ROTATOR CUFF INJURIES

The rotator cuff is made up of four muscles that help move and stabilize the shoulder joint. Damage to any one of the four muscles or their tendons that attach the muscle to bone can occur because of acute injury, chronic overuse, or gradual aging. This can cause significant pain and disability with range of motion or use of the shoulder joint.

The shoulder is a ball-socket joint that allows the arm to move in many directions. It is made up of the humeral head (the upper end of the bone of the upper arm) fitting into the glenoid fossa of the scapula (shoulder blade). The humeral head is kept in place by the joint capsule and labrum, thick bands of cartilage that form an elongated cone where the humeral head fits. The rotator cuff muscles are the dynamic stabilizers and movers of the shoulder joint and adjust the position of the humeral head and scapula during shoulder movement.

Along with rotator cuff injuries there are other conditions that may cause symptoms similar to rotator cuff injuries.

Bursitis - inflammation or irritation of the bursa. The bursa is a sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation.

Impingement - When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain.

Shoulder or acromioclavicular arthritis - AC arthritis is the result of repeated movements that wear away the cartilage surface found at the acromioclavicular joint.

Frozen shoulder - The shoulder capsule thickens and becomes tight. Stiff bands of tissue called adhesions develop. In many cases, there is less synovial fluid in the joint. 

Symptoms include pain and spasm that limit range of motion in the shoulder, weakness, the larger the tear or damage to the tendons the harder it is to move your arm and the injured area, and sharp twinges and painful catches in the shoulder during arm elevation. 

Some of the different treatments from a Western point of view are icing, using anti-inflammatory medication which should be taken with caution especially if there is any underlying stomach, liver, or kidney problems, physical therapy and range of motion exercises, steroid injections into the shoulder joint, and surgical repair.

Shoulder pain is described in Traditional Chinese Medicine as stagnation or obstruction of the flow of qi (energy) and blood in the tendons and muscles of the Large Intestine, Small Intestine, and Internal Membrane acupuncture zones or meridians. Treatment is aimed at stopping pain, decreasing inflammation, and restoring range of motion and strength by moving qi and blood, clearing heat and obstruction, and draining dampness from the shoulder region. 

Cupping, gua sha, acupuncture, and acupressure or deep tissue massage are most helpful. Treatment is generally 6-10 weeks with patients coming in once or twice a week depending on the severity of the injury. 

Acupuncture works by increasing the circulation to the area and decreasing inflammation in the tendons. It also reduces pain and inflammation through regulating neural pain pathways, stimulating the release of natural pain relieves in the body, such as opioids, as well as regulating pain relieving opioid receptors. 

Chinese herbs can also be used to help rectify the qi and blood flow.

Massage techniques for the shoulder girdle will help increase blood circulation to the area, which also increases oxygen and nutrient flow which will encourage healing. Getting massage on a regular basis will help facilitate healing. 

Tuina acupressure massage is a bodywork therapy that has been used in China for over 2,000 years. Tuina uses the traditional Chinese medical theory of the flow of qi through the meridians. Through application of massage and manipulation techniques Tuina seeks to establish a more harmonious flow of qi through the system of channels and collaterals, allowing the body to naturally heal itself. One of Tuina’s advantages over simple massage is its ability to focus on specific problems, especially chronic pain associated with muscles, joints, and the skeletal system. It’s especially effective for joint pain, sciatica, muscle spasms, and pain in the back, neck, and shoulders. Tuina does not simply work on the muscles, bones, and joints. It works with the energy of the body at a deeper level!

I also want to add to this blog a little information on essential oils. Whether you are browsing this because you have a rotator cuff injury or you are a therapist looking for information on rotator cuff injuries, essential oils can also be a very effective addition to therapy. There are a number of essential oils that help relieve pain, relieve inflammation, and help circulation that can be applied to the shoulder and other parts of the body to assist in healing. Be sure to consult with someone who is trained in essential oils because there are contraindications for certain oils. I will list some essential oils that could be beneficial in massage for rotator cuff injuries! 

