Seeking Balance When Recovering from an Overuse Injury

By: Sarah Penning, DPT

Overuse injuries are the most common yet at times the most difficult injuries to rehab. It takes time, patience, hard work and the most challenging of all, rest from the activity that people often love. Runners, tennis players, swimmers, avid gym members and even those who practice yoga can be at risk for developing on overuse injury.

Recently I had the humbling experience of injuring my own shoulder while practicing yoga. As a physical therapist and strong proponent of yoga I was somewhat baffled by my injury. I thought to myself I have been taking yoga for almost 4 years and have never been injured. I consider myself strong, healthy and well-educated about injury prevention as a health care provider. Then I realized I was just like so many of my patients strong yet prone to injury secondary to imbalance.
Yoga has an over abundance of health benefits and has been around for over 5,000 years. Many have caught the “yoga bug” and swear by the physical and mental benefits of this practice. The Sanskrit word yoga does indeed translate to “union” or “to yoke or harness.”1 For many of us we find ourselves on our mat seeking union, seeking balance in our lives and in our bodies. Yet unbeknownst to us we may be putting our bodies in a vulnerable position if unaware of the muscle imbalances that often develop in yoga.

Muscle imbalances within the shoulder girdle often develop in yoga due to the extensive amount of push type exercises such as chaturanangas that most practices entail, without sufficient counter poses.2 When repeatedly transitioning from a high push-up to a low push-up position into upward facing dog, injuries such as tendonitis (inflammation of the tendon) and bursitis (inflammation of the bursa) can often develop as well as instability of the shoulder.

When in a plank position it requires much strength from the anterior muscles of the shoulder, such as the pectoralis major and minor, anterior deltoid and long head of the bicep tendon. These muscles must work in a static or isometric way to stabilize the anterior aspect of the shoulder girdle. When lowering from a high plank to a low plank position these muscles must then work eccentrically to control the decent of the body as these muscles lengthen. Finally when pushing the chest through to upward facing dog the triceps and muscles that lie between the shoulder blades must concentrically contract or shorten to attain this posture.

In many instances beginners taking a yoga class do not have the strength in the aforementioned muscle groups when quickly transitioning from the above positions. Commonly practitioners find the transition from low plank to upward facing dog the most challenging secondary to weakness in the triceps and inter-scapula muscles. This translates into poor body mechanics of the upper body and trunk. For example, when the shoulders drop lower than the hips in chaturananga this can impinge or inflame the muscles that lie in front of the shoulder through repetition of poor alignment when one struggles through a vinyasa.

After sustaining such a shoulder injury due to yoga people often report pain when lifting the arm overhead, out to the side or across the body. The pain is usually localized to the front or outside of the shoulder and these areas are also tender to touch. Lastly, reports of stiffness and or discomfort may be experienced in the front of the shoulder when efforts to stretch the front of the shoulder girdle are made.

The first thing one should do if they are having shoulder pain is to seek medical attention from a physical therapist and or an orthopedic doctor. Physical therapists specialize in musculoskeletal injuries and can aid in determining a diagnosis so that appropriate treatment can be rendered.
As a physical therapist who is currently recovering from a shoulder injury and providing treatment to many with shoulder pain I believe strongly in the benefits of physical therapy and it’s ability to return athletes to their previous level of activity. When dealing with any person who presents with an overuse injury it is imperative that one determine what weaknesses reside. In many instances there is a commonality in the imbalances found within the shoulder girdle. Frequently patients will present with tightness and muscle bulk in the front of the shoulder which is countered by weakness and atrophy in the muscles in the back of the shoulder and in between the shoulder blades.

In the acute or early stages of a shoulder injury a physical therapist may use an array of various modalities, such as ultrasound, soft tissue massage and ice to decrease the inflammation. Ultrasound functions as a deep heater of the tissue and aids in fueling the healing process while massage helps to break down scar adhesions. Once the signs and symptoms of acuity have decreased a series of stretches and strengthening exercises for the shoulder are prescribed.

When a patient begins to engage in the process of rehabbing the shoulder education is key. As a physical therapist it is imperative to teach patients about their injury and why certain exercises are beneficial or counterproductive. Through sports specific training and education about modifications and safe form, physical therapists can equip people with the appropriate tools to return to the very activity that may have brought them through their doors. In simple terms physical therapy can act as a catalyst for people to achieve equinity and independence in maintaining balance.

The physical therapists at Bounce Back Physical Therapy have been rehabilitating clients with overuse injuries for many years earning a reputation for their individualized sports-specific training and commitment to quality of care. The therapists on staff are happy to conduct a free screening upon appointment for those who may be experiencing pain or are interested in learning about how physical therapy could benefit their body.

By: Sarah Penning, DPT
Bounce Back Physical Therapy
215 Sugartown Rd.
Wayne, PA 19087
http://www.bouncebackpt.com/

References:
Turlington, C. Living Yoga: Creating a Life Practice. NY, NY: Hyperion; 2002.
Yoga and Shoulder Injuries. 2009: 1-4. Available at http://www.acrocore.com/yoga-and-shoulder-injuries/ . Accessed March 3, 2009