The Rotator Cuff: Tear or Imbalance?

The Rotator Cuff (RC) is the grouping of muscles that keep the ball of the humerus into the socket of the shoulder. When asked to describe the RC, we like to use an analogy that’s similar to a radio microphone. The humerus is suspended similar to a microphone by an internal shock mount. The shock mount keeps the microphone centered when it’s balanced correctly. 

This positioning makes it sound and work the way it’s supposed to. When there is an imbalance, the shoulder is pulled one way incorrectly and it doesn’t work appropriately. As any shoulder rotates along different planes, imbalancing causes an impingement along the muscle or muscles that are pulling it out of place. RC muscles not only act as stabilizers for the joint and hold the humerus in place, but they also assist primary muscles in arm movement along all planes. Primary muscles are the big guys responsible for explosive movements. The Shoulder is the most flexible joint in the human body and as such can also be the most unstable. Creating a stable “microphone” is key and should be the primary focus throughout any overhead strength and conditioning program.

Anatomy Stuff

Each one of these muscles is part of the rotator cuff and plays an important role in assistance and stabilization:

• Supraspinatus – Helps the deltoid muscle initiate the abduction (movement away from the body) of the arm at the shoulder (glenohumeral) joint.
• Infraspinatus – Laterally rotates the arm at the shoulder glenohumeral joint. It also helps stabilize the shoulder by drawing the humerus toward the glenoid fossa of the scapula.
• Teres Minor – Laterally rotates the arm at the shoulder glenohumeral joint. It weakly adducts the arm at the shoulder glenohumeral joint and helps stablize the shoulder by drawing the humerus toward the glenoid fossa of the scapula.
• Subscapularis – Medially rotates the arm at the shoulder glenohumeral joint.
• *Pectoralis Minor – The pectoralis minor depresses the point of the shoulder. It draws the scapula inferior. *I’m including this as a common overactive muscle that aids in shoulder stability. *We like to classify this in the RC group for this article.
  
  

“Rotator cuff tears” do exist. They can be repaired with rest and/or surgical intervention. They can often be misdiagnosed and require an MRI to validate any damage. Rotator cuff damage can occur from an acute injury (ie. a fall or accident), from chronic overuse (like throwing a ball or lifting repeatedly), or from gradual degeneration of the muscles and tendons that tend to occur with aging. If there are partial thickness tears, although they may never fully “heal” per say, you can often times function without any symptoms if rehabbed properly.

Muscle imbalances can also create premature degeneration. We routinely hear “my doctor said I tore my rotator cuff and need to take 4-6 weeks off”. This always seems to be an easy diagnosis to give, but not an easy one to take. Let’s face it, we live in a world where taking 4-6 weeks off isn’t all that reasonable or desirable. When all is said and done a “rotator cuff tear” isn’t a very specific diagnosis to begin with, without MRI validation. Allowing tendonitis time to reduce inflammation will surely help but it may not address the root problems that caused the injury in the first place. Lets take a quick look at a possible cause and maybe get to the root of some shoulder pain problems.

POTENTIAL UNDERACTIVE “LAZY BIG BROTHER”

Primary muscles are the primary movers that are meant to control the major movements you are intending to perform. This muscle is typically larger in size and SHOULD be the target muscle in specified lifts and exercises. This is the guy moving the big furniture, not the one making sure we don’t hit the walls. These BIG BROTHERS are typically aided by their “stabilizers” that we will refer to as LITTLE BROTHERS.

POTENTIAL OVERACTIVE “ANGRY LITTLE BROTHER”

Secondary muscles assist the primary muscles to complete an exercise or movement. Both primary and secondary muscles aid in completing a variety of movements, but more often the secondary muscles stabilize a joint and assist movement, while the (BB’s) are designed to do the majority of the work for very sport specific movements. Muscle function varies depending upon joint type, muscle design, and specific movements.

INSTABILITY AND OVERACTIVITY exists when the “BIG BROTHER” (BB) is being inhibited and forced into a “lazy” state by any single or combination of opposing muscles. We call these opposing, inhibiting muscles Antagonists . When an antagonist muscle is tight / short it can cause what is described as Neuorological Inhibition (NI). NI will shut down an opposing muscle due to the circuit functionality in the body. If the brain didn’t shut one of the opposing muscles down while the other is turned on (fully), your body would play Tug O War and potentially hurt itself. This type of dysfunction causes the “LITTLE BROTHER” (LB) to work harder than it’s intended to, causing it to shorten and become “ANGRY.”

HELP! YES … WE CAN HELP

Through some very interesting and unique methods, we can help with a diagnosis and often times a solution. Below is a reference guide to BB, LB and typical antagonists that may be causing some serious pain and dysfunction. Ultimately, it is always wise to seek out a professional that understands these terms and methods to ensure that an accurate diagnosis and perhaps an accurate intervention is made.

Quick steps to help chill out a potentially overactive LB:

1. Find the Inhibitor (antagonist) then lengthen.
   • 30 seconds or more of static stretching has been said to inhibit any particular muscle.
2. Activate or WAKE UP the BB.
3. “Mash” the LB or put him to rest.

Still seek out professionals.

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