Shoulders are the most complicated joints in the body and at the same time are the most diverse and mobile of joints. They allow for a full 360 degree circumduction to occur and they can go behind our backs and be lifted above our heads.

Shoulder pain is a common issue affecting countless Australians every year. A systematic review of general population studies obtained in Jul 2018 showed that the prevalence of shoulder pain in the general population aged less than 70 years ranged from 7% to 27%. But when looked at lifetime prevalence of shoulder pain this statistic was up to 67%.

Be this from aching heavy arms to people that have reoccurring dislocations of the shoulder joint. Be it from past injuries, genetics or from that dreaded poor posture we adopt when we sit in front of the computer. Shoulder pain is a common injury that will inflict many of us.

Joints of the Shoulder

When it comes to shoulder health we need to look at numerous joint. There are 4 main joints that are associated with the shoulder. These are:

1. Glenohumeral/GH joint;
2. Acromioclavicular/AC joint;
3. Sternoclavicular/SC joint;
4. Scapulothoracic joint. (scapular movement on the thoracic cage)

This joints help control and maintain the 7 main movements that the shoulder. These movements are flexion, extension, abduction, adduction, 360° circumduction, internal and external rotation

So when it comes to shoulder stability and control I view the movement of the scapulae as the most crucial factor in shoulder stability. Hence the scapulothoracic joint needs to provide the stability to the thoracic cage, so the then the humerus (arm bone) can move unimpeded. We have 2 scapular (shoulder blades) in our body. The scapular are situated on the thoracic cage

Role of Scapular

The scapulae is a strange looking triangular bone that is slightly curved. It houses a socket into which the head of the humerus fits to form the shoulder joint. When at rest, the scapula must sit at a correct height on the trunk, as well as the correct distance from the spine without any winging. This sets the stage for arm movement. When the arm moves, the scapula must lift upward and elevate, rotating away from the spine, slide away from the spine (abduct), and finally tilt backward (posterior tilting). It must do this to help the arm perform whatever task it’s trying to do. If the shoulder doesn’t help the arm, then excessive stress is placed on the shoulder joint because it bears more than its share of the load. In almost every shoulder patient I see, at least a few of these functions aren’t working well.

Exercise to help shoulder scapular

One of the best exercises for improving shoulder stability and improving scapular mobility is called Scapulae Swimmer Strokes (double and alternate). It is a tough exercise to have full control through the range and if done at your maximal effort will give you burn in the shoulder.

1. Start laying on your stomach with your arms by your sides with palms up and thumbs by your side (internally rotated at the shoulder joint). You should also be a neutral spine.
2. Next lift one arm (if doing alternate or both if doing double) off the floor and bend elbow so that it is able to come behind your back, with palm up.
3. Without letting your hand touch the small of your back slowly straighten your elbow.
4. Now move your hand in an arcing motion up to shoulder level, whilst maintaining internal rotation of the shoulder (palm up).
5. Once you get to the point of your maximal mobility, whilst maintaining your chest on the floor, externally rotate your hand so that the palm turns down
6. Now bend your elbows so that your palms come to the back of your head, whilst maintaining maximal contraction through the arms
7. Repeat these motions slowly and controlled for 60 seconds. Do 3-4 repetitions with a 30 second break in-between.

If sharp pain is felt anywhere during these movements reduce the lift or the range so it is still pain-free but the muscles are actively contracting the whole time. 

The scapulae can move in gliding circles, but their movements are recorded as four directions or a combination of two when locking into position.

The movements occurring at the scapula are Protraction (scapular spreading apart), Retraction (scapular squeezing together), Elevation (scapular lifting up) and depression (scapular moving down).

By gliding through the joint’s movements in this way we can help free up the joint’s range of motion but also develop ACTIVE control over the directions, so that the scapulae are not weak or overactive in any particular direction.

This in turn will aid ALL upper body movements and help to maximise stability of the actual shoulder itself, no matter the position. This freedom in all ranges helps mitigate the most common of injuries that occur to the shoulder. On top of this we need good shoulder mobility too.

Dysfunctional scapulae can often be the cause of related injuries such as shoulder impingement , rotator cuff tears, neural trapping, tissue damage and structural decomposition.

If you have any questions or would like further information please contact us via email or call the clinic on 02 9905 9099.