"To Correct Is Incorrect"

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Everyone is moving in the best way they can with the best tools they have.

There are no inherently bad movements.

Each person in a yoga class is a complex, dynamic organism compromised of numerous subsystems, past experiences, emotions, relationships, beliefs, and an extremely sophisticated nervous system.

Given that our movement emerges out of such unique complexity, how could we possibly know what and how to “correct” in another person’s movement?

As a yoga community, we could use to shift our focus away from “correct alignment”, and more toward exploration, self-knowledge, and helping our students *increase their movement options*.

These types of things can truly make positive change in our students’ bodies - which for me, is the main goal of my yoga practice & teaching!

[Microblog] Should Our Shoulders Always Be "Back and Down"?

You know the idea that we should keep our shoulders "back and down"? Like all the time, in every yoga pose that we do? Well our shoulders were actually designed to *move* - not be pinned into one position all the time.

There are four (four!) joints that make up the shoulder joint complex, and regular movement keeps all of them healthy. Lack of movement, on the other hand, just makes your shoulder joints mad at you.

Why would we want to train our shoulders not to move by keeping them pinned back and down all the time?

[Microblog] Stability Does Not Equal Rigidity

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You know "stability"? As in "core stability", "spinal stability", "shoulder stability", etc? Yes, stability is important, but sometimes we treat stability as though it means we should hold parts of our body rigid and never let them move.

But the technical definition of stability is how well a system can return to an orientation after a perturbation - or in other words, how much *control over movement* there is.

We have stability in our body when we're able to control the ranges of motion that our joints have. That way our body can *move* (not hold rigid all the time), but if there's an element of control there, then there is stability.

Sometimes people are told by doctors, physical therapists, or other health care practitioners that they have "instability" or are "unstable" and therefore shouldn't practice yoga. But if a yoga teacher makes stability a priority (the accurate definition of stability, that is - not the inaccurate one that tends to lead to rigidity and movement avoidance!), then that teacher's yoga class could be a great place for that person!

If you don't have yoga teachers who focus on stability in your area, consider trying out my online class library, which features classes from myself and other special guest teachers who all make stability a priority in our yoga teaching. Your body might liiiike!

[Microblog] Our Bodies Are Naturally Asymmetrical

I don't know how many images of lungs you've looked at, but have you ever noticed that our two lungs are not symmetrical? Check out this medically-accurate image that shows that the right lung has 3 lobes while the left one has 2, and the left one is also a bit smaller than the right to make room for the heart.

Even though we sometimes hold up balance and symmetry as an ideal that we should strive for in our bodies, as though being "imbalanced" is inherently problematic, the truth is that our bodies are not actually evenly-balanced left-to-right to begin with. We don't need to look or feel even on both sides of our body in order to be healthy, functional beings. Asymmetry is a natural part of who we are!

[Microblog] There is No "Right Way" To Do A Yoga Pose

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When I think about yoga alignment, the approach I take these days is that there is no one "right" way to practice any yoga pose. The right way to align a yoga pose really depends on who is practicing the pose and what their individual goals are. Our goals can also change every time we practice a pose, and that's actually great. Otherwise we just practice the same thing the same way all the time and never provide new input into our tissues or our nervous system.

In this "hovering" variation of pigeon pose, my goal is to create *strength* in my hips in a pigeon-like joint arrangement. This is good stuff that will create tissue health and neurological control in my hips - something that nearly all of us can use more of. Consider changing up your pigeon pose regularly and all your other poses too - as long as they align with your specific goal in the moment, then that is "right" way for you to practice the pose.

Top 5 Movement Science Insights For Yoga Teachers

These are 5 of the most eye-opening insights I have learned from anatomy, physiology, kinesiology, and pain science that have given me a much different perspective on the body than the one I learned through my yoga studies alone. I hope you find these ideas interesting and inspiring for your own yoga practice and teaching!

Each of these insights is simply my best offer at a summary and takeaway for yoga teachers who might not have the time or interest to study these issues thoroughly on their own. There are volumes more to be read about each of these points from primary and secondary sources, so feel free to investigate the links and references I've included below, or to do your own research on these topics to help you come to your own conclusions.

If you're interested in how one might embody these Top 5 insights in their yoga teaching, consider trying some classes in my online class library, which is a great resource of practices from myself and other wonderful science-minded yoga teachers I admire.

