www.amtamassage.org/mtj 17 - - nt e on i t i t Cont t er ond Exp on c mm o s c i y th group because their distal tendons and blend attach to d b e t ec Body Mechanics as the rotator cuff gether in a cuff-shape across the greater and lesser tubercles the on head of the humerus. Although all four rotator cuff muscles specific have concen actionstric the at mover glenohumeral joint, their (GH) primary functional importance is to contract isometrically GH joint stabilization. for Because - nts aff Artwork Giovanni Rimasti | Photography Yanik Chauvin Yanik | Artwork Muscolino Rimasti Joseph E. | Photography by Giovanni ie th cl i oup r ng w i

r Cuff G k r

wo Before practicing new any modality or technique, check with your state’s or province’s massage therapy regulatory authority to ensure that it is within the defined scope of practice for massage therapy. Rotato The fourThe rotator cuff muscles are the supraspinatus, infraspinatus, teresand subscapularis minor, (Fig

ure 1). These muscles areure described 1). Rotator Injury Cuff 18 mtj/massage therapy journal fall 2015 tendinitis in other words, tendon, the of inflammation and ritation ir cause can tendon cuff rotator on the placed stress cal physi Excessive tearing. and tendinosus, tendinitis, are pathology cuff rotator of types common most The three body. human the of joint injured monly com most the is shoulder the low conditions, and back neck after fact, In injured. and stressed physically often therefore and active functionally it extremely is roles, mover stabilization both and has group cuff rotator the cuff musculature. musculature. cuff rotator the of injury and overuse in results commonly that workload heavy extremely It this is joint. GH the of motion every most with contracts musculature cuff rotator the functions, mover stabilization tween and 2B). (Figure Therefore, be contracts deltoid the when bones two the of prevents approximation musculature cuff rotator by the head humeral the of stabilization 2A). above Downward (Figure process acromion the against head humeral the of approximation and merus hu the upon force pulling avertical in results tually ac humerus the abduct to deltoid the of contraction isolated An 2. Figure in shown is abduction humeral ing involv this of example An stabilization. proximal this for responsible primarily are muscles cuff The rotator scapula. the of fossa glenoid the into down stabilized be must humerus, the of head the end, proximal sition, the po anatomic from adduction and abduction, extension, flexion, with occurs moved is which upward, humerus the end of distal the Whenever joint. GH at the zation stabili for isometric important primarily are muscles However, cuff rotates. rotator the agroup, as medially subscapularis the and rotate; laterally minor teres and infraspinatus the flexes; and abducts supraspinatus the action(s) joint GH concentric motion:own for humeral its has muscles cuff rotator four the of each stated, As macrotrauma, a rotator cuff tendon tear tendon cuff arotator macrotrauma, or a microtrauma it overuse whether is stress, physical continued with and tendon’s the of structure, weakness tendinosus as to referred is this occurs; tissue tendinous fascial the of degeneration and subsides often process matory and carpenters. Athletes that heavily rely on upper ex rely on upper heavily that Athletes carpenters. and workers, line assembly cleaners, house as such joint, GH the of use involve jobs continual whose for people true especially is This microtrauma. overuse repetitive of form the takes often group cuff rotator the of Injury Rotator Repetitive O Causes Cuff P . If the physical stress is chronic, the inflam the chronic, is stress physical the . If . The degeneration of tendinosus results in in results tendinosus of . The degeneration ve r atholog use Mi cr y ot r au m a might occur. might ------Coracobrachialis Deltoid (cut) Manual: The Skeletal Muscles of the Human Body, 3ed. Elsevier, 2010.) Elsevier, 3ed. Body, Human the of Muscles Skeletal The Manual: System Muscular The Muscolino. E. Joseph from permission with (Reproduced view. view. Anterior B, Posterior A, teres minor, infraspinatus, praspinatus, subscapularis. and Figu B A major (cut) Pectoralis Subscapularis Supraspinatus re 1. The rotator cuff group is composed of the su of the is group composed cuff rotator The Deltoid (cut) Infraspinatus Pectoralis major(cut) Te Supraspinatus res minor - www.amtamassage.org/mtj 19 ------criti s ial Rotation d c mati al Me r e m ma u al Zone au tional Kine tional c r . This in is prevalent clients who repeatedly or d H iti ot r cr he C T c Dysfun Couple Ma A macrotrauma is also a common cause of rotator cuff Examplesinjury. include a bad fall, lifting a very heavy object, accident. a motorvehicle or A macrotrauma can result in tendinitis; if or the traumaenough, is severe tearing. One of the most common causes of rotator cuff tearingoccurs when a client who has anexisting con dition ofrotator cuff tendinosus be even not may (and experiences a macrotrauma. of it), aware In these cases, if theeven macrotrauma is only mild to moderately se becausevere, the tendon is already degenerated and weakened, tearing results. The entireThe rotator cuff group is often overused and in due to its location, the mostjured. commonly However, injured region of the rotator cuff distal