Ep 287 - The Rotator Cuff and Pie Throwing: “The Rebel MT” with Allison Denney

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0:01:26.5 Speaker 2: The ABMPCE Summit on lymph is Tuesday, October 25th. During this free online event, you'll take an in-depth look at the anatomy, function and pathologies of the lymphatic system, as well as an introduction to the manual lymphatic drainage modality and MLD techniques for the neck and face. This online event, including three hours of CE is free for everyone in the profession. Learn more and register at abmp.com/summit. 

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0:02:03.9 Speaker 3: For a time in my life, what seemed like an incredibly long time while I was in the throes of it, I was convinced that I had been unluckily plucked from the masses to have a series of unfortunate events happen to me. And unlike my reaction to the TV show with the same name, I was not amused. Not only was I not amused, I was downright angry. I mean, other people got to have less chaotic stories, happy marriages, high earning jobs, and loving family members who lived right around the corner to help babysit the kids for free. Why was that not my experience? I was a nice person. I logic-ed, I worked hard. I had paid what I thought were my dues. I deserved a good life. I don't really know who I was angry at, but the feeling that I had been jilted would not subside. 

0:02:51.0 Speaker 3: The worst of it though was that the angrier I spun, the worst My life seemed to get, the question, "Why is it my job to not be angry so that people will like me," took up most of my waking days. I know people don't like angry people as a rule, but the fact that I needed to get over my own anger issues to be liked, which would then make me happy, which would then lead to a better life, just seemed entirely unfair. It was the world after all that was so anger inducing. I was just having natural reactions to what seemed like ridiculous circumstances. None of it was my fault. I suppose I had been predestined to this mentality that I deserved more. I have always been rebellious by nature, hence the name of my business. My rebellion though, was not necessarily trying to overthrow my parental/governmental powers that be. 

0:03:45.7 S3: It was always more of an effort to define myself separate from what I was born into. I had no interest in fitting the mold that had been laid out for me. Experiencing different parts of life, new foods, different cities and unfamiliar cultures was the only apparent way that I was going to figure out who I was. I was my own individual person and I was determined to find me. If I really take a philosophical dive into this, I might add that all Americans have this spark of individuality momentum in us. We were after all born into a country that was founded on the notion that we wanted freedom from the monarchy and liberty to be whoever we wanted to be, and there is a beautiful side to this persona. On the grander scheme we as a country have become the place where one can speak their mind, practice their chosen beliefs, and transform ourselves from rags to Oprah. 

0:04:42.5 S3: On a smaller scale we as individuals can spread our wings and explore who we want to be. Rebelliousness is in our genes, so to speak. As things go though, there is a not so beautiful side. Being more self-focused goes hand in hand with having a lack of other focus. This makes sense of course, but I wasn't as clear on the subject during my, I'm angry and none of this is my fault phase. I had always prided myself on my awareness of what other people wanted or needed. I became a massage therapist after all. I loved listening to people and helping them find ways to heal. The irony was that even in my efforts to be other oriented, I was still somehow bringing everything back to me, comparing, competing and constantly finding myself with thoughts of complaints and condescension. It was just way too hard to be endlessly working on myself. It was easier to let my brain drift and do whatever the hell it wanted to do. I deserved my Netflix and my nachos. How then do we break ourselves from what is so deeply ingrained in who we are and why should we even try; speaking as a massage therapist recording a podcast episode that attempts to present anatomy in a clear and digestible manner, I believe that the muscles in our bodies can help explain this conundrum. 

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0:06:12.5 S3: Let's take a look at the rotator cuff. Here are a group of muscles that all perform incredible feats with the shoulder complex when they work well as a team, but they are indeed individual muscles as the SITS acronym helps us to remember. They are the supraspinatus, the infraspinatus, the Teres minor, and the subscapularis. Each strategically situated around the shoulder girdle and attaching themselves onto the head of the humerus in such a way that they tug and pull at the arm to make gorgeous gestures of rotation. These muscles are integral to the health and wellbeing of the shoulder joint. There are examples of organic groupings of four all throughout history, the four horsemen of the apocalypse, conquest, war, famine, and death. The four major mathematical operations, addition, subtraction, multiplication and division, and the four kids of South Park, Cartman, Stan, Kenny, and Kyle. 

0:07:09.6 S3: In each instance, all parts of the four are separate, yet when combined create a more powerful whole. Granted the repetitious killing off of Kenny does not mean that one of the rotator cuff muscles should get mangled at the end of every week. But I would like to add the rotator cuff muscles into the history books. My point is, as each of these individual muscles surrounding, stabilizing and rotating the shoulder are unique and have their own actions, they tend to be somewhat self-oriented. One can get beefy and strong throwing the others into a fit of irritation. But incredible things happen when they put aside their differences and work together as a team like Cartman, Stan, Kenny, and Kyle. When they stop acting selfishly and pull together to create whatever adventure they have schemed up, great episodes are etched into the books. To break this down more specifically, let's separate them out because this is how we learn anatomy and then put them back together because this is how we understand anatomy. Starting at the top... 

