From Pain to Possibility
Episode 12: The Significance of the Rotator Cuff
Intro: You're listening to From Pain to Possibility, with Susi Hately. You’ll hear Susi’s best ideas on how to reduce or even eradicate your pain and learn how to listen to your body when it whispers so you don't have to hear it scream. And now here's your host, Susi Hately.
Susi: With this episode, I want to dig into the rotator cuff, but also into the shoulder girdle, and the reason being is that a lot of times, when we're thinking about the rotator cuff and healing from rotator-cuff injuries, we focus on the rotator cuff, and what we often don't focus on is the shoulder girdle. And yet when you look at the rotator cuff, those fun little four muscles, all of them attach to the blade. The blade is a part of the shoulder girdle. So if we don't pay attention to the blade as part of the shoulder girdle, then we're not going to make the progress, I don't think, that is actually possible. So when we get and understand the amazement of these two parts, the rotator cuff in relationship to the shoulder girdle, and the shoulder girdle in relationship to the rotator cuff, some really cool stuff starts to happen.
Now, if you're sensing any sort of passion in my voice, you're absolutely accurate, because anything movement does turn me on, and you are going to get the next 15 or so minutes of a lot of rotator-cuff and shoulder-girdle love.
So when we look at the shoulder girdle, you're going to hear me talk about it as this extraordinary part of our body, because it is. It’s designed to act as a bridge between our arms and the spine. It provides this delicate strength and immense stability. And at its essence, really, it enables emotion to be transmitted into action as the shoulder stability is transformed into strength, power, and endurance.
So emotionally, the shoulder girdle is a part of a chain of events responsible for hugging and squeezing, caressing, reaching out, grasping, simply through its postural position. The shoulder girdle can express pain, depression, suppression, shock, openness, receptivity, willingness, and comfort with one's own personal power. And in the physical practice of yoga, the shoulder girdle has a similar role, transmitting and transforming energy by impacting our ability to raise the arms overhead, take them out to the side, and influences our ability to balance and plank or chaturanga dandasana, and our ability to move our arms into eagle pose or cow-face pose, behind our back into reverse namaste, also into backbends. Think about it, as we go into upward bow, or wheel pose.
But what’s really vital to understand is that it doesn't act alone, right? The shoulder girdle and how it impacts the rotator cuff and the rotator cuff and how it impacts the shoulder girdle, we need to look at it even in a bigger perspective, because how we breathe and our ability to relax, our relative positioning of our spine as well as the head, our functional leg strength, pelvic stability and core stability, our ability to not force and perhaps move through pain. Those elements will have a big impact on the functioning of our shoulder girdle and our rotator cuff as well as our personal natures. Our thoughts can impact the ability of our shoulder girdle to impart what it does best—grace, freedom, and ease—through our entire system, through our arms and down to the tips of our fingers. So collectively, it's an amazing part of our body and how it transmits from our heart and to our hands.
I love thinking about acupuncture and acupuncture meridians and how the heart and lung meridian move from the heart down to the hands. It moves through those functional arm lines that move through the shoulder girdle, out through the arms and down through the hands. So it really blends in this nice, energetic flow between the center of our body out through to our hands.
So when we take a look at this at the next level, we can look at the shoulder girdle as a collection, really, of information and action sequences that are contained within the systems of the skeleton muscles, nervous system, circulatory system, lymphatic system, and respiratory system. When we're looking at it skeletally, we can look at the shoulder girdle consisting of the sternum; the clavicles, or the collarbones; the scapula; and each of the humerus. I often refer to their configuration is similar to a set of football shoulder pads, pulled over the head, attached at the middle, and spreading wide left and right, with the top of each humerus being the shoulder pads. And when we take a closer look at the clavicles, we can see that they act a little like struts that keep the shoulder joints and arms away from the body. This positioning enables free and easy arm movement that's accessible, strong, and powerful.
And on the medial side, closest to the center line of our body, or the spine, they attach at the manubrium of the sternum. It's a junction that is called the sternoclavicular joint. And to feel this, I want you to place your fingers on the medial edge of your left clavicle—it's easy to use your right fingers to place it on the left clavicle—and then raise and lower your arm, and you'll feel the joint moving under your fingers, right at that area of the clavicle, meaning your manubrium of the sternum. So as you move, what I want you to think about is that this is the only centralized bony connection to the shoulder girdle, a characteristic that allows for a large range of motion in many different directions. And it's a characteristic that distinctly differentiates the shoulder girdle from the pelvic girdle.
On the lateral side, the clavicles, or collarbones, attach the scapula to the acromioclavicular joint, and it's the junction of the acromion process in the clavicle. So to feel this, place your fingers at the tip of the shoulder, and that's the acromion process. And if you slide in about an inch, you'll be on the acromioclavicular joint. And if you slide back out, just over an inch or so, you'll fall off the acromion shelf and land on the head of the humerus. The acromioclavicular joint is reinforced by a couple of ligaments as well as fibers of the trapezius and the deltoid muscles.
So, now let’s look at the shoulder blade, or the scapula, on the ribs. And when you look at that, it's very interesting because there are six ranges of the scapula, or the shoulder blade, on the rib cage. And one is elevation, going up. The other is depression, going down. One in, retraction; one out, protraction; and then upward and downward rotations. There are six ranges. And when those six ranges are not functioning or they're sticky or there's just something not quite working well, that can have an impact through the entire system.
