Shoulder Pain in Downward Facing Dog? Here are 4 Adjustments to Try.

We all can agree that downward facing dog is NOT a resting pose, right?

[check out my article “Is Downward Facing Dog a Resting Pose?” if you don’t!]

Many folks can experience shoulder pain and discomfort in downward facing dog, and if this is the case - it most certainly doesn’t feel restful. 

So what do we do when we or our students feel pain in this pose? 

Here’s what we DON’T want to do:

• avoid it altogether (unless advised to do so by a medical professional)

• instill fear with outdated and misguided languaging

• dismiss it or ignore it 

What we SHOULD do is:

• try different variations/alignments and options to find what works right now 

• adjust the frequency and duration (hold times) 

• build strength and control in a pain-free way 

• return to try those movements again versus avoiding them FOREVER

First things first - we gotta define “pain” 

Pain does NOT always mean injury or harm 

You may be surprised to know how LITTLE pain is correlated with injury or tissue damage. And vice versa! It’s not something we should be associating with one another anymore, based on TONS of research over the last few decades. 

There’s loads of studies that have MRI imaging of folks with extensive tissue damage but no reports of pain, and folks with lots of pain and little to no damage shown on image. This has been shown in many body regions, including the shoulder. 

Now - an acute injury or sudden onset of pain - YES! Pain and damage are likely connected.

But, for many cases we’re talking about more chronic or persistent pain. OR discomfort associated with doing something new with our bodies. 

Pain is MULTIFACTORIAL 

Which is a fancy word to say - it’s complicated. 

There are so many factors that go into pain and our individual perceptions of it. Pain is incredibly subjective (meaning it varies greatly from person to person, and situation to situation)

Pain is shown to be influenced by our upbringing, our social life and mental health, our current stress levels and life stuff that’s happening, our culture, our environment, and more. 

To say it in a more yoga-way: pain is influenced greatly by our lived experiences.

It’s not as simple as “THIS equals THAT”. 

Pain <> Fear

Pain leads to fear of movement, and placing fear in folks can lead to pain.

This is all regardless of actual tissue damage, as we’ve discussed. 

Instilling fear with outdated languaging only exacerbates pain.

Instead - let’s acknowledge that the body is telling us something, and empower folks (and ourselves) to explore options that work better.  

The (really not-so-recent, but finally more widely accepted) research indicates that the more we understand how pain actually works, and recognize how resilient and capable our bodies are - the less pain we experience.

It can become a self-fulfilling prophecy. Have a victim and frail mentality around your body - and you’ll likely feel more sensitive and vulnerable. And this often leads to increased perceptions of pain.

Understanding that your body’s cues are to be respected, but that instead of AVOIDANCE, we adjust/modify, dial back, then work our way up - is the way to go! 

Next - let’s debunk “shoulder impingement” 

Any teaching and cueing in yoga around what to do with the shoulder blades and shoulders/arms is meant to “protect our shoulders from injury” - and usually the big bad wolf that’s cited is SHOULDER IMPINGEMENT. 

This was a term coined by some surgeon in the 70s because of on an inkling he had based on what he say in his surgical patients.

And it just won’t die.

It was quickly refuted by actual research and has been refuted many more times in many more research articles. 

This diagnosis has been very prevalent in the medical field which has trickled down to the yoga and fitness worlds, too. And the language of "pinching" and "impingement" are harmful to our psyche (not to our bodies!)   

Here was the idea: when you raise your arm, there’s a “pinching” that happens between the scapula (shoulder blade) and the humerus (upper arm bone). This contact and pressure causes tissue damage in the muscles, nerves, and bursa in that area.

By externally rotating the shoulder, there’s more space and less “pinching”, which will prevent or reduce tissue damage.

You can also "fix" this by getting a surgery to shave off part of your scapula!

(which has not been proven to be any more effective than sham surgeries and is no more effective than an exercise program/physical therapy program!) 

But the reality is this: YES there’s impingement at the shoulder when we raise our arm. (Maybe you weren't expecting that?)

We have impingements all throughout our body when we move. It's a natural and normal part of human movement mechanics. Our tissues are meant to do this.

When you flex your hip to pull your knee into your chest - guess what - you’re “impinging” the anterior hip muscles and nerves.

Our tissues are strong and malleable, they’re meant to move and squish and stretch. 

There is no evidence that shoulder flexion >> tissue damage. And this is the case regardless of whether we externally rotate our shoulders or not. 

This isn’t to say you will never feel PAIN when elevating your shoulder (it happens to folks a lot), but the CAUSE isn’t impingement. And the pain doesn’t necessarily mean you’re injuring yourself (in fact it’s likely that you’re NOT causing any tissue damage)

The reason to adjust shoulder blade/shoulder alignment is to explore what feels best in your body and to find the most supportive option for YOU, THAT day.

Adjustments and alignment cues can also be made based on our goals - flexibility versus strength and stability, as I'll discuss below.

Alignment changes are not because it’s “right” or “safe”. So play around and don’t be afraid to do what feels best in your body!

The focus should be less on rigid alignment cues and more about controlled motion and progressive overload

Your shoulders and shoulder blades can move all the ways and in all the combinations. Nothing is inherently dangerous or injurious, especially when we’re talking body weight only as we are in yoga. 

