The scapula, or shoulder blade, plays an important role in the movement of the shoulder joint. They term the relationship of the movement between the two areas, the scapulohumeral rhythm. Once the arm is raised above a certain level in front, or to the side, then the shoulder blade starts to work and can assist the “upward movement” of the arm.
Historically, it was thought that the position of the scapulae gave us a great amount of knowledge as to whether that person was at risk of developing shoulder pain. It made sense that a non-optimally positioned scapula would then lead to non-optimal movement of the scapula, and result in poor movement patterns in the shoulder complex. The result being pain. In this case, an assessment would be performed and exercises to correct the altered positioning of the scapula would be prescribed to reduce the pain. Easy right?
However, current evidence does not support the opinion that there is a consistent relationship between the posture of the scapula and the development of shoulder pain (Radcliffe et al, 2014). In fact there is no ideal posture for the shoulders. Everyone is different and everyone has asymmetries throughout the body. The shoulder is no exception. Just because you have been told you have “rounded” shoulders does not necessarily put you into an “at risk” group for developing shoulder pain. In fact, researchers also looked at people with curved mid –upper back postures and found no link between the roundness of your upper back and shoulder pain (Barrett et al. 2016).
The dynamic mechanics of the scapula have also been studied extensively. It has been shown that people with shoulder pain will show changes in the mechanics of the scapula, however, It has not been confirmed whether this was a precursor to injury or whether the shoulder pain has caused muscle inhibition around the scapulohumeral complex, resulting in this change in scapula mechanics (Baskurt et al. 2011, Timmons et al. 2012)
Performing specific scapula stabilisation exercises such as pulling your shoulders back and down when sitting or standing, or when performing movement tasks, are in my opinion, ineffective. There needs to be a greater focus on keeping the shoulder blade in a more natural, neutral position. In this position the scapula is not up, down, forward or back. More dynamic exercises need to be included in the rehabilitation, which will load the whole scapulohumeral complex, not just as few select muscles. Having someone observe your movements when lifting arms overhead or going into a plank type position is important to see how your scapulae are functioning in a loaded, dynamic tasks. If there are glaring abnormalities, then I would suggest reducing the load, gain a more neutral position with the shoulders if necessary, and then load it up again.
In my experience, pain experienced around the scapula and shoulder is more to do with a rapid increase your practice or training load, which could involve trying more advanced postures in yoga, doing more weights in the gym or increasing your swimming distance or frequency. Pain in itself is complex and irritability around this area can also be influenced by poor sleep, fatigue, being run down and stress, just to name a few.
If you do have pain in this area and it is not improving or becoming worse, then you may want to consult a health professional to assess your condition.
Chris is joining the practitioners at Yoga and Health Collective from October 2016. Chris specializes in chronic pain management and will be available to asses and treat Tuesdays and Saturdays by appointment.
Barrett F, O’Keefe M et al. (2016) Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Manual Therapy 21:36. 38-46
Baskurt Z, Baskurt F, Gelecek N, & Ozkan M (2011). The effectiveness of scapular stabilization exercise in patients with subacromial impingement syndrome. Journal of Back and Musculoskeletal Rehabilitation, 24, 173-179.
Radcliffe F, Pickering S, McLean S, Lewis J (2014). Is there a relationship between subacromial impingement and scapula orientation? A systematic review. British Journal of Sports Medicine. 48(16) 1251-6
Timmons M, Thigpen C, Seitz A et al. (2012) Scapula kinematics and subacromial impingement syndrome: a meta analysis. Journal of Sports Rehabilitation. 21(4) 354-70