Please read the insights below with a willingness to question your own biases and an openness to incorporate critical thinking into your approach to yoga and movement. Without further ado, here are my Top 5 Movement Science Insights For Yoga Teachers!

 

 

MOVEMENT SCIENCE INSIGHT #1: STRETCHING & STRENGTHENING ARE NOT OPPOSITES

One of the core rules we tend to learn in our yoga teacher trainings is that after we've "worked" or “strengthened” a muscle or muscle group, we should then stretch the area to lengthen it back out and restore "balance". The reasoning behind this rule is usually that when a muscle "works" or "contracts", it is shortening. Therefore to avoid leaving your muscle in an excessively shortened state, you should balance it out by "lengthening" or "stretching" it after you've worked it.

This idea would make sense if muscles did only shorten when they contract. But shortening while contracting is actually only one part of the physiological equation - muscles work just as often as they lengthen too. Picture your hamstrings and the way they lengthen while they're working to control your swan dive into uttanasana (standing forward fold) in yoga. When a muscle works as it lengthens, this is called an "eccentric contraction", and we move this way all the time in our normal human movements. [Ref]

Because muscles can and do actually contract through all of their ranges (short, long, somewhere in between, etc.), it is clear that the physiological opposite of a muscle contraction is not a stretch. With this in mind, it might be time to re-think our classic "strengthen it, then stretch it" rule!

 

MOVEMENT SCIENCE INSIGHT #2: NO YOGA POSES ARE INHERENTLY "BAD" OR "GOOD"

Last year I wrote a blog post called Are Some Movements Inherently Bad? which basically suggested that no movements are inherently “bad”, and the only truly bad movement is one for which your individual body is not prepared or conditioned. But the inverse of this insight is also true. While no movement is inherently bad, no movement is inherently good, either. There is a trend in the yoga world toward teaching yoga poses and other movements like “corrective exercises” that are thought of as "better", more "functional", or "healthier" for the body. But the reality is that movements don't have inherent value (i.e. "better for you", "worse for you", etc.) outside of the specific context of who is practicing the movement and with what goal in mind.

We honor the complexity of the human body and its relationship to movement when we avoid valuing certain yoga poses and movements as inherently better, more functional, or worse than other yoga poses and movements. Context and individualized goals are the main determinants of what makes a movement “good”, “bad”, “functional”, or “dysfunctional”.

 

MOVEMENT SCIENCE INSIGHT #3: ALIGNMENT IS LESS ABOUT INJURY-PREVENTION AND MORE ABOUT LOAD-OPTIMIZATION

We generally learn in our yoga teacher trainings that alignment is important in yoga poses primarily because it prevents injuries. However, we’re now learning that the categories of alignment, injury, and pain are not as interrelated as we have previously been taught. Many people exhibit “poor alignment” and are pain-free, while many others exhibit “stellar” alignment and have chronic pain (and to make matters more confusing, pain and injury (i.e. tissue damage) are also not always correlated either.) [Link]

It turns out that the human body is more resilient and adaptable than previous models of alignment and pain have accounted for. Our body actually has a remarkable ability to adapt to become stronger in response to the loads it experiences (as long as those loads aren’t beyond the ability of our tissues to withstand.) [Link] Therefore if we habitually position ourselves in a way that is different from “ideal alignment”, it’s less likely that our body will sustain inevitable damage from the “misalignment” and more likely that our body will simply adapt to better handle the loads of this alignment. (This is assuming that the joints in question are asymptomatic and healthy, of course!)

Now in a high-load situation, such as squatting in the gym with a 300-pound barbell on one’s back, alignment is undeniably an important tool for minimizing risk of injury. [Link] Activities like this involve high forces that are more likely to be beyond the ability of our tissues to withstand, and so aligning our joints intelligently is definitely recommended.

But compared to heavy weightlifting scenarios, yoga is for the most part a low-load activity. Small variances in alignment under low load are not enough to cause inevitable injury and damage in most bodies. For example, if someone’s front knee drifts inward a few centimeters in warrior 2 (breaking the classic alignment rule of keeping the knee stacked directly over the ankle), the tissues of the knee will most likely respond to that load by adapting to become stronger at that angle. And if the shoulders drift slightly out of “joint-stacked” alignment over the wrists in plank pose, the shoulders, elbows, and wrists should be signaled to grow stronger and better able to handle load from this new angle.

