Key Points

• The shoulder is the most movable joint in the human body—making it also the most vulnerable.

• A shoulder injury does not automatically mean the problem is the rotator cuff.

Starting off with a clear sense of anatomy is rule number one. Let’s take the rotator cuff, for example. Let’s say you’ve got a client who comes into your office and claims rotator cuff pain as a problem (without having seen a professional) in the way that humans want to claim land. This rushed, unabashed assertion seems to be worth hanging all hopes on—regardless of whether it is right. And that’s OK. The comfort we find in a “diagnosis” is worth something. But the actual rotator cuff is only a small window into what the heck could be going on. And a solid grasp of anatomy is like having a lawyer on your side if someone is trying to claim land you already own.

The truth is there are 17 muscles that manipulate the scapula. And what’s even cooler is the fact that there are no muscles that influence the shoulder that do not touch the scapula. Even the latissimus dorsi stakes a small claim on the inferior angle of the scapula, just to have some skin in the game . . . or fibers, I guess, would be the more appropriate term here. Point being, distinguishing the rotator cuff muscles and their collective raison d’être from the rest of the muscles that just might be throwing a wrench into the equation would be a really great tool to have in your pocket.

Let us review, shall we? The four muscles of the rotator cuff include the supraspinatus, the infraspinatus, the teres minor, and the subscapularis. The tendons for each of these have strategically found a handhold on the head of the humerus so that they create the awesome “rotation” action the shoulder is so good at. But they also team up to secure that humerus in place. In your textbooks, this is categorized as “stabilizes the head of the humerus in the glenoid cavity.” And this is no small feat. The shoulder, as you may know, is the most movable joint in the human body—making it also the most vulnerable. So those tendons have a heavy task to bear.

And when you combine that responsibility with the job of movement these muscles already struggle to manage, a lot can go wrong. The issue is, though, that the other things that can go wrong don’t necessarily mean there is a rotator cuff problem. If you take into account that there are no muscles that move the shoulder without having some sort of contact with the scapula, there are a lot of chefs in the kitchen, so to speak. Every one of them is grabbing at the scapula and pushing or pulling the shoulder in one direction or the other. This means if something goes wrong with one of them, the chances that the others are affected are pretty high.

For example, let’s say the supraspinatus is not operating at peak performance. Maybe it is strained from doing too much. Maybe it’s weak from doing too little. Maybe it is pinched from a particularly heavy purse strap that seems to think digging in and being awkward is funny. Whatever the case may be, the supraspinatus has antagonists. And these antagonists are going to react in some way. They have not meditated enough not to react.

So, because the supraspinatus is in charge of abduction, the antagonists are going to be the muscles that bring the arm back down into adduction. In this case, there are many. To be clear, that list includes the latissimus dorsi, the teres major, the infraspinatus, the teres minor, the pectoralis major, the triceps, and the coracobrachialis. Note: Only two of those seven are rotator cuff muscles. And there is a very good chance that one of those non-cuff muscles is having issues.

Try This

If a client has a supraspinatus like the one described above, don’t join the rotator cuff fan club and limit the possibilities. Methodically work through the list and remain open to the idea that pain and disfunction do not understand the confinement of human categories. Before your client gets on the table, have them abduct their arm against your resistance while you palpate each of those muscles in cahoots to create adduction. Play around with a slight internal and external rotation with each lift of the arm to give you even more information. And then repeat this process with a resisted adduction.

There are an enormous number of factors at play when dealing with shoulder pain. As you engage your clients’ muscles and palpate the surrounding tissue, remember that it can be a little like finding a needle in a haystack—except you have the gift of time and the patience of holistic touch on your side. Use your sessions wisely. Explain to your clients that what you do takes time. And then use your hands as the nuanced tools they were meant to be. This is exactly why we do the work we do.