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.

Yoga Therapy vs. Physical Therapy: What’s The Difference?

Listen in as Brandt discusses how a Yoga Therapist might work with a client who has already been to physical therapy, as well as some of the different approaches between the two therapies.

Neuroplasticity and Habit Change

Listen in as Brandt discusses how to speak with yoga therapy clients about practices which promote neuroplasticity and how that helps with habit change.


Brandt: I think what’s helpful, most helpful for people, is that your brain is completely changeable, and at the same time its tendency is to keep doing the same thing, and therefore, if you want it to change, you actually can’t just think something else, you have to do a practice that changes it. So when I talk to people, and I actually probably have that conversation, one out of five people I see, you know what I mean? Somehow that comes into it because it’s about habit change, right?

And so, the argument for habit change, and I think what’s not intuitive for people, for instance, is that doing an asana practice even, which is shocking to me, makes, you know, enhances neuroplasticity.  So if you want to stop having negative thoughts about … whatever, your spouse, I don’t know, you know what I mean, it wouldn’t naturally occur to you to do a bunch of down-dogs or to do meditation for 15 minutes, right?

So, usually, I’m talking to people about their goals and what’s going to actually get them there. And the science piece is that what’s actually going to get you there, it’s usually around meditation, in my practice right now. So it’s like, what’s actually going to get you there is to actually do this practice that has nothing to do with what you’re trying to do. And that’s the leap, right, because that’s like, “Why would I, you know, follow my breath if I’m trying to…” even, like, lose weight. I mean, whatever, you know, stop eating cookies at night or any kind of habit change, right? Stop road raging. Like, what’s the connection, you know?

Interviewer: And what do you say if they’re like, “How is meditating for 15 minutes a day going to help me stop eating cookies at night?”

Brandt: Because you have your neural pathways that are there now. Your goal is to have different ones, or at least other ones that compete with them. So, right now, you have all the pathway of eat late at night, that’s what we do. And then, you are trying to develop new, basically, brain chemistry, is what they’ve found out. That’s the science, right? Is that it’s not just willpower. In fact, it’s not at all. It’s brain chemistry and how your brain…and the brain anatomy, so it’s like how your brain’s actually configured.

So the science says that you are unlikely to make habit changes unless you put yourself in a state where your brain can become more plastic. I try not to use “plastic” because only me and you understand that, you know what I mean? Such a weird word. So, more changeable. And it turns out…and then you go back into yoga land. But often, I’m saying things like, “Tranquility states and meditation, what you’re almost feeling, is the state in which you can change brain chemistry and neural pathways.”

So you would think that the way to not eat cookies at night is to put a note on your fridge saying, or your cabinet door, saying, “Don’t eat cookies,” right? But it’s not. So everything you’ve been trying to do to stop your patterning, you’re working against yourself. You’re wasting your time because all of the science now is saying people don’t do that. But what people do do is, for instance, meditate for 20 minutes a day, and then are able to actualize change. So it moves, you know, you’ve changed your brain so now that you can actually do what you want to do.


The Money Question: What Should A Yoga Therapist Charge?

In this segment, Brandt discusses setting hourly rates and clinic pricing for Yoga Therapy.

Brandt: So, what was your question? You were asking about rates?

Student: Yeah, how you guys decide to set your yoga therapy rate.

Brandt: You have two options, but for private rates, I would look at what acupuncturists charge, massage therapists charge, and psychotherapists charge, because, you know, like in New York City, people get $120, or $150, or $200 an hour. You know what I mean?

Student: Yeah.

Brandt: Two hours away, where I live, people get $90. If I went an hour and a half from my house to Vermont, people probably more get $75, as you get away from the cities.

Student: Okay.

Brandt: But, I would like at it that way. And, you know, the other option is something I’m working on now, is doing it in a different style – like a clinic style – where it depends on how much money you need, but where you set up a clinic or a couple clinic days, and you do shorter appointments and charge less. So, I’m going to be giving everyone protocols for that because I’m working on that right now, sort of ironing that out. It’s also a good way to get into the community, you know? So, a lot of other kind of alternative medical professionals work that way, where you have, let’s say, you have two days a week, you have office hours and you charge your full rate, let’s say that’s $90 an hour, and then you have like a clinic day where people can come for half an hour for $30 or whatever, so you’re working with both sets of populations. So, that would be another way to think about it.

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.