What is a rotator cuff?
A rotator cuff is comprised of four important muscles known as the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles help bind the head of the humerus to the glenoid fossa of the scapula. Each rotator cuff muscle has a unique function in maneuvering the shoulder and arm. They are as follows:
- Supraspinatus – helps stabilize the glenohumeral joint for arm abduction
- Infraspinatus – laterally rotates the arm
- Teres Minor – laterally rotates the arm, assists in arm adduction
- Subscapularis – medially rotates the arm
When one or more of these muscles is torn, injured, tense or inflamed, you are sure to experience symptoms like shoulder pain, neck pain, limited range of motion, neuropathy (tingling and numbness), difficulty sleeping due to pain, and many other issues.
The muscles of the rotator cuff are involved in many movements, and such actions like brushing your hair or lifting and rotating your arm. However, even movements involving your neck could irritate the pain.
Sometimes the rotator cuff disorder is due to a sudden physical trauma, which tears one or more of the rotator cuff muscles. I personally tore my rotator cuff during a trust fall—someone fell on my right arm, and I felt my Supraspinatus “pop.” You might recall a pop happening before your symptoms manifested. The location of the pop is likely the muscle/ligament that was torn.
These tears are especially common in sports, which is reflected in the alternative names for rotator cuff tendinitis: Swimmer’s Shoulder, Tennis Shoulder, Pitcher’s Shoulder. Moving your arms repeatedly over head, a pictured below, can be an origin of rotator cuff injury, too.
However, a slow build up of tension and inflammation, as well as poor posture, can also irritate the rotator cuff. Tension in the muscles of the neck can compress the vertebrae and impair the flow of qi and blood. The rotator cuff muscles are innervated by nerves the exit the cervical vertebrae. Those of us that have long sessions of looking at our phone are very likely to experience chronic rotator cuff issues, for this reason.
…When myofascial pain is referred to the shoulder joint, the infraspinatus, Supraspinatus, and sometimes the levator scapula muscles are its most likely muscular sources. (Page 556)Travell, J. G., Simons, D. G., & Simons, L. S. (1999). Myofascial pain and dysfunction: the trigger point manual: Vol. 1:Upper half of body. Baltimore: Williams & Wilkins.
Just being stressed out can cause your shoulders to scrunch up, so the origin of rotator cuff issues is can definitely be psychogenic in pathogenesis. To further complicate matters, tension in unrelated parts of your body, like the hips, can exacerbate the issues in your arm. This can really make sleeping difficult, as one struggles to find the right position to rest without pain.
A rotator cuff tear can seriously change your life. Sometimes people undergo surgery to repair the rotator cuff, but there are alternatives that can help you avoid such interventions. Even after rotator cuff surgery, therapies like Acupuncture, Qi Gong, and Herbalism can help reduce shoulder inflammation and improve your quality of life.
An Acupuncturist’s Approach to the Rotator Cuff
In Chinese Medicine, there are several important meridians that travel through the shoulder. They are as follows:
- Large Intestine-Yangming Meridian
- Lung-Taiyin Meridian
- Pericardium-Jueyin Meridian
- Sanjiao-Shaoyang Meridian
- Heart-Taiyin Meridian
- Small Intestine-Taiyang Meridian
These meridians traverse the neck and head, the shoulders, and extend into the fingers (they even go inward and connect to the internal organs and other meridians). If you’ve suffered from a rotator cuff tear, you might have noticed how the injury afflicts your forearm, fingers and wrist. Tingling and numbness, sudden surges of pain, popping and crunching, are a few of the common symptoms you might experience.
Many painful points on the arm can arise after a rotator cuff tear, as the glenohumeral joint is not being “held” properly. This can obstruct the flow of Qi and blood, as the nerves and blood vessels are cramped by the constricted muscles. Indeed, Thoracic Outlet Syndrome or carpal tunnel syndrome can be an unfortunate sequelae of a rotator cuff tear.
A general index of points that are proximal or resting on the rotator cuff muscles are as follows:
- Supaspinatus – Sanjiao 15
- Infraspinatus – Small Intestine 10, 11, 12
- Teres Minor – Small Intestine 9
- Subscapularis – Heart 1
(Interestingly enough, the Small Intestine, Sanjiao and Heart meridian are all Fire meridians!)
Distal pain often follow the trajectories of the meridians, rather than simply corresponding to the individual muscles. So, even though your tear is in your Supraspinatus or your Teres Minor, you might develop pain at your wrist, or your elbow, and not at the expected point of trauma. If you examine the photos of the anatomy model pictured above, you might see lines that parallel your own pain patterns.
Two very effective ways of remedying the rotator cuff are acupuncture and guasha. Acupuncture, applied at trigger points in the muscles of the shoulder and arm, can help unbind points of tension and relax the muscles. Acupuncture applied to trigger points is often rebranded as “dry needling,” but, rest assured, that dry needling is a form of acupuncture, and it is safe when performed by a board certified, licensed acupuncturist.
Guasha, otherwise known as Graston or IASTM (Instrument Assisted Soft Tissue Mobilization), can be used to reduce adhesion and vent inflamed myofascial tissues. Its approach is similar to cupping, insofar that it moves stagnant blood, but it relies on applied pressure instead of vacuum and suction.
Guasha can be explained as creating transitory therapeutic petechia associated with increased surface micro perfusion, increased up regulation of the genetic expression of heme oxygenate-1 (HO-1), stimulation of the immune system and evidence of pain reduction and anti-inflammatory effect that is sustained over time.Nielsen, A. (2014). Gua sha: a Traditional Technique for Modern Practice. London: Elsevier Health Sciences UK.
Focus on the Opposite Side
As the injury progresses, the unaffected side will take on greater physical burdens, which then worsens the afflicted side—it’s a vicious cycle that all unilateral injuries are notorious for. In treatments and therapies, it can be helpful to begin with the unaffected side. The arms can translate problems very readily, and if the scapula becomes unstable, there is increased likelihood that it will tug on the cervical vertebrae, the clavicle, or other anatomical structures. Take care in all movements.
Exercising the Rotator Cuff after an Injury
New symptoms can arise out of no where, so it’s important to work very gently and slowly when doing any new workouts. The Merck Manual recommends that work outs that “push objects away” like push-ups should be avoided, and those that “pull objects closer” should be encouraged. It lists Upright Rows, Downward Lateral Pulls, and Bench Press as therapeutic healing exercises, when done with proper care and guidance. Talk to your doctor or therapist about the right movements for you.
You Can Heal Your Rotator Cuff
Injuring your shoulder can be frustrating and even debilitating. If you are suffering with a rotator cuff injury, I encourage you to reach out to an acupuncturist or massage therapist in your community. They will definitely be able to help relieve your pain with the aforementioned techniques. And, if you are in or near Austin, Texas, I would be glad to discuss how I could be of service to you.
Do not give up on healing, and your shoulder will feel as good as new. Just remember that it takes time, and there are highs and lows. Be patient, be persistent and be kind to your body.