If you have a neutral scapula and a neutral humerus, you need to maintain that neutrality.
For the scapula, this means doing a balanced combination of aBduction work (i.e. push ups, protractions, etc.) and aDduction work (i.e. rows, scap retraction holds, etc. ).
For the humerus, it means doing a balanced combination of internal rotation (i.e. push ups, chin ups, etc.) and external rotation (i.e. DB external rotations, face pulls, etc.).
Even while trying to maintain a balanced combination, you may find yourself in rows 2nd through 6th below.
If you play a sport, where the upper body is used at all, you'll also likely find yourself in rows 2 through 6.
Let's go into treatment options if you are in rows 2nd through 6th by starting on row 2.
In this scenario, we want to keep the scapula neutral. However, the humerus is internally rotated because the pencil points inward. The humerus might be internally rotated because of a mobility restriction (i.e. tight pecs), stability restriction (i.e. weak external rotators), or both.
We don't need to make this more complicated than it is. If you want to test the length of the pecs and lats, you are welcome too. However, I've found that even if you don't find them to be short, it can still help to deactivate dominant pecs and lats which can help in correcting the dysfunction.
In our case, we're going to go through everything.
Let's begin with the pecs. The pecs are a primary humeral internal rotator, and if you're client has done any significant amount of bench pressing or push ups, chances are their pecs may be tight or at the very least contributing towards greater stiffness than the humeral external rotators.
Let's stretch them out. We're going to focus on a static hold for this stretch because this is one of the best ways to help deactivate the pecs. If our scapula is too abducted, this is a great opportunity to try to squeeze the shoulder blade together. Noticed that I said shoulder blade, not shoulder blades. The other shoulder blade might not need squeezing, so make sure you individualize your programming.
This gives us two ways to do our pec stretch. The first is without us trying to retract (or adduct) our scapula, and the other is with trying to retract the scapula.
In the picture below, I'm trying to feel a stretch in the pec area, and not adduct my scapula since it's not abducted.
The last major internal rotator of the shoulder are the lats. We've covered stretching the lats before, but I want to point out that we want to make sure we eternally rotate the arm, then bring our arm overhead. This is a basic lat stretch:
We've addressed the mobility, so let's focus on stability. Specifically, we need greater external rotation of the humerus. We need to work on the primary external rotators which are the infraspinatus, teres minor, and the supraspinatus.
In order to do this correctly, you need to make sure you are getting pure rotation from the shoulder. If you feel or notice forward or posterior translation of the shoulder, you are compensating. You'll see what I'm 'talking about below.
We've come to the third row. We have a scapula which is abducted and a humerus which although it points forward is actually externally rotated. The reason why the humerus is externally rotated is, if the scapula is abducted, this will bring the scapula closer towards the humerus. But, there should always be a one-to-one relationship between the scapula and the humerus.
In order for the humerus to stay neutral, if the scapula becomes more abducted, the humerus must internally rotate. Therefore, if the scapula becomes abducted, but the humerus doesn't internally rotate, this makes not only the scapula non-neutral, but it makes the humerus non-neutral. It makes the humerus externally rotated.
This brings us to the trickiest row out of all the rows, the fourth row.
This row allows for three possibilities:
1. The scapula is abducted moderately, the humerus is internally rotated moderately, which makes the humerus neutral, but the scapula abducted. The only treatment option here is to correct the abducted scapula.
2. The scapula is mildly abducted, the humerus is heavily internally rotated, which makes the humerus too internally rotated. However, the scapula should still be corrected. The humerus needs external rotation which we covered in condition two above.
3. The scapula is heavily abducted, the humerus is mildly internally rotated, which makes the humerus externally rotated. Again, the scapula position still needs to be corrected.
Let's treat the abducted scapula which applies to all three conditions above. We need to adduct the scapula. To do this, we can use a variety of exercises including rows, arms overhead scapula adduction, and face pulls. Since everyone knows what rows and face pulls probably are, I'll demonstrate amrs overhead scapula retraction which is one my favorite drills.
The last rows are effectively the same, but one is more serious.
The only difference between row 5 and 6 is that row 6 is a more serious version of row 5. In both conditions, we need to correct the adducted scapula. Even if during the pencil test, the pencil points forward, the adducted scapula results in an internally rotated humerus. However, if the pencil points inward at all during the pencil test, the humerus is even more internally rotated.
We can clearly see we need greater abduction in the scapula for both conditions. For this, we can use some scapula protractions like these. The most popular protraction exercises are either the push up with a plus or the push-up protraction (without the bending of the elbow).
I prefer the push up protraction without bending the elbow when individuals have an adducted scapula. The reason why is because when the humerus is internally rotated, doing push ups isn't going to help that.
What will help the internally rotated humerus are DB external rotations. If you have the row 6 condition, you will definitely need to focus on DB external rotations.
You should see an almost immediate improvement after doing these exercises. Make sure to to monitor the scapula and the humerus over time to make sure they get neutral (or at least are closer to neutral). I've found that for some clients, it can take quite awhile (like many months or over a year) before even alignment is cleared up. Have patience, be persistent, and assess periodically.
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