, I'd love to hear what has shifted for you. I'll see you next week. Until then, trust yourself, stay curious about what you're learning and keep showing up for your students. Okay, bye.