How To Teach Your T-Spine To Bend

Jennifer Pilotti

Coach

Yoga, Personal Training, Mobility & Recovery

 

We usually think of mobility as it relates to our peripheral joints. Can the ankles move? Can the wrists bend? Can the shoulders let the arms go overhead? When it comes to the spine, the conversation changes. We frequently ask if the back stay still and be stable, rather than inquiring whether our spines move freely.

However, if we want to move well in a variety of conditions, we need our spines to be responsive. As Ping Fu writes, “Bamboo is flexible, bending with the wind but never breaking, capable of adapting to any circumstance. It suggests resilience, meaning that we have the ability to bounce back even from the most difficult times…” So, too, should your spine respond to any movement, only to return to its original shape once the movement is completed.

For the spine to respond well during activity, there needs to be movement throughout the spinal column. Often, people will have the ability to bend really well at one section, only to have parts of the spine not move at all. Increasing range of motion and control from head to tail can make activities like tumbling, climbing trees, and basic gymnastics moves much more enjoyable. It also makes it easier to control your spine when you are performing activities such as single leg deadlifts, squats, and lunges.

The spine, like most joints, can flex and extend. It can also laterally bend and rotate. Let’s focus on flexion and extension.

Where the Breath Meets the Spine

If you were to video yourself doing cat/cow, the movement where you arch and round your back, some of you would have a hard time moving your back at all, while others would notice a lot of movement through your low back, and not as much through your upper back. A small handful of you will be able to move all parts of your spine equally and with control, probably because you have spent a bit of time thinking about how your back moves.

The thoracic spine (the part of your spine where the ribs connect), houses important organs, namely the heart and the lungs. The lungs are designed to change size when you inhale and exhale. The diaphragm contracts during inhalation, moving down and out. When you exhale, the diaphragm relaxes, moving up and in. The movement of the diaphragm moves air in and out of the lungs, acting a bit like a pump. The ribs are built to accommodate this movement of the lungs and the diaphragm, subtly moving every time you breathe.

When you think about your ribs, you probably think about the front of the ribs and the chest. However, the ribs wrap all of the way around and connect to the thoracic vertebrae in the spine. This means the movement doesn’t just take place in the front of the body; it also takes place in the back of the body and in the sides of the body. I think of it like filling a tube of toothpaste with air when you inhale, and when you exhale, it’s like you are squeezing the tube of toothpaste to get a little extra toothpaste out- it gets smaller on all sides.

What often happens with athletic individuals is the front of toothpaste tube gets filled, but the back of the toothpaste tubs remains completely flat. This changes the structure of the tube so the front isn’t just moving forward, it also gets stuck in a slightly up position. To stick with our analogy, it also changes how the toothpaste is squeezed out, with less toothpaste squeezed out each time you exhale.

Get Round and Roll

What in the world does this have to do with spinal flexibility? One way to improve movement through the thoracic spine (which will alter the amount of movement at the lumbar spine), is to use your inhale to get a little bit of movement in the back of the ribs, and to use your exhale to get the front of the ribs to move down and in towards the pelvis. Three exercises found below implement this idea; they also utilize an isometric contraction in a flexed thoracic spine position to increase proprioception and strength at end range.

Once you have the effects of breathing on the thoracic spine worked out, rolling forward and back can begin to integrate flexion and extension throughout the spinal column. When you roll back, your spine rounds from head to tail. Otherwise, you make a clunking sound as you roll back. The softer you can be, the more dispersed the movement is up and down the spine.

When you roll forward, the belly pushes forward, the eyes and head look up a little bit, and you find yourself in a little bit of extension. It’s sort of like cat/cow, but more dynamic (and for many of us, a lot more fun).

As you roll forward and back, can you feel how the spine responds? Can you make it easy, with as little effort as possible? For those of you that practice martial arts or gymnastics, understanding the basics of a seated roll can make backward and forward roll variations a lot more interesting.

Get Long

An aspect of spinal mobility that can make a big difference in terms of how you feel in your low back is the sense that the spine is long. This is different than the spine being extended; rather, it’s the sense that you are light and not compressed down while you are upright.

Understanding the expiratory position of the ribcage is step one; once that is taken care of, you can feel this length by putting yourself in positions where your arms are supported, taking the load partially off of your spine.

