Stabilising the Scapula & Shoulder Mobility

Previous: Shoulder Impingement

Stabilising the scapula is really important for correct movement at the shoulder and is the first step towards strengthening the shoulder joint. Few people do it properly anyway, and all can benefit from this, but if you already have shoulder problems it is particularly important.

The scapulae are the kind of flat bones that make up your shoulder blades, and a bunch of muscles attach to various bits of them. One easy way to see what it should feel like to be able to stabilise the scapula is to get yourself a medium- to high-strength exercise band or tube, stand in the middle of it and hold an end in either hand so it is taut. Shrug your shoulders up to your ears then relax and let the band pull your arms (and shoulders) back down. Pay attention to how your shoulder blades feel when this happens. You should feel them moving down your back an inch or two. One advantage of this method is that it doesn’t require you to lift your arms over your head, which might be painful if you are already suffering from impingement.

If you can lift your arms overhead though, another good exercise for isolating the muscles that bring down the shoulder blades is to hold a light pole, such as a broom stick (do people still use brooms?), or even a taut dynaband, overhead with both hands up. Then try and lower it down in front of you. You’ll feel those muscles working when you do this. This can also be done sitting facing a lat pulldown machine at the gym. Use just enough weight to add a little resistance but not as much as you would use to workout your lats, since it’s your lower trapezius muscles you want to be thinking about. You can also try it without the pole or band, but the effect won’t be as pronounced.

Note that neither of these exercises are an end in themselves, merely methods for learning what it feels like to stabilise the scapula – which muscles move and so on. Once you can isolate those muscles, just get used to doing that over and over. You will find yourself in the non-stabilised position dozens, maybe hundreds of times during the day: when you’re sitting at your desk, driving, cooking, watching TV, working out, just walking along. People tend to carry a lot of tension in their shoulders (mainly because of incorrect movement patterns leading to tight trapezius muscles) and walk around with them a bit hunched up much of the time. Try and become more aware of your scapulas and think about ‘pulling’ them down your back every time you notice they have ridden up again.

Once you get quite good at that, and a bit more body aware, you’re going to learn to move the arms while stabilising the scapula. Stand or sit comfortably, and ‘float’ your arms up in front of you, palms down, until they are parallel to the ground. Don’t actively lift your arms up. Rather, imagine your hands are resting on slowly ascending clouds, and let them float up. If you feel your scapulas inching up, you know what to do – bring them down again. When you can manage that, try taking your arms higher, until you can get them right up over your head, without your shoulder blades and the tops of your shoulders riding up towards your ears. It may take a bit of practice, but if you do it slowly and mindfully to start, pausing to correct your shoulder blades if you feel them moving up, it will eventually become second nature to you.

Then try a wider range of movements at the shoulder (no weights yet), all while keeping the shoulder blades stabilised. The shoulder is a very mobile joint and the arm should be able to go up, down, and round and round, without needing to give the shoulder blades a look in. In the pictures below, note how the shoulders are not riding up the neck.

Another exercise is to use a stability ball. Rest the ball on the wall at around shoulder height and make small controlled circles, gradually increasing the size of the circles as you get more flexible.

If you don’t have a stability ball, you can try using your outstretched arm and pointed finger to ‘write the alphabet’ in space. Lower case letters are more variable than upper case (capitals), so use those. Feel free to do jointed up script writing. You can write to the front, to the side, and, to a lesser extent, to the back. As you get more flexibility, make the letters bigger until you are making large sweeping motions. Remember, the scapula should be set at all times during this exercise.

Get in the habit of looking at other people and check out the position of their shoulders. Once you get good at adjusting your own shoulders, you often have to fight the urge to go up to complete strangers and tell them to bring their shoulders back down from the stratosphere. At least, I do. But then I’m odd that way. Occupational hazard, I guess.

It’s a good idea to master each stage before moving on to the next one, otherwise your existing poor movement patterns will interfere with your progress. But once you can do these exercises, start with the rotator cuff strengtheners in the next post.