In fact, exposing our body to variable loads like this is actually a great way to prevent injury because it helps condition our tissues to become stronger at all angles, rather than strong in only the classic “joint-stacked” position of traditional alignment rules. I would argue that increasing the ability of one's tissues to tolerate load by strengthening the body at all angles and ranges is a much more effective strategy for injury-prevention than "alignment" is.

These days I view alignment as a tool that helps my students direct the loads in their bodies where I intend for those loads to go, rather than as a necessary tool for injury-prevention.

 

MOVEMENT SCIENCE INSIGHT #4: WE USE TOO MUCH FEAR-BASED LANGUAGE AROUND ALIGNMENT IN YOGA

This insight piggybacks right onto insight #3. It’s very common in the yoga world to pepper our alignment instructions with cautionary language, such as “Align your front knee right over your ankle in Warrior 2 to protect your knee” or “Press your pubic bone into the floor in shalabhasana to keep your low back safe.”

As well-intentioned as they are, warnings like this can actually serve to instill a false sense of fragility in our students, which can counterintuitively result in their experiencing pain. We know now that pain is a creation of the nervous system in response to a perceived threat. And our beliefs about our body are actually one influence that can directly escalate or de-escalate our nervous system’s perception of threat and output of pain. [Ref], [Ref], [Ref] Therefore the more we trust in the robustness and resiliency of our body, the more we communicate a message of confidence to our nervous system, which is likely to result in lower threat levels and decreased pain. And conversely, the more we believe that our bodies are innately fragile and vulnerable to injury from low loads and small micro-“misalignments”, the more likely our beliefs are to contribute to increased threat levels and increased pain.

In warrior 2 pose, stating that keeping the knee directly above the ankle is important “to protect your knee” is a potentially nocebic suggestion to offer to our students. (A nocebo is a negative expectation of an otherwise harmless event or action that causes negative consequences like pain.) Likewise, stating that the pubic bone should stay grounded in shalabhasana “to keep your low back safe” suggests to our students that their spines are fragile structures that will experience damage if their pelvis is tilted a few millimeters in the “wrong” direction.

Instead of using cautionary, nocebic language about alignment in our yoga classes, consider talking about alignment in terms of what it helps us achieve in our poses. For example, in warrior 2 we could say “Keep your front knee lined up over your ankle to engage your lateral hip muscles” or “Press your pubic bone into the floor in shalabhasana to lengthen your low back and direct the backbend into your thoracic spine.” These types of cues utilize alignment more for load-optimization reasons and less for injury-prevention reasons. Instead of instilling a sense of fragility about their bodies, these types of cues encourage increased body awareness in our students, which can be confidence-building and empowering.

 

MOVEMENT SCIENCE INSIGHT #5: TWO COMMON YOGA CUES WE CAN STOP USING

We often teach yoga poses in a way that tells our students which specific muscles they should (or should not) be contracting in particular movements.

In certain contexts, suggesting which muscles a student should be using at any given time can be a useful type of guidance. But it's helpful to realize that as a general rule, our nervous system actually does a good job of automatically organizing and coordinating the movement of our body all on its own, without needing much conscious input from our thinking mind. In fact, consciously "micromanaging" which muscles our nervous system chooses to recruit can often interfere with our built-in, sophisticated motor control system in a way that results in less efficient movement. [Ref]

With this in mind, here are two cues that are very common in the yoga world today that we could all use to stop giving:

1) The glutes & bridge/wheel: there is no need to tell our students that they should "soften their glutes", "relax their glutes", or otherwise disempower the main muscles of hip extension that their bodies naturally recruit when they lift their hips up into bridge pose (setu bandha sarvangasana) and upward-facing bow pose (urdhva dhanurasana). [Ref]

2) Arms overhead & shoulder positioning: there is no need to cue our students to "pull your shoulders down your back" when their arms are overhead. When our arms lift up, our shoulder blades naturally rotate and lift along with the arm movement. [Ref] This is a normal, optimal movement that is often referred to as "scapulohumeral rhythm", and it is not helpful to interfere with this natural coordinated action by trying to consciously pull the shoulder blades down the back to prevent them from lifting.

 

Thank you for reading these Top 5 insights with an open mind, and I hope to see you on the mat virtually or in person in the near future!

