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| Turning Shoulder Rehab on It’s Head: A physical therapist's view on how yoga applies to everyday life |
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by Lisa B. Minn, PT - July 25, 2011
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A study published in 2006 in the International Journal of Yoga Therapy showed that performing sirsasana or a yoga-style headstand improved range of motion and decreased pain in patients with a rotator cuff injury. The study was small, only 10 patients. There was no control group, there was an inherent selection bias and the data analysis was unsophisticated. However it is a fascinating paper and provides some evidence that headstand, as taught in the Iyengar tradition of yoga, can indeed result in improvement of the symptoms of rotator cuff tear.
All patients had full or partial thickness tears of thesupraspinatus, as confirmed by MRI. Some patients had additional pathology including teres minor atrophy, bursitis or labral tears. The average age of the subjects was 56 with a range of 42 to 81 years old. The average onset of symptoms was 27 months prior with a range of 1 to 120 months. All patients were instructed in a modified version of headstand with legs on a chair. Two subjects who had some experience with yoga eventually progressed to a fully upright headstand during the 6 week course of the study. The headstand was held for 30 seconds and repeated daily for 6 weeks.
Results:
*7/10 patients increased overhead active range of motion by at least 75%. (Two subjects started with normal ROM and little to
no pain. Their results were unchanged.)
*There was no significant change of internal rotation ROM.
*Pain levels were reduced 75%.
*Two years after the study, 8/10 patients had not had surgery. (The other two subjects were lost to follow-up so it is unknown whether or not they had surgery).
In an effort to understand the mechanics of this substantial improvement, a single subject study was done using EMG findings during headstand. The authors concluded that during the final phase of headstand in which the subjects were instructed to “widen and raise your shoulders further from the floor,” the activity of the anterior and lateral deltoid as well as the subscapularis increased substantially. The rhomboid major also increased slightly. Interestingly there was no change in the activity of the serratus anterior which I would have expected given this final aspect of headstand looks and feels like protraction. The subscapularis somehow automatically compensates for the supraspinatus in its action as a humeral head depressor (well, in this case elevator). This neuromuscular re-education occurs without any tactile or complex verbal cues. And it seems to have an automatic and lasting effect.
So is headstand the cure for rotator cuff tears? Can this one simple yoga posture eradicate the need for surgical repairs? Well, that is unlikely, but it would appear that it is an excellent option for improving glenohumeral mechanics and scapula stabilization. A few points of caution: inversions such as headstands are contraindicated for those with glaucoma, detached retina, orthostatic hypotension and any other condition exacerbated by positioning the head below the heart. In addition, patients with significant cervical pathology should not bear weight on the head.
Most physical therapists are not qualified to teach advanced yoga postures but I would encourage all PTs, especially those in outpatient orthopedics, to consider getting additional training in instructing asana. Not only is it useful for treating our patients but it’s also helpful to understand what patients may be doing in a community-based yoga class. Some patients get hurt in yoga classes. Others often want to try yoga as part of their rehabilitation. If you are a PT but are more comfortable referring your patient to a yoga teacher, make sure to find one who is well qualified. An Iyengar-certified teacher will most likely be a good choice but otherwise find someone who has at least a 200-hour certification validated by the Yoga Alliance, with specific training in yoga therapy.
So what do you think? Would you be willing to consider using headstand as a treatment for rotator cuff tear? Would you be inclined to teach it yourself or would you prefer to team up with a local yoga teacher? Have you ever used any other yoga postures to treat a patient with an injured shoulder?
Reference: Fishman, LM., Konnoth, C., Polesin, A. “Headstand for Rotator Cuff Tear:
Shirshasana or Surgery.” International Journal of Yoga Therapy. No. 16 (2006): 39-47.
Lisa Minn is a licensed physical therapist and yoga enthusiast. She has been incorporating aspects of Yoga and Pilates into her physical therapy practice since 2001 and became a certified yoga instructor in 2004. Her experience ranges from working with athletes at West Point and Georgetown to instructing elderly and wheelchair-bound clients in the fundamentals of Hatha Yoga. Lisa has conducted several lectures and workshops across the US, as well as in Honduras and Peru, where she volunteered her services. She currently resides and practices in Northern California. This and other articles by Lisa can be found at The Pragmatic Yogi.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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