I have had a number of questions on the forums recently about rotator cuff problems. My comments assume that the problems that the individuals report actually have something to do with the rotator cuff (“RC”) muscles muscles. In both cases the patient was recommended to do “rotator cuff exercises”. This is skating over a pond with very thin ice.
I will have to make these RC videos soon because we have not recorded them anywhere and clearly there is a fundamental lack of knowledge about this problem out there in the treatment environment. I say this because after speaking to both of these patients it was clear that internal versus external RC strength had not been measured by the practitioners in question. As well, neither practitioners gave any indication of what a desirable range of movement should be in these key shoulder muscles. The larger problem of shoulder alignment on the thoracic spine was not discussed at all.
I wrote about a recent treatment intervention HERE that appeared to be related to one of the RC muscles, supraspinatus, and that this muscle is often involved with the syndrome known as ‘frozen shoulders’. The other three rotator cuff muscles are infraspinatus and teres minor (the two external rotators) and subscapularis, the strongest internal rotator. I have asked this question of many practitioners: what should the ratio of internal and external rotator cuff strength be for potential maximum shoulder function/health? And, further, when testing internal and external rotator cuff strength, what muscle must critically be turned off in order to avoid confusing the potential results? Few practitioners can answer these questions in a sensible way.
And, without a doubt, focusing on the rotator cuff muscles is itself a very narrow view of shoulder girdle and whole body function: tight hip flexors alone can cause the shoulder girdle to sit in an anteriorly tilted and arms-internally rotated position without any other factors being present. How many practitioners routinely look at the way the shoulder girdle sits on the thoracic spine as a fundamental part of any kind of shoulder problem treatment?
As well, it is extremely common for the long head of biceps tendon to become abraded by gym activities like bench pressing and, again, because this is unsuspected it is not looked for and hence not treated. In my experience of treating patients in my studio over more than twenty five years I can assert that an imbalance (or overall lack of) strength in the rotator cuff pairs and/or irritation to the long head of biceps tendon are the two most common causes of shoulder pain, especially in people who count going to the gym and lifting weights as part of their weekly activities.
Hence the title of today’s post: become your own expert. It is only by digging deeply into your own experience and your own response to the application of, or change to, external stress can any kind of sensible answers to these questions emerge.
At present, post ANU,the chéz Laughlin–Allnutt studio space is in disarray. As soon as the studio is tidied up and a set of stall bars affixed to one of the walls then my studio can start to function as a video production studio as well. The first video I want to shoot is how to test the rotator cuff muscles and, further, how to treat what you find. This will be as much of interest to the lay person as to the practitioner: we have found that arming people with this information only has beneficial results.
I intend to repost this over at the forums but minus this last section, which may be of more general interest. It is only when the patient takes full responsibility for his or her own condition and is actively involved him or herself in the day-to-day treatment that any cure is possible. Patients are human; and thus have an inbuilt tendency to putting the responsibility for any problem onto the practitioner—this can never work in the long run (because it is a combination of genetics and lifestyle that creates the problem in the first place). A practitioner can only hope to influence either aspect.
The last point I want to make is to bring to attention medicine’s inbuilt bias towards objectively measurable phenomena (this is the main reason for the love of X-rays, MRIs and CAT scans). In contrast, much of the testing we recommend is completely non-invasive and can inform much else besides looking at the harder tissues of the body. This bias is nothing more then science’s preference for objective information over subjective information, and it is a bias that has impacted negatively on the enterprise since the beginning (don’t believe me? look up nocebo and placebo.). The trouble is the pain response is the most subjective of all phenomena. All information is potentially important, though, so some relating framework is necessary to make some sense of it all. And the patient’s subjective dimension of the problem is all consuming, and the locus of attention is on immediacy of treatment for its relief—so patients have a bias too, just a different one (and this is what plays into the projection of the problem onto the practitioner).
Speaking most generally, problems like shoulder pain while training or exercising are almost always due to faulty biomechanics or, to put that in more simple terms, inefficient ways of moving. Analysing movement patterns results in perspectives that can be understood in terms of strength, flexibility, and neural patterning. All can be assessed on a continuum from more to less objectively assessable (and recall Plato said more than 2000 years ago that ‘economic movement is a pleasure to the eye’). Considering this, the subjective dimension becomes clear does it not? Subjective knowledge is not the enemy—but if it is ruthlessly excluded from consideration in treatment protocols, a huge and potentially valuable piece of information is thereby discarded.