A presentation to the Bikram Studio in Naperville on how to utlize yoga for recovering from shoulder injuries.

1. Yoga for Shoulder RehabYoga for Shoulder Rehab

2. What’s in a shoulder?What’s in a shoulder?
wikepedia

3. deltoidsdeltoids

4. Scapular StabilizersScapular Stabilizers
“The Middle Child”

5. rhomboidsrhomboids

6. Levator scapuleaLevator scapulea

7. Secondary stabilizersSecondary stabilizers
TrapeziusTrapezius
RhomboidsRhomboids
Latisimus dorsiLatisimus dorsi
Pectoralis major and minorPectoralis major and minor
Serratus anteriorSerratus anterior
TricepsTriceps

8. Skeletal structureSkeletal structure
scapula
humerus
clavicle
ribs
“honorable mention”-the sternum?

9. The Shoulder GirdleThe Shoulder Girdle
R
Party Pooper

10. The JointThe Joint

11. Anatomy of a Standard JointAnatomy of a Standard Joint

12. Cartilage Surfaces can last 80Cartilage Surfaces can last 80
years!years!

13. Side note for less “mortal injuries”Side note for less “mortal injuries”
These concepts go for any joint
hip
knee
back

14. The Rotator CuffThe Rotator Cuff
SupraspinatusSupraspinatus
InfraspinatusInfraspinatus
Teres minorTeres minor
SubscapularisSubscapularis

15. R

16. RCRC
L

17. Rotator Cuff Strain/TearRotator Cuff Strain/Tear
The supraspinatus gets pinchedThe supraspinatus gets pinched
(impinged)(impinged)
The muscle through repetitive injuryThe muscle through repetitive injury
continues to break down and not get thecontinues to break down and not get the
chance to repairchance to repair
Fibrous tissue instead of plump muscleFibrous tissue instead of plump muscle
Tear, retraction, dysfunction, pain, moreTear, retraction, dysfunction, pain, more
dysfunction, more tearing….dysfunction, more tearing….

18. Reasons for strain/tearReasons for strain/tear
RepetitionRepetition
Poor anatomyPoor anatomy
Scapular dyskinesisScapular dyskinesis
Poor form at work or the gymPoor form at work or the gym
FatigueFatigue
Poor protoplasm/health/healingPoor protoplasm/health/healing
AccidentsAccidents
Good note, muscle tissue heals!Good note, muscle tissue heals!

19. Viva Viagra!!Viva Viagra!!
The CapsuleThe Capsule
The BursaThe Bursa
The NervesThe Nerves
The Labrum:The Labrum:
Soft parts heal but not great!Soft parts heal but not great!

20. Glenolabral TearsGlenolabral Tears
The Season Ender

21. ““He’s got a lot ofHe’s got a lot of
nerve!”nerve!”
R

22. Trigger pointsTrigger points
Referred pain pointReferred pain point
Chronically associated with FMSChronically associated with FMS
Will cause contracture to the region theWill cause contracture to the region the
muscle traverses and pain above andmuscle traverses and pain above and
belowbelow
Behaves like a pinched nerveBehaves like a pinched nerve

23. MRI Arthrogram with SLAPMRI Arthrogram with SLAP

24. Bankart LesionsBankart Lesions

25. Bankart with Anchors INBankart with Anchors IN

26. Arthroscopic repairArthroscopic repair

27. Adhesive CapsulitisAdhesive Capsulitis
Stage I - IV
R

28. RSDRSD
“Permanent fight or flight to the arm”

29. RehabRehab ???

30. MovementMovement
Rotation (circumduction)Rotation (circumduction)
AbductionAbduction
AdductionAdduction
ExtensionExtension
FlexionFlexion

31. Standard exercisesStandard exercises
Overhead pressOverhead press
Lateral raiseLateral raise
Upright rowsUpright rows
Internal/External rotation therabandsInternal/External rotation therabands
Shoulder shrugsShoulder shrugs
Incline bench pressIncline bench press

32. Standard therapyStandard therapy
Resistance bandsResistance bands
WeightsWeights
Isometric exercisesIsometric exercises
Manual therapy (only a select fewManual therapy (only a select few
therapists)therapists)
Iontophoresis, TENS Unit!!!!Iontophoresis, TENS Unit!!!!
Dr Saguil Doesn’t like handoutsDr Saguil Doesn’t like handouts