An easy variation of this can be found below. Notice the weight is moving back into my hips while my arms support me. My ribs aren’t flaring away from my pelvis, and I am stretching along the sides of my body using gravity.

Other ways to improve mobility length-wise is through hanging variations and gravity boots, if you are the type of person that likes gear and would rather hang from your feet than your hands. Playing with any of these ideas a couple of times a week will improve your spinal mobility and make it easier to flex and extend.

Extension and the Back Bend

Just like you should be able to flex the thoracic spine, the ability to extend it can be useful for athletic endeavors. Let’s talk about backbends for a brief moment.

The ability to come into a full backbend has its benefits. It strengthens the arms in an unusual position, and requires strength in the muscles that extend the hips. The wrists have to be able strong enough to support a fair amount of weight, the scapula upwardly rotate, and a lot of the muscles in torso work to resist gravity. It also requires mobility throughout the spine and pelvis.

If you are missing any of the mobility pieces in the upper extremity and mid-back, your backbend probably won’t feel very good. The ability to move weight into your arms in a backbend is partially dependent on shoulder mobility and extension in the thoracic spine, so working on those two things can make the backbend more enjoyable and successful.

Now, you might currently be thinking you have no desire to do a full backbend, because it has no purpose in your life. That’s fair. For people working on Parkour or gymnastics skills, the backbend enables the practitioner to work on more advanced skills, but it isn’t a movement that is required on a daily basis like, say, a squat.

But even if you don’t want to work on the backbend, learning how to isolate extension through the thoracic spine and neck translates into more dynamic flexibility during everyday life. The body likes options, and being able to move into extension from somewhere other than the lumbar spine or neck is a good thing.

The short sequence below demonstrates ideas for learning how to isolate thoracic extension. Using the eyes can help initiate the extension pattern in the upper extremity, and learning how to keep the pelvis still will enable you to isolate the movement to the cervical and thoracic area. At the end of the sequence, you will notice I don’t cue holding the body any particular way, giving the body a chance to self-organize. Once you give the nervous system options, it doesn’t need to be micro-managed. It should be able to figure out the most efficient, pain free option, especially if there is no end goal regarding what the movement should look like.

Why Does This Matter?

Remember how proprioception is the ability of the body to sense where it’s located in space? One of the things that happens when you begin to move a joint through its full range of motion is the mechanoreceptors responsible for sending information to the brain about current limb GPS coordinates become more accurate. It’s the difference between Siri sending you to an abandoned warehouse in San Jose, versus the hotel you are trying to get to that’s two blocks over. The improved accuracy makes for more comfortable movements and posture, not to mention a better night’s sleep.

The ability of the entire spine to flex, extend, and get long can alter your relationship to movement. Using the breath to improve mobility can alter thoracic spine mechanics (in a good way), by decreasing the sense of muscular tightness. Learning to extend the spine makes it easier to know what it means to not be extended, and taking a load off of the lower extremity by using gravity to “pull you long” can create a sense of ease throughout the back musculature. Get in touch with how it feels to move different parts of your back and improve control, both separately and in an integrated way for freedom of expression through movement.

Kettlebell Correctives For T-Spine, Chest And Shoulder Health

 

John Spezzano

Coach

Martial Arts, Kettlebells

 

As a martial artist and instructor with decades under my belt, one of the hurdles I struggled with when I started training with kettlebells was my thoracic spine mobility, or rather, my lack thereof. Despite my mother telling me I was special, in this regard I am the rule among martial artists, not the exception. Years upon years of training for hours and hours in a boxing or kickboxing stance had encouraged my back and shoulders to retain that tight, rounded, defensive position, even when not necessary during the rest of my day. 

When you stress the body in a consistent way over time, it will adapt to that stress as the new normal, a concept enshrined in the SAID principle. In other words, if you sit or stand with poor posture (shoulders rounded forward, upper back slumped, head pushed in front of the shoulders) for extended periods of time, your body will adapt to that position.

Time to Call In a Pro

I’m not a medical professional, so let’s ask my good friend Dr. Ira Schneider what he thinks. Dr. Schneider is a former international-level athlete who has been a private practice chiropractor for 25 years, and works regularly with high-level athletes.

Dr. Schneider: Our basic human posture is indeed changing for the worse. Constant and unconscious use of cell phones is creating a forward and downward head position adding additional and unnatural load onto the neck, over-stretching the back and compressing the front. Add to that the use of computers, almost always in a seated position, creating a shortening of the muscles and fascia of the front of the body and often causing a forward glide of the neck, and you have the recipe for neck, upper back, shoulder, and low back pain, as well as headaches.