tendon is the supraspinatus tendon. distal The tendonof the supra spinatus travels between the acromion process of the scapula and the head of the humerus. Whenever the arm is lifted into abduction, the supraspinatus tendon can become impinged between these two strucbony tures. Indeed, this region of the rotator cuff tendon is sooften injured that is often it referred to as the cal zone chronically their have arms raised to the such side, as barbers/hair stylists, artists, house painters, and people theirwho sleep above with head. their arm(s) Impingement of the supraspinatus tendon between the head of the humerus and the acromion process of thescapula most often occurs with improper kinemat patterns) of humeralics (motion abduction. are There three common dysfunctional kinematic patterns in volving humeral abduction. One is humeral abduction coupled with humeral medial rotation; another is hu meral abduction coupled with scapular downward rota tion; and another is humeral abduction with decreased inferior glide of the humeral head. tremity motion,such as swimmers, tennis and players, baseball are players, also to prone repetitive overuse rotator cuff These injury. overuse patterns re involve peated microtrauma to the distal rotator cufftendon thatmight result intendinitis, if or extremely chronic, tendinosus tearing. even or If the arm is medially rotated as is abducted, it the greater tubercle of the humerus becomes aligned in the frontal plane with the acromion process of the scapula. As a result, whenthe arm lifts into abduction, the great - - A, An isolatedcontraction of the deltoid results 2. re A B gu Fi (Reproduced with permission from Joseph E. Muscolino.) mion process above. B, Downward stabilization of the hu in approximation of the humeral head against the acro meral head the by rotator cuff musculature prevents this. 20 mtj/massage therapy journal fall 2015 be obliquely northwest! might to walk motion of direction easiest the when west, fectly per then and north perfectly walking on insist we should than anyenslaved planes the cardinal within to more only moving become not We should them. within out carried be must tions mo workout our why reason isno there But body. the of tions mo describing when space map and to way divide excellent are an planes cardinal transverse and frontal, sagittal, The joint. GH the at motions plane frontal pure involve they when least todesigned improve injurious, at be our health, might actually supposedly are which workouts, gym that isironic It planes. cardinal the in motions involves often which gym, the in out isworking example Another tennis. and ballet include amples Ex arts. the and sports of world the in usually activities, made human- artificial, in involved motions rather but life, natural of motions involve not do that activities during occurs often most degrees to 90 abduction plane frontal pure that out pointed be should it joint, GH to the comes it When plane. frontal the in move even not do joints ankle and elbow, knee, the Indeed, ed. limit more ismuch motion plane However, frontal orientation. our to change plane transverse the in well moves also It plane. sagittal the in to move designed isprimarily body human the to scaption. as referred isoften it that important isso scapula the of plane the within arm the of movement of significance functional The sight. of line our within therefore and scapula, the of plane the within it when functional ismost side to the out arm our of Movement isacoincidence. this that isunlikely It scapula. the of plane the to be happens which plane, sagittal the toward plane frontal the off degrees 30-35 approximately be will it stated, As hand. your see can you until flex) (horizontally anteriorly arm ducted ab your bring slowly now but plane; frontal the in abduction pure into arm your bring and straightforward looking stand before, As exercise: previous our amend now let’s So plane. tal fron the from degrees 30-35 approximately forward is moved it when view into comes first hand the that to note interesting joint. to the stress physical great in ing result tremendous, be would joint glenohumeral our on result would that force leverage the abduction, of degrees 90 at out arm our with object an up to pick wewere if Further, body. our to relative abduction plane frontal pure of position the of out arm the take effectively would arm the toward trunk our tating ro and this; to accomplish body our in lower likely, from rotate likely, as more or just wewould but it, to see neck and head our to rotate it? We with choose might doing weare what see even wecannot where to aposition hand our to move serve it would purpose what So isno. answer The hand? your see even you Can degrees. to 90 plane frontal the in abduction pure into arm your bring and straightforward looking Try Stand this: tional. func very isnot to any height plane frontal the in abduction pure Indeed, amotion. useful or common that isnot degrees to 90 arm the of abduction that wesee life, daily in patterns movement functional at welook If one. isavalid degrees to 90 arm our to abduct want even wewould why of question The S th Looking at the larger picture of human motion, we see that that wesee motion, human of picture larger the at Looking is it side, to the out arm the of movement examining When hould w hould e a ? rm e a b du c t