Next: Rotator Cuff Exercises

Shoulder Impingement

Today and tomorrow I am giving a little tutorial in shoulder impingement and how to go about strengthening your rotator cuff. This is in answer to something that came up on the PN Forums, so for those of you who didn’t come from there, I haven’t gone completely off my rocker.

Just so’s you know, I am actually a qualified personal trainer (you wouldn’t believe it to see the pictures) and sports massage therapist, so those are my credentials.

The majority of the muscular stability in the shoulder comes from the four muscles that make up the rotator cuff group: the subscapularis, supraspinatus, infraspinatus and teres minor. If you click on the picture, it’ll open up the full-size image. These poor under-appreciated muscles all attach onto the head of the humerus, from front to back, in that order, and work together as dynamic stabilisers to hold it in its socket.

Now if you look at the picture of the back of the shoulder, there is a bony prominence running across the scapula (shoulder blade) between the supraspinatus and the infraspinatus. This is called the spine of the scapula, and the big bit that sticks forward on the left is called the acromion process. If you look at the picture again, you will see that there’s a bunch of stuff between the acromion process and the head of the humerus, including the rotator cuff muscles, but also (and not shown in the picture) the tendon of the biceps and the subacromial bursa, a little sac that helps prevent too much friction.

Normally, there is a little bit of space between the tissues and the acromion process, but if something causes this subacromial space to decrease, some of the soft tissue structures can become ‘trapped’ between the two hard structures. This is a sometimes painful condition called ‘impingement’. It will be more or less painful depending on the position of the arm, because some movements will tend to decrease the subacromial space, but others will increase it, easing off or removing the pain. Actions that decrease the space include arm abduction (lifting the arm away from the body to the side), extension (taking the arm behind you), or overhead activities. Overuse in these activities may lead to impingement.

Common causes of impingement

• Things you were born with and cannot change, such as a longer than normal acromion process
• Loose bodies, ie. little bits of things moving around freely on the inside, most likely caused by an injury
• Muscle imbalances causing a narrowing of the subacromial space
• Inflammation of the subacromial tissues, eg. Swimmer’s Shoulder
• Hypertonicity (too big-ness) of the deltoid muscle relative to the rotator cuff. This is a very common cause in body builders who like to train the nice obvious deltoid muscle that sits on top of their shoulders, but don’t pay much attention to what’s underneath.

What you’ll notice

• Pain on overhead function, usually when the arm is lifted between around 70° and 120° to the side, as this is the range of motion (ROM) that tends to decrease the subacromial space. The pain will likely not occur when the arm is lower than this, or higher than this, as the space increases again relieving the pressure.
• You will find it difficult to do overhead tasks, such as reaching up to get things off shelves.
• Also, when lifting your arm past 90° you might find the scapula having to move upwards to facilitate the movement to compensate for the decreased ROM, although a lot of people do this anyway due to tight traps. Try pilates, people. Or at least, stretch!

What to do about it

• If you find the pain causes you to stop using the shoulder much at all, see a professional immediately. It can take less than a week for ‘frozen shoulder’ to develop, and then you are likely to have problems with the shoulder for the rest of your life. Suitable mobility exercises are critical at this time.
• Massage may help, but deep frictions may be necessary for chronic tendinosus (ouch time). Depending on how long the shoulder has been bothering you – for some people it will be years – fixing it will likely take some time.
• Strengthening the rotator cuff muscles.

When to see a specialist

• If you feel pain deep in the joint that doesn’t seem to improve
• If the pain is referred to another location or if you lose sensation along the arm
• If you have no improvement in pain levels or not much improvement in flexibility following remedial massage treatment, eg. sports massage
• If you feel you want to… always trust your own insticts when it comes to your body

Anybody can benefit from doing some rotator cuff strengthening exercises as part of their normal training routine. They’re simple and don’t take much time, but unfortunately, due to the ridiculous length of this post, the exercises will have to wait till tomorrow. ‘night all.

Next: Stabilising the Scapulae & Shoulder Mobility