How can we address these existing and growing postural issues that already negatively affect so many people? Like most problems, there are a number of solutions: the foam roller, chiropractic treatment, and massage therapy are all good choices, depending on the issue and how you respond to the treatment. Brett Jones, the chief instructor for StrongFirst, uses some simple and remarkably effective bodyweight movements in his recent article on T-spine mobility and its impact on shoulder health. 

Today, we will look at another outstanding method to correct postural issues of the upper back and shoulder: kettlebell corrective exercises. Dr. Schneider and I will explain the benefits that a few kettlebell exercises can provide in this arena.

Progress to the Bent Press

If you’re reading Breaking Muscle and have been around for more than five minutes, you have heard of the kettlebell and Pavel Tsatsouline, the man who introduced them to the West. Like most things in strength training, opinions are strong and varied. While I do my best to steer clear of politics (difficult in both martial arts and strength), I will stick to my personal experience with these exercises, as both an athlete and instructor.

Simply put, each and every one of us has seen exponential improvement in T-spine mobility from the movements below. This improved mobility invariably leads to better posture. Better posture leads to more efficient and natural movement of the body, and more important, a better mental attitude and outlook. And a better mental attitude and outlook lead to a better life. Suffice it to say, this handful of kettlebell exercises will fix your life. Really!

I learned this progression toward the bent press from David Whitley, who spent a lot of time studying this quintessential “old time strongman” lift. Arthur Saxon, the king of the bent press, could put 350lb overhead at a bodyweight of just 200lb! The bent press is still done today, albeit without the singlet and handlebar mustache. 

The bent press is an amazing lift, no doubt about it. “But,” you ask, “with my upper back locked up after years of _______________ (fill in the blank: cycling, boxing, Muay Thai, Brazilian jiu jitsu, wing chun, sitting in front of a computer…), how can I safely execute a bent press without risking injury, due to compensation and/or poor form?”

I would answer that question with a question, “What do you do when a student can’t do a pull up?” Yelling at them to do a pull up isn’t going to magically get their chest to the bar. Naturally, you assist them, by hand or with a band, or you use a regression like ring rows. You find a way to require less strength until more strength can be generated.

That’s what we will do today. We will improve T-spine mobility with a progression of movements that are invaluable on their own, and can build up to a bent press down the road, should you choose to learn this amazing lift. 

Kettlebell Corrective #1: The Arm Bar

Safety Tip: Do not take your eye off the bell during any of these exercises.

Dr. Schneider: The kettlebell arm bar, when done correctly, is a major shoulder girdle stabilizing exercise. The position and weight of the bell causes the contraction of muscles surrounding the arm and shoulder, creating coordination and strengthening of those muscles. That effect will benefit anyone doing this movement. Additionally, working the kettlebell into the right position also necessitates the opening of the chest in relation to the shoulders and biceps.

Kettlebell Corrective #2: Bent Arm Bar

Safety Tip: This is an awkward position to press from, so start light.

Dr. Schneider: The bent arm bar requires separate movements of the pelvis and thorax, and will create a coordinated contraction for the intercostal, paravertebral, and muscles of the lateral pelvis, among other intrinsic muscles. As you abduct the shoulder and extend the elbow, you contract the muscles of the upper arm. The biceps and triceps balance each other, as do the flexors and extensors of the forearm. Also, the shoulder stabilizers are put to use contracting at different rates to maintain balance of the weight. This means a large number of muscles are being used for both concentric and isometric contractions, first to move a weight, and then to hold it in place.

Kettlebell Corrective #3: Half-Kneeling Bent Arm Bar

Same safety tips apply.

Dr. Schneider: The additional points of contact with the ground that the half-kneeling bent arm bar requires challenges the balance differently. Sensory proprioception of the feet, hips, alternate arm, and thighs will now be involved in the movement of the kettlebell. The biggest difference between this exercise and the previous two will be in the core, as almost all the muscles will fire to keep the kettlebell controlled. The muscles of the lower leg of the foot on the floor will increase the stability at the ankle and knee, and the intrinsic muscles of the foot will gain strength and be less likely to break down under load. The muscles of the inner thigh of the leg on the ground will engage to keep the pelvis centered under the kettlebell. The isometric contraction of the muscles of the hand on the floor will involve musculature all the way up to the neck of that side. Now add the pressing of the kettlebell, and you have a controlled concentric and eccentric contraction from forearm down to the pelvis and grounded foot.