**Related: Keeping Your Yoga Teaching Current Online Training

Are Some Movements Inherently Bad?

We are often taught that there are ways the body can move that are inherently bad for us. We’re told that these movements will cause damage, “wear and tear”, or imbalance in the body, which will inevitably lead to pain and discomfort. Some examples of movements like these are cervical spine flexion (e.g. "text neck"), lumbar spine flexion, and many classic yoga alignment taboos like placing the foot directly on the knee in tree pose (vrksasana).

While this perspective is certainly well-meaning, it is missing some key insights about the body that recent science has revealed to us. Instead of asking whether a movement is good or bad, a more nuanced and helpful question is: are one’s tissues adapted to withstand the load of a particular movement? When we approach movement from this perspective, it becomes clear that there are no inherently bad movements - there are simply movements whose loads our bodies are not currently adapted to handle.

 


OUTDATED MODEL OF PAIN

One reason that the "bad movements" belief is unhelpful is that it is based on an outdated model of how pain works. If you read my recent article on The New Science of Pain in Yoga International, you may be familiar with the fact that the link between pain and actual tissue damage is often very weak. Recent studies have repeatedly shown that many people have real tissue damage in their bodies and no associated pain, and conversely, many people who experience chronic pain in their bodies have no associated tissue damage at all. Additionally, pain is not an input to the brain from the periphery of the body (i.e. from tissue damage), but an output from the brain that is meant to signal us to take some sort of protective action.

There are many more implications that the new science of pain has for today’s topic of “bad movements”, but for the sake of time I’m going to to leave this part of the discussion at that and encourage you to read my original article about pain if these ideas are new to you. (This paradigm shift is fascinating and important for us yoga and movement teachers to understand!)

 


DO OUR PARTS WEAR OUT LIKE THE TIRES ON A CAR?

The second main issue with the “bad movement” approach is that it is based on a model that views the body as similar to a car, or a machine. In this model, if we move or align our body in sub-optimal ways over time, certain body parts will wear out before others due to the accumulation of microdamage. Just like a car’s tires might wear out unevenly and need premature replacing if they aren’t aligned properly, our body’s joints (think knees, hips, spinal joints) can wear out if we move or align them poorly.

This idea makes great intuitive sense, but there is an important distinction between cars and human bodies that is missing from this perspective. Unlike a car or a machine, whose parts do mechanically wear out with time, our body consists of living, biological tissues which are constantly turning over and remodeling according to the demands they experience. For example, we all know that if we load our muscles and connective tissues with a weight-training program at the gym, they will respond by becoming stronger in order to handle these loads. Another way of saying this is that the tissues of our body adapt to the stresses placed on them (also known as Davis’ Law).


TEXT-NECK AND TISSUE ADAPTATION

Text-neck is not an inherently damaging movement.

Text-neck is not an inherently damaging movement.

As counterintuitive as it may seem, this same principle of adaptation applies in the case of the traditionally-labelled bad movement of “text-neck”. We are often cautioned that our head weighs the approximate amount of a bowling ball, and for every inch forward that it creeps, our neck is burdened with 10 additional pounds of damaging weight, leading to inevitable pain and imbalance in this area. (I have warned my yoga students about the dangers of text neck myself in the past too - believe me!)

But such cautions are rooted in the model which views our body like a machine full of parts that will wear out and break down if poorly aligned. By contrast, the living, biological organism of our body is constantly adapting to the loads it experiences. Therefore, if you position your head slightly forward of your torso on a regular basis, the muscles, fascia, and connective tissue of your neck will naturally adapt to become stronger and better able to withstand this load.

Now it’s certainly the case that holding any position for a long period of time, be it text-neck or otherwise, is problematic. But simply flexing our neck forward to look down is a natural movement that our body is designed to do. As well-intentioned as the cautions against text-neck are, they are not truly science-based and can encourage unnecessary fear and worry around this movement (which, ironically, can contribute to pain!)

 


“BAD ALIGNMENT” IN TREE POSE

Yoga alignment rules are another realm where "bad movement" beliefs often come into play. One classic example is the instruction that nearly every yoga student has heard to never place the foot on the opposite knee in tree pose (vrksasana). The reasoning behind this alignment rule is that the laterally-oriented force that the foot applies can damage the knee joint. We are instead instructed to always place our foot either above the knee (on the thigh) or below the knee (on the shin).

