Monthly Archives: June 2015

Rotator Cuff: Core stability for the shoulder

Most people associate any type of shoulder pain as a problem with the rotator cuff. It’s important to understand that the rotator cuff is not one muscle but a combination of muscles that surround the shoulder and scapula. These muscles act with the ligaments and labrum to stabilize the shoulder and allow it to function in all ranges. Its job is pretty intense because the shoulder must be very dynamic. If the shoulder is injured, often the elbow, wrist, and hand cannot do their jobs. Various other muscles help to stabilize the shoulder as well, so don’t get hung up on strengthening only the rotator cuff. The rotator cuff and scapular stabilizers are much smaller than the overlaying musculature (deltoid, biceps, triceps, pecs) and are often under strengthened and prone to over-use type injuries. Poor posture and poor body mechanics anger small, stabilizing muscles because they are forced to work like the big guys.  A good yoga and meditation practice will assist you in relaxing over worked muscles.  Gentle strengthening, stabilization, and balance will advance your shoulder strength and reduce over use pain.

Guys…everyday cannot by bicep day. Girls…everyday cannot be leg day. Take at LEAST one day a week to incorporate these small, but difficult exercises into your strengthening program to improve lifting strength, and to decrease nagging shoulder, and even neck and mid back pain.

I don’t care how strong you are, scapular strengthening is hard, so use light weights and/or bands. Also movements are small because the muscles are small, so don’t substitute large movements utilizing large muscles.

Two bands are utilized in these pictures.  We have them mounted to a peg board in the garage.  I would recommend a very light band, a light/medium band, and a medium/firm band for these exercises.  If the bands are too firm, an injury or larger muscle substitution occurs, which defeats the purpose.  There are a variety of ways to set the bands up.  Perform 8-12 repetitions of each exercise:

External rotation: Facing toward the bands, lift the arms to 90 degrees and gently rotate, pulling backward.

ER

Internal rotation:  Face away from the bands, elbows up at 90 degrees.  Gently pull forward rotating the arms down.

IR

Single arm external and internal rotation:  Keep the elbow by the side.  Gently pull in with the hand closest to the band (internal rotation) or pull out with the hand farthest from the band (external rotation).  This is a very small movement!

IRER

Scapular protraction or Serratus Anterior punch: Gently push your shoulder blade out.  This is a very small movement as well.

serratus

I, T, Y, W: Starting point (1st picture).  I (2nd picture) pull the bands by your sides squeezing the shoulder blades and sticking the chest out. T (3rd picture) arms are raised to 90 degrees, gently pull the band back squeezing the shoulder blades together.   Y (4th picture) arms are up at 90 degrees, gently pull the band up forming a Y squeezing shoulder blades down and in.W (5th picture) pull the band back forming a W with the arms pull the shoulder blades down and in.

I,T,W,Y

Additional Information:

The rotator cuff consists of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.

Other important shoulder/scapular stabilizers include: Teres major, subscapularis, latissimus dorsi, infraspinatus, teres minor, posterior deltoid, serratus anterior, levator scapulae, rhomboid major and minor, middle and lower trapezius.

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Neck and Shoulder Pain

Nagging neck, mid back, and shoulder pain often impedes, disrupts, or prevents peaceful sleep, and makes sitting, standing, and working in an upright position pure torture.  No matter the cause of the pain, I have created a simple list of easy, in the moment fixes as well as advanced techniques to take it a step further.

As is my soap box–the majority of our pain is a result of some habitual posture.  Balance and symmetry are key here to shift spinal pressures.  When pressures are shifted, the spine gets to “breathe.”  It is extremely important to get up and move out of habitual postures every 15-30 minutes.  You can try the following stretches while taking your posture break:  Standing pec stretch for the anterior neck, an upper trap stretch for the side of the neck, and a back extension stretch for the thoracic spine, and a wall pec/side/anterior neck stretch.  Hold each stretch for approximately 30 seconds to 2 minutes.

trapstanding pec stretchstanding back extensionwall pec

My seconds soap box–Sit with good posture.  Poor posture places more harmful stress through your spine than lifting heavy objects.  Hers how to sit with good posture:

  1.  Scoot your butt all the way back in the seat
  2. You may place a towel roll in your lumbar spine (optional)
  3. Place your shoulder blades on the seat back.  This is the most important step for neck pain sufferers!
  4. Adjust your workstation to accommodate this.  This is the only that position allows your neck muscle to relax.

Here are some additional exercises:

Upper trap stretch with 1st rib mobilization:  The first rib and clavicle often become elevated with neck tension.  Use a belt to mobilize the rib and clavicle down.  This will give an even deeper trap stretch.  belt trap

Self lateral neck traction:  If the pain is present predominantly on one side of the neck or mid back try this: Lie on the non-painful side with 1-2 pillows at your shoulder (not your head). Now hang your head and relax. This acts to open up the painful side of the neck and mid back. Also, this is an easy position to rest in.  This is a form of lateral decompression.  Hold 2-5 minutes.self lateral traction

Eagle pose arms only: Hold for a few breaths or 30 seconds. Now move the arms up for 30 seconds, and down for 30 seconds.  This stretches the posterior neck and shoulder.eagle pose arms only

Decompress with a shoulder stand and/or plow pose: Both act to provide traction through the neck and spine.  Hold 30 sec to 2 minutes

shoulder standplow pose

Floor Pec stretch:  This opens up the shoulders and lengthens the anterior neck.  Hold 1-3 minutesfloor pec

Threading Pose:  This stretches the back of the shoulders and neck.  Hold 1-3 minutesthreading

Towel Roll (rolled hand towel, you may also duck tape it for durability):  Rest with a towel roll running down the center of your back (vertically) or running along the shoulder blades at the most painful area of the mid back (horizontally). This mobilizes painful vertebrae and compresses painful trigger points.towel

Breathe: Take several deep breaths throughout the day. Send the breath to the painful area. Inhale 3-5 seconds, hold 3-5 seconds, and exhale 3-5 seconds, focusing on relaxation on the exhale.  Repeat 3-5 cycles.breathe

Strengthen the rotator cuff.  You can google specific exercises.  I like I, T, Y, rows, and external rotation.  (I will update my shoulder blog soon with specifics on this!)

Relax the jaw: Throughout the day and when trying to drift to sleep, remind yourself to relax the muscles around the jaw and let it drop slightly.relax jaw

Shiatsu massage pillow and Lacrosse Ball:  You can buy shiatsu massage pillows on amazon.com, I recommend one that has a timer to prevent skin breakdown if you fall asleep.  Using a lacrosse ball against a wall or lying down, find the nauseating trigger points around your scapula (shoulder blade), upper traps, and posterior neck.  Push the ball into the trigger points and hold 30sec -2 minutes OR until you feel a relaxation.  lacrosse

Reduce the Pillowage:  People with neck pain typically need to sleep with a flat pillow, tempurpedic pillow, or no pillow at all.  If you sleep with multiple pillows start slowly reducing that number.

Chakras:  Investigate the balance or malady present in the heart, throat, third eye, and crown chakra.  Clear energetic blockages or buildup that may  be present from early childhood or from the recent past or present.