Dismantling the Tough Guy Look
You've all see the big guys that look like this:
Well, the problem is their not neutral. By that, I mean their shoulders are not neutral. If hold a pencil in our hand, that pencil should point forward like this.
This is actually called the Pencil Test. Simply hold a pen or pencil in both hands. Stand up. Relax. Look down at your hands. Note the angle measure of each of the pens in your hands. If they point forward, you can just write "forward."
However, if it points inward at all like this, you may or may not mean you have a problem with your shoulder. You may have a problem with your scapula, shoulder, or both.
To find out which area you have a problem with, we also need to assess the scapula.
We are going to measure the distance from the middle of your spine to the scapula. For our purposes here, we'll measure the middle of the scapula, meaning this area here:
On the scapula, I want you to measure not at the top of the scapula, nor at the bottom. Measure in the middle of the scapula like the picture shown above.
Next, note the measurement. You need to keep track of this over time. Then, we will compare it to the humeral findings above.
A normal measurement of the distance from the middle of the spine to the middle of the scapula is 2.5 to 3 inches. If you are below 2.5 inches, you would be considered aDducted. If you are greater than 3 inches, you are considered aBducted. In either case, you need to try to get back into the normal range.
Here is what you need to know. The scapula and the humerus are intimately connected. The most essential group of muscles which connect directly from the scapula to the humerus are the deltoid, teres major, and the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis.)
If either the scapula or the humerus is out of neutral alignment, it will affect these muscles.
Here's the thing. There are a lot of variations for how the humerus and scapula will be and we are going to go over all possibilities here.
Here is a chart I created to help you.
Let's examine the first row.
If your scapula and humerus is neutral, you don't have to worry about anything. You just need to try to maintain that neutral posture. However, I don't often see much clients who find that are initially like this. They'll usually fall somewhere in rows two to six.
If you are in the second row, you have a neutral scapula position, but your humerus is internally rotated (because the pencil points inwardly). Because of this, you need to get your shoulder more externally rotated. We'll go over these treatments in the next video series.
If you are in the third row, you have a scapula which is aBducted, and you have a shoulder which is externally rotated. You might ask, "but the pencil faces forward, how can I have an externally rotated shoulder?" Well, you would have a neutral shoulder alignment IF your scapula is also neutral. However, if you scapula is abducted, it results in an externally rotated position for your humerus.
This is why the treatment for this condition is both to get your scapula more adducted, and to get your shoulder more internally rotated.
In the fourth row, you have a scapula which is abducted, and you have a pencil which faces inwardly. In this situation, there are three possibilities for the humerus, and we'll cover those right now.
Let's assume you have a scapula which is abducted to 3.5 inches. Let's also assume you have pencil test which results in the pencil inwardly rotated at 45 degrees. In this case, your humerus would actually be neutral, and we would only need to adduct your scapula to get it back to neutral.
Let' assume a different scenario. You're scapula is abducted 4 inches. The angle of your pencil is only rotated inwardly by about 20 degrees. In this case, because the scapula is so abducted, and the inward rotation of the arm is slight, your shoulder is still considered externally rotated. You definitely need to get the scapula adducted, but you can still focus on internal rotation for the humerus.
In our last scenario (under row 4), let's assume you have a scapula which is abducted to 3.25 inches. Now, assume you have a pencil test which is 90 degrees. Basically, the pencil is pointing at the other arm. In this scenario, we have slight abduction of the scapula, and significant internal rotation of the humerus. We can still focus on adduction for the scapula, we we would make sure to try to externally rotate the humerus as part of our treatment.
In row 5, we have an individual who has an aDducted scapula, and a pencil test with the pencil facing forward. In this scenario, we actually have a humerus which is internally rotated. We will need to focus on adducting the scapula and externally rotating the humerus.
In row 6, we have an individual who has an aDduted scapula, and a pencil test with the pencil facing inward. This is a dangerous scenario and in many cases that I've seen, accompanied by shoulder, neck, or upper back pain. It is imperative to not only get greater abduction for the scapula, but to really get the shoulders more externally rotated. In this scenario, we likely have a rotator cuff which is stretched out not only from the scapula being more adducted, but from the humerus being more internally rotated.
With just two simple variables: the scapula and the humerus, we need to be careful which exercises we choose. With anyone who plays a throwing sport, or has had a history of injury around the shoulder, it is critical to understand and track the measurements of both the scapula and humerus. Both need to be neutral (or get more neutral), and stay neutral.
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