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Rotator Cuff Injuries: Prevention and Healing with Healthy Posture

Rotator Cuff Injuries: Prevention and Healing with Healthy Posture

Esther Gokhale
Date

In my experience, people are often unaware that their posture has greatly contributed to their muscular problems and damage. 

In this blog post I would like to talk about a frequently injured group of muscles that attach the arm to the torso at the shoulder blade—the rotator cuff. The rotator cuff helps rotate the arm and lift it sideways and is also responsible for stabilizing the shoulder joint.

Anatomy drawing of the rotator cuff muscles on the bones of the shoulder.
The four muscles of the rotator cuff are supraspinatus, infraspinatus, and teres minor, which lie on the back of the shoulder blade, and subscapularis which lies on the front.

Why we get rotator cuff problems

It’s common for people to be rounded forward in modern times. Many of us habitually adopt a closed, slumped posture with tight muscles across the chest, while the muscles of the upper back and shoulders are often overstretched and lacking in tone. This front-to-back imbalance goes with holding the arms too closely to the body, and too far forward. The muscles of the rotator cuff are mechanically disadvantaged by such postural distortion, and put under undue stress. 

Photo of young man sitting slouched with forward shoulders.
The slumped shoulder posture common in today’s culture leaves the muscles of the rotator cuff prone to injury.

W. Homer painting of young women mending nets with shoulders back (detail).
This painting from 1881 shows both women using the rotator cuff while their shoulders maintain a healthy posterior position. Detail from Mending the Nets by Winslow Homer.

Photo of carpenter (Burkina Faso) standing with shoulders rested back.
Traditional cultures preserve healthy posture for the shoulders. The shoulder and arm of this village carpenter in Burkina Faso align with the back half of his body, not the front. This posterior shoulder position arranges the bones and muscles optimally for rotator cuff health and mechanical advantage.

Of the four muscles in the rotator cuff group, the one that suffers most frequently from poor postural habits is supraspinatus. Supraspinatus is the uppermost rotator cuff muscle. It lies along the top of the shoulder blade and passes through a narrow passage to attach to the humeral head (ball of the shoulder joint). 

Tears can happen through sudden trauma—perhaps due to a fall or a vigorous shoulder movement in sport—or through more gradual wear and tear that leaves the far portion of the muscle like a frayed rug. Depending on the injury, surgical repair may be necessary, followed by physical therapy for up to a year. 

The narrow passage of supraspinatus can lead to wear and tear if the shoulder joint is misaligned due to poor posture.

How the Gokhale Method helps restore rotator cuff health

The good news about your rotator cuff is that it can be improved and often fully healed by adopting natural, healthy posture. 

The local solution is to learn how to do a shoulder roll. This technique will take each shoulder home to its natural position, where it lived when you were a young child. 

The shoulder roll picks up all the bones that make up the shoulder—the upper arm, the collar bone, and the shoulder blade—and allows them to reposition and settle in better alignment with one another. This creates appropriate space for all the soft tissues in the area, including the muscles, bursae, blood vessels, and nerves, so they can function well. 

Shoulder rolls are a more effective and sustainable solution than simply pulling your shoulders back or “sitting up straight.” These common measures tend to create additional problems such as inflamed rhomboids and a swayed lower back.

To practice the Gokhale Method shoulder roll:

  1. Relax your shoulder girdle
  2. Glide one shoulder forward
  3. Rotate your shoulder upward
  4. Continue to rotate it back as far as is comfortable. Let it relax down.

Tip: Make sure the movement occurs in your shoulder. Resist the tendency to wave your arms, sway your back, or twist your torso or neck.

Diagram of figure x 4 performing backward shoulder roll.
This gentle sequence of movement restores a healthy position for your shoulder joint and rotator cuff—one roll at a time.

Students often report that learning the shoulder roll has brought additional benefits such as a more open chest, improved breathing, and improved blood flow to the arms and hands. Over time, performing shoulder rolls counters thoracic kyphosis, or rounding. Its gentle “massaging” action feels pleasant, can relieve knotted muscle tension in the area, and ease neck tension and headaches. You can make a start on your shoulder roll with our free video here.

Happy shoulders are part of healthy posture

Your new healthier shoulder position will always work best in the wider context of your posture as a whole. A change in one place facilitates shifts elsewhere, and vice versa. For example, your shoulder alignment is affected by your head position, your breathing, the angle of your ribcage and pelvis, and even how you stand. The position of your pelvis in particular affects your shoulders and upper body.

The principles and techniques that will help you to remodel your posture are taught in logical sequence and detail in our in-person Foundations course, one-day Pop-up course, and our online Elements course. If you have or are recovering from rotator cuff problems, the Gokhale Exercise program can help you to exercise in a way that is safe, therapeutic, and fun! 

Best next action steps for newcomers

If you would like insight on your posture, consider scheduling an Initial Consultation, online, or in person.

