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Is Your Rotator Cuff in an Abusive Relationship?

If I said “point to your shoulder” you’d probably point to the top of your arm and you’d be correct, that is what is typically thought of as the shoulder joint. Technically this is called the Glenohumeral joint. The bone of the upper arm is the Humerus, the socket it sits in is the Glenoid Fossa, hence Gleno-Humeral.

But what makes up the socket? I remember first learning about the shoulder and not really having a clear idea of what constituted the entire joint. If you think of a Barbie doll, you might recall that her trunk ends in a kind of rectangular top with the round head of the arm snapping into that corner. You could dislocate Barbie’s arm without much difficulty. Truth be told you can dislocate your arm without too much difficulty (as many a parent knows who has held their child’s hands and swung them in circles till their feet lifted off the ground).

Click here for a visual of Barbie’s arms.

Your arm does not attach to the side of your trunk into your ribs though. It actually attaches to the shoulder blade. That’s weird right? It attaches to the thing that is behind your trunk! The shoulder blade is a strangely shaped bone, it’s so strange that once I set out to draw one and discovered I couldn’t figure out how. The shoulder blades of animals have been used as tools by native people, as the edge is quite sharp. This picture was taken (by me) in the recreated Iroquoian village at Crawford Lake, Ontario and is probably a deer scapula.

The anatomical term for the shoulder blade is the scapula (sing.) or scapulas/scapulae (pl.) It’s a flat, roughly triangular bone that sits flush on the back of the rib cage and moves up/down, in/out, and rotates upward/downward (and any combination of those movements).

So what does the scapula attach to, you ask? Excellent question! The scapula attaches to…nothing! Or rather, it doesn’t have a bony attachment or joint – the articulating surface of the scapula on the ribcage is known as a joint, but not a “true joint” in the sense of a synovial joint with a joint capsule and synovial fluid. However, there are a lot of muscles that attach to the scapula, and this is how I’m going to discuss balance in terms of muscle balance here. (p.s. I’m just talking scapular attachments to ribcage, but I’m not addressing the position of the ribcage, which would affect the position of the scapula and muscles that attach to it. This could get very dense and confusing, so for now we’ll just assume that the ribcage is also neutral.)

If the muscles that attach to the scapula are optimal at rest, the shoulder blade will sit in a position on the ribs such that the arm will hang by your side neutrally, and be ready to do any number of things at any time, which is extremely convenient. However if the scapula does not sit in a position on the ribs that allows a neutral arm, you will have less than convenient use of your arms. (You might not realize this at first, as you can still move your arms, just like you can walk around without full use of your feet, but eventually you will experience some problems and then your doctor will tell you you are getting old and things are wearing out and he/she’ll be wrong, or at least halfway wrong, you could be old for all I know.)

How do you know what is optimal? How do you know if your arms hang in a neutral fashion ready for action in any plane at any moment? If your shoulders don’t currently experience any pain or problems, can you assume they are good to go? Does muscle balance mean if one muscle is tight and short, another one must be weak and long? And to “fix” that, should I stretch the tight one and strengthen the long one?

Let me answer those questions individually:
You use alignment points
You use alignment points
No
No
No.

This is what most of us think of as muscle imbalances – something is tight (and tight is often equated with strong), something else is weak (often equated with long or floppy; stretched out like an old sweater). But muscles’ length depend to an extent on the position of the bones they attach to. And if the relationship between the ribs and scapula aren’t what they should be, that relationship can get kind of abusive. Abusive to your rotator cuff, to your thoracic spine, to your breathing mechanics (sometimes a chicken or egg scenario). So to me, balance means the relationship between body parts. And to balance things, we need to start at a place where the relationship can be studied (hence alignment points).

In that sense, shoulders remind me of feet – they both take a lot of abuse, sometimes despite our best interest and intention we strengthen the muscles that attach to the scapula and arm and only create more problems. I’m thinking generally of the classic rotator cuff exercises that are done with bands tied to door handles, and the like. Also, both shoulders and feet are capable of much more movement than we typically use, and when we do go to use them for those movements (in moments that require more mobility usually), we can get into trouble. Wouldn’t it be nice to have full range of motion without anything paying the price?

 

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