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.

Strategies For Working With Client Push Back

In this segment, Brandt discusses how a Yoga Therapist might work with a client that is having difficulty moving forward towards their goals. Listen in as he discusses strategies for working with client push back and creating trust (Satya).

Therapy For Back Pain: What NOT To Do

Listen in as Brandt discusses first steps in dealing with back conditions such as sciatica, spinal stenosis, spondylolisthesis.


I’ve gotten a bunch of different people asking what to do about different kinds of back pain clients, but the one common theme is, for me anyway, is that we should really know what not to do. If you know what not to do, you can work backwards from there. So we have a lot of back education including in the 800 hour, we deal with that. We just did that last module and the one before. But the main thing is, what I’ve seen, online and then some people are referencing me like, “Oh, my client had sciatica,” or “my client had this or that” and, “I saw these exercises online that are good.” Let’s say, you know, “My client had sciatica and I gave him these exercises that were good for sciatica,” or, “My client had a spinal stenosis and I gave him these exercises,” or, “My client that spondylosis and I gave him these exercises.” A lot of the times, those exercises you find are wrong, and I can’t really tell you why other than, you know, free speech is powerful, and people can say whatever they want.

But just a couple of basics, especially for people in the Foundation’s program who are just getting going. It’s important, you know, to get…the best thing is to always get a diagnosis, which you can’t do, but a doctor can, a specialist, not a PCP. And that usually comes with pictures, like an MRI, and those are really useful and probably one of the top three awesome contributions of Western medicine is being able to take pictures of things and see what they look like. And the reason you want…you don’t have to be able to read the pictures, but you want a diagnosis like, “Oh, we see a bunch of bulging discs,” or, “Oh, we see spondylolisthesis, which is basically a slipping of a vertebra,” or, “We see spinal stenosis, which is like a narrowing of the canal, so it squishes the nerve.” Because each one of those comes with contraindications or things that’ll likely make the problem worse. So an example of that is, if you have bulging disks, you generally don’t want to do anything that involves forward bending, and that also includes twists because most people forward bend a little when they twist unless they’re very body aware.

So you want to be careful with those versus in spondylolisthesis… That word is a bit very difficult for me and they should have named it something else. But it basically means one vertebra…I’m trying to give you a good picture…is slipping, usually forward, over the other. So your vertebrae is stacking, you’ve got one slipping. And in that case, forward bending would be better for it, but you don’t want to bend back. And sometimes, they come together, so you’ll have both of those conditions at the same time. So if you get a client and you don’t know what the problem is and they have some sort of radiating back pain like nerve pain down their leg or, you know, spreading all around, and you’re not sure what to do, you say, “Oh, this would be better if you had a diagnosis.” But you want to do something, I mean, generally, the best thing to teach people, right, in a pinch, is how to extend their spine, like their spine gets longer, and how to do it in a neutral position, without their forward bending or back bending, so that’s where you would start.

So you would look for postural problems. Usually, people come in, they say, “Oh, you know, I have a, you know, thing in my back” and they’re not sitting up straight and they’re not extending, and they probably have a lot of weak muscles. You know, if they’re acute like that, you can’t just muscle tests and be like, “Oh, your hip flexors are weak,” etc., etc. You have to kind of stabilize them in a neutral position first, so that’s what you would do. And then, you would sorta wait to figure out whether you need them to go forward or back. But most likely, in any big back pain scenario, at least in the beginning, either bending forward or back is gonna be contraindicated. So if don’t know which way is, you have to be very mindful. If you want to do no harm, think about neutral. So tadasana neutral, side plank, that’s a little dicier, but if the person’s in better shape, you know, their spine is still neutral, you can do exercises seating on a chair, sitting on a chair in neutral. But if you lie them on the ground, for instance, and they’re in a backbend, and you have a condition where that’s contraindicated, you’re gonna make their symptoms worse. I think there’s same, but the opposite, so if you’re pulling their knees into their chest, you think, “Oh, this is great. I’ll just roll their spine on the ground in apanasana,” or whatever, the problem is that you’re doing constant flexing, constant forward bending of that spine, and if they have disc problems, for instance, you’re making them worse or you’re likely to make them worse. But you can’t just go online and be like, “Oh, I found you 10 cool exercises for spinal stenosis.” Just five minutes before I logged on here, I just did a quick tour of those things and I immediately found many movements that make no sense, many movements that, I would say, are contraindicated for that condition.

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.

Using The Joint Freeing Series To Relieve Suffering

In this segment, Brandt explains how the Joint Freeing Series, which is often applied to physical conditions, can also work for mental conditions by balancing vata energy.