You can sign up below to join one of our upcoming FREE Online Workshops. . .

How Do I Fix My Neck Pain?

How Do I Fix My Neck Pain?

Esther Gokhale
Date

Do you suffer from neck tension, muscle knots, or tingling in your fingers? Do you get frequent headaches?

Or maybe your neck is fine most of the time, but seizes up periodically, leaving you unable to function normally in your job, family life, and recreational activities.

Drawing of woman wearing cervical collar
A soft cervical collar is a common prescription to alleviate neck pain. It can give welcome support in the short term, but doesn’t help to strengthen your neck or get to the source of the problem. Wikimedia Commons

Most neck pain involves compression. 

In modern cultures, the head often drifts forward as we slouch and crane our necks towards our computer screens. The weight of the head, (typically 11 lb. or 5 kg—think bowling ball), then requires the muscles at the back of the neck to contract strongly to keep the head up. This contraction compresses the relatively delicate tissues in the area. Not a recipe for a healthy, happy neck. If you have forward head carriage but are symptom-free so far, keep reading for tips that will prevent future problems with the discs, nerves, blood vessels, and bones in your neck.

Man using desk computer, slumped, with forward head carriage
In our culture slumped desk work posture and a degree of forward head carriage is common. Pexels

Restoring the natural length and position of your neck

Young children, ancestral populations, and people living in traditional societies around the world preserve a natural head carriage that stacks the neck well as part of a healthy J-spine. This allows the head to be balanced with only appropriate muscular effort, and the neck to be tall and free from compression. 

Young child with well-aligned neck
As young children we instinctively align our neck well over our body. Pexels

Restoring mobility in your neck

Perhaps you have experienced increased stiffness and reduced mobility in your neck over the years? Or unpleasant gritty sounds when you turn your head? Beware of exercises that include extreme flexion, extension, or head circles. These movements, taken to the end of your range of motion, can damage your discs and pinch your cervical nerves. If they are a part of your exercise regimen, consider reducing their range. 

Diagram showing the bones, discs, nerves, and major blood vessels of the neck.
There are many delicate and vital structures within the neck, so we first want to align it well. (front view). Wikipedia

In our experience it is best to focus on restoring the neck to a healthy baseline length and shape that centers your head well on your spine. The video below shows you how to proceed:

This gentle movement will help you to find a safe, natural trajectory to get started on gliding your head up and back.

If you have areas of long-standing rigidity or curvature in your neck, it is likely linked to your postural distortions elsewhere in your body, for example thoracic rigidity or a tucked pelvis. 

Expect this to take more time and training to change, for which you will be rewarded with additional benefits including comfort, improved circulation, and increased energy.

Finding your neck strength 

While many of the neck’s structures are delicate, they can also be strong. The deep muscles that are intended to support the neck and keep it tall tend not to get used very much in modern industrial culture and are often weak. Besides doing strengthening exercises, as is common in conventional approaches to neck problems, learning to carry weight on the head is extremely valuable. 

Woman in Odisha, India with a tall, straight neck and functional head posture.
People in traditional societies preserve a taller, straighter neck, and more functional head posture. (Odisha, India)

Cultures that headload suffer much less neck pain than we do and can teach us much about how, where, and why to headload. Not only do these people have excellent neck health, but they also have excellent posture throughout their bodies, and move with elegance and efficiency. Students in our classes begin with light weights to sense the axis along which they need to stack their bones. Over time, the weight can be increased to further strengthen the longus colli, inner corset, and other muscles. 

Student learning to head-load in glidewalking, guided by Esther Gokhale.
The small extra weight of the Gokhale™Head Cushion enables students not only to strengthen the deep neck muscles and lengthen the neck, but also to better orient their entire skeleton. 

My book 8 Steps to a Pain-Free Back has many images of people throughout the world headloading. Healthy head carriage, as opposed to forward head carriage, is an important starting point for this activity. It is not possible to carry significant weight without both the healthy neck alignment and strength to avoid compressive forces.

Woman showing an elegant, well-aligned head and neck (Thailand)
A well-aligned head and neck is both highly functional—and elegant

Because about one in three adults are affected by neck pain every year¹, we introduce techniques for the neck early on in our in-person Foundations course (Lesson 1 of 6), in our one-day Pop-up course, and our online Elements course (Lesson 4 of 18). Here students learn in detail the gentle techniques that gradually return the neck towards the length and pain-free position we all enjoyed as infants. Whatever your age, your neck is something you can learn to once again stack in your favor.

References: 

  1. Institute for Quality and Efficiency in Health Care (IQWiG), “Neck Pain: Overview,” InformedHealth.org, last modified February 14, 2019, https://www.ncbi.nlm.nih.gov/books/NBK338120/.

Best next action steps for newcomers

If you would like insight on your posture, consider scheduling an Initial Consultation, online, or in person.

You can sign up below to join one of our upcoming FREE Online Workshops. . .

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