The Rotator Cuff: What It Is and How to Prevent Injuries through Yoga Practice

The number of rotator cuff injuries reported in the United States is increasing, as are the number of surgical interventions for such injuries. These injuries can be debilitating and interfere with work and recreation. Healing can take a long time, and surgery is often required. These injuries take an enormous toll on physical and mental wellbeing.

Rotator cuff injuries often start with impingement. Impingement is when the tendons of the rotator cuff muscle become inflamed or trapped beneath the shoulder blade, usually due to a poorly or inefficiently functioning shoulder joint. This can lead to pain, discomfort, tearing of the tendons, and more serious injury. 

Looking at the underlying mechanisms of why these injuries occur can help us figure out ways to move our bodies that minimize the likelihood of injury. When it comes to rotator cuff injuries, the serratus anterior plays a surprising role in maintaining strength, stability, and health of the shoulder girdle.

Anatomy

Serratus anterior is a muscle that connects the medial border of your scapula to your ribcage. It lies beneath the scapula (shoulder blade). It runs from the medial border of the scapula, under the scapula, and inserts on ribs 1-9. It is a stabilizer of the scapula that helps to keep this bone anchored to the ribcage during dynamic movement. 

Serratus anterior holds the medial border of the scapula against the thorax. It also helps to laterally rotate the scapula as the arm is being lifted overhead. Other muscles contribute to both of these actions, so it is possible to move your arm in this way without fully engaging the serratus anterior muscle. But this is one of the causes of shoulder dysfunction that can lead to chronic injury. 

[By Anatomography – en: Anatomography, CC BY-SA 2.1 jp

Function

The serratus anterior functions to protract the scapula and rotate the scapula upward when you reach your arms overhead. It works in tandem with the trapezius muscle, which is the large, diamond-shaped muscle of the upper back. Most of us have imbalanced use of our trapezius muscle—the upper fibers do most or all of the work, while the lower fibers, along with the serratus anterior, are largely unused. This creates an imbalance in the muscular complex that is responsible for shoulder movement. When we use the upper trapezius almost exclusively, the shoulder blades lift when the arms lift, which can cause compression of the rotator cuff tendons. 

On the other hand, if we engage serratus anterior and the lower trapezius when the arms lift, then the shoulder blade still rotates effectively, but is also stays anchored onto the back of the ribcage, which allows for more space between the scapula, clavicle, and humerus, minimizing the risk for impingement.

Individuals who suffer from rotator cuff impingement show reduced recruitment of the serratus anterior while lifting their arms overhead. Conversely, when the serratus anterior is actively used, it helps to prevent impingement of the rotator cuff muscles, keeping the shoulder girdle stable and strong through a range of activities. 

Strengthening the serratus anterior can promote balanced lifting of the arms overhead without overuse of trapezius.

Serratus Anterior in Yoga

The serratus anterior is the unsung muscular hero of your yoga practice. It is instrumental to so many poses—Adho Mukha Svanasana (Downward Facing Dog Pose), Phalankasana (Plank Pose), Chaturanga Dandasana (Four-Limbed Staff Pose), Bakasana (Crow Pose), Vasisthasana (Side Plank Pose), Adho Mukha Vrksasana (Handstand Pose) and many more arm balances.

A properly functioning serratus anterior can assist you and move you forward in your physical asana practice. An improperly functioning serratus anterior can cause injury. So let’s look at ways we can strengthen this muscle and some cues to make sure that we’re using it properly throughout our yoga practice.

Bharmanasana (Tabletop Pose) Serratus Pushups       

1. Come into Tabletop Pose with your hands slightly in front of your shoulders. For an added challenge, have a friend place a 10-pound sandbag on your upper back.

2. Keeping your elbows straight, sink your chest toward the floor and feel your shoulder blades begin to come together across your back. This represents a totally relaxed (unengaged) serratus anterior muscle.

3. Now press firmly into the floor, lifting your chest and raising your upper back toward the ceiling. In this position, the shoulder blades begin to move around toward the sides of your ribcage and serratus anterior is engaged.

4. Repeat this action 10 to 20 times and then rest.

Practice Tabletop Pose to prep for serratus pushups. Keep your elbows straight as you sink through the upper back. Then press firmly into the ground to lift and round through the upper back, engaging the serratus anterior.

(Tabletop position to prep for serratus push-ups. Keep the elbows straight as you sink through the upper back. Then press firmly into the ground to lift and round through the upper back, engaging the serratus anterior.) 

Phalakasana (Plank Pose)

1. From your Tabletop Pose, extend both legs behind you with your knees lifted off the floor. Your hands should still be slightly in front of your shoulders.

2. Press your arms firmly into the floor and find a lift of the upper back. Try to hold this pose for up to one minute. If you notice that your upper back begins to fatigue and you are collapsing the upper back, then come out of the pose.

