Last month we recapped Jen Crane of CirquePhysio‘s blog posts related to the shoulder. We went through the basic outline of the muscle groups and their function, the circus lats – how to assess their flexibility and exercises for increasing flexibility and injury prevention.

Now, we get to dive into the rotator cuff muscles, the pec minor and the thoracic spine!

ROTATOR CUFF MUSCLES

3444996Jen’s initial article laid the groundwork for rotator cuff anatomy. She says, ‘There are four muscles that make up the rotator cuff: The supraspinatus, infraspinatus, teres minor, and subscapularis. All of these muscles originate on the scapula (shoulder blade) and attach on different parts of the humerus (the top of your shoulder).’

As Jen explains, the role of these muscles is ‘to keep the head of the humerus (the “ball” part of the “ball and socket” joint) positioned in the middle of the glenoid fossa (the socket) while your arm is moving in all positions, but especially overhead.’

Think for a moment about how much these muscles need to work correctly while doing a meat hook, climbing a silk, or working on a one arm handstand. ‘The slightest weakness could cause some massive shoulder pain. If these muscles get irritated or inhibited, you might get that pinchy, painful feeling on top of our shoulder when your arm is overhead.’

A later article in her series went onto explain the difference between isolation and functional exercises. Isolation exercises activate or strengthen one muscle – they train muscles more than movement. Functional exercises strengthen a region of muscles in a way that they need to activate during a particular movements. They increase safety and efficiency of movement components, she explains.

Most of us have a very loved pair of therabands that we use to help isolate these muscles. In Jen’s opinion, the most important rotator cuff band exercises are:

1) Shoulder external rotation at 0 degrees
2) Shoulder internal rotation at 0 degrees
3) Scapular retraction plus shoulder external rotation at 0 degrees
4) Scapular retraction plus shoulder external rotation at 90 degrees.

planksOn the functional side, Jen provided 3 of her favorite exercises. The first is the resisted plank progression – variation 1 & 2. It strengthens the large muscles of the shoulder, the parascapular muscles and the core. A miniband adds in a bias to the rotator cuff, specifically the infraspinatus and teres minor.

1. In a plank position with a miniband around your hands (not wrists), keep shoulders and hips parallel to the floor. Feet positioned wider apart is easier, together is more difficult, and one foot lifted is ninja-status. Take a small step sideways with your right hand. Rotate arm out slightly, initiating rotation from the shoulder vs wrist. Return R hand to the starting position, repeat on the L. If you have no issues, move onto variation 2.

2. The hand and arm movement is the same, but the lower body is in a “downward dog” position. Engage the upper traps in the shoulders-shrugged direction, as you would in a handstand. This variation requires different muscle fibers of your rotator cuff to be active, and more closely mimics the requirements of your rotator cuff in a handstand.

Serratus slides with miniband

serratus2 serratus1You’ll need a foam roll and a mini band for this exercise (or a light theraband you’ve tied in a loop. Start with your hands at eye level, foam roll between wrists and wall. Throughout the exercise, fight to keep your elbows directly under your wrists. Slowly slide your arms up until they are straight, and lean slightly into the foam roll. KEEP YOUR RIBS IN! This trains the rotator cuff muscles along with the serratus anterior, another muscle thats vital for shoulder health.  It’s also a great active flexibility exercise for your lats…IF you keep your ribs in and lumbar spine neutral.

Shoulder external rotation at full elevation

fullerThis is GREAT for active lat flexibility and also requires a concentrated effort to keeping ribs in and back neutral.  Standing with a theraband anchored to stall bars or something equally fixed, start with your arm straight, palm forward, and arm lifted to about 140 degrees. Rotate your shoulder into external rotation as you bring your arm into elevation WHILE keeping ribs in. Slowly reverse to starting position. Wrap the band around your hand at the start of the exercise for maximal rotation.  Start by alternating one arm at a time, then progress to both arms together.

She recommends using the isolation exercises during your warm up to activate these muscles before you start training.  The functional exercises can also be integrated into your warm up, and she recommend 2 sets “to fatigue” on both sides (with light resistance!!).

Disclaimer: All of the exercises are for the NON-INJURED, NON-PAINFUL shoulder. If you have pain during training or daily life, SEE A PHYSIO! You should feel most of these exercises working the muscles on the back of your shoulder and shoulder blade. If you feel pinching on the front or “inside” of your shoulder, see a physio!