Kettlebell Rehab for a Better Life

Limited T-spine mobility is a widespread problem for vast numbers of people, athlete or not, with ramifications inside and outside of training. These three simple movements, the arm bar, bent arm bar, and half-kneeling bent arm bar, produce a powerful rehabilitative effect on the T-Spine, chest, and shoulders with only a light kettlebell. They have helped me and my students make tremendous progress in the area of spinal mobility, and I highly recommend you try them out so you can experience the same incredible benefits.

The Best Method For Talking To Your Doctor About Shoulder Injury

 

Brandi Ross

Coach

Mobility & Recovery

 

I was sitting at the computer one day, looking over Facebook, when I noticed a friend had posted about his shoulder problems. It got me thinking and I wondered what I could do to help him. Well, the distance has been an issue, but what I was able to do was provide him with questions to ask his physician as he attempts to return to full duty. So, I began to think more about what questions a person should ask their physician in regards to various types of shoulder injuries, from acute to overuse.

Most people do not like going to a physician unless it is absolutely necessary. Athletes, especially, really dread going to the physician and hearing those deathly words “surgery,” “rest,” “physical therapy,” and “avoid your sport." Hopefully, a few of these questions I am providing may help to ease the stress, strain, and anxiety of discussing a shoulder injury for the first time and help you get back to your active life.

Rotator Cuff Strain

One of the most common injuries is going to be the rotator cuff strain, which if left untreated, can turn into a complete tear. Just look at professional baseball players and the number who have had surgery.

Once a physician has said rotator cuff, begin to think of questions that affect that particular activity. For example, “What is the recommended treatment?” From there, questions that can be asked include “What type of physical therapy will be needed?” and “How long will I be in therapy?” 

The scary part for many is approaching the subject of imaging and further diagnostic testing. My suggestion is, if the physician doesn’t recommend it right away ask why. Ask “How long do I try therapy before we do more testing?” Sometimes, physicians are hesitant to begin with imaging and try to take a more conservative approach. If you are that concerned, you can push the issue or ask for another opinion. Personally, I think pushing the issue may be the best initial approach. 

Dislocation/Subluxation of the Shoulder

Another injury that happens quite frequently is the dislocation or subluxation of the shoulder. Here is where it gets tricky. A shoulder dislocation can cause damage to so many structures within the shoulder that the treatment is widely variable. Structures that can be injured range from the musculature to the ligaments to the labrum. All of these structures incorporate similar yet different physical therapy components. 

This is when it is important to ask the appropriate questions. First and foremost, ask about immobilization. How long will the shoulder need to be immobilized before physical therapy can begin? What are the short-term effects of being immobilized? What activities can I do while in the sling? Will there be additional imagining, such as an MRI? What are my limitations at work and/or in regards to activity? The fear people have is hearing the worst – that you can’t do anything. In most cases, physicians are willing to work with you on certain limitations, especially when it comes to work.

Remember, a dislocation will take some time to recover. Be patient, but be proactive at the same time. If you don’t understand what is being said, ask the physician to slow down and explain in terms that you understand. The worst feeling is leaving the office and not knowing what was said. 

Shoulder Surgery

A dislocation or subluxation can lead to a worse scenario - surgery. That is most likely the worst word any person wants to hear. Believe me, I know. I have had four knee surgeries, one hand surgery, and one ankle surgery. Yes, the orthopedist likes to see me walk into the office.

When there is the chance the topic of surgery will be approached, go prepared with questions. Most importantly, find out what type of procedure will be used. Ask the physician to explain it. Then, find out what the risks are that are involved with surgery. What is the success rate of the procedure? A key question for people today is, “How much work am I going to have to miss?” The younger athlete may ask, “How long I am going to be out of my sport? Will this affect my chances of a scholarship?” These are all valid questions to consider when deciding on the course of action. 

It even comes down to whether or not you want to do surgery with that physician. You have the right to a second opinion. Get it. If surgery is something that may affect your career, ask for a second opinion. You never know, maybe the other physician has a better procedure or has other options. It never hurts to check it out, especially when it can affect your livelihood.