33. Pump You Up!Pump You Up!
Note the amount of weight-good and pants-bad

34. No Pain No Gain!No Pain No Gain!
Weight and form-good, pants-doesn’t go with couch cover

35. Exercise with veggies!Exercise with veggies!

36. Low Tech/High IntensityLow Tech/High Intensity

37. Theraband!Theraband!

38. Therabore!Therabore!
(For real: I love the concept but I expect you to do this for a very long time.)

39. External Rotator StretchesExternal Rotator Stretches
“Effective Stretch”

40. GarudasanaGarudasana
EagleEagle Now that’s a Stretch!
Leslie Kaminoff

41. The toe hook is a killer!The toe hook is a killer!

42. Ardha MatsyendrasanaArdha Matsyendrasana
Half Lord of the FishesHalf Lord of the Fishes
Stretch and work at the same time
Leslie Kaminoff

43. Lord of the FishLord of the Fish

44. Parivrtta Baddha ParsvakonasanaParivrtta Baddha Parsvakonasana
Revolved Side AngleRevolved Side Angle
Leslie Kaminoff

45. RSARSA

46. BhujangasanaBhujangasana
CobraCobra
1 Side body up 2 Humeral heads back 3 Back bend
Leslie Kaminoff

47. CobraCobra

48. Everybody Now!Everybody Now!
Side body up, shoulders to the earsSide body up, shoulders to the ears
Shoulder heads back, squeezeShoulder 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 aWe are used to a defensive posture as a
society.society.
Fight or flight for life!?Fight or flight for life!?

49. Setu BandhasanaSetu Bandhasana
BridgeBridge
Leslie Kaminoff

50. BridgeBridge

51. Salamba SarvangasanaSalamba Sarvangasana
Supported Shoulder StandSupported Shoulder Stand
Leslie Kaminoff

52. Shoulder StandShoulder Stand

53. Easier than it looks –alignment!Easier than it looks –alignment!
Leslie Kaminoff

54. Muscle strength important butMuscle strength important but
alignment is key-FYIalignment is key-FYI

55. Yoga’s conceptYoga’s concept
EngageEngage
AlignAlign
StretchStretch
Ah Grasshopper, when you can take the pebble from my hand
-you can leave the temple.

56. Engage!Engage!
Align!Align!
Stretch!Stretch!

57. Secondary GainSecondary Gain
Other joint stretching, full body fitnessOther joint stretching, full body fitness
Breath controlBreath control
Blood pressure, heart rate controlBlood pressure, heart rate control
Heart fitnessHeart fitness
Relative lack of exposure to injuryRelative lack of exposure to injury
Dropping into the relaxation responseDropping into the relaxation response
Controlling fight or flightControlling fight or flight
Improving function of every cell in the bodyImproving function of every cell in the body
Digestion improvementDigestion improvement

58. Circulatory benefitsCirculatory benefits
Lymphatic movementLymphatic movement
Synovial wringingSynovial wringing
Muscle perfusionMuscle perfusion
Brain perfusion (inversions)Brain perfusion (inversions)

59. Other cells (controversial inOther cells (controversial in
western medicine):western medicine):
FibroblastsFibroblasts
ChondroblastsChondroblasts
LymphocytesLymphocytes
NeuroblastsNeuroblasts
MyoblastsMyoblasts
Killer T CellsKiller T Cells
Ribosomes? Genetic Expression?Ribosomes? Genetic Expression?

60. Honorable mention to the RRHonorable mention to the RR
Herb BensonHerb Benson
John Kabat ZinnJohn Kabat Zinn
Ekhart TolleEkhart Tolle
Deepak ChopraDeepak Chopra
Wayne DyerWayne Dyer
Fr GabeFr Gabe
Terri (Bikram)Terri (Bikram)

61. Pointers for injured shoulderPointers for injured shoulder
Work first to mobilize the shoulder girdleWork first to mobilize the shoulder girdle
Control pain (spasm) flare up with usualControl pain (spasm) flare up with usual
measuresmeasures
After flexibility is gained, work on muscleAfter flexibility is gained, work on muscle
“tone” and continued flexibility (exhale and“tone” and continued flexibility (exhale and
push)push)
Once accustomed to movement, advanceOnce accustomed to movement, advance
to shoulder challenging posesto shoulder challenging poses
Chronic or acute!

62. A home exercise program by EricA home exercise program by Eric
SchiffmannSchiffmann

63. The Spirit and Practice ofThe Spirit and Practice of
Moving into StillnessMoving into Stillness
-Eric Schiffmann-Eric Schiffmann

64. Understand your pathologyUnderstand your pathology
Most common injury is rotator cuff overuse andMost common injury is rotator cuff overuse and
inflammation/tearinflammation/tear
The space between the humerus and theThe space between the humerus and the
acromial arch is narrow thus creating aacromial 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 moreOnce 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 spaceFrozen shoulder ensues causing smaller space
and poor perfusion of muscle and tighterand poor perfusion of muscle and tighter
shoulder space etc etcshoulder space etc etc

65. Surgical pathology?Surgical pathology?
Once the movement of the scapula isOnce the movement of the scapula is
impaired, the humeral head will not sitimpaired, the humeral head will not sit
correctly in the glenoid fossa and it willcorrectly in the glenoid fossa and it will
start to clunk out of space tearing labrumstart to clunk out of space tearing labrum
(cartilage) or muscle (supraspinatus)(cartilage) or muscle (supraspinatus)
Attempt physical therapy with a ‘shoulderAttempt physical therapy with a ‘shoulder
trained therapist’trained therapist’
Time for surgeon or injection withTime for surgeon or injection with
conventional medicine …….or…….conventional medicine …….or…….
Don’t feel bad…..

