The Clinical Coach: Teres Major Atrophy

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Shoulders have been a huge part of my practice since it’s inception.

I want to thank all my CrossFit patients for that. Not that I am bashing CF.

As a matter of fact is probably one of the fitness modalities that I recommend majority of my patients as it comes with structured coaching classes, technique emphasis, and community.

But this is not a newsletter about CrossFit.

It’s about atrophy. Specifically, teres major atrophy.

What is atrophy?

It is the shrinkage or wasting away of tissues or organs. Yes, it can happen to organs too. But we will focus on muscle tissue.

It occurs when cells in a particular muscle break down, leading to a decrease in size and function. 

There are a variety of causes of atrophy:

• Disuse: Prolonged inactivity or lack of exercise

• Injury: Trauma or damage to tissues or nerves.

• Disease: Certain conditions, such as muscle wasting diseases or neurodegenerative disorders

• Malnutrition: Lack of essential nutrients

• Aging: Natural decline in cell function over time (sarcopenia)

• Hormonal changes: Reduced levels of hormones, such as estrogen or testosterone 

It is important to figure out which type you are dealing with as it provides you with a better understanding on what your outcomes can be.

For example, neurodegenerative muscle atrophy is much less likely to improve with any type of treatment, including exercise, unlike disuse or aging atrophy.

In some instance (like in neurodegenerative conditions) the best outcome for your patients will not include muscle hypertrophy.

Knowing what exercises emphasize different muscles, is highly valuable in this scenario. For example, targeting primarily the supraspinatus muscle requires your patient to perform lateral raise with their thumbs towards the ceiling and abduct their arms within the scapular plane.

Patients presenting with muscle atrophy (regardless of the type) may also experience significant amounts of pain that may or may not improve with passive or active therapies.

In the last 7 years I’ve seen up to 80% of pain reduction in atrophied muscles of the shoulder, specifically the infraspinatus and supraspinatus. To this day, I’ve yet to encounter 100% long-term resolution of shoulder pain when atrophy is present.

Teres major atrophy occurs most commonly in conjunction with large rotator cuff tears or chronic tears involving the infraspinatus muscle. It’s important to note that it accounts for less than 7% of shoulder injuries/pain.

Treating atrophy is not simple.

While we’d like to think that increasing muscle use, eating a caloric surplus or increasing the stimulation to a specific muscle with EMS or IMES should help the contractile tissue. It’s not that easy.

The longer we allow atrophy to set in, the more challenging reversing it.

What we can do, is improve the function of the surrounding muscles.

For teres major atrophy we want to focus on the following motions in our treatment plan.

• Internal Rotation

• External Rotation

• Rowing

• Pulling

While we can’t guarantee muscle regeneration of the teres major, we can improve the function, strength, mobility and capacity of the group; specifically in shoulder based movements.

And we do that with periodized program with dedicated strength and conditioning phases, with specific sets, reps and exercises that aim to promote endurance, strength, mobility and an analgesic effect for our patient.

Until our next issue!

In health and strength,

P.S. I am putting together a 6 week workshop where I will be covering business, technology and finance. I am only opening it to 10 participants.  Get your name in the waitlist