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Shoulder Dysfunction, Neck Pain and the Scapula

Posted September 29, 2007 at 01:30 PM by Julie R. Keen

Section: His Fitness, Injuries & Rehab

My grandmother tells a great story about my mother when she was about 5 years old.  She came into the room and had her hand up behind her back, holding onto her shoulder blade.  She then asked my grandmother if that was where her wings attached when she was an angel. The scapula, or shoulder blade is an often-ignored important component to preventing both shoulder dysfunction and neck pain.  Here’s what it does, why it is important, and how you should incorporate scapular exercises into your training.

Anatomically, the scapula is a triangular shaped bone that sits along the ribcage and is structurally one of the three bones that make up the shoulder girdle.  It articulates with the ribcage at the scapulothoracic joint, the clavicle at the acromioclavicular (AC) joint, and the humerus at the glenohumeral joint.  Dysfunction of the scapula can manifest itself at any of these joints.

Today I’m going to talk mostly about the scapulothoracic joint, where your shoulder blade sits along your ribcage.  Dysfunction at this joint is often overlooked by trainers/therapists/doctors, yet it can be the root of problems in both the neck and the shoulder.

Ideally, in a relaxed position, the scapula should sit so that the medial border is parallel to the spine.  The rhomboids, levator scapulae, trapezius, serratus anterior, pectoralis minor, pectoralis major, and others all play a role in the static and dynamic positioning of the scapulae.

Often the muscles around the shoulder blade are weak as our lifestyles don’t force us to use them the way that they need to be used to stay strong.  Most of us sit for a living, and in poor posture most of the time.  This allows certain muscles to weaken and others to tighten up. 

Think about the last time you were in a fun house at the local carnival.  When that fun house floor is moving all over the place, it is not easy to walk a straight line, right?  Well, the same is true for your arm and your shoulder blade.  Your shoulder blade is the fun house floor, and your arm is you trying to walk the line.  Any time you use your arm, more so in overhead movements, your scapula needs to be stable to prevent those rotator cuff muscles from being pinched and injured.

For example, if the levator is tight, and the serratus anterior is weak, the scapula will rest in a position of downward rotation.  This means that the “socket” part of the shoulder is facing downward instead of to the side.  This puts the rotator cuff muscles in a position where they are more likely to be impinged with any kind of movement.  The levator also attached to the bones in the neck, so if it is tight, there is likely to be some effect on the joints in the neck.

If you continually slouch, then your pectoralis minor is likely tight.  Because of where the pec minor attaches on the scapula (the coracoid process) it has the effect of tipping the shoulder blade on the ribcage, by “winging” the bottom angle away from the ribcage.  The lower traps are often weak as well.  This also puts the rotator cuff muscles in a position where they will be subject to injury with overhead movement.

If the periscapular muscles are weak, then they are not going to be efficient in positioning your shoulder blade and holding it stable while your arm does its thing, whether that is lifting your kid up over head, or throwing a ball, or screwing in a lightbulb.

OK, so I’ve convinced you, now what?  What should you do to keep the muscles around the shoulder blade strong and flexible?

First of all, pay attention to your posture.  Yes, I’ve said it before, and I’ll say it again, your mother was right.  Sit up straight!  Take a posture break every 20 or 30 minutes.  Reach the crown of your head toward the ceiling, relaxing your chin down, and feel your shoulder blades slide along your back toward your back pockets.

Second, incorporate these mobility and activation exercises into your warm-up.

Foam Rolling:  If you haven’t invested in a foam roller yet, what are you waiting for?  This tool is versatile and will quickly improve your mobility.  Thoracic rolling is great for those with neck and/or shoulder issues.  Start with the roller perpendicular to your spine, cross your arms in front of you to get your shoulder blades out of the way, and gently roll up and down your thoracic spine, pausing to arch over the roll at each level.  Spend 5 minutes rolling this area.