3. Try to maintain the integrity of your Plank Pose, not letting your shoulder blades wing out, a symptom of a disengaged serratus anterior.

(Plank Pose. Try to maintain the integrity of your Plank Pose, not letting your shoulder blades wing out, a symptom of a disengaged serratus anterior.) Photo left.

Virabhadrasana I (Warrior I) or Any Arms-Overhead Pose

In Warrior 1, the arms are lifted up overhead. The serratus anterior muscle contributes to this action. When you practice this pose and others like it, make sure to pay attention to how you are lifting your arms and what your alignment is like once you are there.

1. When you are lifting your arms, externally rotate them at the shoulder. Lift slowly.

2. When the arms are in position, make sure you don’t feel any pinching at the shoulders.

3. Engage the muscles of your middle and upper back and think about lifting your chest. Lengthen through your sides and your centerline.

4. Breathe here.

In Warrior 1, try to keep the inner borders of your shoulder blades hugging your ribcage, and keep the bottom tips of the shoulder blades down. This helps to train the proper functioning of the serratus anterior.

(In Warrior 1, try to draw the keep the inner border of your shoulder blades hugging your rib cage, and keep the bottom tips of the shoulder blades down. This helps to train the proper functioning of the serratus anterior.) Photo right.

Adho Mukha Svanasana (Downward Facing Dog Pose)

Proper alignment in Downward Facing Dog Pose is key to healthy shoulder mechanics.

1. In your Downward Facing Dog Pose, make sure that your hands are placed at least shoulder-width distance apart, maybe even wider. Your index fingers should be pointing forward and your fingers should spread.

2. Keep your elbows straight and your shoulder blades wrapping around the sides of your body.

3. If you have a lot of mobility in your shoulders and upper back, resist the urge to sink your chest or place your head on the floor. Try to stay fully engaged in your serratus anterior.

4. Tilt your pelvis forward so that your sit bones point toward the ceiling and there isn’t undue pressure on the lower back.

5. Breathe, and try to maintain the pose for 2-4 minutes.

This is a good pose to practice engaging the serratus anterior while carrying some weight in the upper limbs. Keep your arms lengthening away from the body, as your shoulder blades hug in toward your back.

(Downward facing dog pose. This is a good pose to practice engaging the serratus anterior while carrying some weight in the upper limb. Keep your arms lengthening away from the body, as the shoulder blades hug in towards the back.) Photo left.

Bakasana (Crow Pose)

The last pose on our list is Crow Pose, which is a fairly advanced arm-balancing pose. Not everyone is going to be able to do this pose because it requires not just balance, but flexibility through the hips, and good upper body strength.

If you can safely practice Crow Pose, use this pose as an opportunity to notice the way your hands press into the floor. Try to engage through your back to find lift, rather than letting gravity pull the body toward the earth. If you have difficulty balancing, try the supported version, with blocks stacked under your forehead. 

Crow Pose is a great way to integrate all the previous exercises into a true test for the serratus anterior. Notice the rounding of your upper back, which means that serratus anterior is engaging on both sides to draw the shoulder blades away from one another.

These poses represent just a small sampling of ways to strengthen the serratus anterior. They have the advantage of primarily using body weight and not requiring any special equipment. If you are suffering from rotator cuff impingement, try these poses and see if you notice any reduction in your pain.

(Crow pose is a great way to integrate all the previous exercises into a true test for the serratus anterior. Notice the rounding of the upper back, which means that serratus anterior is engaging on both sides to draw the shoulder blades away from one another.) Photo right.

More yoga practice tips from Sara Doyle Ph.D., E-RYT 500 – To Roll or Not to Roll: Coming Up From Standing Forward Bend in Yoga.

Study Online with YogaUOnline and Marlysa Sullivan – Awaken the Psoas, Free the Breath: Yoga for Balancing the Core, Releasing the Lower Back, and Improving Well-being.

Reprinted with permission from Sara Doyle Yoga and Anatomy.

Asana images courtesy of Sara Doyle

Sara Doyle (Ph.D., E-RYT 500) has a Ph.D. in Anatomy and has taught anatomy to medical students, residents, and undergraduates at Duke University since 2003. She has a thorough understanding of the human body and the anatomy of movement. Sara has spent thousands of hours in the anatomy lab and participated in the dissection of hundreds of cadavers, giving her a unique perspective on how the body works and the anatomical variation between individuals. Her yoga classes and workshops reflect a science-based perspective and include the most current research available.

Sara has completed two 200 hour trainings – the first with Sarah Trelease, and the second more recently with Srivatsa Ramaswami, a direct student of Krishnamacharya. She has also completed a 300-hour training. Currently, Sara is enrolled in the MBSR (mindfulness-based stress reduction) teaching program at the UMass Center for Mindfulness.