Health History
Summary
Jane has a history of previous left shoulder injury that has affected the health of rotator cuff. She presents with shoulder stiffness, pinching, and chest tightness on the left side. Upon observation and examination, there is a decrease in the range of motion noticed when raising the left arm overhead, when reaching behind her back, and when abducting. There is an overall limited movement, which additionally impacts the muscle strength of the left shoulder.
The chronically inflamed and irritated muscles and tendons are compromising shoulder movement, thus causing left rotator cuff impingement.
Determination
The cause of Jane’s shoulder pain has been determined based on the history provided, observation and examination performed as left rotator cuff impingement.
Evidence base of the benefits of Yoga
The literature describes that the practice of Yoga can be remarkably helpful in healing processes, be beneficial for chronic pain. These physical benefits can be measured. Yoga evidence base case studies have shown that:
- Reduces inflammation: In a 2015 study with 218 participants, it was found that yoga practitioners had fewer markers of inflammation compared to a group that did not practice yoga. J Clin Diagn Res. 2015 Jun; 9(6): CC08–CC12.
- Improves flexibility and balance: In a 2013 small study, researchers showed that in 66 elderly patients, those who practice yoga increase their flexibility and balance significantly after a year of regular practice.
- Builds strength, regain mobility in the joint while building strength and stability: In a study with 79 adults, a significant improvement in strength was found when 24 sun salutes were performed 6 days per week for 24 weeks. However, another study showed that improved strength, flexibility and endurance were achieved with just 12 weeks of practice.
Goal
The goal is to design a yoga practice (asana, pranayama, and meditation) for Jane directed to improve and restore strength and range of mobility throughout the entire left shoulder girdle.
Mind-Body Conduit of Choice
I have chosen to work with elements of both, the vagal nerve and the heart-brain connection to channel the convergence between traditional yoga views and current neuroscience evidence. Based on the knowledge that the brain-body connection is bidirectional, I will encourage top-down processes (such as mindfulness), regulation (stimulation) of attention, and setting an intention, as they have been shown to decrease psychological stress. In Jane’s case not only the injury, but also the compromised movement, are causes of stress that will refrain improvement. Therefore, it is my intention to modulate immune function and inflammation by utilizing not only top-down processes as mentioned above, but also to encourage bottom-up processes such as breathing techniques and movement practices. These have been shown to influence the musculoskeletal, cardiovascular and nervous system functions, resulting in changes in immune function and emotional wellbeing.
Specific practices will encourage cultivating vagal tone thus restoring homeostasis, which is connected to trust, compassion, acceptance and joy. These will be achieved by:
- Vibration: Chanting OM, or humming, creates a vibration that stimulates the vagus nerve while relaxing the jaw, face and neck. The client shall be asked to notice how the vibration feels throughout the body, and to follow the vibration imagining where it is releasing stress from the body and tension from the mind. This practice will be incorporated at the end Meditation. Researchers have found that, in a study of functional MRI, “OM’ chanting stimulates the vagus nerve. Also increases oxygenation of the blood from the vibration, facilitates the feelings of relaxation, and relieve in the flexor muscles of the body (Int J Yoga. 2011 Jan-Jun; 4(1): 3–6).
- Awakening of Prana, life force energy: regulatory balance in breath. This will be accomplished by introducing slow, smooth, and deep diaphragmatic (belly) breathing in and out through the nose to create balance between left and right side. This activates the vagal receptors found in the lower lobes of the lung that mouth breathing cannot access. Also activates specific neurons that detect blood pressure, signalling to the vagus nerve to lower heart rate. For example, counting the inhalation to 4-6, holding briefly, and exhaling to a count of 5-7. Alternatively, exhaling through rounded lips can also stimulate vagal tone while providing a cooling and calming effect to the nervous system.
- Activation of the ocular-cardiac (vagal) reflex, to deepen the relaxation response: I will encourage the use of an eye pillow during Savasana or lightly covering the eyes with the palms of hands. There are twelve extra-ocular muscles that contain nerve endings, source of the OCR (ocular-cardiac reflex), a very powerful parasympathetic reflex. The OCR directly affects the vagus nerve, communicating a signal to slow down the heart rate, to lower the blood pressure and to relax the body.
- Open Heart-Chest area: to open across the chest and throat areas will prompt restorative equilibrium.
Yoga uses a variety of practices (Asana, Pranayama, Meditation) that may serve to affect one or more component by impacting the neural platform, vagal nerve (ANS), generating concomitant effects on muscle tone/posture, visceral state, attention, affect and cognition. Yoga emphasizes the cultivation body awareness. Furthermore the traditional roots are centered on a philosophical path (mindfulness) towards understanding the causes of suffering and its alleviation.
Practice Sequences
Practice orientation
Open the heart, across the chest and shoulders. Release tension and strengthen the shoulder girdle. Pacify the mind, relief stress and anxiety.
