The shoulder is a truly amazing example of the genius of the human body’s design. The way that the shoulder is built gives us the ability to reach in all directions, hold, carry and throw objects, hang onto and swing on objects like tree branches and trapezes, and move incredibly heavy objects with the powerful muscles surrounding it. This combination of strength and mobility is partially due to the stability that is created by a group of muscles called the 'Rotator Cuff'. Before we look at the Rotator Cuff, let's have a closer look at the structure of the shoulder joint.
The Ball and Socket Joint
One of the main reasons for its wide range of motion is the fact that it is a ball and socket joint. A ball and socket joint is exactly what it sounds like - the end of the bone has a ‘ball shape’, and it inserts into a ‘socket’, or a concave surface on another bone. In the case of the shoulder, the ‘socket’ part of the joint is very shallow. In fact, it looks more like a golf ball balancing on a tee. Once again, it has the beneficial effect of creating an amazing range of motion, but also results in instability.
What is the Rotator Cuff?
The rotator cuff is a group of muscles that support and stabilize the shoulder as it moves. They arise from the scapula and connect to the head of the humerus, forming a cuff at the shoulder joint. They hold the head of the humerus in the small and shallow glenoid fossa of the scapula. The rotator cuff muscles include the Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. Due to its instability, an imbalance in the strength and flexibility of the muscles surrounding the joint can more easily cause problems. And because the rotator cuff is the only structure stabilizing the shoulder, it is particularly vulnerable to injury and overuse.
Common Rotator Cuff Injuries
Common rotator cuff injuries are bursitis, tendonitis or rotator cuff tears. If pinching in the rotator cuff damages the cushioning pads between the tendon and the bone (bursa), it is called bursitis. If it affects the tendon, it is called tendonitis. Weakness and inability to raise the arm, as well as severe night pain, may indicate the rotator cuff is actually torn. A tear can occur following a trauma to the shoulder or can arise as a result of ‘wear and tear’ of the tendons. It is an injury frequently sustained by athletes who repetitively move their arm through a throwing motion, such as baseball pitchers, quarterbacks, volleyball players, tennis player, swimmers and shotput throwers.
An Approach to Healing the Rotator Cuff
When the rotator cuff is injured or stressed, it is often because it is being repetitively pulled through the throwing motion, and as a result can become over-stretched, torn and and/or weak. An approach to healing most often involves both strengthening and stretching of the rotator cuff muscles, to reposition the shoulder joint properly, and to encourage the muscle/tendon tissue to lose some of its stiffness. A holistic approach will also include stretching the Pectoralis and Biceps, as well as strengthening the Trapezius.
Strengthening the Rotator Cuff (Click to View Video)
(The above video actually includes a strengthening and stretching exercise). To strengthen the rotator cuff, lie on your left side, with a pillow under your head. Place your right elbow on your hip with your elbow at 90 degrees and your hand reaching forward. On an exhalation, raise the arm upward; when you inhale, lower it back down. If this is quite easy, hold a weight in your hand. Repeat 10 times.
Stretching the Rotator Cuff
To stretch the rotator cuff, lie on your left side and move your left arm forward so that the elbow is directly in front of your chin. Raise the hand, then use the right hand to gently push the left hand toward the floor. Be gentle and move into the stretch on an exhalation. Hold each stretch for 10 seconds and repeat 5 times.
Strengthening the Trapezius
To strengthen the Trapezius, lie on your stomach and reach your arms out to the sides, bending the elbows at 90 degrees so that your hands are level with your ears. We’ll do 2 variations here... the first, on an exhalation simply raise your arms toward the ceiling. Avoid pulling the elbows toward your hips. In the second variation, keep your elbows on the floor and raise only your forearms. Repeat 10 times.
Stretching the Pectoralis and Biceps
Lastly, we want to stretch the Pectoralis and the Biceps, as well as encourage the spine to open up in a gentle backbend. The perfect pose to accomplish this is a Lying Chest Opener. Place a bolster of rolled blanket on the ground with a pillow or yoga block about a foot away from one end. Sit on the block, then lie back on the bolster or blanket, so that your spine is along the midline. Reach your arms out to the sides with your palms facing up, and slide the hands up toward your head until you feel a stretch in the front of your shoulders. Stay here for at least 2 minutes.