Yoga Therapy For A Rotator Cuff Tear

Listen in as Brandt shares strategies and discusses best practices for working with rotator cuff tears.

One was a question about rotator cuff tears. What’s the deal with them? Can you tear it more and how careful do I need to be? That’s really the basics of this question. So, the answer to that is, it depends. Without giving an hour lecture on rotator cuff tears, I’ll say this – that basically tears have different sort of grades to them. So, it depends how severe the tear is, so you need some information from their doctor about tears. There’s no way for you to know how torn something is. But that said, unless it’s really intense, so they usually grade them, so if it’s a low-grade tear which is kinda the most common thing especially if it’s not a trauma, if it’s just like over time. I see a lot of people have tears and, you know, usually when a yoga therapist gets, and they’ve been to PT, and so this has been my experience. This is just one possibility, but a lot of times they’ve gone to PT and they’ve done rehab exercises that have either worked partially or not worked. When they haven’t worked, it’s usually has something to do with – well, there’s lots of reasons they could not work. But often what you see as a yoga therapist coming in after all that is, or what I’ve seen is that the PT has given them exercises that were too strong. They didn’t work on them gradually and I think that was a problem.

The other thing I see kind of commonly is with older people, say above 60, sometimes they write them off like, “Yeah. You have rotator cuff tears and here’s a couple of exercises.” And, you know, obviously, no PT or Physio should do this, but it just kind of happens a lot. I don’t know if it’s just because of ageism or…because I just see so many and it’s kind of a mill and it’s hard to keep track of everyone. But they say, “Well, you’re good enough.” I get a lot of those. So, one thing you need to remember is that non-painful movement is really important. So the non-weight bearing, no-pain movement to warm up the area, and also to sort of treat whatever arthritis may not be in there coexisting with the tear, so that would be good. Do a lot of that, a lot of moving and breathing. And then when you start to strengthen, one of the key things is to do it in a way that’s suitable to their shoulder. And you can’t always tell while you’re doing it. So a lot of times it’ll feel fine in the session but what you want to do is follow up and make sure that you’re doing things that don’t really inflame it too much, say, the next day afterwards. I always follow up with my clients. So, those are the two things I would think about.

The third thing is a technique. Actually, Karina in this course was teaching that to us on the last retreat. But where I’ve used forearm stand against the wall, sometimes on the floor, depending on the shoulder to sort of reset the shoulder. I’ve used other techniques like that where you use the muscles and then the working theory is other muscles take over usually for the supraspinatus which is torn. Her group has a technique where you do forearm standing against the wall and you relax your upper traps, and then right afterwards, you kinda swing your arms up and down, and that sort of resets it for the day, or forever, or for a few hours depending on the person. So that’s another technique that I could show you sometime. The main thing is that you have to kind of stay on them and make sure that the strengthening exercises you’re doing are not inflaming it too much because, you know, it’s a sign of a couple of things. But one is that you’re really getting at the sort of attachment where it’s torn and that could be really dangerous.

Where I’ve seen people make mistakes in the past is that they don’t follow up properly. And so the person seems fine, and then it swells up, or it hurts a lot the next day, and then the person thinks, “Well, this is probably just part of me having a hurt shoulder. I’ll just keep doing what I’m doing.” And that’s kind of the danger zone. So I would be careful there. Make sure you follow up. You want to talk to them on the phone the next day. You can do it by email. I try to actually talk to them so I can ask them some questions. Questions like, “Well, does your whole shoulder hurt today more than it did yesterday? Is it more sore today than it was yesterday?” Some people are pain sensitive and they’ll always tell you something hurts. Other people go the other way and they’ll be like, “Oh, it’s fine.” I have a guy like this right now, actually, I’m working with who says, “Oh yeah, it’s fine.” But what he really means is that he can handle the pain. So you have to ask more specific questions like, “Look, is the pain today worse than it was when we were working yesterday?” That’s a very specific question as opposed to “Does it hurt?” So just keep all that in mind.

