Our rotator cuff consists of 4 key muscles and a wide group of tendons and ligaments that hold your shoulder in place. It is one of the most important parts of your shoulder. Your rotator cuff allows you to lift your arms, and carry items around.

What is self-ART?

Active Release Techniques (ART) are a soft tissue method that focuses on relieving tension by the removal of tough tissues/adhesions which can develop as a result of overloading due to repetitive use.[1] These tissue disorders may lead to muscular weakness, numbness, aching, tingling and burning sensations. ART has been reported to be both a diagnostic and a treatment technique, however, although there is little scientific evidence regarding the effects of ART on various pathologies, there is a lot of supporting evidence in anecdotal form and also that based on case reports.

The Purpose of ART?

ART is used to treat symptoms with muscles, tendons, ligaments, fascia and nerves. Its purpose is 3-fold:

• to restore free and unimpeded motion of all soft tissues
• to release entrapped nerves, vessels and lymphatic drainage system
• to re-establish optimal feel, resilience and function of soft tissues.

WHY many people would benefit from completing self-ART?

We live in an age, where because we sit for long periods of time in a poor position, our shoulders gradually become rounded. This leads to shortening and lengthening of muscles, that causes tightness and overloading of specific muscles and tendons. Consequentially, this leads to an increased likelihood of rotator cuff tears.

For this reason, regular self-deep tissue release is recommended in order to soften, warm and restore the relaxed and lengthened state of the tissues. Traditionally this is completed by massage therapists, but with the advancement of products and techniques, there are many self-ARTs that you can do very simply at home, saving you time, money and effort of travelling to a clinic. For any deep seated issues, that although these techniques may help may still persist, it would be recommended to see a GP or Physiotherapist to understand the cause.

HOW do you complete self-ART?

Tissues are prone to negative changes from trauma, such as swelling, and toughness of tissues. During treatment, you apply deep tension at the area of tenderness whilst you actively move the injury site from a shortened to a lengthened position. The placing of a contact point (ball) near the problem area and causing the patient to move in a manner that produces a sliding motion of soft tissues, e.g, nerves, ligaments and muscles beneath the contact point.

Short Example of How:

Easy = tennis ball

Medium = massage ball

Hard = Lacrosse Ball

Variable settings = massage gun

References

1. External coxa saltans (snapping hip) treated with active release techniques: a case report’, The Journal of the Canadian Chiropractic Association, 2006 September, volume 51, num. 1, pp. 23 – 29
2. http://www.xcelart.com/shoulder-pain/
3. https://www.onyourmark.nyc/post/2016/11/20/active-release-treatments-for-shoulder-injuries-and-pain-relief

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The ‘pecs’ or, the pectoralis muscles, as they are formally known, connect the chest bone (the sternum) to the upper arm (the humerus).

The action of the ‘pecs’ is to flex, adduct, extend, depresses and internally rotate the shoulder. As you can tell, they are quite a keystone to shoulder movement and overall posture!

Where do they attach, and why does that matter?

The pectoralis major is a thick, fan-shaped muscle that originates midway along the collar bone (the clavicle) and runs down all the way down the chest bone (sternum) until around the 7th rib. From this wide platform, it fans out to insert into the bicipital sulcus at the top of the humerus.

The pectoralis minor is a thin, triangular-shaped muscle that originates from the 3rd-5th ribs, and inserts into the coracoid process, which is the most forward-facing point of the shoulder blade (scapula).

The attachment points of the pecs are highly significant. This is because, if our pecs become progressively tighter through; prolonged sitting posture, poor ergonomics at our computers, extended periods of texting, too much chest press exercises, and not enough upper back strengthening… to name a few, the pec muscles will pull the top of the shoulder (the humerus) forwards and inwards – causing that infamous ’rounded shoulders’ look.

Additionally, this is the point at which your injury risk exponentially increases. This is because;

1. The rotator cuff muscles alter their share of the load, with tightness (of pecs) leading to strength, and elongation (of rhomboids/back mucles) leading to weakness = increasing likelihood of rotator cuff tears.
2. The subacromial space gets smaller, which then will lead to compression of tendons, and bursa as the arm moves.
3. Degradation of the rotator cuff occurs, when they are continuously overloaded, causing frayed tendons (like rope that’s worn into), until either surgery is required, or intensive Physio rehab to prevent the first option!

