Healing Rotator Cuff Injuries with Acupuncture and Guasha

Disclaimer: The following advice is meant for educational and informative purposes only. If you are suffering with a rotator cuff pathology, please see a licensed healthcare practitioner.

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:

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 (radiating pain, 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 forcefully on my right forearm, 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. Even if the tear was only on one side, both shoulders, or the opposite shoulder can exhibit symptoms.

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.

In foreground, a woman is exercising, extending and abducting the left arm  with a pink barbell held in right arm. In the background, there are other women, in the same posture.
Photo by bruce mars on Pexels.com

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 that 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. Constantly staring down at screens will stress the cervical nerves.

…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. The trajectories of these symptoms can mimic the meridians and also the dermatomes associated with the nerves that exit the cervical vertebrae.

Many painful points on the arm can arise after a rotator cuff tear, as the glenohumeral joint is not being “held” properly. This injurious posture 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. This is why it is important to maintain and care for your shoulder injury.

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! The Fire element relates to upward movement, the emotion of joy, the bitter flavor,

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.
Marks from Guasha. You can see the inflammation follows the trajectory of the Large-Intestine Yangming Meridian, Sanjiao-Shaoyang meridian, and the Lung-Taiyin meridian.

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.

Enkephalin, the Acupuncturist’s Opioid

Have you ever heard of an endogenous opioid peptide? It certainly is a mouthful. I had no clue what it was until I was first introduced to the term Enkephalin in an anatomy audiobook from Audible. The lecturer was listing off advances in peptide research. Then I read about enkephalin in Kiiko Matsumoto & Steven Birch’s book Reflections on the Sea. They mentioned that notable studies were correlating an increase of enkephalin with patients receiving acupuncture treatments. I found this to be so fascinating that I wanted to know more distinctly what enkephalin looks like and how it operates.

A few facts about enkephalin / endogenous opioids:

  • It is a pentapeptide. This means it has five amino acids (Tyr, Gly, Gly, Phe, Met).
  • It is an opioid peptide. These are short chains of amino acids that bind to opioid receptors in the brain. The activation of these receptors inspire the similar responses as an opiate like morphine would.
  • “Brain opioid peptide systems are known to play an important role in motivation, emotion, attachment behaviour, the response to stress and pain, and the control of food intake.”—Wiki
  • Its “brother & sister” peptides are endorphins and dynorphins. Pain and our mood do seem to wax and wane together, don’t they?

Picture of enkephalin structure below

Biochemistry has done a great job of exploring the mechanisms of these endogenous peptides, but I wondered more about how acupuncture could elicit or provoke the release of enkephalin. I scavenged research such as the following articles / books:

Acupuncture Therapy for Neurological Diseases: A Neurobiological View 

This book compiled many different research experiments and compared the literature & statistics. It seemed like the actual points, depth of insertion and intensity of manipulation were not scrutinized exceptionally. They had methodologies that compared chemical profiles of animals, before & after acupuncture. I found the following excerpt to be very informative:

“It has been well documented that opioid receptors play a crucial role in many of the effects induced by manual acupuncture/ EA. The simplest and strongest evidence is that many of the acupuncture effects can be eliminated or attenuated by the opioid receptor antagonists.” — Xie et al. 1985, 1989; Zhao et al. 2002; Tian et al. 2008a, 2008b.

Substances like Naloxone are opioid receptor antagonists. This substance blocks the effects of opioids by shielding or de-activating the receptor. Naloxone is widely used as a remedy for opioid overdosing, and is being sold over the counter in many states now to combat the drug epidemic in America.

Check out the similarities between Enkephalin and Morphine

Morphine itself also comes from older medicinal traditions, namely Herbalism. The herb Ying Su Ke (Poppy husk) has been used within the Chinese herbal pharmacopeia for a long time. The actual opium war was not due to Ying su Ke, but rather British imports and imperialist trading habits that inundated China with strong opium (though it was nothing compared to modern pharmaceutic productions). That caused all sorts of trouble, and I wager we’re seeing history repeat itself presently in the context of America’s opioid crisis. Acupuncture could be the key to positive change in the healthcare of our country, by circumventing the need for chemicals to relieve patients of their suffering.

Acupuncture is widely used in drug detoxification and for suppression of symptoms of addiction. Associations like NADA—National Acupuncture Detoxification Association, certify healthcare providers of all realms to perform an auricular protocol that was developed for meth and heroin addicts. It might be anticipated that the activation and proliferation of endogenous opioids helps to level out the body’s cravings for chemical stimuli. I am starting to see how acupuncture can be good for both pain relief, as well as reducing stress of those recovering from addiction and withdrawal.

Unfortunately, it seems if a person is taking Naloxone while receiving acupuncture, the pain relief effects are greatly diminished. Enkephalin relies on the availability of opioid receptors, though one might wonder if the body still accumulates the peptides, and if they can be absorbed after Naloxone is excreted. The following research on mice could help explain:

Electroacupuncture in awake mice produced analgesia to noxious heat stimuli causing a 54% increase in latency to squeak. Subcutaneous naloxone completely abolished this acupuncture analgesia implicating endorphin. Naloxone injections in control mice caused a 17% hyperalgesia suggesting that “normal” mice also release endorphin. These results imply that endorphin is released at a low basal rate in “normal” mice, and at a much higher rate during acupuncture.

Naloxone blockade of acupuncture analgesia: Endorphin implicated
Bruce Pomeranz, Daryl Chiu

There is a ton of research regarding this subject, and it is very promising to see biochemistry helping to bridge the gap of efficacy and understanding within the realm of Acupuncture. And, in spite of Naloxone, I believe there are many other vectors and mechanisms of acupuncture that can relieve pain and improve bodily function (check out this article to learn more about that). So, even those with Naloxone prescriptions could find it beneficial to some degree, especially if they are seeking to diminish all chemical consumption.

Enkephalin is definitely a key player in understanding acupuncture and, really, the way pain works in response to stress and other deleterious effects of living on this planet. I will continue to explore how peptides, neurotransmitters and other chemicals promote amelioration in the body. Stay tuned, and maybe schedule an appointment so we can get some enkephalin brewing in your body!