Scapular Rhythm, Posture, and Shoulder Health

Relevant Anatomy and Scapular movement

The shoulder complex is comprised of the scapula, clavicle, and the humerus. The glenohumeral joint, AC joint, and their associated musculature all work together to create movement in the shoulder complex.

The shoulder is attached to the torso by acromioclavicular joint and it’s ligaments, while the serratus anterior and subscapularis muscles create a suction like effect which permits the scapula to glide along the thorax. Additionally, while the thoracic spine is not directly considered part of the shoulder complex, it’s mobility, positioning, and musculature are intimately intertwined with scapular position, shoulder movement, and ultimately shoulder health. For example, in the figure below, one could imagine how an overly rounded thoracic spine may cause anterior tilting of the scapula as it glides over the ribcage. This dramatic anterior tilt could increase the incidence of impingement in the shoulder and would be a signal that overhead pressing should be withheld until one has improved thoracic mobility and postural control.  According to McClure et al. healthy subjects with normal scapular movement displayed upward rotation, posterior tilting, and external rotation coupled with clavicular elevation and retraction. 

Video footage from Complete Anatomy by 3D 4 Medical – a software I would HIGHLY recommend to professionals and amateurs alike who are looking to learn more about the body.

The shoulder complex requires both stability and mobility to operate optimally. More specifically, the scapula must remain stable so the glenohumeral (ball and socket joint) can be mobile. Lacking stability and or mobility where it is needed within the complex can cause compensation and dysfunction; signs that one may be at an increased risk of injury especially when training pressing/pulling movements in the vertical and horizontal directions.

How do we gain Stability and Mobility?

Let me start this section by being clear; there are many schools of thought on how to improve these metrics. The phrase “mobility before stability” gets used frequently and for the purposes of this article I am not referring to a long term basis, but rather to acute in session sequencing.

Before we get too far let’s define some key terms:

Mobility is referring to the capacity to create a desired movement through a range of motion. Mobility is ACTIVE.

Stability is referring to the ability to resist unwanted joint movements or positions during a movement.

Flexibility is simply the absolute total range of motion possible at a joint, this is explored passively.

How often do you see folks stretch and stretch, only to continue to move poorly through limited ranges of motion all the while not making measurable progress. OR perhaps you see hyper mobile folks who never get strong, always complain of aches and pains, and who always look wobbly during their lifts? These folks are too flexible, but lack the ability to mobilize, stabilize, or both to really express quality movement control.

This is because stretching temporarily increases the passive ROM (range of motion) of a joint, and while there are a few studies showing that it can cause some tissue changes, most acute changes – those you observe right after a stretching session – don’t last. We need authentic mobility and stability for that.

that’s great and all…but how do i use this info?

First of all, if you have pain – please go to your doctor, get checked by a qualified health care professional – once you’re cleared to train makes sure your PT tells you what exactly is going on with your body and get a detailed assessment of what care you need so you and your trainer/coach can take care of your body appropriately.

For the rest of the average jane gym goers, getting assessed by an in-person professional is ideal, but even self recording and learning to analyze one’s movement can be a step in the right direction. Do your shoulders dump forward? Does your upper back round excessively? If you’re a modern day computer user like yours truly, you are likely to experience some postural dysfunction.

Since you, dear reader, are behind a screen I can’t know your body exactly as it is, and the below exercises are certainly not 100% comprehensive, nor are they prescriptive exercises to “fix” you – only a PT can do that, BUT they are just a handful of the tools I use as a coach to help my clients get strong and stay healthy.

First, we start with simple mobility drills to explore and expand active rom acutely at the beginning of a session, then we cement the new-found mobility by using more challenging stability exercises. Tissue takes time to remodel, you can’t fix years of abuse in a session or two, but if you are dedicated and consistent in your pursuit, and you spend time before and after each session striving to improve by a small percent – it all adds up surprisingly quick.

Banded Thoracic RotationsB

Banded Wall Slide

This gem from Jason Colley from Performance and Recovery Systems

T-Spine Extensions

Turkish get ups – the ultimate, but most difficult shoulder mobility and stability exercise I have clients do

Disclaimer: This article doesn’t take the place of advice by a qualified health professional. What’s appropriate for one individual may be counterproductive for another. If you are suspicious of an illness, injury and/or are in constant pain I encourage you to see a doctor and a therapist to get a proper diagnosis and rule out illness. Illness, pain, and injuries are complicated topics that have a variety of causes and presentations. You should see your doctor before beginning any exercise program. I am not qualified to prescribe treatments, diagnose, or assess medical symptoms or conditions. This article and any information contained there-in is for informational/educational purposes only and is NOT a substitute for medical advice. Please talk to your doctor and medical care providers before starting any exercise or fitness program.

Citations:

1. Crosbie, J., Kilbreath, S., Hollmann, L., & York, S. (2008). Scapulohumeral rhythm and associated spinal motion. Clinical Biomechanics,23(2), 184-192. doi:https://doi.org/10.1016/j.clinbiomech.2007.09.012

2. Lin, J., Lim, H. K., & Yang, J. (2016). Effect of Shoulder Tightness on Glenohumeral Translation,Scapular Kinematics, and Scapulohumeral Rhythmin Subjects with Stiff Shoulder. doi:DOI 10.1002/jor.20126

3. Ludewig, P. M., & Braman, J. P. (2011). Shoulder Impingement: Biomechanical Considerations in Rehabilitation. Manual Therapy,16(1), 33-39. doi:https://doi.org/10.1016/j.math.2010.08.004

4. Paine, R., & Voight, M. L. (2013). The Role of The Scapula. International Journal of Sports Physical Therapy,617-629.

5. Reinold, M. M., Escamilla, R., & Wilk, K. E. (2009). Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature. Journal of Orthopaedic and Sports Physical Therapy,39(2), 105-117. doi:DOI: 10.2519/jospt.2009.2835Scapulohumeral Rhythm. (n.d.). Retrieved from https://www.physio-pedia.com/Scapulohumeral_Rhythm

Holler Box
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