For Rotator Cuff Injuries –Try Yoga

Dov Michaeli

First posted 8/3/11 on The Doctor Weighs In

To Elizabeth, a trainer’s trainer.

My favorite thing to do in the morning is not having a cup of coffee or reading the newspaper (this usually depresses me or sends me into a rage) –it is exercising. Sounds pretty ascetic, requiring military discipline. But no, it actually isn’t; you should try it. Start slow, either with a 30- minute walk outdoors or on a treadmill. I used to run in the morning, but since I screwed up my back I switched to the elliptical. Either exercise is aerobic and beneficial. Your heart will thank you, your stiff lower back will  loosen up and your still somnolent brain will wake up to the torrent of oxygenated blood courtesy of your pumping heart. Having finished the aerobic part, I usually stretch to further loosen up my lower back and then move on to resistance exercises, such as push-ups, pull-ups, and weight lifting.

And therein lies a big problem. Doing the resistance exercises, especially the weight lifting, somehow caused frequent episodes of shoulder pain. Initially I thought I could “blast through” the pain. Mistake!!! Pain is a signal that your body is sending: stop! Something is going wrong. Acute pain can be due a stretched tendon or a muscle spasm. If you stop and let the injured area rest, things will come back to normal very quickly. But if you ignore that signal and continue exercising –chronic inflammation sets in. Not only is the pain more severe, it takes weeks and sometimes months to resolve.

One of the most frequent injuries of resistance exercises is the rotator cuff syndrome. The rotator cuff is a group of 4 muscles that attach to the shaft and head of the humerus (the bone of the upper arm) which participate in lifting the arm above the head.

Actually, raising the arm up to 60- 80° is the responsibility of the deltoid muscle, not formally a member of the rotator cuff group. This muscle group, and especially the supraspinatus muscle, then take over and raise the arm to about 100°-120°, after which the deltoid takes over again all the way to 180°. It is not surprising then that irritation of the supraspinatus tendon, which anchors the muscle to the humerus shaft, would cause pain when elevating the arm; and repeated irritation would cause chronic inflammation. An extreme tug on the muscle or tendon could cause a complete massive tear of the tendon and loss of the muscle’s mooring to the bone. All of which is a real pain in the shoulder, and elsewhere…(sorry,this blog is rated for G, for general audience).

If I haven’t learned anything from Elizabeth, my picky yoga instructor, I learned that form is all. You deviate from the perfect form –and sooner or later you’d pay for it. I used to follow a rigorous exercise regimen called P90X. You must have seen the infomercials promoting it; a truly great fitness program. Elizabeth saw what I was doing and was horrified; several of the exercises had you lift weights above the head. She had told me to NEVER lift higher than the shoulders (about 90°), and to always keep the elbows pinned to the waist. P90X violated her commandments, and hell hath no fury like my yoga trainer’s being spurned. Needless to say, I started getting nagging shoulder pain, which got worse as I stubbornly stuck with the program. Eventually, I simply couldn’t go on. I had to lay off for about 6 weeks before the shoulder healed.

Since then, even though I have been observing the “thou shalt not lift overhead” commandment, I would occasionally get shoulder pain which would resolve after two or three days of rest. Today, after doing a few sets of pushups (and pushing the envelope a bit, I must confess), I felt some pain in my left shoulder when I lifted my arm; nothing that rest would not fix. But then my eyes caught the headline of an August 2  NYT article by Jane Brody:Ancient Moves for Orthopedic Problems.  Brody highlights the work of Doctor Loren Fishman, a physiatrist — a specialist in physical and rehabilitative medicine affiliated with NewYork-Presbyterian/Columbia hospital. Dr. Fishman, a lifelong devotee of yoga who studied it for three years in India before going to medical school, is applying his knowledge to a variety of orthopedic conditions like osteoporosis, osteoarthiritis, scoliosis and… rotator cuff injury! I couldn’t suppress my curiosity; here I am with a freshly acquired shoulder injury –let’s see how good your “ancient moves” are. 

The maneuver he advocates is simple. It is called TFS, for Triangular Forearm Support. Claim: you do this simple thing, and relief is immediate! Yes, you read it right –immediate. And long lasting, as long as 2.5 years (maybe more; that’s as long as the observation period lasted). Not wasting any time I tried it for the recommended 30 seconds. And guess what –it worked! I could immediately raise my arms over my head without much pain (just a twitch).

Incredible; how does it work? I went to the original publication (July/September issue of Topics in Geriatric Rehabilitation) and without getting into the gory anatomical details, the bottom line is that the other three muscles that make up the rotator cuff are trained to take over from the injured supraspinatus and raise the arm through the gap of 80°-120° before the deltoid could take over again.  You have to repeat this exercise for at least 2-3 times a week for 3 weeks, but I intend to incorporate it into my daily stretching routine forever. After all, isn’t it worth 30 seconds?

I never fail to marvel at the wisdom of the ancients. A supraspinatus tendon tear is treated today with either open or arthroscopic surgery, but regardless of how successful the surgery is –the clinical improvement in function is pretty spotty. The ancient yogis could not repair the torn tendon – didn’t have access to sophisticated surgery; they probably wouldn’t have used it anyway. Instead, they trained the other muscles to take over the function of injured one. Their belief that “everything is connected” and their focus on the correct form led them to the most amazing insights. Forget the spiritual mumbo-jumbo –there is real wisdom in those poses.

Dov Michaeli MD PhD is a basic researcher, writing on The Doctor Weighs In.

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