Helping Clients Localize Pain

In this segment, taken from a Breathing Deeply Yoga Therapy Program Q&A, Brandt shares techniques for helping clients specifically identify areas of pain.

Get Out Of Pain: Muscles Vs. Fascia [Yoga Therapy Insights]

In this segment of a Yoga Therapy Program Q&A session, Brandt Passalacqua, founder of Breathing Deeply Yoga Therapy, discusses why exercises that strengthen muscles and promote muscular balance should be prioritized over simply reshaping fascia.

Yoga Therapy For Sciatica

Sciatica ImageSciatica is a common complaint. People experience pain along the sciatic nerve which runs down the back/outside part of the thigh and calf, can affect the foot, the heel and the space between the first and second toes.

Technically, sciatica is not a condition itself. It’s a symptom. And depending on the cause, it needs to be treated differently.

In my practice, I have worked with many for sciatica symptoms. To think of them as one group would be a mistake, since the causes are varied and therefore, the treatments were, as well. All however involve some sort of impingement of the sciatic nerve that causes symptoms.

Some Possible Causes Include:

  • Herniated disk in the lumbar area (lower back)
  • Spinal stenosis (bone growing and irritating nerve)
  • Arthritis in the lumbar or sacroiliac (SI) joint region
  • Other SI problems

Some Muscular Causes Include:

  • Piriformis issues (sciatic nerve runs under or through this muscle)
  • Quadratus lumborum (QL) issues
  • Low back muscles in combination with above

So what do we as Yoga Therapists do to help?

First we try to figure out the issue. Ideally we would have some pictures letting us know if there is a herniated disc or stenosis in the spine. This can also be figured out by knowing whether or not forward bending or back bending makes it worse. If forward bending makes it worse it is usually the herniated disc variety and with back bending, the stenosis variety. People often will want to stretch the pain away. They will stretch their hamstrings and get very temporary relief. This however is often not the best idea because it requires forward bending and often aggravates herniated disc issues.

In my opinion, the ideal approach is to create space in the lumbar vertebrae, strengthen weak muscles that contribute to compression of the spine, and strengthen weak muscles that cause the piriformis to overwork. Finally, stretch muscles that are shortened (usually hip flexors).

If Yoga Therapists do this while keeping in mind the client’s limitations based on the forward bending and back bending assessment, a sequence can be developed that is beneficial for their body and can move them towards resolving sciatica pain.

In Summary:

  • Get a good read on whether back bending or forward bending is contraindicated
  • Don’t stretch away the pain
  • Strengthen weak muscle groups
  • Stretch shortened muscle groups

In the Breathing Deeply Yoga Therapy Program we learn assessment techniques to individualize treatments for conditions like sciatica. You can learn more about our yoga therapy school here or be referred to a BDYT, by contacting us here.

May all beings be free from suffering,

Yoga Therapy For Pain Management: A Real Opportunity [Outside Of Opioids]

pilltrayThere has been so much news this year on the raging opioid epidemic in the US. Doctors have over prescribed addictive opioids for pain syndromes for years. The result is a population needlessly addicted to pharmaceutical drugs—drugs that often stop providing the pain relief they were prescribed for.

The nation (and world) is now looking for alternatives. How can people work with and take charge of their pain without dangerous drugs?

Yoga therapy is an extremely effective treatment for so many pain syndromes. On a physical level, properly prescribed asana (postures) can realign structures, create strength in weak muscles, stretch muscles and reshape fascia to facilitate joint mobility. Asana has provided relief for many musculoskeletal complaints including back pain that affect 80 percent of adults lives.

Studies have also begun to confirm that yoga including meditative practices increase pain tolerance dramatically. In one study, adults who practiced yoga regularly increased their pain tolerance by 2x. Another study found that pain and anxiety tolerance increased in individuals after a 3 day meditation retreat. And there are dozens more of these studies. The take away is that yoga therapy is uniquely positioned to help with conditions that affect most people and is a lower cost remedy, without the extensive lists of side effects.

So is yoga addictive? Well that’s for another day.

Please find me (here) if you are looking for help in this arena. May we all find health, peace, and light today.