Listen Carefully

The last bit of advice I can give is to listen carefully to what the physician is saying. Why? As the physician explains the injury, surgical procedure, or physical therapy, you may come up with additional questions that I didn’t include. If the questions are open-ended and require more than a yes/no answer, you should be able to go through a whole series of questions that will help you to ultimately get the answer for which you are looking. 

Always ask, even if you think it is not important, if you are thinking about it then it is important to you. It’s your shoulder. It’s your health.

How To Self-Diagnose Your Shoulder Pain

 

Tom Kelso

Coach

Strength and Conditioning

 

The shoulder joint is one of the most vulnerable joints in the human body. There is so much range of movement that it is surprising more shoulder injuries don't occur.

If your shoulders are healthy, you must be doing the right things to strengthen them. If not, you are either performing compromising movements or are negligent on your strengthening protocols.

If you are experiencing shoulder pain during your training or competitions, it's time to step back and determine the root cause. What follows are simple hands-on tests that can determine why your shoulders are in pain. A partner is recommended to assist with each test.

Impingement

1. While seated, have a partner raise the arm of your sore shoulder to the front and overhead as far as possible.
2. Your partner should use one hand on your arm and the other hand supporting your shoulder blade (scapula).

The space where your rotator cuff tendons and shoulder bursa reside (the sub-acromial space) becomes smaller when your arm is raised overhead and pushed to the limit. If pain is felt in your shoulder, the test is considered positive. The pain is likely caused by impingement of the tendons or bursa in that area of your shoulder.

Biceps Tendonitis Test

1. While seated, raise your painful arm (shoulder) forward to the front.
2. While holding your arm out straight in front of you, turn your palm up (e.g., forearm supinated).
3. You partner should then push your arm down, while you attempt to resist.

"There are multiple articulations (movements) at the shoulders, making it a challenge to directly pinpoint an injury. But proper assessment and movement tests to determine specific pain can narrow it down to specific injury issues."

Pain felt in the front of your shoulder while resisting your partner's arm push means biceps tendonitis is the probable cause of your shoulder pain.

Labrum Tear

The Labrum tear test has two parts: the apprehension and relocation tests.

The Apprehension Test:

1. Begin by lying on your back on a flat, elevated surface (e.g., a bench or table).
2. Move your arm out to the side perpendicular to the torso.
3. Flex your elbow to a ninety-degree angle.
4. Your partner should slowly rotate your arm so your hand moves toward your ear with the partner pushing as far as possible. Maintain the ninetydegree elbow flexion.

If you are apprehensive (hesitant) about shoulder movement beyond the joint, this test is considered positive for a possible labrum tear.

The Relocation Test:

You may feel your shoulder is unstable and potentially wants to move out of place - or relocate - especially when your shoulder is in extreme external rotation. If this is the case, have your partner gently press on the front of your shoulder to relocate the joint.

If you feel less relocation and your shoulder feels more stable, believe it or not this test is considered positive and a torn labrum is the probable cause.

AC Joint Separation

The test for an AC (acromial-clavicular) joint separation is called the AC joint compression test. The shoulder blade (scapula) connects to the collarbone (clavicle) at this joint.

1. While seated, have your partner place one hand at the front of your shoulder joint and one hand at the rear.
2. The partner should slowly, but firmly press on both sides of your shoulder to compress the AC joint.

"The aforementioned tests are simple protocol anyone can use to determine the possible cause of shoulder joint injuries." 

If there is a joint separation, pain will be felt at the joint between the downward pressing hands. In addition, pain while raising the arm upward and while sleeping are also indications of an AC joint separation.

Rotator Cuff Tear

1. While seated, have your partner raise the painful arm/shoulder to the side and parallel to the floor.
2. While you relax the arm, the partner lets your arm drop.

If your arm drops involuntarily and you are unable to maintain that parallel position you may have a rotator cuff tear. Some may compensate for a torn rotator cuff by elevating the scapula toward the ear. Be vigilant of this when performing the rotator cuff tear test.

Supraspinatus Tear

The empty glass test is used to assess the status of the supraspinatus, one of the four rotator cuff muscles. The supraspinatus is located on the upper part of the shoulder joint and is involved in abduction (arm raising).

1. While seated or standing, lift the sore arm forward and to the side about thirty to 45 degrees.
2. Pronate your wrist so the palm of your hand faces down to the floor (as if you were trying to empty a glass of water).
3. In this position your partner should gently push your arm down.