Now, one thing to note about the scapula on the rib cage and moving through those six ranges is that it's not an actual joint, like a fibrous joint, but it is referred to as a functional joint. So when those movements aren't working really well, it can have an impact to the entire system.
So now let's look at the scapula meeting the humerus, because this is where we start to get into the rotator cuff. So this joint is the glenohumeral joint, and this is where the humerus connects into the glenoid fossa, hence the name glenohumeral joint. Also, short form is the G.H. joint. So it's highly movable, and the supportive structures surrounding the joint need to cultivate steadiness while at the same time facilitating a freedom of movement. So to facilitate and to nurture this, we have a fibrous capsule called the articular capsule, and that supports the joint, and it's both thin and lax. Supporting the capsule is where the rotator cuff muscles come in, and there's four of them—infraspinatus teres minor, supraspinatus, and subscapularis. And so they support that joint in most ranges of motion.
Now, what becomes interesting is we also need to support the rotator cuff to do its job. Because the shoulder blade is a movable item, we need to have good stability around that shoulder blade because the rotator cuff attaches to both the shoulder blade and the arm bone. So I like to call the muscles that support the shoulder blade the primary stabilizing structure. And the primary stabilizing structure are the trapezius—upper, middle, lower—levator scapula, serratus anterior, and the pec minor. All of those muscles, when working in a balanced way, support that shoulder blade to stay on the rib cage in an effective and efficient way. So when the shoulder blade is not functioning well—maybe because of an imbalance of that primary stabilizing structure, maybe because of the way the breath holding patterns are being expressed, maybe because of poor core stability or poor function through the pelvis or poor leg strength—then that's going to impact how their rotator cuff functions.
So in light of that, what I like to make sure that my clients focus on when they're recovering from rotator-cuff issues is to pay attention to the exercises that they've been given. And many of them that I've seen are also working with another healthcare professional. So whether it's a physical or a physiotherapist or a physical-therapy assistant or a chiropractor or an osteopath, typically they've been given some remedial exercises from that professional that they're doing. So what I want to make sure of as they're doing them is what's happening at their shoulder blade. What's happening with their breathing? What's happening with their pelvis and their legs and their overall posture setup? Because if somebody is blasting through those remedial exercises without breathing, then those are remedial exercises are only going to take them so far. If they are moving their shoulder blade rather than helping to specifically work on that glenohumeral rotation and other aspects of the glenohumeral movement related to the rotator cuff, and that blade’s moving or it's getting stuck or it's not being supple on the rib cage, that’s going to impact how the rotator cuff functions and, in turn, how it supports the humerus in the socket.
So it's really vital to understand these components because a lot of times people who have damaged their rotator cuff, they're doing all these exercises, but they're not making progress with the rotator cuff. And that could be a reason why, because their blade might be stuck as a supportive mechanism because the rotator cuff was injured, except the supportive nature of it is no longer actually being supported. It's a compensation that's no longer serving them in terms of their recovery. So we need to be able to support someone in being able to regain good neuromuscular movement, good coordinating patterns, and overall better control between their blade and their arm bone, their breathing patterns, how they're standing through their pelvis and into their feet.
So how can you do this? Well, one way I love to work with people who are new to this process is instead of knocking off three sets of 10 or three sets of 30 or whatever the number is that's been given for the exercise, is to pay really close attention to how you're doing the movement and then to count the number of breaths. So if you're thinking about inhaling and exhaling as you do a rotator-cuff movement, then maybe count off 10 breaths as opposed to 10 reps, because when you start to focus in on your breathing, you tend to slow the breathing down. The other thing to pay close attention to is what's happening with your shoulder blade, or are you utilizing upper trapezius muscles or neck or jaw muscles as a compensatory strategy to try to move your humerus in the way that you're being asked to do it to improve your rotator cuff?
So pay attention to any extraneous movement—held pelvic floor, held breathing, grippiness or stuckness through your shoulder blade. If you're utilizing weights or a band, are you white knuckling it through your hands? Are you clenching through your toes? Here is an idea to play with. Can you do the movement or the exercise that you've been given with 5 or even 15 percent less effort and still have the same result? This last part’s vital. It's not just doing less effort, because you might not go as far. Can you do it with less effort and still have the same result? And then see what happens. Notice what occurs within your tissue. Notice what occurs within your system. Notice how you feel overall. And when you finish it, as you walk about, as you pay attention to your overall sense of self, is there anything different that you're now aware of? It becomes really fascinating to see ourselves in movement beyond just rehabilitative exercise. How is that rehabilitative exercise supporting ou selves in the process of recovery?
So your takeaway from this episode is, can you explore your rotator cuff from a place of presence, from a place of awareness, to really allow for the transmutation of energy from the center of your body out through towards your hands so that the rotator cuff can really function in a way that serves you and serves your entire system and your system can then serve the rotator cuff so you can reduce the compensation so you can improve your breathing mechanics and really feel a whole lot better?
Give it a go. Do your exercises with 5 to 15 percent less effort and still have the same result. Easily breathe. Notice the result. See how you feel.
If this way of thinking is resonating for you and you're a teacher or you are a healthcare professional and you're wanting to integrate yoga into your practice, then send me a note. You might be interested in the Susi’s Resource Library, where I have 200 hours of video and lots of extra courses that you can explore movement and how to integrate this with your clients or your patients. And if you're someone who would like to have one on one and more personal care, then send us a note, send us an email, or click the link below, and connect with us to have a chat.
You guys have a great time exploring.