© Klenova | Dreamstime Stock Photos &Stock Free Images

Lavender - Helpful in relieving pain and inflammation. Treats muscle spasm, strains and sprains, cramps, contracture, and rheumatic pain.
Peppermint - Relaxes tense muscles, helps relieve tension headaches, relieves sore muscles and for general aches and pains. Increases white blood count, activates lymph flow and relieves blockage. 
Chamomile - Is a highly effective anti-inflammatory, and good for muscle pain and low back pain. German Chamomile  relieves pain and swelling from soft tissue injuries, possibly the best aromatherapy treatment for sprains, strains, contusions, and inflammation.
Clary Sage - Beneficial in relieving muscle spasm and cramps, has a powerful relaxing effect, helps relieve tension and stress. 
Sweet Marjoram - is a pain reliever and has powerful effects on pain and stiffness, it is recommended for rheumatoid and osteoarthritis which makes it an excellent choice for inflammation of the shoulders and other joints.
Vetiver - Fortifies and stimulates red blood cell production, increases oxygen in blood, vasodilator, stimulates circulation venous and arterial, detoxifies blood and connective tissue. 
Helichrysum - Muscular pain and contracture, sprains, and rheumatoid arthritis. 
Spruce - Relieves muscle aches, poor circulation, aching joints, arthritis, and is an anti-inflammatory. 
Lemongrass - Helps with connective tissue injuries (tendons and ligaments), muscular pain and injury, muscle fatigue, relieves aches and pains, anti-inflammatory, and increases blood and lymphatic circulation. 

Flower Essence and Healing

Flower essences represent one of the most dynamic healing resources available on the planet. Flower essences are infusions of flowers in water that are potentized and then stabilized in a solution of brandy and water. The water used should be purified or distilled in some way for best results. The essence itself has no floral scent or perfume and should not be confused with Essential Oils. Flower essence is very diluted, and the preparations are different as well. Also do not confuse herbal tinctures with the Flower Essences, they too are very different.

Flower essences are mainly used to promote awareness of emotional, mental, and spiritual imbalances. In addition to that they also may stimulate physical healing. They work on vibrational levels effecting subtle, deep change on the soul and psyche. They carry life-force energy from the flower devas to our body's energy/ Qi channels, acting as catalysts to rebalance us spiritually, emotionally, psychologically, and physically. The essences hone in on where we need realignment and balance, and encourage the self-healing that is needed. Flower essences can be used alone or in conjunction with other types of remedies and medications.

The length of time one should use flower essences is people by people basis, and once started, the dosage bottles are meant to be finished. It will take at least that long (approx. 4-6 weeks) for them to effect the desired vibrational shift. Some formulas can be taken indefinitely or at intervals (i.e. Immune Boost, Insomnia, Crisis/Trauma, Anxiety/Panic Attack, Jet Lag/Travel). Using your intuition to self-adjust your dosage is strongly encouraged. Also keeping a dream journal is recommended, the dreams you experience will help give you insight and become very vivid while using flower essences.

When making the flower essences, they do not “harvest” the plants. In most cases only a few wild flowers are gathered to prepare the infusions. The chosen flowers are placed in a glass bowl with water and put in the rays of the sun. It is stabilized by the brandy and subsequently diluted so that only minute traces of chemical compounds from the original flowers remain, making them completely safe for use. One could not overdose on flower essence. When making flower essences, listen to the plants and they will help you.


For the most part, flower essences are gentle and forgiving, and it is impossible to overdose on them because they are self-adjusting. Also, they are non-toxic and non-invasive. Nature is said to hold everything we humans need for our healing. With thousands of essences now available, there is an essence or essence combination that can benefit everyone.


I am having the pleasure of experiencing the flower essence of Bleeding Heart, Yarrow, Angelica, Baby blue eye, and Rock water. I have been ingesting this blend for a couple of months and have had amazing dreams filled with sorrow and grief, growth with the help of animals and endless travels. The dreams seem real, as real as this waking life. I feel as though my spirit inside me is creating a stronger connection with my body and mind. A bond of the body, mind and spirit that had been broken for to long. I give thanks to the flowers everyday along with my body because with their help, I am healing myself! No pills, drugs, or prescriptions! Just me, the flowers, some essential oils and a journal. Looking back I see how I have grown and enjoy the experiences I have had. But also learning to open up to the endless possibilities of what might be in the future.. And it all started with 5 different flowers.

some sites i found interesting and gathered info from

http://www.greenhopeessences.com/healing.html
http://www.flowersociety.org/

Heidi's case study

My client is 26 yrs old, 6’2 and is active and eats healthy. He has been a mechanic for 7 years. Client clams his job requires him to put his hands and body in to cramping positions. He clams of pain in both forearms, lower back, both shoulders (upper traps and rhomboid area), and that his hands will freeze up often, when this occurs he has to stop his work till he can move his hands again. which could take anywhere from 5-60 minutes.

The first massage was a relaxation massage with additional time spent on both arms, working the LI pain path. I noticed that his lung 9-10 acupoints were rock solid. The client states his hands didn’t freeze up for over a week. Used to happen 1-2x a week.