The solution?

1. Ensure those dastardly ergonomics at your desk are optimal.
2. Strengthen your upper back muscles by completing low rows and banded external rotation exercises.
3. Stretch those pecs regularly. (prevention is better than cure, trust me!)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836557/

https://ard.bmj.com/content/56/5/308

https://www.physio-pedia.com/Epidemiology_of_Shoulder_Pain

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25% of the population will develop shoulder pain in their lifetime

The basics of anatomy

The shoulder is a ball (head of the humerus) that sits in a socket (glenoid fossa – part of the shoulder blade) – which is held together in a truly magical form by an array of muscles that ultimately work together to bring about some truly awesome feats.

“Did you know that the shoulder joint has the most range of any joint in the body.”

The four key muscles responsible for maintaining shoulder stability and providing strength for everyday tasks are the rotator cuff muscles. These are the; Supraspinatus, Subscapularis, Infraspinatus and Teres Minor.

Our other friend is the ‘acromion’. This is a flat bone that sits above the ball (top of arm), and holds the shoulder to the rest of the body by allowing muscles to connect to the shoulder blade. Between the ball and the acromion, lies the ‘sub-acromial space’. This structure is vital to understanding rotator cuff injuries and shoulder pain. This is because, when the head of the humerus moves, so does the shoulder blade. This complicated relationship, can cause havoc if parts of the rotator cuff mess up!

Below are some of the most common injuries seen by Physiotherapists; 

• Subacromial Impingement or SAI
• Rotator Cuff Tendinopathy
• Frozen Shoulder
• Arthritis of Shoulder
• Myofascial Trigger Points

Most of these are caused by poor care for our shoulders, and more specifically, our rotator cuff.

Why does it all fall apart?

Your 4 rotator cuff muscles are akin to 4 horses pulling a cart – they all work together to lift/push/pull/stabilise and hold the shoulder, and body. If one is weaker, then the other horses have to take up the slack, or if stronger, they take away the natural strength training away and compounds the weaker muscles. This trajectory is heading towards injury.

So why would some be weaker, and others stronger? Were we designed incorrectly? Have I got a disease? The answer is no, very simply, it is our lifestyle!

The human body was created for activities such as, walking, running, swimming, climbing – not sitting tied to a desk for long periods of time, relentless tapping on our phones/devices, or indeed slumped into a sofa binge-watching netflix!

Now, the sad truth is, that due to our long-standing affair with sitting, our culture is turning into ‘C’ shapes and along with this, comes the truth behind the rising level of shoulder injuries.

How to prevent breakdown of your shoulder?

1. “Prevention is better than cure” – so the saying goes. Unfortunately, this really is true. We can either wait until our lifestyle pulls our shoulders so far out of line that underlying damage starts and the long road out of the biomechanical mess begins, let alone the impact on our neck and back, or we can start today and get on the road to strength!
2. You need to assess 2 key areas and make changes. You NEED both actions to WIN. One without the other and you will be spinning the wheels of rehab and getting nowhere fast.
   1. What are you doing that is positively impacting your shoulders?This can include;
      • strengthening your upper back
      • stretching your pectoralis muscles
      • strengthening the external rotators of your shoulders
      • awareness of posture at rest and during play – and more…
   2. What are you doing that is negatively impacting your shoulders?For example;
      • poor desk set-up/laptop working
      • too many chest presses/not enough rows
      • sitting posture
      • lifting weights far too heavy for you

Your 3 Takeaways

1. Your shoulders need intentional tender loving care, to prevent breakdown, and injury.
2. You have the ability to wage war on your shoulders, or bring peace through the actions you take, or indeed, don’t take.
3. Stay connected with Siphox Health to help you through your rehab journey – and share the joy with others!

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836557/

https://ard.bmj.com/content/56/5/308

https://www.physio-pedia.com/Epidemiology_of_Shoulder_Pain

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