Levator Stretch:  This pesky muscle is tight in nearly every client I have ever seen.  It attaches to the medial superior angle of the scapula and also to the cervical vertebrae.  To stretch it, reach your arm up overhead, then bend your elbow and put your hand as far down your back between your shoulder blades as you can.  Your elbow should point directly at the ceiling.  Turn your head and look at the opposite armpit.  If that isn’t enough stretch, then reach the other hand up and gently pull your head down like you are trying to put your nose into your armpit.  Hold for 30 seconds.  Repeat twice on each side.

Chest Stretch:  This will stretch out the pectoral muscles, which get tight with slouched posture.  Sitting or standing, interlace your fingers together behind your back, keeping your elbows straight.  Pinch your shoulder blades together, and gently lift your hands away from your back.  Be sure to keep your posture upright and your chin dropped.  Hold for 30 seconds and repeat twice.

Wall Slide/Stick Ups:  This is a great postural correction exercise that dynamically stretches the tight muscles, and isometrically strengthens the weak ones.  Start by leaning against a wall with your feet a few inches away from the wall, but your butt, upper back, and head in contact with the wall.  Place your forearms against the wall (as illustrated above) so that your elbows and the backs of your wrists are in contact with the wall.  Slowly slide your arms up overhead, while maintaining contact with the wall at all points (butt, back, head, elbows, wrists, shoulders).  Hold for a few seconds then slowly lower again maintaining contact at all points.  Repeat for 2 sets of 10 reps. Your goal should be to increase your range of motion each rep, while improving contact.

Prone Y, T, W, L:  This is a great exercise for retraining the scapular stabilizer muscles, especially the lower traps and rhomboids.
Start by lying on a stability ball with your feet planted a little wider than hip width apart.  Brace your abs and lift your torso so that your body makes a straight line.  To start use NO weights.  As you progress, you can try the small pink dumbbells (1-5#).  Do all the reps of each of the following with no rest between exercises (or as little as you can).
Y:  Lift your arms up making the letter “Y” with your body (come on … you know … Y M C A!).  The effort should come from your shoulder blades moving down your back toward your back pockets.  Slowly lower down.  Perform 8-12 reps before moving to the next movement.

T:  Same as the Y but your arms are straight out at shoulder height now like you are pretending to be an airplane.  8-12 reps

W:  Same as the T, but start with your elbows bent about 90 degrees.  8-12 reps

L:  Start with your arms hanging down toward the floor in front of you.  Lift your elbows up while pinching your shoulder blades down and back, then rotate your hands up until they are level with your shoulders.  8-12 reps.

Scapular Push Ups:  Start in a push up position, with your hands about shoulder width apart and directly under your shoulders, resting on your toes.  Abs are braced, and your head is in alignment with your body.  Push through your hands and let your shoulder blades slide forward (protraction).  Keep your spine and elbows straight and your chin tucked in.  Hold for 5 seconds, and actively pull your shoulder blades together, keeping your shoulders relaxed (i.e. NOT up under your ears).  Hold this for 5 seconds.  That’s 1 rep.  Perform 2 sets of 8-12 reps. To see a quick video of someone performing scapular pushups, go to gocolgateraiders.com

Third, if your problem is long-standing and you have shoulder and/or neck pain, then do yourself a favor and go see a qualified medical professional.  There are some things that just can’t be corrected for free over the Internet!

Julie R. Keen is a physical therapist and personal trainer.  To find out more about Julie please visit her website at http://www.keenfitness.com.

Research sources and for more information: [picture1]; [picture2]; [picture3] [picture4]; [stick up picture]; [YWTL exercise pictures]

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Tags: acromioclavicular joint, chest stretch, clavicle, exercises, foam rolling, julie keen, levator stretch, neck pain, posture, prone l, prone t, prone w, prone y, ribcage, scapula, scapular dysfunction, scapular push ups, shoulder girdle, shoulder pain, stick ups, therapy, wall slide

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