If pain or weakness prevents you from maintaining your arm position, you may have a supraspinatus tear.

Frozen Shoulder

A frozen shoulder is also known as adhesive capsulitis. It occurs slowly over time and can limit functional use of your arm. A frozen shoulder manifests in pain and tightness. This makes it difficult to reach overhead, press a dumbbell, or scratch your back.

"It is imperative to strengthen all participating muscles and shoulder articulations to enhance shoulder joint health due to the vulnerability of the body part."

There is no special way of diagnosing a frozen shoulder, nor is there a diagnostic test to verify it (e.g., an X-ray or MRI). A frozen shoulder diagnosis is made by observing the specific shoulder moving through a range of motion.

Frozen Shoulder Procedure:

1. Stand in front of a mirror. A partner should observe you while moving the arm and shoulder. The partner should be noting the range and quality of motion of the shoulder joint.
2. Slowly raise both arms to the front and overhead. If you suffer from frozen shoulder, your painful arm may only come up to a point just past parallel with the floor. Additionally, as your scapula elevates towards your ear, you will feel general pain in the shoulder.
3. From this position, slowly lower the arm down, and then slowly lift the arm out to the side. Note the range of motion that occurs. If the arm only goes up to a point parallel to the ground - and it's painful - then you likely suffer from frozen shoulder syndrome.

A final test for frozen shoulder is to stand with both arms at the sides and the elbows flexed at ninety degrees. Externally rotate the arms outward. If the frozen shoulder syndrome is present, the painful arm will not rotate outward in comparison to the healthy shoulder.

Assessing Your Shoulder Health

Shoulder joint injuries can be head-scratchers. There are multiple articulations (movements) at the shoulders, making it a challenge to directly pinpoint an injury. But proper assessment and movement tests to determine specific pain can narrow it down to specific injury issues.

The aforementioned tests are simple protocol anyone can use to determine the possible cause of shoulder joint injuries. You may discover one specific issue (e.g., only a rotator cuff tear) or multiple issues (e.g., biceps tendonitis and impingement).

Either way, multi-dimensional shoulder joint articulations can be problematic. It is imperative to strengthen all participating muscles and shoulder articulations to enhance shoulder joint health due to the vulnerability of the body part.

You might also like The Best Method For Talking To Your Doctor About Shoulder Injury and this list of articles how to prevent and treat shoulder injuries.

Stop Blaming The Rotator Cuff: The Mechanism Of Shoulder Injuries

 

Robert Camacho

Coach

Strength and Conditioning, Physical Therapy, Mobility & Recovery

 

A few weeks ago a friend of mine messaged me. She’d been having some intermittent shoulder pain that was starting to bother her during workouts. The pain was primarily on the anterior aspect of the shoulder and was particularly bad whenever she did push ups or shoulder presses.

Push ups put a lot of stress on the shoulders.

 

This is a pretty common issue and usually requires a straightforward fix, but before I could even tap out the beginning of a response, she wrote to me: “I think it’s my rotator cuff.”

Sigh.

It’s not really her fault. I see a lot of articles and discussions involving what people believe to be rotator cuff problems. It’s become something of a stock response to shoulder injury or pain: “It’s probably your rotator cuff.”

The truth is quite the opposite. With a few exceptions, most shoulder injuries are not the cuff’s fault. It is just a victim. In this article, I’m going to discuss why this is the case, what’s actually going on, and what you can do to keep your shoulders healthy and happy.

Mechanism of Injury - The Man Holding the Knife

One of the biggest issues in physical therapy is the over-focus on the nature of the injury, while ignoring the mechanism of the injury. Both of these things are important, but for slightly different reasons.

"With a few exceptions, most shoulder injuries are not the cuff’s fault. It is just a victim."

Early on, the nature of the injury is the most significant factor in determining a proper course of rehab. Muscular, bone, and soft-tissue injuries all require a slightly different approach. Once the physical damage has been repaired, though, understanding the mechanism of injury is pivotal in preventing it from happening again.

When you’re talking about cuff injuries, in most cases the problem didn’t originate with the cuff itself, but much of late-stage rehab will involve rotator cuff strengthening. If you’re a pitcher, a tennis player, or involved in any other sport that puts a great deal of strain directly on the cuff, then that approach makes some sense. If your shoulder injury was the result of working out and lifting weights, this approach pretty much disregards the true mechanism of injury.