Second massage was similar with the back shu points added in. LU and HT shu points were tense and tender.

After this I formed a treatment for him involving guasha, bladder opening pattern [modified tui na massage], and working the LU and HT shu points and meridians down arms. Po Sum On is added to the treatment with success. 

As a result of the treatment the client’s hands have not frozen up on him, there is less pain in his forearm and he knows how to stretch them correctly. His energy level has increased and generally feels better. He is continuing massage weekly.

Six Week Journey

When I asked my sister if she wanted to help me with massage school, she didn't know what she was in for.  I explained that each student needed a case study, "Huh?"   A hands on experience, working with the same client to try and help with a chief complaint.  I told her the plan was to give one massage a week for six weeks.  She said she might be able to tolerate something like that.

I then came to know my sister in a whole new way.  She told me all about an experience she had in Oregon.  She woke up in the middle of the night, blood streaming out of her nose.  Jumping to her feet she noticed that her low back was spasming.  Waking a roommate to take her to the ER, she went to the restroom to grab something to staunch the blood flow   She next woke up on the floor, inches away from the cabinets under the vanity.  The ambulance was called. After a gurney trip to the ER, she was released with a clean bill of health.  She told me that she would really like to not feel faint anymore.  Not to be afraid of another night like that one.  In true Taoist fashion I gave the confident "I can help with that."

Learning a little about Traditional Chinese Medicine from the advanced classes in school gave me tools to put together a treatment plan.  I thought it would be best to do a series of three general relaxation massages, followed by more specialized treatments specifically to balance the water element.  This element jumped out at me from what she said about being afraid of fainting.  In Chinese Medicine fear is closely associated with the water element.  Armed with this as an overarching scheme, I hoped to add on more techniques as I learned them.

I was delighted to find out that my client was also planning to see an acupuncturist.  The treatments complimented each other nicely.  I noticed that in the massages just after her acupuncture she felt much more "open." Four weeks into treatment she confided that she no longer felt like fainting.  I noticed a shift in things at this point as well.  Many more lively happy days, a drive to eat healthy and exercise more.  An overall brightening of outlook on life.

To balance the water element I used an extended version of a pattern I had learned in school.  The Bladder meridian opening pattern.  This Tui Na flavored massage emphasizes warming the low back and balancing the entire body via the organ acupressure points on the back, known as the Shu points.  I also integrated an essential oil blend to help warm and boost immune function.  I used a mix of Ginger and Hyssop oils applied to the back in a carrier oil.  After the oil treatments the client always felt "great"

The six weeks had flown by.  My client was showing excellent improvement that I attribute to the acupuncture backed up by the balancing massage therapy.  In short, receiving massage on a regular basis seems to have many benefits.  This experience gave me a chance to observe them first hand.  My client reported: better digestion, more energy, less knots in back, generally warmer. improved mood, relaxed state carrying over into working life.  She plans to continue to receive massage and to enjoy its wonderful benefits.  And as for me, I am encouraged to grow as a therapist. I plan to learn as much as I can about how to help others, and myself, along life's journey. Namaste

Betsy's Case Study

Summary

My client was diagnosed with Multiple Sclerosis in September 1996 at the age of 35 and had no prior symptoms before this time.  She had to have a lumber puncture/spinal tap to rule out a brain tumor.  The puncture didn’t seal correctly and spinal fluid began to leak.  This situation put her in the hospital for a longer stay and when she left the hospital, she was no longer mobile and resided in a wheel chair for 3 months.  Through extensive therapy she was able to walk unassisted in the Spring of 1997 and in the Fall went back to work.

In 2001, she began receiving Acupuncture (5 Elements) and has had over 250 treatments to date. In 2004, she decided to stop all Western Medicine drugs and have had no further MRIs. Since that time, she feels that her health gotten better and the number of MS relapses have definitely decreased.  She now sees a general physician specializing in alternative medicine, a chiropractor, and receives massage once a month.

When my client heard that I was doing a case study,  she asked if she could be the person.  She was interested in receiving massage more often to see what may happen

with her health. 

Her Qi on left side normal, strong, easy flow.

Her Qi on right side heavy, right hip joint achy, right leg feels heavy.

Treatment Plan

Massage weekly

Essential Oil Blend with Spinal application 5 days/weekly: Base - Sweet Almond-Hemp Oil.  In addition to the base, 4 oils are mixed -  Neem, Spikenard, Cardamon, Peppermint and Frankincense

Focus - Qi flow from spine out to shoulders, down arms and legs.

  Qi flow from spine, down back to hips and down legs.