ASANA Sequence (40 minutes Asana practice)
- BALASANA Wide legged with hands on blocks. Forehead rests on the ground or folded blanket. Invite to set intention, awareness, love and compassion towards self/affected area. Slow, smooth and deep breathes (3 cycles).
- BALASANA -inh-> BITILASANA -exh-> MARJARYASANA -inh-> BITILASANA -exh> BALASANA Flow with slow, smooth and deep breathes (3 cycles).
- BALASANA -inh-> BITILASANA -exh-> MARJARYASANA -inh->MARJARYASANA knees off & hold-inh-> BITILASANA -exh> BALASANA. Flow with slow, smooth and deep breathes (3 cycles).
- BALASANA variation, with “thread the needle” Lengthening/outstretching both arms, the arm underneath and the top forward extended arm to stabilize the scapula and stretch the nerves of the brachial plexus. Relax the face and through the jaw to activate PSN (vagal nerve) relaxation response, to tone the vagus nerve. Hold each for 3 slow, deep breaths. Both sides.
- On hands and knees, Table top: Arm lifts high, open and hold, then ‘thread the needle’-cheek to earth. On the 3rd hold the ‘thread’ for 3 slow and deep breaths (relax the face, release the tongue from mouth roof, unclench the jaw). Flow with slow, smooth and deep breathes (3 cycles).
- From hands and knees (table-top), slide on your belly for Prone Shoulder stretch. Right arm opens wide to the side, at shoulder height. Left arm bends at elbow for cactus arm with fingertips (spider fingers) pressing on the mat. Left leg bends and flips over and across right extended leg to twist open towards the left side. Switch side. Hold on each side for 3 slow, smooth and deep breaths.
- From neutral, prone position BALASANA -inh-> ADHO MUKHA SVANASANA Hold the pose and breath freely *(work on alignment weight distribution to accommodate shoulder/scapula stabilization to ease shoulder griddle)-inh->UTTHANASANA.
- UTTHANASANA -inh-> UTKATASANAÂ Cactus arms -exh-> hands to opposite shoulders. Repeat arm flow (in UTKATASANA) two more times with the breathe, then -exh-> TADASANA. 3 cycles.
- TADASANA circle breath flow with interlaced fingers. TADASANA, take Anjali Mudra -inh-> interlaced fingers to chin -exh-> bend knees press interlaced fingers away, chin to chest -inh-> stand, press interlaced fingers, overhead to the sky -exh->interlaced fingers behind head (press head against hands and hands against head, elbows wide)-inh-exh->bend head, chin to chest, elbows motion towards midline -inh-> head to neutral -exh-> press interlaced fingers, overhead to the sky -inh, exh-> arms wide, interlaced fingers at the back -inh-> lengthen interlaced fingers towards the earth, open chest, gaze towards the sky -exh-> Anjali Mudra. Flow with slow and steady breathe (3 cycles).
- Using block, hold by the sides pressing firmly with hands in “L” shape. TADASANA -inh-> HASTA TADASANA -exh-> UTKATASANA -inh-> HASTA TADASANA -exh-> UTTHANASANA -inh-> UTKATASANA -exh-> TADASANA.
- TADASANA shoulder rolls. Inh-> roll shoulders forward and up -exh-> roll back and down. Flow with slow, smooth, and deep breathes (3 cycles each) 12.
- Wall Shoulder stretch.
- Stand by the wall, R) hip against the wall
- R) arm raised high, palm facing/planted on the wall
- L) arm wraps around to catch R) waist
- Slow and progressively walk R) arm back and down on the wall with slow, steady and deep breaths, while
- L) hand rotates R) waist towards the front, this motion increases stretch across pectoral muscles and shoulder joint
- Switch sides
- TADASANA -> BADDHA VIRABHANDRASANA.
- TADASANA Clasp hands behind back with Palms together or apart. Elbows straight or bent.
- – Inh –> step L) leg back for VIRABHANDRASANA I legs, breath freely
- – Inh–> Lengthen arms towards the earth
- – Exh–> Bend down into BADDHA VIRABHANDRASANA/Humble warrior, –
- R) shoulder to inner R) knee, hold pose and breath freely
- – Inh–> rise up
- – Exh step feet together, TADASANA
- Second side; x 2 each side
- Flow with breath
- TADASANA
- HASTA TADASANA
- UTTHANASANA
- ADHO MUKHA SVANASANA
- EKA PADA MUKHA SVANASANA L) leg
- ANJANEYASANA L) leg front
- VIRABHANDRASANA I, back/right leg transitions into
- GARUDASANA legs and arms, unhook R) leg step back
- VIRABHANDRASANA I legs with
- GARUDASANA Arms, unravel arms wide then, into Temple mudra
- ANJANEYASANA, hands to ground, step back
- ADHO MUKHA SVANASANA
- Second side
- Variation: VIRABHANDRASANA legs with shoulder mobilization:
- hold strap shoulder level -inh-> move up and above the head
- – exh -> to move arms back and behind.