6839078pec minorPEC MINOR 

A muscle that you may not think would interfere with your shoulder, or refer problems there is the pec minor. Jen dedicated a blog post to explaining what it is and how to know if it’s too tight. 

She explains that the pec minor is a small muscle that lies under the pec major that functions in breathing and anteriorly tilting and protracting the shoulder blade. When it’s tight, it will pull the shoulder blade forward resulting in rounded/hunched shoulders. If you bring your arm overhead and you feel a sharp pain, the humeral head may hit the ‘roof’ of your shoulder much sooner in the range of motion, causing the rotator cuff to be pinched between your humeral head and your shoulder blade. It could also show up as an achey pain around the front and side of your shoulder, or even down your deltoid and to your elbow. The pec minor lies on top of nerves and blood vessels, so if it’s too tight it can also cause nerve irritation or compression, numbness and tingling down your arm and into your fingers. Tight pec minors inhibit many muscles that are vital for controlling the end range of shoulder mobility, which is crucial for most circus practitioners.

assessment illustration

If you can identify with any of the below, your pec minors may already be tight, and possibly getting tighter:

• someone who has a desk job, sits, travels, looks at your iPhone/iPad, or reads a lot.
• aerialists who train meathooks, reverse meathooks, back levels, skin the cats, or climb on any apparatus
• contortionists who train chin stands
• handbalancers who train straight arm handstand presses
• gymnasts or acrobats who practice tumbling, trampoline, or flying trapeze involving twisting flips
• someone who is a ‘side sleeper’

How can you assess yourself and stretch appropriately? Jen has outlined several measurability tests and stretches. Have a friend take a photo of you like the one here. The optimal measurement from the posterior accordion (marked in the photo at the top of the arrow), to the floor is 2 cm from the ground. The difference between that measurement between shoulders should not vary more than 1 cm.

4402943_origTo stretch them out, she outlines the tennis ball active release stretch.

Use your opposite hand to press a tennis/lacrosse/baseball into your pec minor, just below the top of your shoulder on the upper edge of your ribcage. First, just take a few deep breaths — because of its attachment on the ribs, even just deep breathing can actively release this muscle. Next, incorporate some arm movements. Start with your arm out to your side at 90 degrees on the floor. Then move arm up and over towards your opposite shoulder. You can do a similar release with a “snow angel” type movement. Keep consistent pressure on the ball the whole time, taking breaks as needed…this is NOT comfortable!! 2 sets of 6-8 slow repetitions per side is great. Doing each rep while exhaling is an added bonus.

9930570The tennis ball active release with parascapular muscle activation.

Same concept as the prior exercise, but with the added bonus of activating the parascapular muscles (rhomboids, upper and middle trap, rotator cuff). These are the muscles that are inhibited when the pec minor gets too tight, so I LOVE this exercise because it both releases the pec minor while incorporating neuromuscular re-education for the parascapular muscles. Start face down with the ball on your pec minor and arm to the side, palm down. From here, first engage the muscles in your shoulder blade by bringing your shoulder blade towards your spine. Also think about bringing the front of your shoulder away from the floor. From this engaged position, you can bring your arm up overhead slowly.

4896295Lastly, the partner foam roll stretch
This is a great stretch to do after the first two releases. Lie on a foam roll with both your head and sacrum on the roll. Rest your arms either on the floor with palms up, or on your belly with your hands clasped. Your partner sits behind you and applies gentle downward pressure with cupped hands on the uppermost part of your ribs, just below the front of your shoulder. DO NOT PRESS ON THE SHOULDER! Here, you can do some contract relax PNF stretching: relax for 15 seconds while your partner applies gentle downward pressure, then try to push up into their hands against their resistance- hold for 8-10 seconds, then relax for 15. Do this for a total of 2 minutes.

She recommends doing these exercises before circus training as part of your warm up. It’s also a good idea to do one or two of these as part of your cool down, ESPECIALLY if your training session involved any of the previously mentioned activities that contribute to tight pecs.

