A: To answer this question more fully and accurately it would be helpful to know exactly what type of “painful shoulder issue” you have developed (diagnosis) as well as what your current “western rehab program” is like now.
As a physical therapist, when someone in pain comes to see me, I know it is important to try to pinpoint the MAIN area of dysfunction as well as the SECONDARY areas of discomfort. Sometimes the place that hurts the most isn’t the cause of the pain (like painful shoulder) but the pain may be coming from another area of your body. It is very common for neck pain to cause shoulder pain, poor postural habits definitely can cause and exacerbate shoulder pain. Non-ergonomic work stations and driving can also absolutely contribute to painful shoulder as well as recreational activities that you may do, such as rowing for crew, a lot of overhead home repairs, sleep positions and a bed that may be ready for replacement, significant pruning of trees in your garden, backpacking—I think you get the picture.
Usually yoga does not cause pain, but yoga done with structural instabilities and imbalances can exacerbate weak areas and make pain "appear" so we blame yoga for the problem. But the problem is bigger than yoga. My opinion as a yoga teacher and PT is that the teacher doesn’t fit the student to the asana; the asana is there for the student to explore and to find their own release and expansion. In an interview on the Yoga Dork blog Power Your Yoga: Creating Space for Exploring the Present Judith Lasater discusses this very point very eloquently. If you are an experienced student and you know that certain poses cause you difficulties, it is your responsibility to talk to the teacher before class and explain that you have this shoulder problem and if you need to modify a pose it is because you are trying to protect yourself from injury. If the teacher is not agreeable to this plan, then my advice is that you stop practicing with this particular teacher. Now if you are new to yoga and do not feel that you have the experience to modify poses in your class independently, you can ask whether it is possible for you to meet privately so the teacher can teach you ways to modify poses that cause you discomfort or pain.
I always tell my students that I would rather be interrupted in a class to assist a student with a modification than to have that student silently suffering—often their particular issue may also be felt by other students. But some people are too shy to speak up even though the class culture encourages this. (All yoga classes become their own mini ecosystems and there is an exchange and dialogue—not necessarily through words—continuously between students and teachers.)
There are certain rigidities in different styles of yoga that may be less amenable to students who are not all following the same instructions in class. In this instance it might be important for you to stop and reassess why you are studying this particular type of yoga or with this particular teacher. Sometimes it's not the style of yoga but the particular teacher that you may not resonate with. Again, no one can force you to do a pose that is painful or unsafe for you to do.
I would also recommend that you give the rehab professionals that you are working with pictures of the asanas that are currently difficult for you. They can then break down the poses biomechanically to target specific areas of tightness and weakness that are preventing healthy integrated biomechanics in the performance of the asana.
The poses that you listed as having difficulty with (dog pose, up dog, shoulder stand, headstand) all involve significant weight bearing through the arms, cervical and thoracic spine. Downward-Facing Dog pose has many modifications that you can substitute for the “traditional” pose. For example, if your difficulty with Downward-Facing Dog pose is shoulder range of motion, then it might be better to go back to working with the preparatory position: on all fours, with appropriate shoulder stabilization, torso stabilization, cervical and thoracic neutral positioning and supportive abdominals BEFORE you push up into dog pose. If you are deficient in shoulder range of motion, you might want to practice Half Dog pose at the Wall (or with a table top) to work into stability at 90 degrees shoulder flexion first. Then return to the floor with preparatory Dog, progress to knees off the floor with rocking and then slowly work back into Dog pose using a chair first then returning to the floor. (This progression is difficult to explain without me actually seeing you and watching how you move.)
As to Shoulderstand, a lovely variation is chair Shoulderstand, which takes almost all the weight off the shoulders, and with a bolster under the shoulders, the head and neck are much less weighted. Headstand is a different problem because even with using a Headstander prop or two chairs to unweight your head and cervical spine, this pose puts a lot of weight into your shoulders. So if the problem is truly from your shoulder, I would recommend that you do not do Headstand until you are pain free or, if the studio where you practice has wall ropes, perhaps you can have your teacher instruct you on how to do the inversion without bearing with through your head or shoulders.
Good luck in your explorations!
—Shari
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