If the muscles around your scapulae are weak, no amount of rotator cuff strengthening is going to be able to pick up their slack.

Think about it like this. Let’s say you were out walking around and someone stabbed you with a knife. Your immediate concern would be to stop the bleeding. But once that’s taken care of, you still need to deal with the man holding the knife. Why did he stab you?

Was it an accident and he didn’t mean to do it at all? This scenario is analogous to contact injuries and other accidental issues. If the mechanism of injury was truly accidental, it’s probably not worth worrying about too much.

On the other hand, if his actions were the direct result of your own behavior, it’s a more pressing concern. Sure, you stopped the bleeding, but what if he just stabs you again? Staunching the flow of blood is still the immediate concern, but if you never address the man holding the knife, then your problem is never going to be solved.

Scapular Stability - The Common Culprit

The shoulder “joint” is probably the most complicated joint in the human body because it’s actually a combination of three different joints (or four, depending on who you ask).

• The primary bony articulation of your shoulder is actually on your sternum at your sternoclavicular joint.
• From there, your scapula is attached to your clavicle at your acromioclavicular joint.
• Your scapulae rest on top of the posterior aspect of your rib cage, which provides the surface they move around on. Some people refer to this as the scapulothoracic joint.
• Finally, we have the glenohumeral joint, where the head of the humerus attaches to the glenoid fossa of the scapulae.

Whew, did you get all that? The take-home point here is that the rotator cuff, due to its location, is only capable of stabilizing motion at the glenohumeral joint, the third point of articulation.

The muscles around the scapulae are responsible for providing true shoulder stability.

The rotator cuff muscles are found on your shoulder blade. When you see them on a cadaver, they’re tiny, even in specimens with well-developed muscles. By comparison, the muscles around your scapulae (trapezius, rhomboids, and even the latissimus dorsi has a scapular attachment on some people) are enormous. It’s those muscles that are responsible for providing true shoulder stability.

If the muscles around your scapulae are weak and your scapulae are immobile, no amount of rotator cuff strengthening is going to be able to pick up their slack. On top of that, many people who have weak scapular muscles also have poor scapular positioning, which complicates the issue further.

Why Are We So Focused on the Rotator Cuff?

I’m not entirely sure why we’re so concerned with the cuff, to be honest. I think some of it is that rotator cuff repairs are one of the most common shoulder surgeries, which leads people to believe the rotator cuff is a problem. Rotator cuff strength is also easy to measure objectively through manual muscle tests.

"The ultimate goal is to learn what a neutral position feels like and how to consciously activate your scapular musculature so that, with enough practice, the stabilization becomes reflexive." 

Scapular positioning and stabilization, on the other hand, is more of an art than a precise science. The human body is incredibly adaptable, which means that even if your scapular positioning sucks, your body can probably find a way to work around it. If you don’t specifically look at the scapular motion and only focus on the movement of the humerus, it may well appear that nothing is wrong.

How Can You Help Yourself?

First and foremost, if you genuinely believe you have a rotator cuff problem, then you need to see a healthcare professional. Once you’ve been cleared of an actual structural injury, then there a couple of simple strategies you can employ to get your scapulae back on track.

Diaphragmatic and 90/90 breathing exercises are some of the best ways to reset your body’s position to neutral. You don’t necessarily need to live in this new position, but you need to develop the kinesthetic awareness of what neutral feels like.

90/90 breathing demonstration

Once you’ve established a neutral position, you can start with something simple like scapular retraction drills and then progress to prone alphabet raises (T,Y,I) and wall drills like the wall Y.

Prone Y raise demonstration

The ultimate goal is to learn what a neutral position feels like and how to consciously activate your scapular musculature so that, with enough practice, the stabilization becomes reflexive. Addressing initial pain and dysfunction is usually quick (one to four weeks), but developing reflex stabilization can take quite a bit longer.

Find the Real Culprit

In my experience, the presentation of an injury is usually the least useful factor in determining a long-term course of rehabilitation. Often the presentation is just the straw that broke the camel’s back. The real issue is the man holding the knife.

Labrum tears, impingement, anterior pain, and rotator cuff issues are all potentially preventable through improved scapular mobility and stabilization. Accidents happen and some injuries aren’t avoidable. That said, do yourself a favor. Stop blaming your rotator cuff. It’s just another victim and it probably needs your help.