Disclaimer: You might feel numbness and tingling during these stretches due to the nerves and arteries that lie under the pec minor especially in the first week of incorporating them. If so, stop and shake it out. Wait for the numbness and tingling to subside, and continue at a LOWER INTENSITY. The goal is to feel a stretch without any numbness or tingling. Bending the elbow can also alleviate the tingling by putting the nerves on slack.
Another word of caution: There are a LOT of different structures and injuries that can cause the same symptoms as those listed above, and some are very serious.  If your symptoms stick around for longer than a few days, that’s a red light. CALL A PT!  Constant pain should not be a staple in your circus training.


thoracic spine T-SPINE

Lastly, we explore the t-spine, and thoracic mobility.

Our t-spine consists of 12 vertebrae and are much stiffer than your neck or low back since it’s where your ribs connect to your spine. The thoracic spine directly affects rib cage position, and plays a huge role in scapular position and shoulder mechanics. A circus artist needs a mobile t-spine, that can flex, extend, rotate and side bend. A healthy t-spine should extend slightly, which allows the shoulder blade position to keep the rotator cuffs from becoming impinged.

Where t-spine mobility goes wrong or becomes limited is most commonly related to prolonged periods of sitting or anything that causes you to have poor posture with a rounded spine. If you are doing any of the following, your t-spine can be negatively affected if it’s tight:

• reverse meathooks
• the ‘sweep’ phase on flying trapeze
• hollow back handstands
• beats on any aerial apparatus
• snake bridge in contortion
• any trick involving a standing arabesque

Peanut thoracic extension

If you happen to have a desk job by day and practice or perform circus at night, you should check out the exercises and stretches Jen outlines for improving thoracic spine extension and rotation. Warming up with a foam roller for a couple of minutes does not count!

Peanut thoracic extension

What’s a peanut? To create your very own peanut, take two tennis or racquetballs and either tape them together or put them in a sock and tie off the end with a hair tie. Then place the peanut on either side of your spine, at mid-back level. Take a deep breath in, then as you breathe out, drop your butt and head to the ground at the same time, so you “hinge” over the peanut. Do this 5-8 times at each level, from mid back to where the shoulders and neck meet. You can also do the same thing alternating arms overhead as pictured instead of hinging over the peanut.

7703745Resisted quadruped thoracic rotation/extension

For this exercise, you’ll need a theraband tied to stall bars, or something similarly fixed. Hold the theraband with the arm furthest from the stall bars while on all fours. Engage your ribs and rotate up towards the ceiling on the exhale. Try to initiate he movement by drawing your shoulder blade towards your spine. Hold at the end of the rotation for a complete inhale and exhale.

For bonus points and an AWESOME core exercise, do the same thing in a plank position. You’re welcome.

Straddle thoracic flexion/rotation

2744596This exercise is an awesome multitasker. You not only get thoracic mobility, but also lat flexibility on the opposite side, and a bit of a leg stretch too. Start with a foam roller parallel to your thigh and the back of your forearm on top, palm up. On the exhale, roll forward and into the rotation, while reaching your chest through your arms and towards the ceiling. You get a different stretch in different degrees of straddle, so try a few out! 

If you’re going to be doing a lot of back bends (or other aforementioned t-spine heavy tricks), throw a few of these exercises in to your warm up and see how you feel!  For those of you with desk jobs, I HIGHLY suggest keeping a peanut or foam roll at work…a few stretch breaks throughout the work day will do wonders for your circus shoulder…and probably every other ailment you have!  And hey, if thoracic mobility doesn’t solve the problem, maybe rub some coconut oil on it…or better yet, see a physio!!  


Credit: Arielana Reed Photography

Credit: Arielana Reed Photography

Dr. Jennifer Crane is a physical therapist, athletic trainer and board certified orthopedic specialist.  She has been a sports medicine professional for eight years, and has worked with a wide variety of athletes and performing artists throughout that time. Most recently, she spent seven months in China, working and traveling with the Chinese Olympic Teams in preparation for the Rio 2016 Olympics. While in China, she worked with multiple sports teams: diving, weight lifting, fencing, gymnastics, synchronized swimming, and track and field. Of the athletes she worked with, 18 of them went on to get an olympic gold medal in Rio. Now happily back in San Francisco, Jen is resuming her physiotherapy practice where she specializes in injury prevention and treatment of circus artists. Over the past three years, she has worked with performing artists of all specialties and all levels, from the brand new aerial student to professional acrobats, aerialists, handbalancers, and contortionists. When she’s not working with circus artists at her clinic, she can usually be found standing on her hands, swinging on flying trapeze, or spinning on a single point trapeze.
Check out all of her content at http://www.cirquephysio.com

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