Shoulder tilt > shoulder retraction
We’ve all heard the cue a thousand times, whether from an actual physical therapist or our own mothers, “pull your shoulder back!” While the intent behind this means well, I beg to ask if it’s correct.
Whether from overhead sports, painting walls, or rearranging that cluster f*ck of a tupperware cabinet, our arms will be active over our heads at one point or another. This often causes a pinching pain in the top or front of the shoulder that we as athletic trainers refer to as ‘shoulder impingement’. This term reflects the fact that the humeral head (the ball to the shoulder socket) has elevated and is now pressing on the structures that lay above it, especially when the arm is overhead. Now, this can happen for a lot of reasons, but I would like to argue that one of the reasons is that our rotator cuff is no longer working the way we would like it to and is disrupting the congruency of our scapula and humerus.
Now, a common cue when doing shoulder rehab for such a nagging and painful injury is to pull the shoulder blades together (scapular retraction). In this retracted position, the patient is usually asked to then move their arm in a series of ways. While I agree that there needs to be SOME engagement of the scapula toward the spine, locking them in that position can do more harm than good. The scapula is supposed to move as the arm moves, that is what makes a shoulder girdle so healthy: good congruency between the two bones. If we actively take away a movement of the scapula, we have disrupted the relationship between the two. I would like to argue the point that having awareness in the rotator cuff and a solid congruency between the humerus and the scapula is what will best relieve shoulder impingement and it’s likeliness to reoccur.
Our rotator cuff is a set of 4 small muscles that originate on the shoulder blade and act to help move our arm. Rotator cuff muscles are known to do 2 motions: internal and external rotation
When our arm is in external rotation, the scapula also does this crazy thing called ‘posterior tilt’ which essentially means that the point of the shoulder blade rotates down toward the rib cage. This posterior tilt puts the socket of the shoulder blade and the ball of the humerus in congruence with each other. With the rotator cuff activated, the arm externally rotated, and the scapula in a posterior tilted position, the head of the humerus is able to depress and no longer impinge on the structure above.
Try this on for size. While walking around, if you tend to slump, think about where your thumbs are in relation to your body. Those who don’t walk with engagement in their rotator cuff and latissimus muscles tend to walk with thumbs that brush up against their legs (....me). Now, simply try walking, but thinking about your thumbs going forward as opposed to in. Do you feel the change in that musculature that lives under and behind your armpit? It’s that simple. Turn on those wings, and see how far you can fly (or at least how long you can clean up that tupperware cabinet for).
