The scapular region can be a particularly challenging area to work with. It must be simultaneously stable and mobile, a tricky balance to strike when so many people have very little sense of connection to this area.
A very specific biomechanical misunderstanding about function in this area has led to the use of a cue which can inadvertently lead to development of shoulder pain, despite the good intentions behind them.
The structure of the shoulder is such that a bony roof made up of a projection from the scapula (the acromion) and its junction with the clavicle (collarbone) create a protective arch over the structures which nestle beneath, including the tendons which pass over the “ball” or the ball and socket joint of the shoulder.
Normal biomechanics of the scapula dictate that as the arm is lifted overhead, the scapula should rotate upwards, which moves the bony “roof” out of the way in order for the arm to freely lift without compressing the sensitive structures underneath. If this normal motion does not occur, these tendons can be subject to repetitive compression, which in turn can lead to impingement pain on lifting the arm.
So far so good.
Now one of the most common cues used in the fitness and rehabilitation fields is to “draw the shoulder blades back and down”.
This is understandable. If the individual uses an elevation pattern for upper limb motion i.e. the scapula is drawn upwards, shoulder mechanics are interrupted and increased load is directed to the neck. Similarly, for the person who habitually holds their shoulders in a forward position, biomechanics are compromised. Surely then the “back and down” cue is perfect?
Well, let’s look a little further into the issue.
While having the shoulders up or forward are not ideal, actively holding them in the opposite position, even “gently”, can have some undesirable effects.
The first is that it places the scapulae in a fixed position. As we know, the scapula must be mobile in order to support normal arm function. Imagine how unnatural it would be just to reach into the back of your kitchen cupboard while keeping your shoulders fixed back and down. Try winding up into a golf back swing without allowing one scapula to slide forward around your rib cage, and the other to slide back towards the spine. Feel how restrictive it is to reach upwards while keeping your scapula fixed back and down. It feels awkward for a reason, and that reason is that it interferes with your biomechanics. It quite simply is not normal movement.
It is routine for the “draw back and down” cue to be given to people to prepare them for lifting their arms overhead, whether in sitting, standing or lying down. However, this interferes with the scapula’s free upward rotation in response to arm movement, increasing the possibility of tendon compression. It is not surprising then that we see many people with shoulder impingement pain that has developed as an unfortunate consequence of their attempts to improve their posture and function.
The bilateral nature of the cue is also associated with diminished trunk rotation and arm swing. Normal, efficient gait requires alternating rotation of the upper torso against the lower torso. This centrally generated rotation initiates natural, connected arm swing. When the scapulae are actively drawn back and down, it blocks rotation and alters the mechanics of walking and running. (Incidentally, when this happens people can begin to over push with their calves to compensate for the loss of efficiency, so a cue at the top of the body can create issues at the other end of the chain).
Hmm. How do we avoid creating a problem while trying to solve another?
Our first priority is the foundation position against gravity. In standing, softly lengthen the spine through the top of the head, and then sense the balance point where your weight feels as though it falls through the centre of your feet. This position encourages the shoulders to fall away from the ears.
Note whether you are shorter on the front or the back of your upper body, or whether the shape of your body is convex on one side and concave on the other. It usually only takes a small adjustment to ease your shoulders into a position which evens out the length or shape, and it should not provoke any sense of tension.
Now the chest is open and the shoulders can hang freely. When cuing the arm lifting movement in those who elevate their shoulders to initiate the motion, there are many options. Ask for a soft hand to lead the motion, as tension in the hand frequently provokes tightness in the shoulder. Bring the focus to maintaining a lovely long neck, which attracts awareness to the area without the compromise on normal movement that drawing the shoulders down can cause. Finally, encourage a sense of lengthening through the body as the arm reaches overhead, to allow it to connect into the elastic support available in the trunk.
There are so many interactions in the body constantly influencing each other that seemingly logical solutions can be deceptive. To avoid the dark side of any cue, bear two things in mind. The first is to focus on what you positively do want to elicit rather than attempting to stop what you don’t want. The second is always to be aware of normal movement, to make sure that whatever we share with clients aligns with an enhancement in health and efficiency.
Let’s shed a little light on those shoulders!
If you’d like to know more about developing healthy, normal, functional movement, visit www.jemsmovement.com or email us at firstname.lastname@example.org about our upcoming JEMS course for Health, Fitness and Wellbeing Professionals.