0:08:12.1 S3: The supraspinatus lives just under the traps in the area that is often debated as to whether or not it is the neck or the shoulder. The meat of this muscle is nestled in the supraspinatus faucet of the scapula or the trough just above the spine of the scapula, and is mostly responsible for lifting the arm up and away from the body as if one might try to grab a pie off a shelf that is excessively high. Moving down the back of the shoulder, the infraspinatus is what is revealed after the curtains of the posterior deltoids and the lower traps seem to have parted. It lives flat on the infraspinus faucet of the scapula or the main surface of the scapula under the spine of this bone and its main job is to pull the arm back and rotate it up like when one might get ready to throw, said pie in a friend's face. Traveling down and into the armpit a bit... 

0:09:04.7 S3: The Teres minor is tucked under the infraspinatus almost as a lateral extension of it, existing just on the upper lateral edge of the scapula. The teres minor pulls the arm back down towards the ribs, keeping its position of lateral rotation, as if one might have changed their mind about decorating their friend's face with a pie. And last but wholeheartedly not least is the subscapularis. Tucking itself between the scapula and the rib cage and eating up the entirety of the subscapular faucet of the scapula, the subscapularis twists the arm inward as if one is trying to impress an on looking potential mate with looping said pie in and under the arm without dropping it. The insertions of each of these players dictates what the arm is going to do if one of them might contract. The SITS acronym, S-I-T-S, like I mentioned before, is not only a good way to remember the names of the complete cuff, but is also a visual representation of each attachment onto the head of the humerus. 

0:10:06.6 S3: And as this is a podcast, I will include a diagram on what this looks like in the show notes instead of trying to describe it and making an imaginative mess of things. Once you understand where they are and what they do, working on the rotator cuff muscles becomes a little more accessible. But I would argue that the real art of guiding them back to health is less about acknowledging them as individuals and more about teaching them the truth of teamwork. With your client prone on the table, arm at 90 degrees with the forearm dangling off the table, begin by standing on the opposite side of the table from the shoulder that is your focus. With your thumbs facing towards each other and your fingers cupping the medial border and superior angle of the scapula, begin by sliding out laterally following the outline of the scapula and sinking with your thumbs and thenar eminences into the infraspinatus and the supraspinatus. 

0:10:58.4 S3: Once you have reached the end of the shoulder where it starts to become the arm, wrap your fingers around the entirety of the shoulder and begin to lift it up off the table toward you and then pressing it back down into the table and then away from you. After repeating this a few times and adjusting this to make this move your own, switch your own position to the same side of the table as the shoulder you are working with, saying for the purpose of demonstration that you are working with the client's right arm, use your right hand to cup under their elbow. Lift their arm slightly up off the table and pull it up towards the head of the table near their ear. As you move the arm into this position and continue to move it into variations of shallower or deeper stretches, use your left hand to work into each of the rotator cuff muscles. 

0:11:45.2 S3: Slide under the axillary area to access the subscapularis, friction through the lateral border of the scapula. Opening up the teres minor, pin and stretch the infraspinatus, relieving some of the tension that lives there and sink into the softened supraspinatus. Offering it a rest from all that gravity. There are an unlimited number of versions of what you can do to unify this frenzied foursome, but keep this in mind as you go. If each of these muscles believes in itself so intensely and thinks that they are in a competition with the other muscles, and maybe even that they themselves are the victim of a series of unfortunate events, their ability to put their own self aside and think like a team will never be accessed. Showing a muscle how to communicate and get along with other muscles in its own group is the only way they will begin to know what being other focused even means. 

0:12:39.1 S3: The ability to love those you are partnered with in an effort to generate happiness and health isn't something that comes naturally. It is a learned skill. It takes a lot of hard work to know when you want to do something because it's all you've ever known, as opposed to choosing to do something because it will make those around you happy. You may have a deep seated gut feeling that throwing a pie in your friend's face might make people laugh and hence make you the head of the party. In reality though, it will most likely create a divide between you and your friend that might not be repairable. So how do we break ourselves from what is so deeply ingrained in who we are? We retrain ourselves to move in congruity and synchronicity and not with the sole purpose of single-mindedness. And why should we even try?  

0:13:29.0 S3: Because health and happiness stems from the wisdom of knowing who we are in our team because health and happiness stems from a wisdom of knowing who we are in our team and keeping that team in balance. I had to learn this the hard way, and I'm still learning. Even if we are still practicing this in our own lives, we can help our clients muscles to connect with themselves to strengthen that which might be weak and to calm that which might be overactive. As the famous family therapist, speaker and author, Terrence Real says, "The rule that surpasses all rules is that you must be connected, willing to see what's in front of you and willing to move if what you're doing isn't working." The rotator cuff is just like any other relationship. 

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0:14:16.7 S3: It is a team, and in order to work as a team, each of its members only do well if it recognizes this crucial rule. Implementing this into the work we do can change a person's life. 

0:14:33.8 Speaker 1: Members are loving ABMP five minute muscles and ABMP pocket pathology. Two quick reference web apps included with ABMP membership, ABMP five minute muscles delivers muscle specific palpation and technique videos, plus origins, insertions, and actions for the 83 muscles, most commonly addressed by body workers. ABMP pocket pathology created in conjunction with Ruth Warner puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today, ABMP members log in at abmp.com and look for the links in the featured benefits section of your member homepage, not a member. Learn about these exciting member benefits at abmp.com/more.