This alignment taboo does make intuitive sense, but let’s use the lens of biomechanics to look a bit closer. First of all, as we discussed above, the tissues of the body adapt to the loads placed on them. Therefore, in theory, if someone were to practice tree pose with their foot on their knee frequently enough, the tissues of the knee should adapt and get stronger to handle that load.

Secondly, yoga teachers often cue their students to actively press the standing leg and tree leg foot into one another in this pose. If practiced this way, this action actually creates stability in the standing knee joint which should resist any pressure applied by the tree leg foot.

And lastly, tree pose can be practiced with the tree leg actively working to hold itself up, rather than passively leaning against the standing leg. (Picture the leg lifting itself, rotating, and placing the foot on the opposite leg all on its own, without the help of your hand, and then holding itself up there.) In this scenario, the tree leg’s foot would actually be placing no pressure on the standing knee at all.

Upon closer examination, it becomes clear that the classic teaching that foot-on-knee placement in tree pose is inherently “bad alignment” is a questionable belief that probably does not apply to most bodies in this pose.

 


HEADSTAND (SIRSANA)

Another controversial asana in the yoga community is headstand (sirsana), a movement that many wonderful and well-meaning yoga teachers believe should never be practiced because our cervical spine is simply not designed to carry the full weight of our body in such a fashion.

It is absolutely the case that most Western bodies are not adapted to handle the loads that headstand places on their cervical spine. (This is why teaching full headstand to a group class is definitely not advisable!)

But if we look at headstand as a movement that applies certain loads to the body, and if we understand that the tissues of our body adapt to the loads they experience, we begin to realize that if someone were to intelligently and progressively load their cervical spine over time (and it would need to be slowly and over a lot of time!), it would be possible for their body to adapt to the loads of headstand. Sirsana would be a safe asana for this body to practice. It's therefore an oversimplification to state that headstand is an inherently bad movement. It would be more accurate to say that it is simply a movement which many bodies are not currently adapted to handle (but they could be trained with time!)

 

CONCLUSION

When we start thinking about movement in terms of load instead of inherently “good” or “bad”, we gain a more nuanced perspective on the body. It’s true that any movement with high enough loads can injure us, but low load positions that we frequent regularly are unlikely to be the source of damage and pain in our body because our tissues will respond by adapting to handle them. These realizations lead us away from viewing our body as an innately fragile structure that is vulnerable to damage from suboptimal forces, and instead as the strong, resilient, and adaptable organism that it truly is.

Is The Cue "Pull Your Shoulders Back" Helpful?

One of the most common instructions we tend to hear in yoga class is “pull your shoulders back”. This cue is often offered as a universal guideline for how we should position our shoulders throughout our entire practice, and it has its roots in a broader cultural idea that “shoulders back” is inherently good posture. In fact, this belief is so ubiquitous that we often don’t think to question the anatomical reasoning behind it. But as we now know, many of yoga’s traditional alignment rules could benefit from the insight of a more modern movement-science perspective. It turns out that as well-intentioned as the “shoulders back” cue is, on an anatomical level this instruction does not solve postural issues, nor does it help our body function better.

 

THE ANATOMY OF “SHOULDERS BACK”

For many of us, the extent of our anatomy knowledge is that our shoulders are the general, vague area located underneath the prominent shoulder pads of our mom’s awesome 80’s blazer. :)

This seemingly-simple part of the body is quite complex, however, consisting of three separate interlocking bones and four individual moving joints. At the bony level, our shoulder (often referred to anatomically as the “shoulder joint complex” or the “shoulder girdle”) actually looks something more like this under those eye-catching shoulder pads:

The shoulder girdle can move in a myriad of different ways. One pertinent pair of shoulder movements for our discussion today is protraction and retraction. When we protract our shoulders, our scapulae (shoulder blades) move away from one another on our back, and when we retract, they move toward each other. One of today’s postural realities is that many of our yoga students present with “rounded-forward shoulders” and the corresponding appearance of a caved-in chest. We interpret this overly-protracted position as non-optimal, and we therefore naturally conclude that in order to remedy it, our students should pull their shoulders back, or retract their scapulae, throughout their entire yoga practice.

Here is my good friend Rachel exaggerating the appearance of rounded-forward shoulders.