------preventing impingement of the tendon and bursa (Fig bursa and tendon the of impingement preventing thereby rotating, downwardly it preventing from lized, stabi be will scapula the deltoid, the with along tracts anterior) con or serratus lower trapezius, trapezius, per abduction.) humeral the panies it accom as rotated were laterally humerus even the if occur would impingement this that noting (It worth is 3C). (Figure humerus the of head toward the downward moving is process acromion the process, acromion the upward toward lifting is head humeral the as because process; acromion the and humerus the of head the between bursa subacromial and tendon supraspinatus the of impingement cause would This humerus. the toward rotation downward into scapula the pulls it also joint, GH at the arm the of abduction create to contracts deltoid the when because important is This impinged. become will tendon supraspinatus the zone of critical the prevent Otherwise, to rotation. downward bilized sta be must scapula the abduction, humeral During upper crossed syndrome crossed upper as known body the of pattern postural dysfunctional larger the of part usually is itself shoulders Rounded humeri. tated ro medially and girdles shoulder involves protracted rounded as shoulders known pattern functional dys apostural of aresult often is imbalance muscular deltoid). This minor, posterior teres (i.e., infraspinatus, muscles rotator lateral inhibited weak/overly and/or major), teres dorsi, latissimus major,lis subscapularis, minor, (i.e., pectora muscles rotator pectoralis medial facilitated tight/overly capsule, GH the in adhesions fascial to due be can This rotation. medial humeral in stuck are they because arms their rotating laterally or more. degrees 90 approximately to whenever it abducted is rotated laterally be to arm for the important 3B). it extremely is reason, For this (Figure pinched be to likely less are tissues soft the and acromion and humerus the between afforded is room more tubercle, greater the than smaller is er tubercle less the Because plane. frontal the in process romion ac the with tubercle however, lesser the rotation, aligns Lateral abduction. of degrees 90 at approximately curs oc usually tissues these of space.) Impingement this in impinged be may also tendon brachii biceps the of head long and ligament, coracohumeral capsule, GH the of 3A). aspect (Figure The superior (Note: bursa acromial sub the and tendon supraspinatus the are tissues soft These structures. osseous two these between located tissues soft the movement pinching and obstructing process, acromion the hit eventually will er tubercle Couple If instead, an upward rotator muscle (such up the muscle as upward rotator an instead, If Unfortunately, many people have a difficult time time have adifficult people many Unfortunately, d Sc r apula Downward Rotation . , which , which ------吀漀 栀愀瘀攀 愀挀挀攀猀猀 琀漀 琀栀攀 挀漀洀 瀀氀攀琀攀 愀爀琀椀挀氀攀Ⰰ 猀甀戀猀挀爀椀戀攀 琀漀 䐀椀最椀琀愀氀 䌀伀䴀吀⸀

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