66. ……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

67. Surgery or not get a goodSurgery or not get a good
physical therapist!physical therapist!
Naperville PT (630) 369-1015Naperville PT (630) 369-1015
http://www.napervillept.comhttp://www.napervillept.com
Personal Best Performance DownersPersonal Best Performance Downers
Grove (630) 435-1800Grove (630) 435-1800
Hand/Shoulder Therapy Plainfield/Hand/Shoulder Therapy Plainfield/
Lombard (630) 393-0968Lombard (630) 393-0968

68. Alternative HealingAlternative Healing
With poor healing comes the introductionWith 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 Ayurveda
Acupuncture or Marma therapyAcupuncture or Marma therapy
Less 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!

69. Hands on HealersHands on Healers
Reiki therapistReiki therapist
Massage therapist (oil knowledge)Massage therapist (oil knowledge)
Physical therapist (Manual therapy, shoulderPhysical therapist (Manual therapy, shoulder
training, kinesio taping)training, kinesio taping)
ReflexologistReflexologist
AcupuncturistAcupuncturist
ChiropractorChiropractor
Marma practioner, Thai Massage, YogaMarma practioner, Thai Massage, Yoga
TherapistTherapist

70. ReflexologistReflexologist
Jennifer Adams in Aurora (630) 710 0304

71. AcupuncturistAcupuncturist

72. Frank GrillFrank 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

73. Yoga “Therapist”Yoga “Therapist”
Bikram YogaBikram Yoga
Living Yoga AuroraLiving Yoga Aurora
Total Body Yoga MundeleinTotal Body Yoga Mundelein
The Chopra Center California SSLYThe Chopra Center California SSLY

74. Ayurvedic MedicineAyurvedic Medicine
The antiinflammatory diet for the long runThe antiinflammatory diet for the long run
Specific supplements for the short runSpecific supplements for the short run
Topical oilsTopical oils
HomeopathyHomeopathy
Energy healingEnergy healing
Massage (thai, deep tissue, hot stone,Massage (thai, deep tissue, hot stone,
lymphatic)lymphatic)

75. Control InflammationControl Inflammation
The Antiinflammatory DietThe Antiinflammatory Diet
TurmericTurmeric
Vitamin D3Vitamin D3
Omega 3 fish oilOmega 3 fish oil
WaterWater
Abstinence from damaging intakeAbstinence from damaging intake
(etoh, high GI foods,(etoh, high GI foods,
tobacco,dairy)tobacco,dairy)
--Nutritionist Andrea Klouda (630) 855-7907Nutritionist Andrea Klouda (630) 855-7907

76. ““Food as Medicine”Food as Medicine”

77. SupplementsSupplements
TumericTumeric
Vitamin D3Vitamin D3
Omega 3 fish oilOmega 3 fish oil
White willow bark, shark cartilage,White willow bark, shark cartilage,
oregano, ginger, holy basiloregano, ginger, holy basil
Helicrysium, tea tree, traumeel,Helicrysium, tea tree, traumeel,
frankinsence. menthol, marjoramfrankinsence. menthol, marjoram

78. My favoritesMy favorites

79. 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…..

80. ……Call them out!Call them out!
Call the 800 numberCall the 800 number
Ask for R&D departmentAsk for R&D department
Ask if the supplement has been tested forAsk if the supplement has been tested for
level of “bioavailability”level of “bioavailability”
Ask if the supplement has been tested forAsk if the supplement has been tested for
mercury contentmercury content
Ask if you can get a copy of the studyAsk if you can get a copy of the study

81. The Saguil ApproachThe Saguil Approach
Do no further harmDo no further harm
Stop inflammation (ice therapy)Stop inflammation (ice therapy)
Relative restRelative rest
Sling at night (8 hours)Sling at night (8 hours)
Gentle movement at dayGentle movement at day
Job alterationJob alteration
Watch for secondary spasmWatch for secondary spasm
Develop the Relaxation ResponseDevelop the Relaxation Response

82. Engage!Engage!
Align!Align!
Stretch!Stretch!

83. Thanks and NamasteThanks and Namaste
Q&A time!Q&A time!
www.herbal411.comwww.herbal411.com
Enrique Saguil, MDEnrique Saguil, MD
(630) 689-7986(630) 689-7986