When Good Rotator Cuffs Go Bad: Healing Shoulder Pain From The Inside Out

By Jeffrey Lang

We all have it – after sitting at the computer finishing a project, receiving bad news, or just a hard workout, that feeling that the sides of our neck are getting shorter! But it’s not that our neck is getting shorter; instead, our shoulders are tensing, particularly the levator scapulae muscles that attach our shoulder blades to our neck and can cause neck pain.

Our shoulders are also affected by breathing patterns when we are under stress. When under stress, breath shortens and becomes more shallow, and rather than breathing from our diaphragm, we begin to breath from our upper chest and shoulders. This places undue stress on the shoulder muscles and quickly tires them to overuse, leading to an overdevelopment of the trapezius and levator scapulae muscles and hiking them (permanently) up to our ears.

As teachers and practitioners, many of us are familiar with the student who has trouble with downward facing dog, and is unable to fully extend his or her elbows with the arms overhead. My student’s name was Roger and after class one day, he came to me and asked, “Jeff, is there anything I can do to create more flexibility in my shoulders?”

I could tell this wasn’t just about yoga, but a quality of life issue – there was emotion behind it. He was feeling insecure about not being able to do what he thought a person of his age and health should be able to do. He felt pain when he moved certain ways, when he slept the wrong way, and when he lifted weights. He had been to doctors who had told him the problem was a frayed rotator cuff, which was followed by some physical therapy, but the pain never really ceased and he was looking for something else.

Severe pain around the top, front, and side of the shoulder is quite common and can often be traced to problems in the Rotator Cuff, the group of muscles surrounding the shoulder joint.

Rotator Cuff Basics

The four muscles of the rotator cuff wrap around the arm bone, attaching it to the bones of the shoulder and holding it in the hollow of the joint. The supraspinatus, infraspinatus, teres minor and subscapularis play a key role in all movements at the head of the humerus. They help lift the arm forward, pull it back, lift it to the side, and work together to circle it all the way around. When a pitcher winds up to send the ball over the plate, it is the rotator cuff that gives him the control to follow through with force.

The repetition of daily tasks can cause limited range of motion, as well as a hardening and shortening of the muscles in the complex structure of the shoulder, which can lead damage and inflammation. Going from everyday repetition to the demands of sports takes an even greater toll on the rotator cuff.

Understanding the Common Problems of/associated with the Rotator Cuff

Think of these muscles like the cuff of your shirt. Ideally, they should be supple and pliable, allowing the arm to move in the socket with ease. 
However, these muscles are often either over-used or tight from inactivity and the cuff becomes more like a stiff t-shirt. In this condition, the rotator muscles can easily become frayed or even torn through repetitive motions or sudden movements. They can also become irritated by rubbing against the bones of the shoulder. In these conditions, inflammation is virtually inevitable, which can severely inhibit motion, even to the point of preventing it altogether, causing a condition known as Frozen Shoulder.

The road to recovery: Steps to a Healthy Shoulder

The first step is to give your shoulder a break—playing or working through the pain will only lead to further injury. Your first priority is to remove inflammation from the muscles of the rotator cuff by applying the RICE treatment (Rest, Ice, Compression, Elevation). Removing inflammation will help relax the muscle, which accomplishes three objectives:

1. Relaxed muscles occupy less space and therefore there is less chance of abrasion of the tendons and muscles on the bones of the shoulder joint.
2. The relaxed muscle exerts less pull on the irritated tendons and therefore less pain.
3. Relaxed muscles allow greater circulation of blood and nutrients and therefore give the damaged tissues greater efficiency in healing and a speedy recovery.

Although the treatment options following this vary, the most important thing is restoring resiliency to the tissue to keep them from further damage.

I took a quick look over Roger and had him go through some range of motion exercises. He said he felt a huge relief from doing Shoulder Circles, which you can find in the video below. Keeping the shoulders supple prevents other shoulder problems such as rotator cuff injuries, bursitis, tendonitis, and arthritis from developing. Self-massage of the rotator cuff muscles using Yoga Tune Up Therapy Balls can be a great help. Try these suggestions and see if they help you to calm and reorganize the family of muscles that surround and stabilize the shoulder joint.

—