Juggling is a complicated skill requiring one to have intricate handling of various objects. One false move and the act is over. Add more objects and the tasks require more attention to detail. I have tried it and still cannot perform it. I am in awe and jealous that someone can make it look that easy. Maybe, I just need to practice it more often. This analogy is my way of explaining how the shoulder works. A common question I get is, “Can a torn shoulder (rotator cuff) muscle heal itself?” or “Can a tear get worse?” In order to appreciate the complexity of that simple question, I will explain how the shoulder unit works.
The shoulder is the most unstable joint in the body. It is connected to the skeleton by the inner part of our collar bone, the sternoclavicular joint. There are two main groups of muscles that support arm movement, the rotator cuff and shoulder blade muscle groups. The two groups of muscles are designed to fail. How? The shoulder joint is a ball and socket design. Picture a basketball supported by a small bowl (1/3 size of the ball). Try to keep that ball from falling out as you spin it. If you say that is not a problem, flip that design upside down and try to keep the basketball centered within that bowl. You can’t! That is the job of the rotator cuff muscle group – to suck the ball within the bowl when you reach back, side, and up. This is one reason why it is common to dislocate your shoulder. If you dislocate your arm, the chances of it reoccurring increases dramatically. Imagine that you are attempting to juggle on a unicycle and you will understand the job of the shoulder.
The shoulder blade (scapular) muscle group is designed to support and lift the socket in a position so the ball does not tip out so easily. Okay, how and why is this a flawed design then? Our sitting and inactive society is the culprit once again. Children are doing less and less primitive movements like climbing, hanging, throwing and crawling. School systems and parents are more afraid to let their children run wild nowadays. I personally am afraid due to all the weirdos and pervs out there. The high demands of pushing, pulling, and lifting help our scapular muscles become strong. Prolonged sitting causes our scapular muscles to be molded in a position of weakness. Think a big bodybuilder with massive arms who workouts his pecs/chest only. One can see that they have limited overhead motion since their biceps and chest muscles get in their way. Sitting produces that same phenomenon, but to a milder form. When they say “sitting is the new smoking”, it applies just as much to the arm than to the back.
Did you know that to reach above to the highest part of your kitchen cabinet requires your (thoracic) spine and ribs to assist in producing the end range of shoulder overhead reach?The sitting society impacts this factor which places our shoulder to work at a disadvantage again. You can feel this happen. Sit up tall and raise your arm over your head. Then sit slouched and raise your arm over your head. You should feel how your arm feels stiff and possibly painful to raise you arm in a slouched posture. Imagine now that you are attempting to juggle with one arm behind your back on a unicycle. It is possible but just harder to perform this feat.
There are more factors to “juggle” when managing the complexity of the shoulder region. When I write about rebalancing the “inner and outer” core, I find that this concept is commonly overlooked. To explain the “inner” core impact on the shoulder, bunch up the bottom left side of your shirt into a knot. Raise your left arm and you should feel your neck line slowing your ability to raise your arm up. It is a mild form of tension. This is how organ issues, ranging from upset stomach and indigestion to constipation can impact efficient shoulder motion. This concept is exaggerated if one has a history of abdominal surgery like gall bladder and appendix removal (which is all too common nowadays).
“Outer” core is important, especially for athletes. An unstable shoulder complex relies heavily on a strong trunk to leverage movement. With decent arm strength, you can get by if you have strong trunk control and strength. A strong-arm can only do so much with a weak core. Think fishing from a row boat compared to fishing from a pier. You work less reeling a fish to you from a pier than from a row boat. A pitcher will likely fail if his “core” is weak and his strong arm fatigues.
Now that I explained how the shoulder unit moves and functions, the answer to whether a rotator cuff muscle tear can heal itself is “yes but rarely.” The tear tends to get larger over time due to the mechanics of the shoulder. The juggling act is what intrigues many rehab clinicians to love treating the shoulder, but frustrates me at times when there is a plateau in the patient’s care. There are so many factors to juggle within a short amount of time. Oh yeah, add the brain to it and the juggling goes to a whole new dimension. Juggle work, family, healthy eating, and other factors and now you can see the complexity of shoulder care. I like this analogy because when a shoulder rehab does not go your way, understand there is still hope. Your shoulder needs more than a shoulder care but a commitment to a comprehensive upper body fitness program and thorough look at the environment to help the juggler learn without the extra life distractions.
Contact me if you are interested in ten shoulder care exercises, whether you are a pitcher or a teacher, young or old.