BUT - if you’re lacking control (strength, stability, muscle coordination) in certain motions - then your shoulder may be speaking up to say it’s uncomfortable. That’s not to say you’re hurting your shoulder when this happens and it doesn’t mean that the motion is BAD for you - just that it may be something you can work on to improve your tolerance. 

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A quick word to the hyper-mobile

It is common for hyper-mobile/hyper-flexible folks to “dump” into their shoulders, which leads to more flexion in the shoulders and likely some extension in the spine (shown below)

If you're more flexible than strong, this could also lead to some pain/discomfort in your shoulders in down-dog and in your yoga practice in general.

• While doing downward facing dog this may feel like a nice stretch (and is totally harmless!) - adding some intentional muscle activation can help you increase your strength and control.

• You can do this with a few cues to add some muscle activation to the mix:

  • pushing into the mat and lifting out of the shoulders more

  • allowing the upper back to broaden and shoulder blades spread out and puff up

Can you see the difference in the picture below compared to the one above?

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What's PROGRESSIVE OVERLOAD?

Many newer students have shoulder discomfort in weight bearing poses like downward facing dog. Why is this?

It’s not because they’re doing it “wrong” or have “bad alignment” - it’s much more likely because their arms aren’t STRONG enough to comfortably accept the new demands you’re placing on them!

Yes, it’s probably THAT simple. 

It’s key with any strengthening to start low and slow, and build up strength and endurance.

So if holding a down-dog for several breaths is too much - take it to where you feel you’ve had enough, and rest those poor arms! 

If you take a super hot-and-heavy vinyasa class with a ton of chaturangas and down-dogs and your shoulders didn’t love that - maybe take a slower flow or a shorter class or take more breaks. 

You have to work your way up. It’s not that you did something WRONG - it’s that you gotta start where you’re at. 

Having a more targeted strength training program to complement your yoga practice is also hugely beneficial both to reduce or eliminate pain on and off your mat, but also to improve your asana practice! 

OK - I’ll get off my pain soap box and give you what I promised! 

Four variations to try if you have shoulder pain in downward facing dog

disclaimer: I do want to mention that if you are having pain, it is best to consult with a medical professional. This is general advice and isn't meant to replace any individual advice you've been given by a medical professional! And teachers - advise your students to do the same. We can give some options, but we as yoga teachers are NOT physical therapists nor medical professionals.

1: Adjust the distance between your hands 

It is true that having your shoulders straight overhead causes more compression in your tissues - so if that is feeling sensitive, separating your hands further apart will lessen this compression and may help create some relief. 

You can also adjust your hands-distance to be closer. For some folks that may feel better in their body.

We are all structured differently and all have different lived experiences that impact how our bodies prefer to move. So try any distance of the hands and see what your shoulders like best!

2: Adjust the direction and degree of rotation of the shoulders/hands

Typically downward facing dog is taught with fingers straight forward, which would be a more “neutral” rotation of the shoulders. 

But if this isn’t comfortable, try pointing your fingers more out, which will externally rotate the shoulders. This does create some more space and will decrease the tissue squishing happening at the acromion of your scapula and may make down-dog feel more comfortable. 

Just like the hands-distance, though - some folks may prefer to be more internally rotated at the shoulder, which would lead to fingers pointing more inward. 

You can also adjust the rotation in the shoulders by

• pulling inner-elbows forward/triceps wrapping back (external rotation)

• pulling inner elbows/biceps inwards, and triceps away from you (internal rotation)

Try it all and find what works. 

3: Shorten your stance

Downdog is WORK for your shoulders.

If the pain or discomfort is simply due to some weakness/lack of endurance - shortening your stance will lessen the force or load on your shoulders, possibly making it more tolerable. 

Similar to what I stated earlier, you can also adjust the frequency and duration of your holds to alleviate the work on the shoulders (until you can build that strength up in a pain-free and sustainable way!) 

You can of course also try to lengthen your stance, hands further away from your feet. This will increase the work on your shoulders, but also changes other angles and mechanics throughout the whole body, which may prove more comfortable for you. 

4: Add props under hands 

Blocks or a chair for your hands will lessen the work required by the shoulders, too. It can also affect the angles and degree of shoulder flexion required, which may be helpful in your body. 

Having blocks in a "level 2" orientation (skinny side up) would allow you to grip the blocks more and create more external rotation of the shoulder, which similar to number 2 above, may help your shoulders feel more spacious and reduce any discomfort or pain. 

Using a wall can take the shoulder work almost fully out of the equation - so you can explore the shape without loading the shoulders at all. 

*while this is a great option for many reasons - appropriately loading the shoulder muscles is a MUST!

If doing so in down-dog isn’t for you, be sure to add supportive strengthening to this area in other ways!

Final thoughts

Do not be afraid of pain or sensitivity in downward facing dog. But don't ignore it either!

Instead, focus on what you can adjust:

• frequency/duration

• intensity (shortening your stance, adding props under the hands)

• alignment

  • hand distance

  • rotation in hands/wrists

  • rotation in the shoulders themselves

Empower yourself and your students to learn more about pain science, about human anatomy, and the importance of exploration and self-discovery to find what works best for each person as an individual! Nearly nothing is off limits forever, it's about starting slow and building the strength, flexibility, and tolerance to whatever level you wish! You got this!

Don’t forget to add supportive and complementary strengthening for your shoulders and shoulder blades to make your yoga practice stronger and more pain-free! 

Questions? Thoughts? Head to our Yoga & Strength Training Resource Facebook Group and post it there!