Here is my good friend Rachel exaggerating the appearance of rounded-forward shoulders.

But this well-intentioned notion is problematic for a few reasons. The first and possibly most fascinating has to do with a lack of awareness that many of us have about the way we move. Unless we’ve consciously worked to change this pattern, most of us aren’t actually able to pull our shoulders back without also moving our spine into a slight backbend. In anatomical language, we would say that most people aren’t able to retract their scapulae without also extending their spine.

Just to make sure we understand the clear difference between these two movements, let’s take a look at a simple visual aid. Scapular retraction is a horizontal motion performed by the muscles that lie between the shoulder blades and the spine:

Scapular retraction.

Scapular retraction.

Whereas spinal extension is a vertical movement performed by the muscles that run up and down along the spine, like this:

Spinal extension.

Spinal extension.

Although these are clearly two distinct anatomical actions, in most people they have become “lumped together” as one undiscriminated movement. Therefore, when we ask students to pull their shoulders back, they will more than likely also unconsciously extend their spine.

Now spinal extension is of course a fine movement in general, but if we’re asking our students to move their shoulders back, we’re really requesting pure scapular retraction - no unnecessary extra movements included. Aside from that, as I’ve discussed before, when many of us extend our spines, we end up unknowingly performing most of the movement at T12/L1, the very mobile vertebral segment at which the thoracic and lumbar spines meet. When this happens, our front lower ribs protrude forward, our chest lifts toward the sky, and we end up creating non-optimal compression in the lumbar spine region. This is not a favorable position for our spine, but it is the position that 95% of our students will assume if we ask them to pull their shoulders back.

Another reason that constantly pulling our shoulders back all day is undesirable is that it negatively impacts the quality of our breath. The “shoulders back, chest up” position which we so commonly equate with good posture in fact impedes our ability to take a full, nourishing breath. Give this experiment a quick try in your own body: for a moment, pretend that your yoga teacher just cued your class to pull their shoulders back, and be a dutiful student by retracting your scapulae and lifting your chest. Then place your hands on either side of your rib cage and take a full breath cycle of inhale and exhale, allowing your rib cage to swell laterally into your hands on the inhale. Notice how deeply you were able to inhale. Now stop squeezing your scapulae back - just allow your shoulders to relax forward - and find a neutral rib cage by dropping your front low ribs down until they are buried beneath your abdominal flesh. Try inhaling into your hands in this new position. Your breath capacity should be noticeably more expansive. This is a perfect example of how the way you choose to position your body in space can have a direct effect on how your body functions.

 

A third reason that chronic scapular retraction is problematic is that this action creates unnecessary tension in our upper- and mid-back. In fact, if you happen to be familiar with massage therapy, you might know that the rhomboids and middle trapezius - the muscles that lie in between the shoulder blades - are a classic place in which clients love to receive massage. One main reason that this area so commonly craves the therapeutic touch of massage is that many of us spend the majority of our day using muscular effort to pull our shoulders back. Massage helps to relieve the chronic tension created by this habit, but its effects are usually only temporary.

 

WHAT SHOULD WE DO WITH OUR SHOULDERS INSTEAD?

As radical as it might seem, instead of pulling your shoulders back, try simply allowing them to relax. Let go of any retracting effort and just let your shoulders naturally fall where they will. Although this might “feel” to you like your shoulders are too rounded forward, the truth for most people is that if they were look at themselves in a mirror, they would discover that their shoulders are not nearly as far forward as they thought they were (although some rounding is quite normal). Allow your default alignment to be a shoulder girdle that is relaxed and free from effort. And then in the longer term, begin to proactively target the tension that is pulling your shoulders forward in the first place with smart stretches and conscious movement exercises designed for the pectoralis major and pectoralis minor muscles of the front of the chest.

 

In conclusion, the idea that we should pull our shoulders back throughout our whole yoga practice (and all day long in general) is a universal alignment cue that does not serve our body well. Let’s instead learn to only offer this cue during yoga asanas in which scapular retraction enhances the specific anatomical purpose of the pose. The more that we strive to teach intentional movement versus scripted alignment cues, the more our students will benefit from the insightful quality of our classes!
 

Related Post: Common Movement Blind Spot #2: The Shoulder Blade & Spine Connection

Related Online Class: Shoulders-Focused Practice