Implement Liver, Kidney, Spleen, Stomach, Gall Bladder and Bladder Meridian Patterns on the legs, focusing emphasis on Kidney and Stomach Meridians.

Effects of Massage

The first two weeks massage was given two times per week but it was to taxing on the client’s body because of the Multiple Sclerosis.  Client enjoyed have the massage twice a week for muscle tension and relaxation but weekly seemed to be better to keep the Qi in balance.

Client’s body responded well to the essential oil blend.   When the essential oil blend was first applied, she felt tingling down her spine.  The blend was applied regularly  over the next two months. Application wasn’t as regular the next few months due to her work/travel schedule.

When receiving massage weekly, the client mentioned that her core felt stronger, her chest area felt more open and in general, her health was better.  As the client was traveling out of state with her job often, she was only able to receive massage monthly.  At this time her right leg was noticeably more swollen and the Qi had difficultly moving.  The client is back to receiving massage once a week and her body is responding positively.    

Massage and Traditional Chinese Medicine

Case Study

2/11/13

I chose my client because he has low back pain, as many people do.  During the interview, he expressed that he is mostly sedentary, drives a truck all day and only exercises when taking his dogs for a walk.  He carries stress in his neck and low back and has been experiencing bouts of low energy and cold feet.  Over the next couple of sessions he later expressed that he has many ideas but had a problem getting the motivation to start them (will power) and also mentioned that he wasn’t sure what he was doing with his life and couldn’t seem to figure out what career path to follow (purpose).  These concerns in conjunction with low back pain and low energy levels immediately made me think of the Water Element.  Then my client actually said, “I feel like water, just going with the flow of life and taking the path of least resistance.”  At this point it was clear that we would be working on his Water Element.

Over the two months of the case study I gave him relaxation massages that lasted between one and two hours that included deep tissue techniques.  I also incorporated the Bladder Meridian Pattern – working the scalp, the Shu Points on the back, and the legs and the Kidney Meridian points 1-9.  I asked the client to do a couple of stretches for the low back at home, daily if possible. The first stretch is to lay down on the floor with one leg straight, the other leg is bent at the knee and laid over the straight leg, and the arm on the side of the straight leg can be used to help keep the bent leg down, turn head towards the straight arm.  The other stretch is to lie on the floor, bend knees to chest with arms around the knees/shins, and roll side to side.  To reduce stress, I asked my client to try relaxation breathing.  Sit in a chair (since it was difficult for him to sit on the floor for long periods) and breathe in through the nose and into the lower abdomen (Lower Dantian) slowly and slowly exhale through the nose while relaxing the shoulders.  Eventually he incorporated a couple of Qi gongs – Mixing Fire and Water and Reaching for Heaven and Earth (seated in a chair at first and eventually standing).

By the end of the case study my client’s low back issues as well as overall stress levels had dissipated. Energy levels have improved as well as his blood circulation.  He even found a job that he actually enjoyed!  I look forward our continual work together.

Case Study

• Male
• 28 years old
• Biologist
• Very active
• Eats  healthy 

I did 7 massages with my case study. He said that his chief complaint was pain under his right occipital bone that radiates down right side of neck and down into the traps. Client said that he hurt it while he was lifting rocks at his cabin in June 2012.

Our first massage was a general relaxation massage. During this massage I noticed that he could barely turn his neck to the right. The pain would shot all the way to his traps. By the end of the massage the client was able to move his neck and said his pain level had decreased.

I spent a lot of time working his neck and traps. Client likes deep work on his traps and along neck. After our first massage I started to design a treatment plan that consists of Range of Motion, yoga stretches, Cupping, Gua Sha and Acupressure points.

I believe that his pain is coming from his SCM and Inferior Oblique Capitis. I thought of these two muscles because of where the client showed me where his pain was. SCM muscle is often tight at the start of each massage but by the end it is lose and client says it stays that way for a few days.

Client responded very well to the Bladder meridian opening pattern [modified Tui Na massage]. Client said that every time we did the BL opener his pain was almost gone half way through the massage. 

The first few times I did Gua Sha on client  it showed up almost black which means the stagnation of the blood has been there for quite some time. Cupping brought up heat and odd marks every time but the last massage.

The first few sessions that we did stretching client couldn’t keep legs straight to do a forward bend. With daily stretching and ROM client is able to do a full forward bend.

On the last massage there was no discoloration or heat coming from clients’ back shu points. By the end of our case study client said that he no longer had any pain at the time of interview. Client also said that he will get regular massage to obtain the feeling of being pain free and will continue to stretch.