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:
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!