Should We Externally Rotate Our Shoulders in Down Dog?
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Have you ever been instructed to “externally rotate” (ER) your shoulders in down dog?
In my experience, this is a very common alignment cue.
Other similar alignment cues that create ER in down dog (without using the specific anatomical language of ER) include...
“wrap your triceps back”
“wrap your outer upper arms back”
“spin your elbow creases forward"“
Why are we taught to externally rotate the shoulders in down dog, from a biomechanical standpoint?
It’s commonly believed that our shoulders are in a safer position if we ER them in down dog. This alignment is said to "protect our shoulders" from injury.
But is this true? Are our shoulders actually safer in ER? Current research on shoulder pain suggests this is actually NOT the case!
The belief that ER’ing our shoulders in down dog is safer has to do with something called “shoulder impingement.”
Back in the 1970s, a surgeon named Charles Neer proposed the idea that shoulder pain was often caused by the compression of tissues between our shoulder bones when we lift our arm overhead.
He called this “impingement syndrome.”
The main tissues of concern are a rotator cuff tendon and/or a bursa (fluid-filled sac), which live between our acromion process and the head of our humerus – in the “subacromial space.”
The idea is that these tissues can become impinged if the subacromial space becomes too narrow when we lift our arm, and this can cause pain and injury.
To fix this issue, Neer proposed a shoulder surgery to shave down the acromion process bone to make more space. This surgery is called an acromioplasty, and millions of them have been done to date!
In addition, it’s known that if we ER our shoulders when our arms are overhead, this creates more space between the shoulder bones.
This is why we have this down dog cue in the yoga world!
However, remember that these ideas were proposed 50 years ago.
We’ve learned a lot since then (Khan et al 2019, Beard et al 2017, Paavola et al 2021, Lewis 2018). In particular:
Shoulder surgery to shave down the bone (acromioplasty) is no more effective than sham surgery!
Shoulder surgery is no more effective than an exercise program (physical therapy)!
Clearly, people don’t need to physically increase the space between their shoulder bones in order to get out of shoulder pain.
So was the cause of their shoulder pain actually *impingement*?
And is externally rotating the shoulders important to create more space?
As it turns out, shoulder pain is about a much bigger picture than the subacromial space. A multitude of factors from the biological, psychological, and social realms can all contribute to shoulder pain.
Long story short: pain is complex and multifactorial, and nope, we don’t need to externally rotate our shoulders in down dog. We can retire this cue!
There's much more to say about this topic than I can fit into a single email, though. :)
Tune into episode 31 of the Yoga Meets Movement Science podcast, where we discuss external rotation and shoulder impingement, plus *tons* more about the anatomy, biomechanics, and cueing of down dog!