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Rotator Cuff Injuries and NAT Treatment

Posted by Simeon Niel Asher on

The main damaged muscle for rotator cuff issues is the Supraspinatus


The reason the rotator cuff muscles are so key to our shoulder function is that our ball and socket joint is inherently unstable.

The body is a marvellous, complex and self-healing machine. Proper shoulder alignment and function allows us to interact and manipulate our environment in an efficient way that requires minimal effort. The problem is that when one of our muscles or tendons ‘goes wrong’, the body is forced to compensate and adapt.

The reason the rotator cuff muscles are so key to our shoulder function is that our ball and socket joint is inherently unstable. Our shoulder affords us a lot of movement but to achieve this there is instability built into the mechanics.

The rotator cuff muscles work together to pull the ball joint, downwards and backwards into the socket. The cuff muscles interact to help maintain shoulder stability as well as initiate and help with movement. Because of this dual function any problems with one of the cuff muscles will often become amplified. The rotator cuff muscles blend together to share a common thick flat tendon. This tendon is vulnerable to overhead activities, sports occupation, overuse, underuse and aging.

Trigger Points

This complex situation means that when one of the rotator cuff muscles goes wrong not only do the other muscles have to compensate but also over time, they can become problematic themselves. The muscles respond by getting tight and forming knots or ‘trigger points’ that often perpetuate pain and reduce shoulder function. The brain sets-up a protective ‘holding pattern’. The damaged muscles become weak and, over time are prone to waste leaving a dent under the skin. Some years ago, we began to recognize that all shoulder problems follow a similar ‘holding pattern’. In the case of the rotator cuff, the holding pattern is similar to that of a frozen shoulder.

NAT practitioners not only understand these concepts, but they have also learnt how to apply efficient, simple hands-on techniques to reduce pain and improve cuff function. For the rotator cuff NAT practitioners add an evidence-based shoulder rehabilitation and exercise program to help clients return to full function. It's worth noting that manipulative manual medicine is suitable for the vast majority (90% - 95%) of all rotator cuff problems.

NAT uses the body’s own wisdom

By far the main damaged muscle for rotator cuff issues is the supraspinatus. This sits horizontally in a groove at the top of the shoulder blade. During the day the weight of the arm hanging down shuts off the blood supply to this muscle, at night when there is no weight, the muscle attempts to repair itself causing horrible, classic night pain. Supraspinatus is the most mechanically vulnerable shoulder muscle to injury; it is also vulnerable to wear and tear especially in overhead activities.


NAT and Rotator Cuff Specifics

NAT is an advanced trigger point technique; it was originally developed in 1999 by Osteopath Simeon Niel-Asher to treat frozen shoulder syndrome. The same concepts have since been similarly applied for the treatment of a wide range of musculoskeletal disorders.

NAT involves specific repeatable and deliberate neuromuscular and trigger point (massage and compression algorithm). In NAT the idea is that stimulating trigger points can equally be viewed as neural inputs; promoting changes in feedback to and from the brain. With NAT these inputs are made in a deliberate and repeatable sequence to trigger points within agonists, antagonists and super trigger points (STP’s) around the joints. The idea is to reduce the number of these neural inputs to a structured minimum. NAT deliberately utilizes automatic reflexes including:

- reciprocal inhibition;

- post isometric relaxation;

- post-activation depression;

NAT is fast, effective and evidence based; having successfully undergone randomized placebo controlled trials at Addenbrookes hospital, Cambridge UK (Weis et al 2003), and is now regularly used by thousands of therapist worldwide to treat a wide range of common musculoskeletal conditions.


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