- – inh -> to move arms from behind back to overhead.
- – exh-> to move arms down and in front, shoulder height.
- – step feet together
- Second side leg, and repeat shoulder mobilization flow.
- Release strap -> ANJANEYASANA, hands to touchdown ground and step back into ADHO MUKHA SVANASANA
- Release knees to ground
- BALASANA Slow, smooth, and deep breathes
- On to your belly SALABASANA. Cactus arm variation flow, outstretch arms to the front -exh-> squeeze shoulder blades towards midline as you move arms into cactus. Goal: to strengthen through the trapezius and rhomboid muscles. Flow with slow, deep breathes (3 cycles).
- BALASANA -> ANAHATASANA with elbows resting on blocks
- – Hands in Anjali mudra at the back of the head (progressively moving towards back of the neck). The goal is to stretch around armpit area (brachial plexus).
- – Slow, smooth and deep breathes, drawing attention to heart area. Breathe love and compassion to open the heart.
- Subscapularis release,
- – With knees bent, lay on your side, placing the side of the armpit area on top of a block (use a 1-fold blanket in between), rest, relax and draw attention on the breath (slow, smooth and deep breathes (5 cycles each side).
- MATSYASANA/Fish pose, Supported
- – Legs straight or bent. Use two blocks +/- bolster to set up. Hold for 2-5 minutes with Pranayama breath count. Relax fully. This pose creates a gentle stretch to lengthen and strengthen the connective tissue across the chest. Does not require muscle engagement. Note: If any sharp pain or stabbing pain, tingling, or numbness is felt, avoid the pose.
- Release the props and move into SAVASANA.
PRANAYAMA
To then guide PRANAYAMA to open the 4th Anahata-Heart Chakra, expand self with love. Focusing on VYANA VAYU, the energy of expansion, the web of connection. This is a most powerful way to stimulate and awaken the wisdom of the heart chakra as it will revive the brain and support new neuronal networks/paths that can restore and sustain emotional balance
- Close your eyes and expend a few minutes lengthening your inhales and exhales.
- Bring your attention/awareness to the area between your shoulder blades, and place your tongue at the roof of your mouth.
- Inhale slowly and draw down your breath upwards from the back of your heart chakra towards the crown of your head.
- Exhale slowly, release the tongue and the breath draw down from the top of head to the front of your chest.
- Repeat 5-10 times.
MEDITATION
Move into MEDITATION with another PRANAYAMA exercise
- Sit in a comfortable cross-legged position, tall with straight spine.
- Hands in Auspicious Mudra: right hand to the heart center, left hand on top of right. Think of something you love about yourself, someone you love, or an experience you love or would love. This will start to open your heart energy.
- Inhale through the nose as you open your arms out wide to the side like giving a big hug. As you do this, imagine a color of your choice, swirling from your heart and spilling out through the fingertips and all around you.
- As you exhale, bring the arms in and hands back into Auspicious Mudra to the heart center, and with them bring in the love and light.
- Continue for 5 rounds, feeling light and love around you.
This Pranayama will open the heart, help strengthen lungs and circulation, and ease and calm the mind. It also helps to reduce stress and depression.
TO FINISH
Inhale and with long exhale Hum (5 times). And explained at the beginning the vibration creating by the sound will stimulate the vagus nerve provoking the feeling of relaxation.
Teacher Profile
 Delia Hernández
My yoga journey began with an end – after experiencing a not so perfect, not to plan holiday, I paradoxically ended my trip with a delightful yoga experience. I then made the decision to further the adventure, and between 2018 and 2019 completed my yoga training with YIMI and BYOME.
Since, I have been involved in the practice of Vinyasa yoga, and have also taken some elements of Iyengar yoga to tailor to my own. Thus, both my personal and teaching journey is shaped from both styles. Having a background as Medical Doctor has provided the backbone to better comprehend the anatomy, physiology and biomechanics behind a yoga ãsana or pose. Furthermore, to have Ph.D. and Postdoctoral training in cell biology and neuroscience provides a wealth of understanding about the cellular and molecular bases underlying the benefits of the traditional practice of yoga.
All combined helps to build expertise that can only be crystallized by a conscientious yoga practice. Devoting to master the art of drawing attention inwards, into your own body, your own mind, and your own spirit, is a path, is a journey, and is a project. I have embarked in this philosophy of life and found delight. Is my desire to invite others to feel as I feel: in a delightful balance.
If you would like to contact The BioMedical Institute of Yoga and Meditation by Celia Roberts to learn more about the Yoga teacher training journey, please do visit our Yoga Teacher Training Page or find us on Facebook or Instagram or contact Celia directly.